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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 ... months without treatment ... (DILI) Viral Hepatitis ... #Failure #Cirrhosis ... #Hepatology #gastroenterology
Common Etiologies of Cirrhosis

Inflammation

 - Hepatitis B (15 percent)

 - Hepatitis C (47 percent)

 - Schistosomiasis
Inflammation - Hepatitis ... 15 percent) - Hepatitis ... Nonalcoholic fatty liver ... #Diagnosis #Differential ... #Hepatology #Cirrhosis
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
Tests (LFTs) - Differential ... • NAFLD • Cirrhosis ... Chronic Viral Hepatitis ... • Acute Viral Hepatitis ... #Diagnosis #hepatology
Hepatomegaly - Differential Diagnosis Algorithm
Malignant
 • Primary Carcinoma
 • Metastases
 • Lymphoma
 • Leukemia
 • Polycythemia
Hepatomegaly - Differential ... Non-Malignant • Fatty Liver ... Primary Biliary Cirrhosis ... #Hepatomegaly #Differential ... Algorithm #Causes #Hepatology
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic liver ... disease (cirrhosis ... or chronic hepatitis ... #Diagnosis #hepatology
Patterns of Liver Injury
Transaminase Levels:
  > 50x normal - Ischemic Hepatitis
  > 20x normal
Patterns of Liver ... CMV), Alcoholic cirrhosis ... #Patterns #Liver ... #Injury #hepatology ... transaminitis #differential
Chronic Hepatitis B - Diagnosis and Management Algorithm

• Who to treat: Essentially treat the pts with
Chronic Hepatitis ... Diagnosis and Management ... viremia or have cirrhosis ... Algorithm #Diagnosis #Management ... #Treatment #Hepatology
Hepatobiliary Manifestations of Sickle Cell Disease
Acute sickle cell hepatic crisis:
 • Fever, acute onset RUQ pain,
hepatic crisis: • Fever ... Supportive with treatment ... Liver transplant ... Hepatobiliary #hepatology ... #hepatitis #differential
Approach to the Hospitalized Patient with Cirrhosis
1) Recognize and Manage Decompensation
 • Ascites
 • Variceal Bleeding
Hospitalized Patient with Cirrhosis ... Scenarios • Alcoholic Hepatitis ... Portosystemic Shunt • Liver ... #diagnosis #treatment ... #management
Hepatitis B - Treatment Indications
Treatment not indicated:
 • Immune tolerant state - HBe-Ag detectable, high HBV
Hepatitis B - Treatment ... or fibrosis • Cirrhosis ... failure #HepatitisB ... #Indications #management ... #hepatology