Acute liver failure
Резюме
განსაზღვრება
ანამნეზი და გასინჯვა
ძირითადი დიაგნოსტიკური ფაქტორები
- hepatotoxic drugs
- chronic alcohol misuse
- pregnancy
- jaundice
- coagulopathy
- signs of hepatic encephalopathy
სხვა დიაგნოსტიკური ფაქტორები
- absence of history of chronic liver disease
- abdominal pain
- nausea
- vomiting
- malaise
- signs of cerebral edema
- right upper quadrant tenderness
- hepatomegaly
- absence of splenomegaly
- absence of spider angiomata
- absence of palmar erythema
- absence of ascites
- depression or suicidal ideation
- Wilson disease
- exposure to hepatotoxins
- illicit drug use
- absence of malignancy
რისკფაქტორები
- chronic alcohol misuse
- poor nutritional status or fasting
- female sex
- age >40 years
- pregnancy
- chronic hepatitis B
- chronic pain and narcotic use
- herbal and dietary supplement hepatotoxicity
- Wilson disease
- acetaminophen and antidepressant therapy
- chronic hepatitis C
- HIV and hepatitis C coinfection
დიაგნოსტიკური კვლევები
1-ად შესაკვეთი გამოკვლევები
- liver function tests
- prothrombin time/INR
- viscoelastic testing (VET)
- basic metabolic panel
- CBC
- blood type and screen
- serum amylase and lipase
- arterial blood gas
- arterial blood lactate
- acetaminophen level
- urine toxicology screen
- viral hepatitis serologies
- autoimmune hepatitis markers
- pregnancy test
- chest x-ray
- abdominal ultrasound with Doppler
გასათვალისწინებელი კვლევები
- factor V level
- viral hepatitis polymerase chain reaction (PCR) studies
- serum ceruloplasmin
- serum copper
- 24-hour urinary copper excretion
- slit-lamp ophthalmologic examination
- arterial ammonia
- HIV test
- urinalysis and urine sodium
- surveillance cultures
- Coombs test
- biomarkers
- liver biopsy
- CT scan of head
- CT/MR cholangiography
- transcranial Doppler
მკურნალობის ალგორითმი
all patients
კონტრიბუტორები
ავტორები
Stevan A. Gonzalez, MD, MS
Associate Professor
Department of Internal Medicine
TCU and UNTHSC School of Medicine
Medical Director of Liver Transplantation
Annette C. and Harold C. Simmons Transplant Institute
Baylor All Saints Medical Center
Fort Worth
TX
Divulgaciones
SG is a paid consultant and speaker for Mallinckrodt Pharmaceuticals.
Agradecimientos
Dr Stevan Gonzalez would like to gratefully acknowledge the late Dr Emmet B. Keeffe who previously co-contributed to this topic; an esteemed colleague, friend, and mentor.
Divulgaciones
EBK declared that he had no competing interests.
Revisores por pares
Timothy J. Davern, MD
Director of Acute Liver Failure Program
California Pacific Medical Center Liver Transplant Program
San Francisco
CA
Divulgaciones
Not disclosed.
Muhammad Dawwas, MRCP
Specialist Registrar
Liver Unit
Addenbrooke's Hospital
Cambridge
UK
Divulgaciones
Not disclosed.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Shingina A, Mukhtar N, Wakim-Fleming J, et al. Acute liver failure guidelines. Am J Gastroenterol. 2023 Jul 1;118(7):1128-53.Texto completo Resumen
Lee WM, Squires RH Jr, Nyberg SL, et al. Acute liver failure: summary of a workshop. Hepatology. 2008 Apr;47(4):1401-15.Texto completo Resumen
American Association for the Study of Liver Diseases. AASLD position paper: the management of acute liver failure: update 2011. Nov 2011 [internet publication].Texto completo
Wendon J, Cordoba J, Dhawan A, et al; European Association for the Study of the Liver. EASL clinical practical guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017 May;66(5):1047-81.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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