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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 ( ... months without treatment ... disease, liver ... #Hepatology #gastroenterology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Liver disease ... - Cirrhosis ... - Alcoholic hepatitis ... fatty liver of ... #hepatology #SAAG
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 ... albumin #gradient #hepatology ... #differential # ... diagnosis #algorithm
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
Elevated Liver Function ... • NAFLD • Cirrhosis ... Hepatopathy • Acute ... (Drug-induced liver ... LouLectures #Liver
Causes of Severe Acute Liver Injury
 - Ichemic hepatitis
 - Acute biliary obstruction
 - Drug-Induced liver
Causes of Severe Acute ... Liver Injury ... - Drug-Induced liver ... #Causes #Differential ... #Hepatology #Diagnosis
Hepatobiliary Manifestations of Sickle Cell Disease
Acute sickle cell hepatic crisis:
 • Fever, acute onset RUQ pain,
Supportive with treatment ... liver failure ... Liver transplant ... Hepatobiliary #hepatology ... #hepatitis #differential
Patterns of Liver Injury
Transaminase Levels:
  > 50x normal - Ischemic Hepatitis
  > 20x normal
Patterns of Liver ... > 20x normal - Acute ... CMV), Alcoholic cirrhosis ... #Patterns #Liver ... #Injury #hepatology
Causes of Acute Liver Injury - Differential Diagnosis
Hepatocellular - Liver Parenchyma
 • Infectious: Hepatitis C, A,
Liver Injury - Differential ... Hepatocellular - Liver ... Artery: Shock Liver ... Sophia_Hayes_MD #Liver ... #algorithm #hepatology
Hepatomegaly - Differential Diagnosis Algorithm
Malignant
 • Primary Carcinoma
 • Metastases
 • Lymphoma
 • Leukemia
 • Polycythemia
Hepatomegaly - Differential ... Diagnosis Algorithm ... Non-Malignant • Fatty Liver ... Primary Biliary Cirrhosis ... #Causes #Hepatology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
HTN: ascites (SAAG ... /acute hepatitis ... sarcoidosis) • Liver ... metastasis • Fatty liver ... Diagnosis #causes #hepatology