Flashcards for:
Acute Liver Failure

Grade 1: Subtle behavioral changes and altered sleep-wake cycle Grade 2: Onset of asterixis, lethargy, disorientation Grade 3: Severe confusion, disorientation, somnolence Grade 4: Coma

High risk due to compromised Kupffer cell function. Protocol: Culture at presentation and for any infection concern, aggressive treatment, low threshold for empiric antibiotics.

Toxic causes, viral causes, autoimmune causes, infiltrative causes, and pregnancy-associated causes.

Hepatitis A, B, D, and E serology; Herpesviruses (HSV, VZV, CMV, EBV).

Ammonia levels correlate with the risk of intracranial hypertension (ICH): <75 (rare), >100 (risk of high-grade HE), >200 (predicts ICH development).

Indicators: Hepatic, neurologic, psychiatric abnormalities, bilirubin/alkaline phosphatase ratio >2. Workup: Ceruloplasmin, ferritin, additional imaging.

Administered for both acetaminophen and non-acetaminophen induced ALF. Increases transplant-free survival for Grade 1&2 hepatic encephalopathy.

The liver synthesizes clotting factors (except factor VIII) and anticoagulants (protein C, S).

Rare in Grades 1 and 2, 25-35% in Grade 3, and 65-75% in Grade 4.

Elevate head 30°, maintain even fluid balance (CRRT), hyperventilation, hypertonic saline, mannitol.

Clinical or laboratory evidence of acute liver injury or hepatitis (elevated LFTs), coagulopathy (INR ≥ 1.5), encephalopathy (graded by West Haven criteria), duration < 26 weeks, no pre-existing cirrhosis. Exceptions: Wilson disease, hepatitis B reactivation, autoimmune hepatitis.

SHOCK: Septic, Hypovolemic, Obstructive, Cardiogenic, Combined.

Thrombosis of the hepatic vein, associated with polycythemia, malignancy, and pro-thrombotic states.

Caused by the liver's role in glycogen storage and gluconeogenesis. Treated with dextrose infusion, monitored via frequent blood glucose checks.

Initiate acyclovir until HSV and VZV are ruled out.