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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

3 pathways of acetaminophen metabolism

Sulfate conjugation 20-40%


Glucuronidation 40-60%


N-hydroxylation by CP450 to NAPQI 15-20%

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

This criteria is used to estimate prognosis of patient with acute liver failure

Kings College Criteria

West Haven Criteria

I - lack of awareness, euphoria, short attention span


II - lethargy, disorientation


III - somnolence, gross disorientation


IV - coma

Differentiate fulminant vs subfulminant

Fulminant - onset of hep enceph within 2 weeks of jaundice


Subfulminant - within 3-12 weeks

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)

What causes encephalopathy in patients with fulminant hepatic failure?

Ammonia


Glutamine


Other amino acids


Proinflammatory cytokines



Cause cytotoxic edema and breakdown of BBB

How may indomethacin work (possibly) to decrease ICP?

Induces vasoconstriction