Acute liver failure

Leading cause of acute liver failure in developing countries is

A. Viral hepatitis
B. Paracetamol overdose
C. Mushroom poisoning
D. Fatty liver of pregnancy

Not commonly seen in acute liver failure

A. Breathing difficulty
B. Sepsis
C. Spontaneous bleeding
D. Encephalopathy

ALL are true of acute liver failure except

A. Can be caused by herpes simplex virus infection
B. Wilson’s disease has high mortality without liver transplantation
C. Acute fatty liver of pregnancy is associated with HELLP syndrome
D. Reactivation of hepatitis B’ in chronic carriers is not a cause of hepatic failure

Metabolic screening in acute liver failure should include

A. Serum copper
B. Iron levels in blood
C. Serum zinc
D. Manganese level

Liver transplantation is indicated in all cases of ALF except

A. Paracetamol induced with prothrombin time (PT) >100 s
B. With idiosyncratic drug reaction, more than 7 days’ jaundice before encephalopathy, PT >50 s,
C. PT >50 s, Age <10 years, Bilirubin >300 μmol/L
D. Non-paracetamol induced, with PT >50 s

In short

In paracetamol-induced hepatotoxicity, N-acetylcysteine (NAC) is an effective treatment, although efficacy is closely related to the interval between drug ingestion and commencement of therapy.

NAC is also beneficial in non-paracetamol-induced ALF, improving survival in patients with low-grade encephalopathy.

If a viral cause is identified, specific antiviral therapy, such as ganciclovir for CMV, may be beneficial.

Autoimmune hepatitis may present as ALF, and treatment with intravenous corticosteroids is often commenced.

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