00:01
Our topic, fulminant liver failure.
00:04
This means that now,
Liver failure has occurred
in its overt nature.
00:10
All the different reasons is to why
you might be going through liver failure
well everything that causes
liver failure extensively,
Will go to liver failure
and you call this a cirrhotic liver.
Point of no return.
00:21
Hepatocellular dysfunction.
00:23
with encalopathy.
00:24
of jaundice without history
of prior liver disease.
00:28
is Fulminant liver failure.
00:30
How important is this?
Asterixis.
00:34
Really important.
00:36
Because this to you should
indicate in a stem of a question,
that your patient
is going into
or is
in Fulminant liver failure.
00:48
Encaphalopathy, what does that mean
to you?
It means you have increased amounts
of ammonia.
00:53
In the brain, resulting in encephalopathy.
00:55
In addition, there might be cerebral edema
And with that cerebral edema
in different types of herniation,
might actually cause brain death.
01:05
presentation, complicated by
sepsis.
01:09
hypotension, renal failure
hypoglycemia coagulation
or coagulopathy and hemmorage
so a number of complications
that you want to keep in mind
the one that is really dangerous here
will be sepsis, but the one that is dangerous here
will be sepsis, but anyone of these,
we'll talk about more of the sequelae
as you progress through liver failure.
01:28
up to this point. we've talked about
number of differentials
that causes liver damage.
01:33
you take all these differentials
and understand that if liver failure
kicks in.
01:38
we will go in to sequelae
and complications.
01:42
Etiology infections
that we've talked about, viral.
01:45
Herpes in pregnancy,
I've mentioned to you.
01:49
drugs, I talked about
acetominaphens in great detail.
01:53
And,
mushroom poisoning.
01:56
NAC by the way stand for
n Acetylcysteine
other causes, now this one,
or this
these set of differentials will
be interesting
let's just make sure we're clear.
02:10
vascular, resulting in
Shock liver. What if you have something
like Budd-Chiari?
What's Budd-Chiari?
it is specifically
hepatic vein thrombosis.
02:23
Nothing else
can be called Budd-Chiari
unless you find thrombosis
in the hepatic vein.
02:31
Be careful, students always get this
confused
And they forget, oh,
of the thrombosis of
the inferior vena cava.
02:38
that must be Budd-Chiari, no.
02:40
That is inferior vena cava
thrombosis. That is not Budd-Chirai.
02:44
Is that clear?
Metabolic causes of liver failure.
02:51
Wilson's disease?
Let me ask you one question,
Actually, I lied.
02:57
Two questions.
02:58
What is your total copper
in Wilson's disease?
Decreased. Good.
03:03
What is your free copper in
Wilson's disease? Levels?
Free
increased.
03:08
Hence, you find it in the urine.
03:11
Acute Fatty liver of
pregnancy.
03:14
A possible cause of
fulminant liver failure.
03:20
Other differentials that
we've talked about,
Auto immune hepatitis.
03:24
Or at least know this.
03:25
Let me give you an acronym,
L- Liver.
03:29
K- Kidney.
03:32
M- Microsome.
03:34
Know that as a possible marker
for autoimmune hepatitis.
03:39
L-Liver
K-Kidney, M-Microsome.
03:44
Massive Malignant infiltration.
03:47
This is not something to be
taken at lightly,
What is the most common causes
of cancer
in many organs?
Metastasis.
03:56
Metastasis
So if you are thinking about
co-rectal cancer,
the number sight for its metastasis
would be
the liver.
04:05
the malignant infiltration causing
Fulminant liver failure.
04:10
Are we clear?
Some of the important differentials
that may result in liver failure.
04:19
On this table, we will compare
and contrast
acetaminophen toxicity
and non acetaminophen toxicity
Let's begin.
04:29
Acetominophen toxicity
warrants its own discussion.
04:33
Because it is one of the most
common causes of hepatitis.
04:36
And could be the leading cause
of liver transplants
in some patients.
04:41
Especially the young.
04:43
Acetominophen toxicity
you find your Arterial pH to be
perhaps decreased at 7.3
all through of the following:
A PT increased.
04:55
And greater than 100 seconds.
04:57
What is normal?
11-15.
05:01
Creatinine
A kidney could be involved.
05:05
We'll talk about this
in a little bit.
05:08
What is normal creatinine?
0.6
to 1.2
3.4 or greater
that is significant.
05:18
Right?
And then encephalopathy
Anytime that you have encephalopathy
at this point, yes there is grade 3 or 4.
05:26
Always understand though
if encephalopathy kicks in
and yes there will be edema
and asterixis
This is not good.
05:33
Non-acetominophen
A PT greater than 100 or any
of the three.
05:39
Drug or non-viral hepatitis, Jaundice,
greater than 7 days.
05:45
Age, less than ten years.
05:48
or greater than 40 years old.
05:49
A PT greater than 50 seconds.
05:52
or bilirubin being elevated.
05:55
So, two major list of criteria
in which you would know
as to whether or not your patient
is suffering from quickly,
Acetominophen toxicity
take a look at that
arterial pH lest than 7.3.
06:07
Or Non-acetominophen,
all the differentials
and perhaps three of the following.
06:14
From henceforth,
you do not take acetominophen
poisoning lightly.
06:19
It warrants its own discussion.
06:20
And has its own criteria
Because you cannot afford
to miss
Fulminant liver failure
if you have a patient
coming through that door
with acetominophen toxicity.
06:32
You have to establish diagnosis
ASAP.
06:38
Now, all of these comes under
to what we call King's college criteria.
06:41
are indicators of poor prognosis and
need for liver transplantation.