acute liver failure william bernal, m.d., and julia wendon, m.b., ch.b. kurdistan board geh journal...

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Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

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Page 1: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

Acute Liver FailureWilliam Bernal, M.D., and Julia Wendon, M.B., Ch.B.

Kurdistan Board GEH Journal club

Page 2: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

IT IS A RARE LIFE-THREATENING CRITICAL ILLNESSOCCURS MOST OFTEN IN PATIENTS WHO DO NOT HAVE PREEXISTING LIVER DISEASE. INCIDENCE <10 CASES PER MILLION PERSONS PER YEAR SEEN MOST COMMONLY IN 30S IT PRESENTS UNIQUE CHALLENGES IN CLINICAL MANAGEMENT.THE CLINICAL PRESENTATION USUALLY INCLUDES HEPATIC DYSFUNCTION, ABNORMAL LIVER BIOCHEMICAL VALUES, COAGULOPATHY; ENCEPHALOPATHY MAY DEVELOP, WITH MULTIORGAN FAILURE& DEATH OCCURRING IN UP TO 50%THE RARITY ,SEVERITY& HETEROGENEITY, HAS RESULTED IN A VERY LIMITED EVIDENCE BASE TO GUIDE SUPPORTIVE CARE. SURVIVAL HAVE IMPROVED SUBSTANTIALLY IN RECENT YEARS THROUGH ADVANCES IN CRITICAL CARE MANAGEMENT & EMERGENCY LIVER TRANSPLANTATION.

Introduction:

Page 3: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

“A SEVERE LIVER INJURY, POTENTIALLY REVERSIBLE IN NATURE WITH ONSET OF HEPATIC ENCEPHALOPATHY WITHIN8 WEEKS OF THE FIRST SYMPTOMS IN THE ABSENCE OF PRE-EXISTING LIVER DISEASE,”. IN HYPERACUTE CASES, THIS INTERVAL IS A WEEK OR LESS& THE CAUSE IS USUALLY ACETAMINOPHEN TOXICITYOR A VIRAL INFECTION. MORE SLOWLY EVOLVING, OR SUBACUTE, CASES:MAY BE CONFUSED WITH CHRONIC LIVER DISEASE.OFTEN RESULT FROM IDIOSYNCRATIC DRUG-INDUCED LIVERINJURY OR INDETERMINATE CAUSE. DESPITE HAVING LESS MARKED COAGULOPATHY & ENCEPHALOPATHY, HAVE A CONSISTENTLY WORSE OUTCOMEWITH MEDICAL CARE ALONE.

Definition:

Page 4: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club
Page 5: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club
Page 6: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club
Page 7: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club
Page 8: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club
Page 9: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club
Page 10: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club
Page 11: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club
Page 12: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

The most common cause of viral-induced Acute Live Faliure is:A. Hepatitis A.B. Hepatitis B.C. Hepatitis C.D. Hepatitis E.E. A&D.

BO5s:

Page 13: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

The most common cause of viral-induced Acute Live Faliure is:A. Hepatitis A.B. Hepatitis B.C. Hepatitis C.D. Hepatitis E.E. A&D.

BO5s:

Page 14: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

Subacute compared with acute acute Live Failure is characterized by all except:A. Simulates chronic liver disease.B. Has better prognosis.C. Caused more by idiosyncratic drug reaction.D. Has less encephalopathy.E. Has less coagulopathy.

BO5s:

Page 15: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

Subacute compared with hyperacute acute Live Failure is characterized by all except:A. Simulates chronic liver disease.B. Has better prognosis.C. Caused more by idiosyncratic drug reaction.D. Has less encephalopathy.E. Has less coagulopathy.

BO5s:

Page 16: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

Encephalopathy in acute liver failure differs from that in chronic liver disease by:A. Antibiotics has clear beneficial role.B. Lactulose has deleterious effects.C. Intra-cranial hypertension plays no important role.D. Hypothermia has no any benefits.E. Grading is different.

BO5s:

Page 17: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

Encephalopathy in acute liver failure differs from that in chronic liver disease by:A. Antibiotics has clear beneficial role.B. Lactulose has deleterious effects.C. Intra-cranial hypertension plays no important role.D. Hypothermia has no any benefits.E. Grading is different.

BO5s:

Page 18: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

Management of intra-cranial hypertension in acute liver failure include the following except:A. IV Manitol.B. Hypothermia.C. IndomethacinD. Thiopentone.E. IV hypotenic saline.

BO5s:

Page 19: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

Management of intra-cranial hypertension in acute liver failure include the following except:A. IV Manitol.B. Hypothermia.C. IndomethacinD. Thiopentone.E. IV hypotenic saline.

BO5s:

Page 20: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

The following contribute to intracranial hypertension in acute liver failure except:A. Hyperamonemia.B. Hyponatremia.C. Hypoglycemia.D. Infections.E. Renal failure.

BO5s:

Page 21: Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

The following contribute to intracranial hypertension in acute liver failure except:A. Hyperamonemia.B. Hyponatremia.C. Hypoglycemia.D. Infections.E. Renal failure.

BO5s: