Summary
Definition
History and exam
Key diagnostic factors
- 存在的危险因素
- 肝毒性药物
- 长期酒精滥用
- 黄疸
- 肝性脑病的症状
Other diagnostic factors
- 无慢性肝病史
- 腹痛
- 恶心
- 呕吐
- 不适感
- 脑水肿症状
- 右上腹压痛
- 肝肿大
- 无脾肿大
- 无蜘蛛痣
- 无肝掌
- 无腹水
- 抑郁或自杀意念
- 肝毒素暴露
- 违禁药物滥用和高风险行为
- 无恶性肿瘤
Risk factors
- 长期酒精滥用
- 营养不良
- 女性
- 年龄>40 岁
- 妊娠
- 慢性乙型肝炎
- 慢性疼痛和麻醉剂的使用
- 补充和替代药物肝毒性
- 对乙酰氨基酚和抗抑郁治疗
- 慢性丙型肝炎
- HIV和HCV合并感染
Diagnostic tests
1st tests to order
- 肝功能检查
- 凝血酶原时间/INR
- 基础代谢检查
- 全血细胞计数（FBC）
- 血型和筛查
- 血清淀粉酶和脂肪酶
- 动脉血气
- 动脉血乳酸
- 对乙酰氨基酚水平
- 尿毒物学筛查
- V因子水平
- 病毒性肝炎血清学
- 自身免疫性肝炎标志物
- 妊娠试验
- 胸部 X 线检查
- 腹部多普勒超声
Tests to consider
- 病毒性肝炎聚合酶链反应（PCR）检测
- 血清铜蓝蛋白水平
- 血清铜
- 24小时尿铜排泄
- 裂隙灯眼科检查
- 动脉氨
- HIV 检查
- 尿常规和尿钠
- 监测培养
- Coombs 试验
- 肝脏活检
- 头部 CT 扫描
- 经颅多普勒检查
Treatment algorithm
所有患者
Contributors
Authors
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
Disclosures
SG has received honoraria from Mallinckrodt Pharmaceuticals for advisory and consulting activities and from Intercept Pharmaceuticals for advisory activities, none of which conflicts with this topic.
Acknowledgements
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.
Disclosures
EBK declared that he had no competing interests.
Peer reviewers
Timothy J. Davern, MD
Director of Acute Liver Failure Program
California Pacific Medical Center Liver Transplant Program
San Francisco
CA
Disclosures
Not disclosed.
Muhammad Dawwas, MRCP
Specialist Registrar
Liver Unit
Addenbrooke's Hospital
Cambridge
UK
Disclosures
Not disclosed.
Differentials
- 急性重症肝炎
- 胆汁淤积
- 溶血
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- ICU 内成人急性和慢加急性肝衰竭管理指南：心血管、内分泌、血液学、肺和肾方面的注意事项
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