Acute Liver Failure

Question 1

king College hospital Criteria for Liver Transplantation in Acute Liver Failure

Answer 1

1-Acetaminophen - induced ALF
PHL < 7.3 رقم لوحده كده
Or… ال٣ اللي جايين مع بعض
كل اللي جاي مع بعض
Creat > 3.4
HE Grade 3 or 4
INR > 6.5

Question 2

king College hospital Criteria for Liver Transplantation in Acute Liver Failure

Answer 2

2-If non Acetaminophen induced ALF
INR > 6.5 رقم لوحده
OR
any 3 of the following
* Idiosyncratic drug reactions, halothane hepatitis
* Non A, non B
* Duration of Jaundice before encephalopathy > 7 day
* Age < 10, > 40 years
* Bilirubin > 18
* INR > 3.5

Question 3

خلي بالك

Answer 3

1-ALF due to acetaminophen has better prognosis than ALF due to wilson, AIH,idioscrepancy.
2-Acetaminophen is the most common cause

Question 4

Acute Liver failure

Answer 4

Sudden severe impairment of liver function ascociated with coagulopathy and encephalopathy within 6 months of onset of symptoms previously in patients without pre-existing liver disease.

Question 5

Causes of ALF

Answer 5

1-Drugs:
- Acetaminophen
- INH (Isoniazid)
- Nitrofurantoin
- Halothane
2-Viral:
- Hepatotropic: A, B, E
- Non-hepatotropic: CMV, EBV, HSV
3-Infection: Leptospirosis
4-Metabolic: Wilson
5-AIH (Autoimmune Hepatitis)
6-Budd-Chiari Syndrome
7-Pregnancy-related liver disease:
- HELLP Syndrome
- Acute fatty liver of pregnancy
8-Ischemic hepatitis
9-Poisons:
- Mushroom
- Carbon tetrachloride

Question 6

Subclassification of acute liver failure

Answer 6

Hyperacute <7 days
Subacute 7 - 21 days
Acute > 21 days but less than 6 Month

Question 7

C/p of acute liver failure

Answer 7

1-C/P of hepatitis - Jaundice, fatigue,
2-C/P of cause:
- Acetaminophen toxicity
Initial Phase -> 0 - 2 h -> N/V/D, anorexia
Latent Phase -> up to 2 days -> absence of GIT symp and increase alt
overt Phase -> 2 days -> ALF
(Coagulopathy, encephalopathy, Jaundice)
3-C/P of Complications:
* Cerebral edema
* ↑ IC Tension
* DIC
* Coagulopathy
* Hypoglycemia, hypokalemia, hyponatremia
* Metabolic acidosis
* Renal impairment

Question 8

Treatment of ALF

Answer 8

الاصل هو علاج السبب
*If acetaminophen induced ALF,
① N - Acetyl Cysteine (IV or oral throughNasogastric tube)
initial dose 150mg/kgover1/4h
(If IV) then 50mg/kg over 4 hours then 100mg/kg over 16 hours
or If oral 140mg/kg then 70mg/kg every 4 hours
② Supportive care & M of $
* Cerebral edema -> IV mannitol, Elevation head of
bed
* Coagulopathy -> vit K, Fresh Frozen Plasma, platelet
transfusion, PPI to prevent stress ulcer
* Correction of metabolic disturbance -> feeder
* give antibiotics if +ve culture, grade 3,4 encephalopathy, patient is for liver transplant.
* Renal failure -> hemodialysis