The Clinical Problem Solvers Episode 306: Schema Episode – Severe Acute Liver Injury
14 snips
Oct 18, 2023 The hosts discuss Halloween anticipation, management of severe acute liver injury, distinguishing sludge from gallstones, diagnostic workup, complications and recovery, and the importance of base rate and epidemiology in disease diagnosis and prevention.
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Encephalopathy Defines Liver Failure
- Distinguish severe acute liver injury from acute liver failure by presence of hepatic encephalopathy.
- Acute liver failure needs ICU monitoring and early transplant center contact because it can progress rapidly.
Start With Plumbing Versus Parenchyma
- Think first whether the problem is a 'plumbing' issue or primary hepatocyte injury.
- Evaluate hepatic vein/artery/biliary causes, infections, toxins, and autoimmune disease in that order of likelihood.
Very High Enzymes Narrow The Differential
- Extremely high AST/ALT (10,000s–20,000s) narrows causes toward ischemia, stones, toxins, and viral hepatitis.
- Alcohol rarely causes transaminases in the many thousands, so deprioritize it for extreme elevations.