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Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
those with CLD (± cirrhosis ... Failure Infections Alcohol-Associated ... Hepatitis (AAH) ... #Hepatology #gastroenterology ... #management #diagnosis
Patterns of Liver Injury
Transaminase Levels:
  > 50x normal - Ischemic Hepatitis
  > 20x normal
Patterns of Liver ... cirrhosis, Portal ... #Patterns #Liver ... #Injury #hepatology ... #differential #diagnosis
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Causes of Ascites Normal ... - Cirrhosis ... - Alcoholic hepatitis ... Ascites #Causes #diagnosis ... #differential #hepatology
Hepatomegaly - Differential Diagnosis Algorithm
Malignant
 • Primary Carcinoma
 • Metastases
 • Lymphoma
 • Leukemia
 • Polycythemia
Algorithm Malignant ... Non-Malignant • Fatty Liver ... Inflammatory • Alcoholic ... Primary Biliary Cirrhosis ... #Hepatology
Elevated Liver Enzymes - Differential Diagnosis Algorithm
Severe ALT > 15x ULN
 • Viral
 • Drugs/Toxins
 •
Elevated Liver Enzymes ... Algorithm Severe ... hepatitis • Drugs ... Infiltrative • Cirrhosis ... Others #LFTs #Hepatology
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis
Hepatocellular Pattern (ALT or AST > ALP):
Abnormal Liver Function ... - Differential Diagnosis ... Algorithm for Transaminitis ... Congenital, Others, Cirrhosis ... #diagnosis #hepatology
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
Albumin Gradient (SAAG ... - Differential Diagnosis ... >1.1 g/dl): - Cirrhosis ... - Alcoholic hepatitis ... #hepatology
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
Failure (ALF): ... ALT Ratios: • Alcoholic ... : < 1 • Cirrhosis ... #chemistry #diagnosis ... #differential #Hepatology
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
- Differential Diagnosis ... Algorithm Vascular ... ALT Ratios: • Alcoholic ... : < 1 • Cirrhosis ... #algorithm #hepatology