小结
定义
病史和体格检查
关键诊断因素
- hepatotoxic drugs
- chronic alcohol misuse
- pregnancy
- jaundice
- coagulopathy
- signs of hepatic encephalopathy
其他诊断因素
- 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
危险因素
- 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
诊断性检查
首要检查
- 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
需考虑的检查
- 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
治疗流程
all patients
撰稿人
作者
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
利益声明
SG is a paid consultant and speaker for Mallinckrodt Pharmaceuticals.
鸣谢
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.
利益声明
EBK declared that he had no competing interests.
同行评议者
Timothy J. Davern, MD
Director of Acute Liver Failure Program
California Pacific Medical Center Liver Transplant Program
San Francisco
CA
利益声明
Not disclosed.
Muhammad Dawwas, MRCP
Specialist Registrar
Liver Unit
Addenbrooke's Hospital
Cambridge
UK
利益声明
Not disclosed.
参考文献
关键文献
Shingina A, Mukhtar N, Wakim-Fleming J, et al. Acute liver failure guidelines. Am J Gastroenterol. 2023 Jul 1;118(7):1128-53.全文 摘要
Lee WM, Squires RH Jr, Nyberg SL, et al. Acute liver failure: summary of a workshop. Hepatology. 2008 Apr;47(4):1401-15.全文 摘要
American Association for the Study of Liver Diseases. AASLD position paper: the management of acute liver failure: update 2011. Nov 2011 [internet publication].全文
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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