Acute Liver Failure

 

Acute Liver Failure.

GEORGE BEDU-ADDO

10/25/16

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Challenging condition to treat

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Intensie care

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!ier trans"lantation #er$inolog%

&%"erac'te lier (ail're  Ac'te lier (ail're )'*ac'te lier (ail're

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Definitions 

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&%"erac'te lier (ail're+ ence"halo"ath% des ,ithin  da%s o( the onset o( .a'ndice  Ac'te lier (ail're+ ence"halo"ath% des -2 da%s a(ter onset o(  .a'ndice )'*ac'te lier (ail're+ #he interal *et,een onset o( .a'ndice and ence"halo"ath% is (ro$ -12 ,s

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Clinical features. Ence"halo"ath%+ Ra"id in onset and "rogression is co$"licated *% 1

2

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cere*ral ede$a $ild con('sion3 inerted slee" "attern3 restlessness 5 c%cles/sec !etharg%3 slo, res"onses3 disorientation to ti$e3 a$nesia3 ina""ro"riate *ehaio'r Asteri4is3 ata4ia3h%"ore(le4ia 4

 

Clinical features.  )o$nolence *'t ro'sa*le Disorientation as regards "lace3 aggressie *ehaio'r Asteri4is3 h%"eractie re(le4es3 $'scle rigidit%3 (le4or "lantar re"onse 

EEG 5 c%cles/sec Co$a3 decere*ration3 a"nea Delta ,ae

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Clinical features. 

Cere*ral ede$a contri*'tes to RI

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ro('se s,eating3 tach%cardia3 cardiac arr%th$ias3 (eer (eer

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)%$"to$s o( lier disease+

7a'ndice is dee" and "rogressie )$all3 nor$al3 nor$ al3 enlarged lier lier & 8 ascites

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Clinical features

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Renal disorders+ olig'ria3 an'ria  AR9 is ('nctional

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Res"irator%+ 'l$onar% ede$a

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Cardioasc'lar+ rogressie asodilatation3 h%"otension

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Cause ALF. Causess of ALF 

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 Ac'te iral he"atitis A3B A3B33 :on A-non A-non E &)3 ;-ilson3s D43 D43  Ac'te (att% lier o( "regnanc% "regnanc%33 B'dd-Chiari s%nd3 Gensing Dr'gs+ $ol3 :)AID)3 &alothane3 hen%toin3 A$itri"t%lin A$itri"t%lin 8

 

Diagnosis.

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!ier transa$inases ?000 '/!

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&%"ogl%ce$ia

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rolonged # ?50 sec

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Bilir'*in ?00 $c$ol/!

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Medical management. 

&%"ogl%ce$ia+ De4trose

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rogressie asodilatation :oradrenaline

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or adreanalin adreanaline e In(ection+)electie intestinal deconta$ination 'sing anti('ngal and *road s"ectr'$ anto*iotic anto*iotics s

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Coag'lo"ath%+ 99/;ita$in @3 lts3 Blood

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Gastric "rotection+ )'cr'l(ate3 2g tid Red'ces ris o( GI *leed 10

 

Medical management. 

Ence"halo"ath%+

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I; $annitol 0-1g/g (or RI

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)odi'$ thio"entone

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hen%toin

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=agnesi'$ ene$a hrl%s'l"hate oral or 

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=etronidaole

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Surgical Care.

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!ier trans"lantation de(initie treat$ent

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Orthoto"ic lier trans"lantation

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&eteroto"ic a'4illiar% lier trans"lantation

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)'""ort ,ith *ioarti(icial lier

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E4tracor"oreal lier assist deice

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