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9 Cards in this Set
- Front
- Back
Leading cause of acute liver failure |
US - acetaminophen Worldwide - hep E coninfection with hep A |
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3 pathways of acetaminophen metabolism |
Sulfate conjugation 20-40% Glucuronidation 40-60% N-hydroxylation by CP450 to NAPQI 15-20% |
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What is the significance of NAPQI? |
N-acetyl-p-benzoquinone imine (NAPQI) is a toxic intermediate, and is conjugated with hepatic glutathione to a nontoxic final product. When glutathione stores become depleted, NAPQI accumulates, leading to liver necrosis |
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This criteria is used to estimate prognosis of patient with acute liver failure |
Kings College Criteria |
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West Haven Criteria |
I - lack of awareness, euphoria, short attention span II - lethargy, disorientation III - somnolence, gross disorientation IV - coma |
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Differentiate fulminant vs subfulminant |
Fulminant - onset of hep enceph within 2 weeks of jaundice Subfulminant - within 3-12 weeks |
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Classification of hep enceph based on time between onset of symptoms to development of hep encep (more recent classification) |
Hyperacute (within 7-10d) Acute (10-30d) Subacute (4-24 weeks) |
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What causes encephalopathy in patients with fulminant hepatic failure? |
Ammonia Glutamine Other amino acids Proinflammatory cytokines
Cause cytotoxic edema and breakdown of BBB |
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How may indomethacin work (possibly) to decrease ICP? |
Induces vasoconstriction |