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

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... months without treatment ... disease, liver ... EmoryGastroHep #ACLF #Acute ... #Chronic #Liver
Indications for Albumin for Management of Cirrhosis
 • Large volume paracentesis (>5 liter) - 8g per
Indications for Albumin ... Management of Cirrhosis ... ascites removed • Acute ... terlipressin #Albumin ... #treatment #hepatology
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 ... vs. chronic) 2) ... history (cardiac, liver ... , renal disease)
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
INR, bilirubin, albumin ... /acute hepatitis ... • Infiltrative diseases ... sarcoidosis) • Liver ... Veno-occlusive disease
Approach to Thrombocytosis - Elevated Platelet Count - Differential Diagnosis Algorithm

Peripheral Smear concerning for malignancy?
for workup, including ... : Acute blood loss ... , Acute hemolysis ... infections, TB, Acute ... Severe trauma, Acute
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 ... Production: • Albumin ... : > 1 • Acute
Diuretics and Agents Regulating Renal Excretion

Carbonic Anhydrase Inhibitors (Acetazolamide, Dichlorphenamide)
 • Glaucoma
 • Epilepsy
 • Altitude
Torsemide) • Acute ... cirrhosis, chronic ... cirrhosis, chronic ... cirrhosis, chronic ... hyperaldosteronism • Acute
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
>1.1 g/dl): - Cirrhosis ... ascites - Massive liver ... Veno-occlusive disease ... - Acute fatty ... liver of pregnancy
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
Commonly Observed Laboratory Findings in Hepatic / Liver Failure
 - Elevated conjugated and unconjugated bilirubin -
Hypoalbuminemia - Decreased albumin ... —100-fold with acute ... hepatocytes; in chronic ... liver disease, ... suppression leads to chronic