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

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Failure (ACLF) ... Infections Alcohol-Associated ... #Failure #Cirrhosis ... #Hepatology #gastroenterology ... #management #diagnosis
Hepatomegaly - Differential Diagnosis Algorithm
Malignant
 • Primary Carcinoma
 • Metastases
 • Lymphoma
 • Leukemia
 • Polycythemia
Non-Malignant • Fatty Liver ... • Right Heart Failure ... Inflammatory • Alcoholic ... Primary Biliary Cirrhosis ... #Hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
protein ≤ 2.5 g/dL: Cirrhosis ... syndrome, Massive liver ... 2.5 g/dL: Heart failure ... albumin #gradient #hepatology ... #algorithm
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
- Heart failure ... - Cirrhosis ... - Alcoholic hepatitis ... Ascites #Causes #diagnosis ... #differential #hepatology
Common Etiologies of Cirrhosis

Inflammation

 - Hepatitis B (15 percent)

 - Hepatitis C (47 percent)

 - Schistosomiasis
Sarcoidosis Toxic - Alcohol ... Nonalcoholic fatty liver ... Congestive heart failure ... 14 percent) #Diagnosis ... #Differential #Hepatology
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
Albumin Gradient (SAAG ... - Differential Diagnosis ... - Alcoholic hepatitis ... Fulminant hepatic failure ... #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
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
- Differential Diagnosis ... HTN: ascites (SAAG ... including R heart failure ... /acute hepatitis ... #causes #hepatology
Hepatocellular Liver Injury - Differential Diagnosis Framework:
Liver Injury → liver test abnormalities without evidence of liver
failure 1) Hepatocellular ... • Infections: Hepatitis ... Drugs (MDMA), Alcohol ... #hepatology #algorithm ... Transaminitis #LFTs #hepatitis
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