4.3 J) Iii) Gastrointestinal Acute Liver Failure

Front 1

Acute Liver Failure Criteria (3) ?

Back 1

1. Increasing coagulopathy
2. Hepatic encephalopathy
3. Jaundice

Front 2

Causes of Acute Liver Failure ?

Back 2

1. Drug-induced
2. Viral hepatitis
3. Autoimmune
4. Shock / hypoperfusion
5. Idiopathic /unknown

Front 3

Miscellaneous causes of Acute Liver Failure?

Back 3

1. Wilson's disease
2. Budd Chiari Syndrome
3. Autoimmune
4. Cardiogenic
5. Pregnancy-related

Front 4

Viral causes of acute liver failure?

Back 4

1. HBV
2. HCV
3. HSV
4. EBV
5. CMV
6. VSV

Front 5

Drug causes of acute liver failure?

Back 5

1. Paracetamol
2. NSAIDS
3. Steroids
4. Anticonvulsants
5. Anti-tuberculous therapy
6. Herbal remedies
7. Recreational drugs {ecstasy ; cocaine}
8. IDIOSYNCRATIC

Front 6

Drugs causing Idiosyncratic drug reactions causing acute liver failure? {11 categories}

Back 6

1. Antibiotics [ Augmentin ; ciprofloxacin ; doxycycline ; erythromycin ; isoniazid ; nitrofurantoin ; tetracycline ; sulphonamides ]
2. Antivirals [ fialuridine]
3. Antidepressants [ amitriptyline ; nortriptyline ]
4. Oral hypoglycaemics [metformin ; troglitazone ]
5. Anticonvulsants [ phenytoin ; valproate ]
6. Anaesthetics [ halothane ]
7. Statins [ atorvastatin ; simvastatin ]
8. NSAIDS
9 Salicylates [ Reye's Syndrome]
10. Anti-thyroid drugs [ PTU]
11.Antiarrhythmics [ amiodarone ]
12 Immunosuppressants [ MTX ; Gold ; cyclophosphamide ]

Front 7

Infectious mimics of Acute Liver failure at presentation? [Returned Traveller]

Back 7

1. Falciparum malaria
2. Typhoid fever
3. Leptospirosis
4. Dengue fever

Front 8

The 4 Grades of hepatic encephalopathy ?

Back 8

Grade I : Drowsy -coherent
Grade II : Drowsy-confused - inappropriate
Grade III : Very drowsy + stuporose + restless + agitated
Grade IV : Comatose

Front 9

Patients with Acute Liver failure secondary to what conditions should be listed for OLT {transplantation}?

Back 9

1. Mushroom poisoning
2. Wilson's Disease
3. Autoimmune hepatitis
4. hepatic vein thrombosis

Front 10

Which Causes of Acute liver failure have the better outcomes?

Back 10

1. Paracetamol
2. Pregnancy
3. hepatitis A

Front 11

Which causes of Acute liver failure have the poorer outcomes?

Back 11

1. Seronegative hepatitis
2. non-A non-B viral hepatitis
3. Idiosyncratic drug reactions
4. Wilson's disease
{Note hepatitis B has INTERMEDIATE outcome}

Front 12

Prognostic scoring systems for Acute liver failure and transplantation requirement?

Back 12

1. King's College (London) Criteria
2. Clichy
3. MELD ( Model for Endstage Liver disease)

Front 13

Tintinalli
The most common cause of Acute Liver Failure (in U.S) is ?

Back 13

Acetaminophen (paracetamol)

Front 14

(Tintinalli)
What are the Pathophysiological consequences of Hepatocellular death?

Back 14

Disruption of liver METABOLIC AND SYNTHETIC function
--> Toxin accumulation
--> Coagulopathy
--> Nutritional deficiencies

Front 15

(Tintinalli)
Which of the following is incorrect?
A. Patients with alcoholic liver disease can present with acute hepatitis
B. HBV is the most common of all blood borne infections in the US.
C. AN AST : ALT ratio of > 2 usually suggests alcoholic hepatitis
D. A prolonged PT and elevated bilirubin (>20) indicates significant disruption of liver function.

Back 15

B. HCV

Front 16

(Tintinalli)
What is the "continuum" of progression of alcoholic liver disease?

Back 16

Asymptomatic fatty liver
--> hepatitis
--> cirrhosis
--> End-stage Liver disease

Front 17

(Tintinalli)
What are the 4 pathological mechanisms of medication-induced liver disease?

Back 17

1. Hepatocellular necrosis (Paracetamol)
2. Cholestasis ( OCP ; steroids)
3. Steatohepatitis ( Valproate ; amiodarone)
4. Chronic disease ( Nitrofurantoin)