L71 Flashcards
Causes of acute liver failure
- Acetaminophen OD
- Other drugs:
- Mushrooms
- Viral
- Alcohol
- Genetic: Wilson’s
- Pregnancy: Fatty Liver + HELLP
- Ischemic
- Budd Chiari
How is acetaminophen metabolized in the liver?
NAPQI = tox int
Bound to glutathione (gained from diet)
Labs for acetaminophen OD
↑↑↑AST/ALT - 10s of thousands (should be
What is the liver injury caused by acetaminophen OD?
Tubular necrosis
What is the King’s College Criteria for dx acetaminophen acute liver failure
- arterial pH 6.5 + Cr > 3 + grade 3/4 encephalopathy (aggressive or coma)
Treat acetamin OD
UNDER 3 hrs = activated charcoal
Otherwise, N-acetyl-cysteine IV
What vegetable might give you acute liver failure?
Amanita phalloides mushrooms
↑↑↑ AST/ALT in 10s thousands
Treat acute LF due to mushrooms
Penicillin G + milk thistle
If you get acute LF from starting a new drug, is it dose dep? What kind of drugs do this?
NO Like an allergic rxn, dose indep Anti-convulsants: phenytoin, valproic acid Antibiotics: macrolides NSAIDs Herbals!!!
What viruses cause acute LF?
Hep A, B, D, E
Could be C but unlikely
All: ↑AST/ALT
Hep A transmission
Fecal-oral
Shellfish/polluted water
Dx Hep A infection? Can this go chronic?
Hep A IgM = infection
IgG = exposure
Can NOT go chronic - acute only
Hep B transmission
Sex, IVDU
Vertical trans in 3 world
Dx Hep B infection. Can this go chronic?
HBsAg
HBcAb IgM
Many adults get infection and clear -> immune
CAN go chronic, esp kids infected vertically
Why is Hep D infection unique? Dx.
Required Hep B!! Duh… you know this.
HDAb IgM
Hep E transmission - who are you most worried about getting this?
Fecal-oral
Acute LF severe in pregnant women
What do labs look like for acute LF due to alcohol?
↑AST/ALT but not over 300
AST 2: ALT 1
Leukocytosis - aka you also might be thinking infection
Treat alcohol acute hepatitis
Limited options: anti-inflams
GCs
What genetic disease might cause acute LF in young pts accompanied by neurologic symptoms?
Wilson’s disease
Cu accumulation in liver + brain
What labs are key signs for Wilson’s?
↓↓alk phos
Alk phos : total bili ratio
What cause of acute LF would present with massive liver necrosis? What are the other lab findings you’d expect?
Auto-immune hepatitis More likely to be reason for chronic hepatitis Also: ↑AST/ALT ↑Alk phos ↑Bili \+ IgG and auto-immune markers
What 2 liver diseases are unique to pregnancy?
Hep E isn’t unique…
- Acute Fatty Liver Disease of Pregnancy
- HELLP = Hemolysis, Elevated Liver enzymes, Low Platelets
Lab + histo findings of acute fatty liver disease of prenancy
AST/ALT 300-500
Microvesicular steatosis (US) = tiny fat in cells
More likely to be a dx of exclusion for acute LF in a pregnant woman
What do you know about HELLP
Complication of pre-eclampsia
↑AST/ALT
