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diagnosis differential liver injury transaminitis management albumin ascites causes chemistry chronic dili druginduced gastroenterology gradient hepatocellular hepatorenal hrs interpretation liverenzymes
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... months without treatment ... Infections Alcohol-Associated ... Hepatitis (AAH) ... #Cirrhosis #Hepatology
Patterns of Liver Injury Transaminase Levels: > 50x normal - Ischemic Hepatitis > 20x normal
20x normal - Acute ... cirrhosis, Portal ... AST:ALT > 2.5 - Alcoholic ... Liver #Injury #hepatology ... #LFTs #transaminitis
Elevated Liver Enzymes - Differential Diagnosis Algorithm Severe ALT > 15x ULN • Viral • Drugs/Toxins •
Drugs/Toxins • Ischemia ... hepatitis • Drugs ... Infiltrative • Cirrhosis ... • Others #LFTs ... #Hepatology #LiverEnzymes
Hepatocellular Liver Injury - Differential Diagnosis Framework: Liver Injury → liver test abnormalities without evidence of liver
evidence of liver failure ... Drugs (MDMA), Alcohol ... • Vascular: Ischemic ... #algorithm #Transaminitis ... #LFTs #hepatitis
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
Interpretation of LFTs ... Liver Failure ( ... ALT Ratios: • Alcoholic ... : < 1 • Cirrhosis ... #differential #Hepatology
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm DILI suspicion Features toxic aetiology: Skin involvement, Kidney injury,
non-essential drug/HDS treatments ... HEV, EBV, CMV), Alcohol-related ... disease, Hepatic ischaemia ... dechallenge • Acute ... #hepatology
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis High albumin gradient (>1.1 g/dl): - Cirrhosis - Alcoholic
- Alcoholic hepatitis ... Fulminant hepatic failure ... Veno-occlusive disease - Acute ... associated with bowel ischemia ... Differential #Diagnosis #hepatology
Alcoholic Hepatitis - Management Algorithm Assess Eligibility for Treatment: - Maddrey Discriminant Function ≥ (or possibly MELD
Alcoholic Hepatitis ... - Management Algorithm ... : - Acute kidney ... - Multiorgan failure ... #Algorithm #hepatology
Hepatorenal Syndrome (HRS) Definition: • Functional, potentially reversible kidney impairment. • Occurs in advanced liver disease: cirrhosis, severe alcoholic
liver disease: cirrhosis ... hepatitis, or acute ... liver failure ... Treatment Overview ... Hepatorenal #Syndrome #Hepatology
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