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Acute Liver Failure - Coggle Diagram
Acute Liver Failure
Definition
O'Grady
Hyperacute <1 week
Acute 1-4weeks
Subacute 4-12 weeks
Causes
INfections
Hepatitis A-E
Drugs/Toxins
Paracetamol
Malignancy
Primary/secondary
Vascular
Ischaemic/ Budd chari
Pregnancy related
HELLP
Acute fatty liver of pregnancy
Metabolic
Wilsons
Autoimmune
Seronegative
West Haven Criteria
Grade 1 - trivial
Grade 2 lethargy
Grade 3 somnalence
Grade 4 - Coma
Paracetamol toxicity
Mechanism
Glucuronicdation
Glutathione
Cytochrome P450
NAPQI
Cytochrome induction
Alcohol
Enzyme inducers eg St Johns Wart
Glutathione Depletion
Malnutrition
Treatment
Modified Rumack-Matthew nomogram
NAC
Management
Medical
Neuroprotective measures
Mannitol/hypertonic saline
Barbituates
Indomethacin
Respiratory
Aviod excessive PEEP to reduce hepatic pressure and ICP
Early intubation
Cardiovascular
Terlipressin
Avoid excessive lactate load
GI
NAC
Laxido
Renal
Na 145-150
RRT/ammonia clearance
High volume plasma exchange
Haematolgy
Coagulopathy correctction
TEG
Transplantation
Kings criteria
Non-paracetamol induced ALF
INR >6.5
Or ANY three of
Age <11 >40
NonA/B hepatitis or idiosyncratic drug reaction
Time of onset of jaundice to encephalopathy >7days eg not hyperacute
Bilirubin >300
Paracetamol toxicity
Or ALL three of
INR>6.5
Cret >300
Grade 3/4 encephalopathy
pH<7.3
Transjugular intrahepatic portosystemic shunt procedure