Hepatic failure and hepatorenal syndrome are characterized by liver dysfunction and associated kidney impairment. Portal hypertension and toxins that normally metabolized by the liver can accumulate in the brain, causing encephalopathy. Hepatorenal syndrome is classified as type 1 with rapid renal decline or type 2 with slower progression. It involves circulatory changes and activation of vasoactive systems. Treatment focuses on correcting precipitating factors, volume expansion, medications to constrict renal vasculature, and liver transplantation which is the definitive treatment. Dialysis may be used as a bridge to transplantation.
Acute liver failure describes severe liver dysfunction that occurs within 6 months of symptoms appearing. It can be caused by infections, drugs, autoimmune conditions, or inherited metabolic disorders. Clinically, it presents with jaundice, coagulopathy, and hepatic encephalopathy ranging from changes in consciousness to coma. Investigations show prolonged prothrombin time and elevated bilirubin. Treatment focuses on supportive care, identifying and treating precipitating causes, reducing gut-derived toxins like ammonia through dietary changes and medications like lactulose, and managing complications like hepatic encephalopathy and cerebral edema. The prognosis depends on the severity of encephalopathy and underlying cause.
A 55-year-old male with a history of chronic alcohol use presented with altered mental status and black stools. On examination, he was conscious but confused with signs of liver dysfunction. The main differential diagnoses were hepatic encephalopathy, alcohol withdrawal, cerebrovascular accident, meningitis, and metabolic encephalopathy. Hepatic encephalopathy was suggested as the leading diagnosis given the history of chronic liver disease and characteristic clinical features including fluctuating neurological signs and asterixis. Treatment focused on identifying and removing precipitating factors while providing supportive care and medications to reduce ammonia like lactulose.
This document provides an overview of acute liver failure (ALF), including its definition, classification, etiology, clinical manifestations, diagnosis, treatment, complications, prognosis, and liver support devices. ALF is defined as evidence of coagulation abnormalities and mental alterations in a patient without preexisting cirrhosis within 26 weeks of illness onset. Common etiologies in India include hepatitis E, drug-induced liver injury, and acetaminophen toxicity. Presentation may include jaundice, coagulopathy, and hepatic encephalopathy. Treatment involves supportive care and managing complications such as cerebral edema. Prognosis is assessed using scoring systems like King's College criteria, with liver transplantation indicated for those who do not recover spontaneously.
Hepatic encephalopathy is a complex, reversible neuropsychiatric disorder seen in patients with severe liver dysfunction. It ranges from mild cognitive impairment (minimal HE) to coma (overt HE). Precipitating factors like infections, GI bleeding, and high protein intake can trigger episodes. Treatment focuses on removing triggers, lowering ammonia with lactulose/rifaximin, and considering liver transplant for persistent cases. Diet, lactulose, antibiotics, and surgery to reduce portosystemic shunting are used to manage and prevent recurrent episodes of hepatic encephalopathy.
Portal-systemic encephalopathy is a brain disorder caused by liver dysfunction that allows toxins to reach the brain. It is characterized by alterations in mental status, neurological abnormalities, and distinctive EEG changes. The main underlying mechanism involves increased levels of ammonia in the bloodstream from the gut that are normally processed by the liver. Treatment focuses on reducing ammonia production in the colon through medications like lactulose and restricting protein intake. Prognosis depends on the underlying liver disease and can range from fully treatable acute episodes to chronic and potentially fatal cases.
Renal failure occurs when the kidneys cannot remove waste or regulate fluids and electrolytes. There are two main types: acute renal failure, which develops rapidly over hours to days; and chronic renal failure, which is progressive and irreversible. Acute renal failure causes a sudden loss of kidney function and can result from prerenal issues, direct kidney damage, or urinary tract obstruction. Chronic renal failure is treated through diet, medication, and often dialysis to remove waste when kidney function declines. Nursing focuses on managing complications, nutrition, fluid balance, and educating patients.
acute liver failure in pediatrics final.pptxmeetgvsv
1. Acute hepatic failure is defined as severe liver injury with coagulopathy and encephalopathy developing within 8 weeks, without pre-existing liver disease.
2. It can be caused by viral hepatitis, drugs, metabolic diseases, and other conditions like Budd-Chiari syndrome or autoimmune hepatitis.
3. Major complications include cerebral edema, coagulopathy, sepsis, and renal failure. Management involves stabilizing blood pressure and glucose, fluid management, treating complications, and considering liver transplantation for eligible patients.
Hepatic encephalopathy is a neuropsychiatric syndrome that occurs secondary to liver disease and portosystemic shunting. It is caused by toxic metabolites like ammonia that bypass the liver and affect the brain. Clinical features range from subtle personality changes to confusion, coma, and death in acute liver failure. Treatment involves identifying and removing precipitants, providing nutrition support, antibiotics, and procedures to reduce ammonia levels like lactulose. Prognosis depends on the underlying liver disease severity.
Acute liver failure describes severe liver dysfunction that occurs within 6 months of symptoms appearing. It can be caused by infections, drugs, autoimmune conditions, or inherited metabolic disorders. Clinically, it presents with jaundice, coagulopathy, and hepatic encephalopathy ranging from changes in consciousness to coma. Investigations show prolonged prothrombin time and elevated bilirubin. Treatment focuses on supportive care, identifying and treating precipitating causes, reducing gut-derived toxins like ammonia through dietary changes and medications like lactulose, and managing complications like hepatic encephalopathy and cerebral edema. The prognosis depends on the severity of encephalopathy and underlying cause.
A 55-year-old male with a history of chronic alcohol use presented with altered mental status and black stools. On examination, he was conscious but confused with signs of liver dysfunction. The main differential diagnoses were hepatic encephalopathy, alcohol withdrawal, cerebrovascular accident, meningitis, and metabolic encephalopathy. Hepatic encephalopathy was suggested as the leading diagnosis given the history of chronic liver disease and characteristic clinical features including fluctuating neurological signs and asterixis. Treatment focused on identifying and removing precipitating factors while providing supportive care and medications to reduce ammonia like lactulose.
This document provides an overview of acute liver failure (ALF), including its definition, classification, etiology, clinical manifestations, diagnosis, treatment, complications, prognosis, and liver support devices. ALF is defined as evidence of coagulation abnormalities and mental alterations in a patient without preexisting cirrhosis within 26 weeks of illness onset. Common etiologies in India include hepatitis E, drug-induced liver injury, and acetaminophen toxicity. Presentation may include jaundice, coagulopathy, and hepatic encephalopathy. Treatment involves supportive care and managing complications such as cerebral edema. Prognosis is assessed using scoring systems like King's College criteria, with liver transplantation indicated for those who do not recover spontaneously.
Hepatic encephalopathy is a complex, reversible neuropsychiatric disorder seen in patients with severe liver dysfunction. It ranges from mild cognitive impairment (minimal HE) to coma (overt HE). Precipitating factors like infections, GI bleeding, and high protein intake can trigger episodes. Treatment focuses on removing triggers, lowering ammonia with lactulose/rifaximin, and considering liver transplant for persistent cases. Diet, lactulose, antibiotics, and surgery to reduce portosystemic shunting are used to manage and prevent recurrent episodes of hepatic encephalopathy.
Portal-systemic encephalopathy is a brain disorder caused by liver dysfunction that allows toxins to reach the brain. It is characterized by alterations in mental status, neurological abnormalities, and distinctive EEG changes. The main underlying mechanism involves increased levels of ammonia in the bloodstream from the gut that are normally processed by the liver. Treatment focuses on reducing ammonia production in the colon through medications like lactulose and restricting protein intake. Prognosis depends on the underlying liver disease and can range from fully treatable acute episodes to chronic and potentially fatal cases.
Renal failure occurs when the kidneys cannot remove waste or regulate fluids and electrolytes. There are two main types: acute renal failure, which develops rapidly over hours to days; and chronic renal failure, which is progressive and irreversible. Acute renal failure causes a sudden loss of kidney function and can result from prerenal issues, direct kidney damage, or urinary tract obstruction. Chronic renal failure is treated through diet, medication, and often dialysis to remove waste when kidney function declines. Nursing focuses on managing complications, nutrition, fluid balance, and educating patients.
acute liver failure in pediatrics final.pptxmeetgvsv
1. Acute hepatic failure is defined as severe liver injury with coagulopathy and encephalopathy developing within 8 weeks, without pre-existing liver disease.
2. It can be caused by viral hepatitis, drugs, metabolic diseases, and other conditions like Budd-Chiari syndrome or autoimmune hepatitis.
3. Major complications include cerebral edema, coagulopathy, sepsis, and renal failure. Management involves stabilizing blood pressure and glucose, fluid management, treating complications, and considering liver transplantation for eligible patients.
Hepatic encephalopathy is a neuropsychiatric syndrome that occurs secondary to liver disease and portosystemic shunting. It is caused by toxic metabolites like ammonia that bypass the liver and affect the brain. Clinical features range from subtle personality changes to confusion, coma, and death in acute liver failure. Treatment involves identifying and removing precipitants, providing nutrition support, antibiotics, and procedures to reduce ammonia levels like lactulose. Prognosis depends on the underlying liver disease severity.
- Hepatorenal syndrome (HRS) is a form of kidney failure seen in patients with cirrhosis or acute liver failure. It is caused by severe renal vasoconstriction due to excessive vasodilation in the splanchnic circulation.
- There are two main types - type 1 is rapidly progressive over 2 weeks and has a very poor prognosis, type 2 progresses more slowly over weeks/months.
- Treatment options include TIPS to reduce portal hypertension, midodrine/octreotide to constrict vessels, terlipressin which is effective but can cause ischemia, and liver transplantation which is curative but limited by organ availability.
Hepatorenal syndrome is a condition characterized by impaired renal function in patients with advanced liver disease and portal hypertension. There are two types - type 1 is rapid and progressive, leading to death within a month without treatment, while type 2 is less severe but still associated with worse prognosis. The pathogenesis involves splanchnic vasodilation triggering renal vasoconstriction. Treatment involves vasoconstrictors like terlipressin combined with albumin to increase mean arterial pressure and improve renal function. Achieving at least a 10 mmHg increase in MAP with vasoconstrictor therapy correlates with better renal outcomes in hepatorenal syndrome patients.
This document discusses fulminant hepatic failure (FHF), also known as acute liver failure (ALF). It defines ALF as liver dysfunction occurring over a period of 8 weeks or less without pre-existing liver disease. The most common causes in the US and Europe are acetaminophen overdose and viral hepatitis in Africa and Asia. The pathophysiology involves massive hepatocyte destruction and impaired regeneration. Clinically, patients present with jaundice, fever, vomiting and eventually hepatic encephalopathy. Management involves supportive care, treating complications, and liver transplantation for eligible patients. Prognosis depends on the cause and stage of encephalopathy.
Chronic excessive alcohol consumption can lead to a spectrum of alcoholic liver disease including fatty liver, alcoholic hepatitis, and cirrhosis. Fatty liver is most common, while only 10-20% of alcoholics develop hepatitis. Hepatitis is characterized by hepatocyte injury, ballooning, and inflammation. Cirrhosis results in fibrosis and nodular regeneration of liver architecture. Complications include ascites, variceal bleeding, and hepatic encephalopathy. Treatment of alcoholic liver disease involves abstaining from alcohol and managing complications. Corticosteroids may benefit severe hepatitis. Liver transplantation is an option for end-stage disease if abstinence is maintained.
1) Liver transplantation involves replacing a diseased liver with a healthy donor liver. It has improved survival rates from 30% to over 90% due to advances like immunosuppressive drugs.
2) There are various indications for liver transplantation in both adults and children, including cirrhosis, liver cancer, and genetic liver diseases. Recipients are selected based on factors like MELD score and disease severity.
3) The surgery requires connecting the donor liver's blood vessels and bile duct. Post-operatively, patients are closely monitored and given immunosuppressants to prevent rejection while managing side effects.
This patient, a 21-year-old male, presented with jaundice, fatigue, pruritis and dark urine for 1-2 months. On examination, he was deeply jaundiced with hepatomegaly but no other abnormalities. Laboratory tests found elevated liver enzymes, bilirubin, INR and low albumin. This suggests the patient has conjugated hyperbilirubinemia likely due to chronic liver disease given the clinical findings and lab abnormalities. Further evaluation is needed including hepatitis and autoimmune serology, imaging and potentially a liver biopsy to determine the underlying cause.
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver failure and characterized by changes in cognition, behavior, and personality. It ranges from minor alterations in brain function to deep coma. The main causes are thought to be increased levels of ammonia and other toxins in the blood due to the liver's inability to remove them. Treatment focuses on reducing ammonia production in the gut through dietary changes, antibiotics, and lactulose. Managing precipitating factors and providing supportive care are also important. For severe or recurrent cases, procedures to bypass the liver such as TIPSS or liver transplantation may be considered.
Acute renal failure in children is defined as a sudden deterioration in renal function resulting in the inability to maintain fluid and electrolyte homeostasis. It can be classified as pre-renal, intrinsic renal, or post-renal. Common causes include dehydration, infections, nephrotoxins, and obstructions. Symptoms include decreased urine output, edema, and mental changes. Treatment involves fluid resuscitation, electrolyte management, dialysis for complications like hyperkalemia, and treating the underlying cause. The prognosis depends on the cause, with acute tubular necrosis having a 90% complete remission rate.
1. Hepatic encephalopathy is a serious complication of chronic liver disease characterized by alterations in mental status and cognitive function occurring in liver failure. Common precipitating factors include blood transfusion, infection, GI bleeding, use of sedative drugs, constipation, alkalosis, low potassium, and high protein diet.
2. Treatment of acute overt hepatic encephalopathy includes supportive care, identifying and treating precipitating factors, reducing nitrogenous load in the gut through medications like lactulose, and assessing need for long-term therapy or liver transplant.
3. Prevention and management of recurrent or persistent hepatic encephalopathy involves avoiding precipitating factors and continued drug therapy like lactulose and rifaximin,
Acute renal failure (ARF) is a sudden loss of kidney function that can be reversible. It is caused by renal cell damage from ischemia or toxic substances. ARF progresses through oliguric, diuretic, and recovery phases. Nursing management focuses on fluid and electrolyte balance, preventing infections, maintaining nutrition, and preserving neurologic function. Dialysis may be needed to correct electrolyte imbalances or other complications of ARF.
Anesthesia for Liver transplantation - Dr.Sandeepdeepmbbs04
Liver transplantation is a complex procedure that requires careful anaesthetic management due to the pathophysiological changes associated with end-stage liver disease. Key considerations include monitoring for haemodynamic instability, coagulopathy and metabolic disturbances. Frequent intraoperative monitoring and correction of abnormalities are important to assess graft function and optimize patient outcomes.
This document discusses cirrhosis and its complications over two parts. Part I covers what cirrhosis is, its etiologies, clinical presentations, physical exam findings, laboratory tests, liver biopsy, and prognosis for different etiologies. Part II covers complications of cirrhosis including portal hypertension, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, and hepatocellular carcinoma screening and treatment. Liver transplantation is also discussed as a treatment option.
This document provides an overview of anaesthesia for liver transplantation. It discusses the indications and contraindications for liver transplant, preoperative evaluation including scoring systems, and the pathophysiology of end-stage liver disease affecting various organ systems. It also describes the intraoperative management considerations including hemodynamic monitoring, induction, vascular access, ventilation and complications. Postoperative care including management of coagulopathy and intensive care are also discussed.
1) Acute renal failure in children is defined as a sudden deterioration in renal function resulting in the inability to maintain fluid and electrolyte homeostasis. It can be caused by pre-renal, intrinsic renal, or post-renal factors.
2) Common causes include dehydration, infection, nephrotoxins, and obstructive uropathy. Presenting symptoms include decreased urine output, edema, and mental changes.
3) Treatment involves fluid resuscitation, restricting intake of fluids/proteins/electrolytes, and treating complications like hyperkalemia. Dialysis may be needed to correct fluid/electrolyte imbalances or uremia. Prognosis depends
The document summarizes key information about liver emergencies seen in the emergency department. It covers topics such as definitions of different types of liver failure (acute, chronic, fulminant), common causes of acute liver failure including paracetamol poisoning and viral hepatitis, complications of liver failure like encephalopathy and infections, criteria for liver transplantation in acute liver failure, management of acute liver failure including supportive care and transplantation, spontaneous bacterial peritonitis in patients with cirrhosis, and Budd-Chiari syndrome which is a rare cause of liver failure due to blockage of hepatic veins. Imaging modalities, investigations, and treatment approaches are also discussed for different liver conditions.
This document provides an overview of hepatic encephalopathy. It defines hepatic encephalopathy as a complex metabolic disorder seen in patients with liver dysfunction, characterized by disturbances in consciousness and behavior. It discusses the pathogenesis, including the ammonia and false neurotransmitter hypotheses. Precipitating factors and clinical manifestations ranging from mild cognitive changes to coma are described. Diagnosis involves ruling out other causes and elevated ammonia levels. Treatment focuses on reducing ammonia through dietary changes, lactulose, antibiotics, and other supportive measures. Prognosis depends on the severity and underlying liver disease.
Acute renal failure (ARF), also known as acute kidney injury (AKI), is a rapid loss of kidney function caused by damage to the kidneys. It is characterized by the sudden loss of the kidneys' ability to excrete waste, conserve electrolytes, and maintain fluid balance. ARF can be caused by pre-renal factors that decrease blood flow to the kidneys, intra-renal issues that directly damage kidney tissue, or post-renal obstruction of urine outflow. The management of ARF focuses on treating the underlying cause, maintaining fluid and electrolyte balance, and potentially initiating renal replacement therapy.
- Hepatorenal syndrome (HRS) is a form of kidney failure seen in patients with cirrhosis or acute liver failure. It is caused by severe renal vasoconstriction due to excessive vasodilation in the splanchnic circulation.
- There are two main types - type 1 is rapidly progressive over 2 weeks and has a very poor prognosis, type 2 progresses more slowly over weeks/months.
- Treatment options include TIPS to reduce portal hypertension, midodrine/octreotide to constrict vessels, terlipressin which is effective but can cause ischemia, and liver transplantation which is curative but limited by organ availability.
Hepatorenal syndrome is a condition characterized by impaired renal function in patients with advanced liver disease and portal hypertension. There are two types - type 1 is rapid and progressive, leading to death within a month without treatment, while type 2 is less severe but still associated with worse prognosis. The pathogenesis involves splanchnic vasodilation triggering renal vasoconstriction. Treatment involves vasoconstrictors like terlipressin combined with albumin to increase mean arterial pressure and improve renal function. Achieving at least a 10 mmHg increase in MAP with vasoconstrictor therapy correlates with better renal outcomes in hepatorenal syndrome patients.
This document discusses fulminant hepatic failure (FHF), also known as acute liver failure (ALF). It defines ALF as liver dysfunction occurring over a period of 8 weeks or less without pre-existing liver disease. The most common causes in the US and Europe are acetaminophen overdose and viral hepatitis in Africa and Asia. The pathophysiology involves massive hepatocyte destruction and impaired regeneration. Clinically, patients present with jaundice, fever, vomiting and eventually hepatic encephalopathy. Management involves supportive care, treating complications, and liver transplantation for eligible patients. Prognosis depends on the cause and stage of encephalopathy.
Chronic excessive alcohol consumption can lead to a spectrum of alcoholic liver disease including fatty liver, alcoholic hepatitis, and cirrhosis. Fatty liver is most common, while only 10-20% of alcoholics develop hepatitis. Hepatitis is characterized by hepatocyte injury, ballooning, and inflammation. Cirrhosis results in fibrosis and nodular regeneration of liver architecture. Complications include ascites, variceal bleeding, and hepatic encephalopathy. Treatment of alcoholic liver disease involves abstaining from alcohol and managing complications. Corticosteroids may benefit severe hepatitis. Liver transplantation is an option for end-stage disease if abstinence is maintained.
1) Liver transplantation involves replacing a diseased liver with a healthy donor liver. It has improved survival rates from 30% to over 90% due to advances like immunosuppressive drugs.
2) There are various indications for liver transplantation in both adults and children, including cirrhosis, liver cancer, and genetic liver diseases. Recipients are selected based on factors like MELD score and disease severity.
3) The surgery requires connecting the donor liver's blood vessels and bile duct. Post-operatively, patients are closely monitored and given immunosuppressants to prevent rejection while managing side effects.
This patient, a 21-year-old male, presented with jaundice, fatigue, pruritis and dark urine for 1-2 months. On examination, he was deeply jaundiced with hepatomegaly but no other abnormalities. Laboratory tests found elevated liver enzymes, bilirubin, INR and low albumin. This suggests the patient has conjugated hyperbilirubinemia likely due to chronic liver disease given the clinical findings and lab abnormalities. Further evaluation is needed including hepatitis and autoimmune serology, imaging and potentially a liver biopsy to determine the underlying cause.
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver failure and characterized by changes in cognition, behavior, and personality. It ranges from minor alterations in brain function to deep coma. The main causes are thought to be increased levels of ammonia and other toxins in the blood due to the liver's inability to remove them. Treatment focuses on reducing ammonia production in the gut through dietary changes, antibiotics, and lactulose. Managing precipitating factors and providing supportive care are also important. For severe or recurrent cases, procedures to bypass the liver such as TIPSS or liver transplantation may be considered.
Acute renal failure in children is defined as a sudden deterioration in renal function resulting in the inability to maintain fluid and electrolyte homeostasis. It can be classified as pre-renal, intrinsic renal, or post-renal. Common causes include dehydration, infections, nephrotoxins, and obstructions. Symptoms include decreased urine output, edema, and mental changes. Treatment involves fluid resuscitation, electrolyte management, dialysis for complications like hyperkalemia, and treating the underlying cause. The prognosis depends on the cause, with acute tubular necrosis having a 90% complete remission rate.
1. Hepatic encephalopathy is a serious complication of chronic liver disease characterized by alterations in mental status and cognitive function occurring in liver failure. Common precipitating factors include blood transfusion, infection, GI bleeding, use of sedative drugs, constipation, alkalosis, low potassium, and high protein diet.
2. Treatment of acute overt hepatic encephalopathy includes supportive care, identifying and treating precipitating factors, reducing nitrogenous load in the gut through medications like lactulose, and assessing need for long-term therapy or liver transplant.
3. Prevention and management of recurrent or persistent hepatic encephalopathy involves avoiding precipitating factors and continued drug therapy like lactulose and rifaximin,
Acute renal failure (ARF) is a sudden loss of kidney function that can be reversible. It is caused by renal cell damage from ischemia or toxic substances. ARF progresses through oliguric, diuretic, and recovery phases. Nursing management focuses on fluid and electrolyte balance, preventing infections, maintaining nutrition, and preserving neurologic function. Dialysis may be needed to correct electrolyte imbalances or other complications of ARF.
Anesthesia for Liver transplantation - Dr.Sandeepdeepmbbs04
Liver transplantation is a complex procedure that requires careful anaesthetic management due to the pathophysiological changes associated with end-stage liver disease. Key considerations include monitoring for haemodynamic instability, coagulopathy and metabolic disturbances. Frequent intraoperative monitoring and correction of abnormalities are important to assess graft function and optimize patient outcomes.
This document discusses cirrhosis and its complications over two parts. Part I covers what cirrhosis is, its etiologies, clinical presentations, physical exam findings, laboratory tests, liver biopsy, and prognosis for different etiologies. Part II covers complications of cirrhosis including portal hypertension, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, and hepatocellular carcinoma screening and treatment. Liver transplantation is also discussed as a treatment option.
This document provides an overview of anaesthesia for liver transplantation. It discusses the indications and contraindications for liver transplant, preoperative evaluation including scoring systems, and the pathophysiology of end-stage liver disease affecting various organ systems. It also describes the intraoperative management considerations including hemodynamic monitoring, induction, vascular access, ventilation and complications. Postoperative care including management of coagulopathy and intensive care are also discussed.
1) Acute renal failure in children is defined as a sudden deterioration in renal function resulting in the inability to maintain fluid and electrolyte homeostasis. It can be caused by pre-renal, intrinsic renal, or post-renal factors.
2) Common causes include dehydration, infection, nephrotoxins, and obstructive uropathy. Presenting symptoms include decreased urine output, edema, and mental changes.
3) Treatment involves fluid resuscitation, restricting intake of fluids/proteins/electrolytes, and treating complications like hyperkalemia. Dialysis may be needed to correct fluid/electrolyte imbalances or uremia. Prognosis depends
The document summarizes key information about liver emergencies seen in the emergency department. It covers topics such as definitions of different types of liver failure (acute, chronic, fulminant), common causes of acute liver failure including paracetamol poisoning and viral hepatitis, complications of liver failure like encephalopathy and infections, criteria for liver transplantation in acute liver failure, management of acute liver failure including supportive care and transplantation, spontaneous bacterial peritonitis in patients with cirrhosis, and Budd-Chiari syndrome which is a rare cause of liver failure due to blockage of hepatic veins. Imaging modalities, investigations, and treatment approaches are also discussed for different liver conditions.
This document provides an overview of hepatic encephalopathy. It defines hepatic encephalopathy as a complex metabolic disorder seen in patients with liver dysfunction, characterized by disturbances in consciousness and behavior. It discusses the pathogenesis, including the ammonia and false neurotransmitter hypotheses. Precipitating factors and clinical manifestations ranging from mild cognitive changes to coma are described. Diagnosis involves ruling out other causes and elevated ammonia levels. Treatment focuses on reducing ammonia through dietary changes, lactulose, antibiotics, and other supportive measures. Prognosis depends on the severity and underlying liver disease.
Acute renal failure (ARF), also known as acute kidney injury (AKI), is a rapid loss of kidney function caused by damage to the kidneys. It is characterized by the sudden loss of the kidneys' ability to excrete waste, conserve electrolytes, and maintain fluid balance. ARF can be caused by pre-renal factors that decrease blood flow to the kidneys, intra-renal issues that directly damage kidney tissue, or post-renal obstruction of urine outflow. The management of ARF focuses on treating the underlying cause, maintaining fluid and electrolyte balance, and potentially initiating renal replacement therapy.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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2. DEFINITION
• Portal-systemic encephalopathy is a complex organic brain syndrome
characterized by disturbances in consciousness, fluctuating neurologic signs,
asterixis or “flapping tremor” and distinctive electroencephalographic
changes.
• Acute and self-limiting or Chronic and progressive.
6. PATHOGENESIS
• Shunting of Portal Blood Directly to Systemic Circulation Bypassing
liver.
• Severe Hepatocellular Damage & Dysfunction .
In both circumstances Toxic Substance absorbed from intestine not
metabolized by liver Toxins accumulate in the brain.
8. Ammonia Theory
• Ammonia -produced by the catabolism of amino acids involving 2 reactions:transamination
(catalysed by aminotransferases) oxidative deamination (catalyysed by L-amino acid oxidase).
• Normally, ammonia is detoxified in the liver by conversion to urea by the Krebs-Henseleit cycle.
Ammonia is also consumed in the conversion of glutamate to glutamine, a reaction that depends
upon the activity of glutamine synthetase.
• Two factors contributing to the hyperammonemia seen in cirrhosis.
1. decreased mass of functioning hepatocytes fewer opportunities for ammonia to be detoxified
by the above processes.
2. portosystemic shunting may divert ammonia-containing blood away from the liver to the systemic
circulation.
*Ammonia crosses the blood–brain barrier absorbed and metabolised by the astrocytes (cells in
the brain that constitutes 30% of the cerebral cortex).
*Astrocytes use ammonia when synthesising glutamine from glutamate.
*Increased levels of glutamine increase in osmotic pressure in astrocytesswelling of astrocytes.
9. Clinical Features
• Disturbance in Conciousness.
• Disturbacne in Sleep Pattern.
• Hypersomina is the Earliest Feature.
• Change in Personality
• Childish Behaviour.
• Irritabiltiy
• Aggressive
• Defecation & Urination at inappropriate
places.
• Fetor Hepaticus
10. Fetor Hepaticus
• Sour Musty Odour in the breath due to volatile substances normally
formed in the stool by bacteria.
• These mercaptanes if not removed by the liver are excreted through
the lungs and appear in the breadth.
• Fetor Hepaticus does not correlated with the degree or duration of
encephalopathy.
12. Diagnosis
• Usually one of exclusion.
1. Evidence of Advanced Hepatocellular Disease extensive
portosystemic collateral shunts or both.
2. Characteristic Clinical Features.
Forgetfullness & ConfusionStuporDeep Coma.
1. Fluctuating Neurological Signs.
2. Characteristic EEG Changes.
13. Investigation
• Diagnosis is usually clinically
1. No Liver Function abnormality.
2. Elevation of Blood Ammonia Level.
3. Hypokalemia.
4. EEG
5. CSF or CT SCAN
6. Visual Evoked Potential Abnormality in initial Stages.
7. Routine Investigation
14. Treatment
• Hospitalisation
• ABC Maintain
• Remove the cause and precipitating Factor.
• IV Fluid dextrose Saline and Injection thiamine.
• Maintainence of Fluid & Electrolytes & Calories.
• Ryle’s Tube Feeding and Urinary Catheterization.
• Diet Restriction of Protein diet & High Glucose Diet.
• Inj Vitamin K
16. Lactulose
• Non absorbable diasaccharide.
• Osmotic Laxative Effect.
• It Reduces ph of the colonic content and thereby prevents absorption
of NH3.
17. LOLA
• L-Orinithine-L-Aspartateis used to increase the generation of urea
through the urea cycle, a metabolic pathway that removes ammonia
by turning it into the neutral substance urea.
• It may be combined with lactulose and or rifaximin if these alone are
ineffective at controlling symptoms.
18. Complications
• Brain Herniation.
• Brain Edema
• Increased Risk of Cvs Collapse, Renal Failure, Respiratory Failure,
Sepsis.
• Permenanat Nervous system damage.
• Progressive Irreversible Coma
• Side effects of Medications.
19. HEPATORENAL SYNDROME
• It is syndrome that occurs in a patient with cirrhosis portal
hypertension and advanced liver failure characterized by imapaired
renal function with marked abnormalities in the arterial circulation
and activity of endogenous vasoactive system.
• Functional disorder.
• Kidneys are histologically normal.
20. IAC(International Ascites Club Criteria)
• Chronic or Acute Liver disease with advanced hepatic failure and portal
hypertension.
• Low GFR or Serum Creatinine >1.5 Mg/dl.
• Absence of shock, ongoing bacterial infections, and current or recent Rx
with nephrotoxic drugs.
• Absence of GI fluid losses.
• Absence of renal fluid losses in response to diuretic therapy.
• No sustained improvement in renal function after diuretic withdrawal and
expansion of plasma volume with 1.5 liters of isotonic saline.
• Proteinuria <500mg/day, and no USG e/o obstructive uropathy or
parenchymal renal disease.
22. Types of Hepato Renal Syndrome
• Type I
Rapidly progressive reduction of renal function as defined by doubling
of the initial S.cr to a level >2.5 mg/dL in < 2 wk.
Clinical Pattern Acute Renal Failure.
• Type 2
Moderate renal failure (S.cr ranging from 1.5 to 2.5 mg/dL) with a
steady or slowly progressive course.
Clinical Pattern Refractory Ascites
27. Prevention
• SBP: IV albumin administration.
• Severe acute alcoholic hepatitis: Oral pentoxyphylline.
• Low protein ascites: Norfloxacin as 1o SBP prophylaxis.
• Large volume paracentesis: IV albumin to prevent paracentesis
induced circulatory dysfunction (PICD).
28. Management
• Liver transplantation is the only definitive treatment option.
• Renal failure at time of transplant has poorer outcomes.
• Bridge to Liver Transplantation needed.
29. Initial Management
• Admission to monitored care setting with Vitals Monitoring.
• Central line placement for CVP helpful, not mandatory
• Routine blood and urine investigations
• Abdominal USG
• Diagnostic paracentesis
• Discontinue diuretics
• Plasma expansion with albuminEvaluation for Orthoptic liver
transplantation
31. TIPSS
• Few studies available (case series).
• Decreases portal pressure and
consequently reduces renal
sympathetic activity.
• Improvement in renal function
and survival noted compared to
no treatment (but may take
several weeks).
• Careful patient selection needed
to optimize safety and efficacy.
32. Renal Replacement Therapy
• To be used in patients with an urgent indication of HD and for
patients with no response to vasoconstrictor therapy.
33. Artificial Hepatic Support
• Detoxification treatment ~ form of artificial extracorporeal liver
support.
• Considered to be a bridge to liver transplantation
• Liver dialysis devices
1. Molecular Adsorbents Recirculation System (MARS)
2. Single Pass Albumin Dialysis (SPAD).
3. Prometheus system.
34. Liver Transplantation
• Treats the causative organ dysfunction.
• 1 yr survival rate: not on HD – 78.8% , on HD – 73.7%.
• Decrease survival with s.cr at similar MELD scores .
• Similar 2 yr and 5 yr survival among non HRS and HRS LT.
• Beneficial outcomes with renal protective immunosuppression.
35. Liver Kidney Transplantation
• Usual norms::
Preoperative HRS/ ATN usually don’t need KTP .
Many times 1o renal disease can be managed medically.
FACTORS CONTRIBUTING RENAL FAILURE::
Improved medical management leading to better survival.
Long waiting time for transplant.
Post-LT calcineurin inhibitors.
Patients of HRS who required prolonged HD (> 4 - 8 wks) may require
KLT and better outcomes have been reported.