ACUTE LIVER FAILURE. Aliakbarian M, M.D
|
|
- Jonas Burke
- 5 years ago
- Views:
Transcription
1 ACUTE LIVER FAILURE Aliakbarian M, M.D
2 Acute Liver Failure Definition Rapid deterioration of liver function resulting in altered mentation and coagulopathy in a patient without preexisting cirrhosis and with an illness of less than 26 weeks duration.
3 Acute Liver Failure. Fulminant hepatic failure Fulminant hepatitis Subfulminant liver failure Subacute hepatic necrosis Subacute liver failure Hyperacute liver failure
4 Index of Suspicion for ALF Clinical signs of moderate to severe hepatitis Laboratory findings including an increase in the prothrombin time of 4-6sec.(INR 1.5). Altered sensorium INR Altered Mental Status = ALF
5 Suspect ALF?...Admit to ICU
6 ALF Etiologies Viral Drug Poisoning Ischemia VOD Malignant Infiltrate Wilson s Disease Microvesicular steatosis AIH Hyperthermia OLT Partial hepatectomy
7 Viral Acute Hepatitis A-E Reactivation of HBV Chemotherapy Immunosuppresion Herpes simplex Varicella-Zoster EBV
8 Acute HAV and ALF ALF uncommon Frequency 0.01% - 0.1% in jaundiced patients ALF occurs early Survival (transplant- free) 75% Age related survival
9 Acute HBV and ALF HBV alone or with HDV co-infection (rare) Transplant-free survival is 23% Overall survival 77% because of transplantation
10 Drug Induced ALF Many drugs implicated Acetaminophen Halothone and derivatives INH/ Rifampin Tricyclics/ MAO inhibitors Phenytoin/ NSAID Increased risk: acetaminophen (as little as 2gms) + ETOH median dose: 13 gm Increased risk if drug continued after jaundice appears
11 Poisoning and ALF Amanita mushrooms (amanatoxins) - LD = 50 gms (3 mushrooms) - Toxins not destroyed by cooking - Rapid onset of HE in 4-8 days following severe emesis and diarrhea Solvents - chlorinated hydrocarbons Herbal remedies Yellow phosphorus
12 Obstruction of Hepatic Veins and ALF Budd-Chiari syndrome and thrombosis of hepatic veins VOD - Post BMT Chemotherapy, Irradiation
13 Other Etiologic Causes of ALF Wilson s Disease can be presenting feature usually in patients <20 yrs can occur if patient discontinued D-penicillamine for a few years
14 Other Etiologies (2) Microvesicular steatosis Acute fatty liver of pregnancy Reye s syndrome Drug Induced - Valproic acid AIH May appear as an acute hepatitis on initial presentation More common if anti-lkmi antibody present ASMA usually not present
15 Other Etiologies (3) Hyperthermia (Heat stroke) Direct thermal injury Hepatic ischemia due to -DIC -Perfusion defect OLT Poor presentation of donor liver Acute graft rejection Thrombosis - hepatic artery, hepatic vein, portal vein Partial hepatectomy Removal of 80% or more of healthy liver Removal of 50% or less in hepatic dysfunction
16 Evaluation & Diagnosis of Impending ALF History! History! History! Sexual contacts Pregnancy Risk Factors IDU Mushrooms Medications Travel Toxic exposures
17 HISTORY Family members with liver disease? Recent cold sores Onset of jaundice Work environment- toxic agents Hobbies Herbal products/dietary supplements
18 Physical Exam Determine presence or absence of pre-existing liver disease Hepatic tenderness Hepatic decompensation
19 Laboratory Tests (1) Drug screening ALT, AST, Alk Phos, Glu, Bilirubin Lytes, Albumin, Mg, Phos., CBC with differential Coags: PT, PTT Anti HAV IgM Anti HBc IgM/ Anti HBsAg/ Anti-HCV
20 Laboratory Tests (2) If under 35 years of age Ceruloplasmin Serum & urine copper Arterial blood gas Arterial lactate Pregnancy test Autoimmune markers ANA, ASMA, Ig levels HIV status Amylase & lipase
21 Liver Biopsy Reserved for diagnostic dilemma - AIH, HS (Transjugular approach)
22 Diagnosis of ALF Hallmarks - occurs simultaneously or in succession Altered mentation Clinical EEG Arterial Ammonia Coagulopathy PT 4 sec prolonged (INR 1.5) Arterial ph<7.3 if acetaminophen ingested (cause for immediate transfer for OLT)
23 Management of ALF (1) Directed towards prevention of complications ICU setting Central line(s)-10% dextrose Pulmonary artery pressure and CO Inform Transplant Service and transfer with onset of HE Monitor VS and urinary output (Foley) strict I&O Laboratory Testing every 4-6hr electrolytes, BUN, creatinine, CBC, platelets, PT, PTT, ALT, AST, T. bilirubin, Alk Phos, Albumin
24 Management (2) Maintain gastric ph above 5 - protonix IV Preparation for endotracheal intubation Prepare to initiate monitoring intracranial pressure Enteral feeding tubes for grade 3 or 4 coma
25 Cerebral Edema Cerebral Perfusion Pressure Mean Arterial Pressure ICP = Cerebral Perfusion Pressure (CPP) Ideal ICP<20-25mm Hg Ideal CPP>50-60mm Hg Imazaki, et al When CPP<40 for 2 hrs. 0 of 7 patients recovered When CPP>50 6 of 8 patients recovered Improved ICP first sign of spontaneous recovery
26 Management (3) Cerebral Edema & Intracranial Hypertension (Most serious complications of ALF) Clinical signs of elevated ICP (Intracranial Pressure) -sluggish pupillary response -increased limb-muscle tone -none Monitoring ICP -usually reserved for grade 3 or 4 coma -awaiting OLT
27 Management (4) Cerebral Edema - General Measures -quiet environment -elevate head avoid sedation (use restraints) -avoid Valsalva-like maneuvers -mental status assessments q1-2h -mannitol if signs of impending uncal herniation (0.5mg/kg, lolus q4-8h) when ICP<30-40mm -assisted ventilation (in all grade 3 and 4)
28 Multiple Organ Failure Hepatic damage Failure of clearance Endotoxemia increased risk of infection MOF Gut leak Activation of macrophages Tissue Circulating Release of Hypoxia changes cytokines TNF, IL-1, IL-6 Williams, Sem Liver Dis, Vol 16, No.4, 1996
29 Management (5) Hemodynamic Complications include: Hypotension, tachycardia, vascular volume decrease with capillary leak and vasodilation Volume expansion (central line) FFP or 4.5% albumin, 10% dextrose Maintain pulmonary capillary wedge pressure 12mm-14mm Hg Minimize salt solutions (ascites, interstitial accumulation) Inotropic/pressor support(epi, norepi, dopamine), but not vasopressin.
30 Management (6) Coagulopathy/Bleeding Diathesis FFP or platelets given in presence of bleeding Conventional treatment of GI bleeding DIC thrombocytopenia Metabolic Complications Prevent hypoglycemia Phosphate and magnesium levels monitored - replace early Enteral feeding, 60gm protein/24 hrs No role for high branched-chain AA Monitor for lactic acidosis secondary to tissue hypoxia, sepsis
31 Management (7) Renal Failure - In 42% to 82% of ALF poor prognostic sign - Rising creatinine and oliguria - Metabolites of acetaminophen are nephrotoxic leading to acute renal failure similar to ATN and loss of phosphate -HRS
32 Additional Complications ARDS Sepsis - Severe complement deficiency - Decreased PMN motility - Decreased Kupffer cell function and removal of endotoxins - Increased levels of TNF and IL-6
33 Prognostic Factors Dependent on Etiology Younger patients do better (<40 and >10) Presence of cerebral edema Delay between jaundice and HE of more than 3 weeks - poorer prognosis MOF - poor prognosis
34 Current Treatment Transplantation
35 OUTCOME RESULTS U.S. ALF STUDY GROUP 308 Patients Spontaneous Survivors n=132 (43%) Transplanted N=89 (29%) Died before Transplantation n=87 (28%)
36 Transplanted N=89 (29%) Alive N=75 (84%) Died N=14 (16%)
37 Approach to Suspected ALF Etiology and Pathogenesis Evaluation and Diagnosis Complications Management Prognosis Current and future treatment approaches
MANAGEMENT OF ACUTE HEPATIC FAILURE
MANAGEMENT OF ACUTE HEPATIC FAILURE -NEW CONCEPT PROF. DR.MD ZAKIR HOSSAIN PROFESSOR & HEAD DEPARTMENT OF MEDICINE RANGPUR MEDICAL COLLEGE & HOSPITAL Rangpur Medical College & Hospital Begum Rokeya Shakhawat
More informationAcute Liver Failure. Agenda. Natalie H Bzowej, MD, PhD, FRCPC. Case Introduction Definition Diagnosis Initial Laboratory Evaluation Acetaminophen NAC
Acute Liver Failure Natalie H Bzowej, MD, PhD, FRCPC Agenda Case Introduction Definition Diagnosis Initial Laboratory Evaluation Acetaminophen NAC 1 Case 27 year old female presents to ER with N/V Denies
More informationAcute Liver Failure. Neil Shah, MD UNC School of Medicine High-Impact Hepatology Saturday, Dec 8 th, 2018
Acute Liver Failure Neil Shah, MD UNC School of Medicine High-Impact Hepatology Saturday, Dec 8 th, 2018 Disclosures None Outline Overview of ALF Management of ALF Diagnosis of ALF Treatments and Support
More informationAcute Liver Failure in the USA 2011 Evaluation of diagnostic criteria to approach DILI causality
Acute Liver Failure in the USA 2011 Evaluation of diagnostic criteria to approach DILI causality William M. Lee, MD Professor of Internal Medicine Meredith Mosle Chair in Liver Diseases UT Southwestern
More informationCurrent Concepts in Diagnosis and Management of Acute Liver Failure
Current Concepts in Diagnosis and Management of Acute Liver Failure Oren Fix, MD, MSc, FACP, AGAF, FAASLD Medical Director, Liver Transplant Program Swedish Medical Center Seattle, WA Learning Objectives
More informationAcute Hepatitis: An Approach to Infectious and Other Causes. Mary Anne Cooper MSc, MD, MEd, FRCPC
: An Approach to Infectious and Other Causes Mary Anne Cooper MSc, MD, MEd, FRCPC Faculty: Dr. Mary Anne Cooper Relationships with commercial interests: Consulting Fees: Lupin Pharmaceuticals, Canada Objectives
More informationLiver failure &portal hypertension
Liver failure &portal hypertension Objectives: by the end of this lecture each student should be able to : Diagnose liver failure (acute or chronic) List the causes of acute liver failure Diagnose and
More informationPACT module Acute hepatic failure. Intensive Care Training Program Radboud University Medical Centre Nijmegen
PACT module Acute hepatic failure Intensive Care Training Program Radboud University Medical Centre Nijmegen Acute Liver Failure Acute on Chronic Liver Failure Acute loss of hepatocellular function in
More informationViral hepatitis. Supervised by: Dr.Gaith. presented by: Shaima a & Anas & Ala a
Viral hepatitis Supervised by: Dr.Gaith presented by: Shaima a & Anas & Ala a Etiology Common: Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Less common: Cytomegalovirus EBV Rare: Herpes
More informationDiseases of liver. Dr. Mohamed. A. Mahdi 4/2/2019. Mob:
Diseases of liver Dr. Mohamed. A. Mahdi Mob: 0123002800 4/2/2019 Cirrhosis Cirrhosis is a complication of many liver disease. Permanent scarring of the liver. A late-stage liver disease. The inflammation
More informationApproach to the Patient with Liver Disease
Approach to the Patient with Liver Disease Diagnosis of liver disease Careful history taking Physical examination Laboratory tests Radiologic examination and imaging studies Liver biopsy Liver diseases
More informationPediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University
Pediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University SHOCK Definition: Shock is a syndrome = inability to provide sufficient oxygenated blood to tissues. Oxygen
More informationAcute Liver Failure. Critical Care Medicine and Trauma Course May 30, 2000
Acute Liver Failure Critical Care Medicine and Trauma Course May 30, 2000 Tim Davern, MD Director - Acute Liver Failure Program CPMC Liver Transplant Program davernt@sutterhealth.org Acute Liver Failure
More informationSuspected Isoflurane Induced Hepatitis from Cross Sensitivity in a Post Transplant for Fulminant Hepatitis from Halothane.
ISPUB.COM The Internet Journal of Anesthesiology Volume 25 Number 1 Suspected Isoflurane Induced Hepatitis from Cross Sensitivity in a Post Transplant for Fulminant Hepatitis from Halothane. V Sampathi,
More informationPACT module Acute hepatic failure. Intensive Care Training Program Radboud University Medical Centre Nijmegen
PACT module Acute hepatic failure Intensive Care Training Program Radboud University Medical Centre Nijmegen Acute Liver Failure Acute on Chronic Liver Failure Acute loss of hepatocellular function in
More informationDialyzing challenging patients: Patients with hepato-renal conditions
Dialyzing challenging patients: Patients with hepato-renal conditions Nidyanandh Vadivel MD Medical Director for Living kidney Donor and Pancreas Transplant Programs Swedish Organ Transplant, Seattle Acute
More informationHepatology cases for the generalist. Will Gelson Consultant Hepatologist Addenbrooke s Hospital
Hepatology cases for the generalist Will Gelson Consultant Hepatologist Addenbrooke s Hospital 30 y o man with upper GI haemorrhage Background heavy alcohol use Hxof 3 pint haematemesis P 100, BP 90/40,
More informationFULMINANT HEPATIC FAILURE
FULMINANT HEPATIC FAILURE 1 Definition FULMINANT HEPATIC FAILURE A clinical syndrome characterized by encephalopathy and coagulopathy due to massive hepatocellular necrosis or sudden severe impairment
More informationApproach to Abnormal Liver Tests
Approach to Abnormal Liver Tests Scott W. Biggins, MD, MAS Assistant Professor Division of Gastroenterology UCSF Scott.Biggins@ucsf.edu (Thanks to Hal Yee, MD) This Morning s Presentation Clinical vignettes
More informationPatterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function / liver function
More informationLiver Failure. The most severe clinical consequence of liver disease is liver failure:
Liver diseases I The major primary diseases of the liver are: - Viral hepatitis, - Nonalcoholic fatty liver disease (NAFLD), - Alcoholic liver disease, - Hepatocellular carcinoma (HCC) Hepatic damage also
More informationHepatocytes produce. Proteins Clotting factors Hormones. Bile Flow
R.J.Bailey MD Hepatocytes produce Proteins Clotting factors Hormones Bile Flow Trouble.. for the liver! Trouble for the Liver Liver Gall Bladder Common Alcohol Hep C Fatty Liver Cancer Drugs Viruses Uncommon
More informationHepatitis. Dr. Mohamed. A. Mahdi 5/2/2019. Mob:
Hepatitis Dr. Mohamed. A. Mahdi Mob: 0123002800 5/2/2019 Hepatitis Hepatitis means the inflammation of the liver. May cause by viruses or bacteria, parasites, radiation, drugs, chemical and toxins (alcohol).
More informationWorld Health Organization. Western Pacific Region
Basic modules for hepatitis 1 Basic Module 1 Liver anatomy and physiology 2 Position of liver Midline Located in right upper abdomen Protected by the right rib cage Right upper Measures: 12 15 cm in vertical
More informationPatterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function tests / tests of
More informationLiver Transplantation
1 Liver Transplantation Department of Surgery Yonsei University Wonju College of Medicine Kim Myoung Soo M.D. ysms91@wonju.yonsei.ac.kr http://gs.yonsei.ac.kr History Development of Liver transplantation
More informationEVALUATION OF ABNORMAL LIVER TESTS
EVALUATION OF ABNORMAL LIVER TESTS MIA MANABAT DO PGY6 MOA 119 TH ANNUAL SPRING SCIENTIFIC CONVENTION MAY 19, 2018 EVALUATION OF ABNORMAL LIVER TESTS Review of liver enzymes vs liver function tests Clinical
More informationA Review of Liver Function Tests. James Gray Gastroenterology Vancouver
A Review of Liver Function Tests James Gray Gastroenterology Vancouver Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationManagement of autoimmune hepatitis. Pierre-Emmanuel RAUTOU Inserm U970, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France
Management of autoimmune hepatitis Pierre-Emmanuel RAUTOU Inserm U970, PARCC@HEGP, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France 41 year-old woman, coming to emergency department for fatigue
More informationProfessor Peter Hayes University of Edinburgh
Professor Peter Hayes University of Edinburgh Acute liver failure BHIVA meeting, April 2018 No disclosures relevant to this presentation ALF DEFINITIONS Trey and Davidson, 1970 Potentially a reversible
More informationChapter 143 Acetaminophen
Chapter 143 Acetaminophen Episode overview 1) Describe the metabolism of Acetaminophen 2) Describe the 4 stages of Acetaminophen toxicity 3) List 4 mechanism of action of N-acetylcysteine 4) When do you
More informationVIRAL HEPATITIS. Definitions. Acute Liver Disease (Hepatitis A &E, Alcoholic hepatitis, DILI and ALF) Acute Viral Hepatitis Symptoms
Acute Liver Disease (Hepatitis A &E, Alcoholic hepatitis, DILI and ALF) Definitions AST and ALT Markers of hepatocellular injury Ryan M. Ford, MD Assistant Professor of Medicine Director of Viral Hepatitis
More informationAcute Liver Failure Fulminant Hepatic Failure
Acute Liver Failure K. Rajender Reddy, M.D. Ruimy Family President s Distinguished Professor in Medicine Professor of Medicine in Surgery Director of Hepatology Director, Viral Hepatitis Center Medical
More informationA Mysterious Rise in LFTs
Bita V. Naini, M.D. UCLA David Geffen School of Medicine Disclosure of Relevant Financial Relationships USCAP requires that all faculty in a position to influence or control the content of CME disclose
More informationCrackCast Episode 28 Jaundice
CrackCast Episode 28 Jaundice Episode overview: 1) Describe heme metabolism 2) List common pre-hepatic/hepatic/post-hepatic causes of jaundice Wisecracks: 1) What are clinical signs of liver disease? 2)
More information4/27/2018. Disclosures LIVER FUNCTION TESTS LIVER FUNCTION TESTS LIVER FUNCTION TESTS APPROACH TO THE PATIENT WITH ABNORMAL LIVER TESTS
APPROACH TO THE PATIENT WITH ABNORMAL TESTS Kimberly A. Brown, M.D, FAST, FAASLD, AGAF Chief, Division of Gastroenterology and Hepatology Henry Ford Hospital Henry Ford Health System Detroit, Michigan
More informationInvestigations before OLT, Immunosuppression and rejection, Follow up after OLT.
Investigations before OLT, Immunosuppression and rejection, Follow up after OLT andrea.degottardi@insel.ch When is liver transplantation indicated? When is liver transplantation indicated? Frequent: CIRRHOSIS
More informationAcute Liver Failure UCSF Critical Care Medicine and Trauma Meeting June 6, 2008 Tim Davern, MD UCSF Liver Transplant Program
Acute Liver Failure UCSF Critical Care Medicine and Trauma Meeting June 6, 2008 Tim Davern, MD UCSF Liver Transplant Program timothy.davern@ucsf.edu Acute Liver Failure - Outline - Incidence Definition
More informationIN THE NAME OF GOD. D r. MANIJE DEZFULI AZAD UNIVERCITY OF TEHRAN BOOALI HOSPITAL INFECTIOUS DISEASES SPECIALIST
IN THE NAME OF GOD AZAD UNIVERCITY OF TEHRAN BOOALI HOSPITAL D r. MANIJE DEZFULI INFECTIOUS DISEASES SPECIALIST Acute Viral Hepatitis The Anatomy of the Liver Hepatic Physiology Liver: Largest solid organ
More informationPITFALLS IN THE DIAGNOSIS OF MEDICAL LIVER DISEASE WITH TWO CONCURRENT ETIOLOGIES I HAVE NOTHING TO DISCLOSE CURRENT ISSUES IN ANATOMIC PATHOLOGY 2017
CURRENT ISSUES IN ANATOMIC PATHOLOGY 2017 I HAVE NOTHING TO DISCLOSE Linda Ferrell PITFALLS IN THE DIAGNOSIS OF MEDICAL LIVER DISEASE WITH TWO CONCURRENT ETIOLOGIES Linda Ferrell, MD, UCSF THE PROBLEM
More informationINVESTIGATION OF ADVERSE TRANSFUSION REACTIONS TABLE OF RECOMMENDED TESTS. Type of Reaction Presentation Recommended Tests Follow-up Tests
Minor Allergic (Urticarial) Urticaria, pruritis, flushing, rash If skin reaction only and mild hives/ rash
More informationChronic Hepatic Disease
Chronic Hepatic Disease 10 th Leading Cause of Death Liver Functions Energy Metabolism Protein Synthesis Solubilization, Transport, and Storage Protects and Clears drugs, damaged cells Causes of Liver
More informationSign up to receive ATOTW weekly -
MANAGEMENT OF ACUTE LIVER FAILURE IN CRITICAL CARE ANAESTHESIA TUTORIAL OF THE WEEK 251 20 TH FEBRUARY 2012 Dr Paul Maclure, University Hospital, Coventry, UK Dr Bilal Salman, Warwick Hospital, Warwick,
More informationEuropean Society of Anaesthesiologists MANAGEMENT OF LIVER FAILURE
European Society of Anaesthesiologists MANAGEMENT OF LIVER FAILURE 12RC8 JULIA WENDON Institute of Liver Studies London, United Kingdom Sunday June 6, 2004 10:30-11:15 Room 3A EPIDEMIOLOGY OF LIVER FAILURE.
More informationACUTE LIVER FAILURE IN A 61-YEAR-OLD MAN. 11/29/18 Muhammad Ahmed, MD
ACUTE LIVER FAILURE IN A 61-YEAR-OLD MAN 11/29/18 Muhammad Ahmed, MD H&P 61-year-old male with a history of chronic ethanol use (4-6 beers/day x decades), hypertension, and a family history of hemochromatosis
More informationDefinitions. You & Your New Transplant ` 38
Definitions Acute Short, relatively severe Analgesic Pain medicine Anemia A low number of red blood cells Anesthetic Medication that dulls sensation in order to reduce pain Acute Tubular Necrosis (ATN)
More informationProceeding of the NAVC North American Veterinary Conference Jan. 8-12, 2005, Orlando, Florida
Proceeding of the NAVC North American Veterinary Conference Jan. 8-12, 2005, Orlando, Florida Reprinted in the IVIS website with the permission of the NAVC http:/// The North American Veterinary Conference
More informationApproach to Acute Hepatitis other than. Dan Kottachchi, MD, MSc, FRCP
Approach to Acute Hepatitis other than viral Dan Kottachchi, MD, MSc, FRCP General approach Step 1 Yes Acute Liver Failure (ALF) INR 1.5 any degree of encephalopathyy) in a patient without preexisting
More informationDESCRIPTIONS FOR MED 3 ROTATIONS Critical Care A2 ICU
Critical Care A2 ICU A. Neurological 1. Delirium Discuss the differential diagnosis and appropriate investigation for delirium. Provide non-pharmological and pharmological treatment options for delirium.
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Accelerated intravascular coagulation and fibrinolysis (AICF) in liver disease, 390 391 Acid suppression in liver disease, 403 404 ACLF.
More informationHypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC
Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC Objectives 1. Define Hypoxic-Ischemic Encephalopathy (HIE) 2. Identify the criteria used to determine if an infant qualifies for therapeutic
More informationCONTROLLED DOCUMENT. Cirrhosis Care Bundle CATEGORY: Clinical Guidelines. CLASSIFICATION: Clinical. Controlled Document CG201 Number:
Cirrhosis Care Bundle CONTROLLED DOCUMENT CATEGORY: Clinical Guidelines CLASSIFICATION: Clinical Controlled Document CG201 Number: Version Number: 1 Controlled Document Clinical Guidelines Group Sponsor:
More informationSalicylate (Aspirin) Ingestion California Poison Control Background 1. The prevalence of aspirin-containing analgesic products makes
Salicylate (Aspirin) Ingestion California Poison Control 1-800-876-4766 Background 1. The prevalence of aspirin-containing analgesic products makes these agents, found in virtually every household, common
More informationDisclosures Drug-induced Acute Liver Failure
Disclosures Drug-induced Acute Liver Failure I have nothing to disclose. Raga Ramachandran, MD, PhD UCSF Pathology May 25, 2012 Acute liver failure (Fulminant hepatitis) Definition - onset of hepatic encephalopathy
More informationPost-Cardiac Surgery Evaluation
Post-Cardiac Surgery Evaluation 20th Annual Heart Conference October 15, 2016 Gary A Mayman PROFESSOR PEDIATRICS UNIVERSITY OF NEVADA Look Touch Listen Temperature, pulse, respiratory rate, & blood pressure
More informationShock is defined as a state of cellular and tissue hypoxia due to : reduced oxygen delivery and/or increased oxygen consumption or inadequate oxygen
Shock is defined as a state of cellular and tissue hypoxia due to : reduced oxygen delivery and/or increased oxygen consumption or inadequate oxygen utilization The effects of shock are initially reversible
More informationCirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association
CIRRHOSIS AND PORTAL HYPERTENSION Cirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association WHAT IS CIRRHOSIS? What is Cirrhosis? DEFINITION OF CIRRHOSIS
More informationDefinition: fibrosis and nodular regeneration resulting from hepatocellular injury
Cirrhosis Understanding the liver: Patterns of LFT Abnormalities - Hepatocellular/Transaminitis: o Ratio of AST: ALT >2:1 ETOH (keep in mind AST is also produced by red cells, heart muscle) o If Aminotransferases
More informationDepartment of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
SIRIRAJ MEDICAL LIBRARY SpecialIssue Clinical Practice Guide for the Management of Dengue Hemorrhagic Fever (DHF), Siriraj Hospital Kulkanya Chokephaibulkit, M.D., Wanee Wisuthsarewong, M.D., Gavivann
More informationSIRS Score Reflects Clinical Features of Non-Acetaminophen-Related Acute Liver Failure with Hepatic Coma
ORIGINAL ARTICLE SIRS Score Reflects Clinical Features of Non-Acetaminophen-Related Acute Liver Failure with Hepatic Coma Yasuhiro Miyake, Tetsuya Yasunaka, Fusao Ikeda, Akinobu Takaki, Kazuhiro Nouso
More informationAcute Liver Failure: Supporting Other Organs
Acute Liver Failure: Supporting Other Organs Michael A. Gropper, MD, PhD Professor of Anesthesia and Physiology Director, Critical Care Medicine University of California San Francisco Acute Liver Failure
More informationDisclosure. Technician Objectives. Pharmacist Objectives. Definition of ALF. Patient Case 3/4/2015. Acute Liver Failure
Disclosure Acute Liver Failure Jacquelyn Lansing, PharmD, BCPS PGY-2 Critical Care Pharmacy Resident Jackson Memorial Hospital, Miami, FL I do not have a vested interest in or affiliation with any corporate
More information2. Liver blood tests and what they mean p2 Acute and chronic liver screen
Hepatology referral pathways for GP 1 Scope For use within hepatology Contents 2. Liver blood tests and what they mean p2 Acute and chronic liver screen p2 Common reasons for hepatology referral 3. Raised
More informationLiver Disease in the ICU: Acute Liver Failure
Liver Disease in the ICU: Acute Liver Failure Steven C Pugliese, MD Assistant Professor Division of Pulmonary Sciences and Cri@cal Care Medicine University of Colorado Denver 48 y/o male w/out prior liver
More informationHepatorenal Syndrome
Necker Seminars in Nephrology Institut Pasteur Paris, April 22, 2013 Hepatorenal Syndrome Dr. Richard Moreau 1 INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, 2 Université Paris Diderot
More informationLIVER DISORDERS (PRACTICAL MANAGEMENT) Dr Pok Kern (PK) TAN Gastroenterologist Calvary hospital, ACT 1 st April 2017
LIVER DISORDERS (PRACTICAL MANAGEMENT) Dr Pok Kern (PK) TAN Gastroenterologist Calvary hospital, ACT 1 st April 2017 TOPICS TO COVER Acute liver failure Chronic liver failure Portal hypertension : Ascites
More informationState of Florida Hypothermia Protocol. Michael D. Weiss, M.D. Associate Professor of Pediatrics Division of Neonatology
State of Florida Hypothermia Protocol Michael D. Weiss, M.D. Associate Professor of Pediatrics Division of Neonatology I. Entry Criteria 1. Gestational Age greater than or equal to 35 weeks gestation
More informationManagement of Chronic Liver Failure/Cirrhosis Complications in Hospitals. By: Dr. Kevin Dolehide
Management of Chronic Liver Failure/Cirrhosis Complications in Hospitals By: Dr. Kevin Dolehide Overview DX Cirrhosis and Prognosis Compensated Decompensated Complications Of Cirrhosis Management Of Complications
More informationInitial Evaluation for HCV Therapy. Hope McGratty PA-C, MPH
Initial Evaluation for HCV Therapy Hope McGratty PA-C, MPH Conflict of Interest Disclosure Statement None Who are we talking about today? Treatment naïve Chronic infection This patient seems complicated
More informationFunctions of the Liver. Defined.. Epidemiology. Etiology 3/2/2015
Functions of the Liver Acute Liver Failure Rebecca Duke DNP, MSN, APN-CNP AACN Spring 2015 Transplant Surgery Nurse Practitioner Secretory 1) Bile acid from cholesterol 2)Conjugation of bili Excretory
More informationAscites Management. Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology
Ascites Management Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology Disclosure 1. The speaker Atif Zaman, MD MPH have no relevant
More informationHEAT STROKE. Lindsay VaughLindsay Vaughn, DVM, DACVECCDVM, DACVECC
HEAT STROKE Lindsay VaughLindsay Vaughn, DVM, DACVECCDVM, DACVECC Heat Stroke More Preventable Than Treatable Heat Stroke A form of hyperthermia associated with a systemic inflammatory response leading
More informationCHAPTER 1. Alcoholic Liver Disease
CHAPTER 1 Alcoholic Liver Disease Major Lesions of Alcoholic Liver Disease Alcoholic fatty liver - >90% of binge and chronic drinkers Alcoholic hepatitis precursor of cirrhosis Alcoholic cirrhosis end
More informationHepatic sinusoidal obstruction syndrome due to herbal ingestion in South African children - An 8 year review
UNIVERSITY OF PRETORIA Hepatic sinusoidal obstruction syndrome due to herbal ingestion in South African children - An 8 year review L. Hendricks, A. Meyer, A. Terblanche Dept of paediatric gastroenterology
More informationThe Yellow Patient. Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust
The Yellow Patient Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust there s a yellow patient in bed 40. It s one of yours. Liver Cirrhosis Why.When.What.etc.
More informationNONSPECIFIC Starts in the blood by
BASIC IMMUNOLOGY and ORGAN TRANSPLANTATION Ahmed Mahmoud,MD Host defense against infection is 1- nonspecific or 2- specific (immune system) NONSPECIFIC Starts in the blood by 1) leucocytes phagocytosis
More informationKey Aspects of Diagnosing Alcoholic Hepatitis. Mark Sonderup University of Cape Town & Groote Schuur Hospital
Key Aspects of Diagnosing Alcoholic Hepatitis Mark Sonderup University of Cape Town & Groote Schuur Hospital 42 year old woman, married with 3 children No significant co-morbidities or illnesses Habits
More informationManagement of the Cirrhotic Patient in the ICU
Management of the Cirrhotic Patient in the ICU Peter E. Morris, MD Professor & Chief, Pulmonary, Critical Care and Sleep Medicine University of Kentucky Conflict of Interest Funding US National Institutes
More informationPrinted copies of this document may not be up to date, obtain the most recent version from
Children s Acute Transport Service Clinical Guidelines Septic Shock Document Control Information Author Claire Fraser P.Ramnarayan Author Position tanp CATS Consultant Document Owner E. Polke Document
More informationShock, Hemorrhage and Thrombosis
Shock, Hemorrhage and Thrombosis 1 Shock Systemic hypoperfusion due to: Reduction in cardiac output Reduction in effective circulating blood volume Hypotension Impaired tissue perfusion Cellular hypoxia
More informationSudden (Acute) Liver Failure
Customer Name, Street Address, City, State, Zip code Phone number, Alt. phone number, Fax number, e-mail address, web site Sudden (Acute) Liver Failure Basics OVERVIEW Sudden (acute) damage to the liver
More informationTransplant Hepatology
Transplant Hepatology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified
More information2016 LLSA Review ARTICLE 1. Options for Reversal. Introduction. Fresh Frozen Plasma (FFP) Vitamin K 11/6/2017. Articles 1, 9, 11, 12
2016 LLSA Review Articles 1, 9, 11, 12 Brian Felice, MD Beaumont Health System Royal Oak November 13, 2017 ARTICLE 1 Anticoagulants/Antithrombotics Frumkin K. Rapid reversal of warfarin-associated hemorrhage
More informationGastrointestinal System: Accessory Organ Disorders
Gastrointestinal System: Accessory Organ Disorders Mary DeLetter, PhD, RN Associate Professor Dept. of Baccalaureate and Graduate Nursing Eastern Kentucky University Disorders of Accessory Organs Portal
More informationSpecific Panels. Celiac disease panel. Pancreas Panel:
Specific Panels Celiac disease panel Anti Endomysium IgA Anti Endomysium IgG Anti Gliadin IgA Anti Gliadin IgG Anti Transglutaminase IgA Anti Transglutaminase IgG Total IgA Total IgG Stool analysis +Sudan
More informationDrug Induced Liver Injury (DILI)
Drug Induced Liver Injury (DILI) Aisling Considine- Consultant Hepatology Pharmacist. King s College Hospital NHS Foundation Trust aislingconsidine@nhs.net Drug Induced Liver Injury /Disease Acute Liver
More informationManaging the Patient With Acute Liver Failure
REVIEW Managing the Patient With Acute Liver Failure Filipe S. Cardoso, M.D., M.Sc.,* and Constantine J. Karvellas, M.D., S.M., F.R.C.P.C., Acute liver failure (ALF) is a rare condition characterized by
More informationAcute liver failure (ALF) is that unique concatenation of
2B: Liver Approach to Acute Liver Failure William M. Lee, MD, FACG Acute liver failure (ALF) is that unique concatenation of events when a previously healthy person develops acute hepatic injury of such
More informationRenal Care and Liver Disease: Disease Trajectory and Hospice Eligibility
Renal Care and Liver Disease: Disease Trajectory and Hospice Eligibility Terri L. Maxwell PhD, APRN VP, Strategic Initiatives Weatherbee Resources/HEN Course Materials & Disclosure Course materials including
More informationIl trapianto di cellule staminali emopoietiche nel paziente portatore di virus epatitici
Il trapianto di cellule staminali emopoietiche nel paziente portatore di virus epatitici Anna Locasciulli Ematologia e Trapianto di Cellule Staminali Emopoietiche Ospedale S.Camillo, Roma Il trapianto
More informationTherapies for DILI: NAC, Steroids or NRF-2 activators?
Therapies for DILI: NAC, Steroids or NRF-2 activators? William M. Lee, MD Professor of Internal Medicine Meredith Mosle Chair in Liver Diseases UT Southwestern Medical Center at Dallas Drug-Induced Liver
More informationCertified Clinical Transplant Nurse (CCTN) * Detailed Content Outline
I. PRETRANSPLANTATION CARE 9 11 3 23 A. Evaluate End-Stage Organ Failure 1 1 1 3 1. History and physical assessment 2. Vital signs and / or hemodynamic parameters 3. Lab values 4. Diagnostic tests B. Monitor
More informationFluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationSteps in Assessing Fibrosis 4/30/2015. Overview of Liver Disease Associated With HCV
Overview of Liver Disease Associated With HCV Marion G. Peters, MD John V. Carbone, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco San Francisco,
More informationDisorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome.
Disorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome. Azotemia and Urinary Abnormalities Disturbances in urine volume oliguria, anuria, polyuria Abnormalities of urine sediment red
More informationDr Kirsten Herbert. Dr Melita Kenealy. MBBS(Hons) FRCPA FRACP. Common Blood Tests
Common Blood Tests Your Haematologist may order numerous blood and urine tests to help diagse or manage your condition. Listed below are some of the more common tests that can be ordered in a haematology
More informationModule 1 Introduction of hepatitis
Module 1 Introduction of hepatitis 1 Training Objectives At the end of the module, trainees will be able to ; Demonstrate improved knowledge of the global epidemiology of the viral hepatitis Understand
More informationEpic Labs Orderable As STAT PRIORITY As of 06/22/2016
ABG+HB(CORDARTERIAL) - BABY A ABG+HB(CORD ARTERIAL)- BABY B ABG+HB(CORD ARTERIAL)- BABY C ACETAMINOPHEN LEVEL ALANINE AMINOTRANSFERASE (ALT) ALBUMIN, FLUID ALBUMIN, PLEURAL FLUID ALBUMIN, SYNOVIAL FLUID
More informationConflicts of Interest
Anesthesia for Major Abdominal Cancer Resection John E. Ellis MD Adjunct Professor University of Pennsylvania johnellis1700@gmail.com Conflicts of Interest 1 Upper Abdominal Surgery Focus on oncologic
More information