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Formal diagnosis of acute liver failure An increase in PT by 4-6 seconds (INR>1.5) And the development of hepatic encephalopathy (HE).
Definition: HRS ARF in a patient CLD, severe alcoholic hepatitis or ALF from any cause End-stage of reduction in renal perfusion induced by increasingly severe hepatic injury.
The pathophysiology of HE A large body of work points at ammonia as a key factor in the pathogenesis of HE.
In acute and chronic liver disease, increased arterial levels of ammonia are commonly seen. The coagulopathy of liver disease Failure to produce clotting factors II, V, VII and IX Failure of the diseased liver to clear activated clotting factors. Topics Definitions of failure and classification Aetiology- Acute versus acute on chronic Basic diagnostic workup Liver biopsy in. In a patient wi" title="Formal diagnosis of acute liver failure An increase in PT by 4-6 seconds (INR>1.5) And the development of hepatic encephalopathy (HE).

In a patient without pre-existing cirrhosis and with an illness of less than six months duration. Portal ammonia is derived from both the urease activity of colonic bacteria and the deamidation of glutamine in the small bowel. Lactulose – reaches colon, where bacteria will metabolize the lactulose to acetic acid and lactic acid.
Target -three soft bowel movements per day If response to disachharide is poor- add antibiotic (metronidazole or rifaximine after 48Hrs) to reduce enteric bacterial mass. An excessively sweet taste, flatulence, and abdominal cramping are the most frequent subjective complaints with this drug. Degree of hypersplenism and thrombocytopaenia often adds to the coagulopathy, especially if disseminated intravascular coagulation (dic) also co- exists.
The intact liver clears almost all of the portal vein ammonia, converting it into glutamine and preventing entry into the systemic circulation.

Grade IV HE is strongly associated with elevated levels of serum ammonia, a high incidence of raised intracranial pressure and the development of uncal herniation. This lowers the colonic pH formation of the non-absorbable NH4+ from NH3, Other effects like catharsis also contribute to the clinical effectiveness of lactulose. The degree of coagulopathy is a measure of severity of liver disease and of patient prognosis.

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