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

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... Liver Failure ( ... Injury (DILI) ... #Chronic #Liver ... Cirrhosis #Hepatology #gastroenterology
Causes of Severe Acute Liver Injury
 - Ichemic hepatitis
 - Acute biliary obstruction
 - Drug-Induced liver
Causes of Severe Acute ... Liver Injury ... - Drug-Induced liver ... injury - Viral ... #Causes #Differential
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
Elevated Liver Function ... Cirrhosis • Chronic ... Hepatopathy • Acute ... (Drug-induced liver ... injury) • Ischemic
Causes of Acute Liver Injury - Differential Diagnosis
Hepatocellular - Liver Parenchyma
 • Infectious: Hepatitis C, A,
Liver Injury - Differential ... Hepatocellular - Liver ... Artery: Shock Liver ... #Injury #Differential ... #algorithm #hepatology
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
Acute Liver Injury ... Liver Injury: ... Liver Injury: ... Liver Injury: ... #injury #hepatitis
Patterns of Liver Injury
Transaminase Levels:
  > 50x normal - Ischemic Hepatitis
  > 20x normal
Patterns of Liver ... > 20x normal - Acute ... 5-10x normal - Chronic ... #Patterns #Liver ... transaminitis #differential
Hepatobiliary Manifestations of Sickle Cell Disease
Acute sickle cell hepatic crisis:
 • Fever, acute onset RUQ pain,
hepatomegaly and anemia ... liver failure ... Liver transplant ... Hepatobiliary #hepatology #hepatitis ... #differential #
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm
DILI suspicion
Features toxic aetiology: Skin involvement, Kidney injury,
Drug Induced Liver ... Alcohol-related liver ... cholangitis Consider liver ... dechallenge • Acute ... #DrugInduced #Liver
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
Liver Chemistries ... viral hepatitis ... > 2 • NASH, Chronic ... > 3 • Chronic ... chemistry #diagnosis #differential
Causes of Anemia by Mean Corpuscular Volume (MCV) - Differential Diagnosis Algorithm
Low Mean Corpuscular Volume (<80
Volume (MCV) - Differential ... Diagnosis Algorithm ... Renal Disease, Liver ... Reticulocytosis • Liver ... #Diagnosis #Algorithm