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1、AcuteLiverFailureDr.EduardoMartinezFoiegras(pronounced/fwɑːˈɡrɑː/inEnglish;Frenchfor"fatliver")isafoodproductmadeoftheliverofaduckorgoosethathasbeenspeciallyfattened.FoieGrasMetabolicCarbmetabolismProteinandlipoproteinmetabolismFattyacidmetabolismBiotransformationofdrugsStorageGlyc
2、ogenVitaminsA,D,E,andKIronandcopperFunctionsoftheLiverImmunologicalfunctionsSynthesisofimmunoglobulinsPhagocytosisbyKupffercellsFiltrationofbacteriaDegradationofendotoxinsExcretionofbilirubinandureaformationHaematologicalfunctionsBloodreservoirHaematopoiesisinthefoetusFunctionsofth
3、eLiverALFSyndromethatleadstoMOFanddeathPreviouslynormallivermayfailwithindaysHighgradeencephalopathy,survivalis<20%Earlydeath:cerebraloedema,CVScollapseLatedeath:Sepsis,MOFDefinitionandClassificationsALF:Sd.definedbyEncephalopathyCoagulopathyJaundiceIndividualwithpreviouslynormalli
4、verDefinitionandClassificationsFulminantHepaticFailurePotentiallyreversibleconditionConsequenceofsevereliverinjuryEncephalopathyappearswithin8wks.ofinitialSx.Absenceofpre-existingliverds.DefinitionandClassificationsKing’sclassification:Hyperacute:encephalopathywithin<7daysParacetam
5、ol,ischaemic,viral,toxinsAcute:8-28daysSubacute:5-26weeksSeronegative,idiopathic,drug-relatedDifferentetiologyPoorerprognosisEtiologyCauseAgentResponsibleViralHepatitisHep.A,B,D,E,CMV,HSV,seronegativehepatitis(14-25%inUK)Drug-relatedDose-related,e.g.paracetamol;idiosyncraticreactio
6、ns,e.g.anti-TB,statins,recreationaldrugs,anticonvulsants,NSAIDs,manyothersToxinsCarbontetrachloride,amanitaphalloidesVasculareventsIscahemichepatitis,veno-occlusivedisease,Budd-Chiari,heatstrokeOtherPregnancy-relatedliverdisease,Wilson’sdisease,lymphoma,carcinoma,traumaEtiologyMost
7、commoncauses:Worldwide:HepatotrophicvirusesA-EUKParacetamoloverdoseSeronegativeornon-A-EhepatitisIdiosynchraticdrugrxs.orWilson’sds.WorkupIdentifytheetiologyHx.,examination,viralandautoimmuneprofilesBloodsFBC,EUC,CMP,coags,LFTs,druglevelsAbdoUSGandCTVascularpattern,ascitis,splenome
8、galyWorkupLiverBx.Donebytr
