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

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... those with CLD (± cirrhosis ... disease, liver ... EmoryGastroHep #ACLF #Acute ... #Failure #Cirrhosis
Causes of Severe Acute Liver Injury
 - Ichemic hepatitis
 - Acute biliary obstruction
 - Drug-Induced liver
Causes of Severe Acute ... - Acute biliary ... - Wilson disease ... LiverInjury #Severe #Acute ... #Differential #Hepatology
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
• NAFLD • Cirrhosis ... Chronic Viral Hepatitis ... Hepatopathy • Acute ... Viral Hepatitis ... Differential #Diagnosis #hepatology
Causes of Acute Liver Injury - Differential Diagnosis
Hepatocellular - Liver Parenchyma
 • Infectious: Hepatitis C, A,
Causes of Acute ... , Acute biliary ... Syndrome, Celiac Disease ... Diagnosis #Causes #Acute ... #algorithm #hepatology
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
Hepatobiliary Manifestations of Sickle Cell Disease
Acute sickle cell hepatic crisis:
 • Fever, acute onset RUQ pain,
Acute sickle cell ... crisis: • Fever, acute ... of SCD crisis Acute ... progressing to acute ... #hepatitis #differential
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
Acute Liver Injury ... Vascular Causes of Acute ... Hepatocellular Acute ... Cholestatic Acute ... : > 1 • Acute
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
/acute hepatitis ... • Infiltrative diseases ... sarcoidosis) • Liver ... metastasis • Fatty liver ... Veno-occlusive disease
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
Hepatocellular - Check Acute ... Mixed - Check Acute ... Imperative to Identify Acute ... : < 1 • Cirrhosis ... : > 1 • Acute
Differential Diagnosis and Evaluation of Hyponatremia:
1) Identification of onset (acute vs. chronic)
2) Presence of symptoms (HA,
Diagnosis and Evaluation ... Identification of onset (acute ... history (cardiac, liver ... , renal disease) ... Differential #Algorithm #Ddxof