Published on May 31, 2014
MOHAMAD HAFIZ BIN MOHAMAD NGARIP MUHAMMAD KHAIRUL ADHA BIN FUAAD
• Acute liver failure – occur suddenly in healthy liver. • Chronic liver failure – occur as a result of decompensation of chronic liver disease. • Fulminant liver failure – clinical syndrome resulting from massive necrosis of liver and leading to severe impairment of liver function. Hyperacute : encephalopathy within 7 days of onset of jaundice. Acute : within 8-28 days. Subacute : within 5-26 weeks.
Nitrogenous waste (ammonia) build up in the circulation and passes to brain (convert to glutamine). Excess glutamine causes osmotic imbalance-cerebral oedema. • Grade 1 : Altered mood/behaviour, sleep disturbance. • Grade 2 : Increasing drowsiness, confusion, slurred speech. • Grade 3 : Stupor, incoherence, restlessness, significant confusion. • Grade 4: Coma. Rule out other causes – sepsis, trauma, hypoglycemia and seizure activity.
• Infection – viral hepatitis (B, C, CMV), yellow fever, leptospirosis. • Drugs – paracetamol overdose, halothane, isoniazid. • Toxins – carbon tetrachloride. • Vascular – Budd Chiari syndrome, veno-occlusive disease. • Other – alcohol, primary biliary cirrhosis, hemochromatosis, autoimmune hepatitis, Wilson’s disease, fatty liver of pregnancy, alpha 1-antitrypsin deficiency.
• Hepatic vein obstruction by thrombosis or tumour causes ischemia and hepatocyte damage. • Presentation – liver failure or insidious cirrhosis, abdominal pain, hepatomegaly, ascites and increase ALT, portal hypertension occurs in chronic forms. • Causes – hypercoagulable states ( pregnancy, malignancy, paroxysmal nocturnal haemaglobinuria, polycythaemia rubra vera, thrombophilia), liver tumour, renal tumour, adrenal tumour.
• Jaundice • Hepatic encephalophaty • Fetor hepaticus (smells like pear drops) • Asterixis (flapping tremor) • Signs of CLD – Gynaecomastia Hepatomegaly Ascites Loss of axillary hair Hepatorenal syndrome
• FBC – any infection, bleeding. • Renal profile • LFT • Coagulation profile – prothrombin time, INR, APTT. • CMV and EBV serology. • Chest x-ray • Abdominal ultrasound • Doppler studies of portal vein – in suspected Budd-Chiari syndrome. • Abdominocentesis - >250/mm3 neutrophils suggest spontaneous bacterial peritonitis.
• General – -Secure airway with intubation and insert nasogastrict tube to avoid aspiration and remove any blood from stomach. -insert urinary and central venous catheters to assess fluid status – maintain normal body volume. -haemofiltration or heamodialysis if renal failure develops. -avoid sedatives or other drugs with hepatic metabolism. • Specific – depending on the cause -N acetylcysteine in PCM overdose. -Acyclovir – in viral hepatitis -liver transplant
• Management of complications -cerebral oedema – mannitol. -bleeding – IV vit K. -infection – ceftriaxone, avoid gentamicin (incr. risk of renal failure) -ascites – fluid restriction, low salt diet, diuretics. -encephalopathy – avoid sedatives, decrease protein diet.
Calcification Inhibitors in CKD and Dialysis Patients
critical care medicine n engl j med 369;26 nejm.org 26december , 2013 2527 Although acute liver failure after acetamino-phen ingestion can occur ...
Acute liver failure is a rare but life-threatening critical illness that occurs most often in patients who do not have preexisting liver disease.
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Acute liver failure is an uncommon condition in which rapid deterioration of liver function results in coagulopathy, usually with an ...
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Acute liver failure — Comprehensive overview covers symptoms, diagnosis, treatment of this medical emergency.
Acute liver failure is the appearance of severe complications rapidly after the first signs of liver disease (such as jaundice), and indicates that the ...
Bibliographic details: Ma SS, Wu JZ, Ning QY, Zhong DN, Wu JL. Effect of entecavir on survival of patients with HBV-related liver failure: a meta-analysis.
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