1. Acute Liver Failure William Bernal, M.D., and Julia Wendon, M.B., Ch.B. Kurdistan Board GEH Journal club

2. IT IS A RARE LIFE-THREATENING CRITICAL ILLNESS OCCURS MOST OFTEN IN PATIENTS WHO DO NOT HAVE PREEXISTING LIVER DISEASE. INCIDENCE <10 CASES PER MILLION PERSONS PER YEAR SEEN MOST COMMONLY IN 30S IT PRESENTS UNIQUE CHALLENGES IN CLINICAL MANAGEMENT. THE CLINICAL PRESENTATION USUALLY INCLUDES HEPATIC DYSFUNCTION, ABNORMAL LIVER BIOCHEMICAL VALUES, COAGULOPATHY; ENCEPHALOPATHY MAY DEVELOP, WITH MULTIORGAN FAILURE& DEATH OCCURRING IN UP TO 50% THE RARITY,SEVERITY& HETEROGENEITY, HAS RESULTED IN A VERY LIMITED EVIDENCE BASE TO GUIDE SUPPORTIVE CARE. SURVIVAL HAVE IMPROVED SUBSTANTIALLY IN RECENT YEARS THROUGH ADVANCES IN CRITICAL CARE MANAGEMENT & EMERGENCY LIVER TRANSPLANTATION. Introduction:

3. “A SEVERE LIVER INJURY, POTENTIALLY REVERSIBLE IN NATURE WITH ONSET OF HEPATIC ENCEPHALOPATHY WITHIN 8 WEEKS OF THE FIRST SYMPTOMS IN THE ABSENCE OF PRE-EXISTING LIVER DISEASE,”. IN HYPERACUTE CASES, THIS INTERVAL IS A WEEK OR LESS& THE CAUSE IS USUALLY ACETAMINOPHEN TOXICITY OR A VIRAL INFECTION. MORE SLOWLY EVOLVING, OR SUBACUTE, CASES: MAY BE CONFUSED WITH CHRONIC LIVER DISEASE. OFTEN RESULT FROM IDIOSYNCRATIC DRUG-INDUCED LIVER INJURY OR INDETERMINATE CAUSE. DESPITE HAVING LESS MARKED COAGULOPATHY & ENCEPHALOPATHY, HAVE A CONSISTENTLY WORSE OUTCOME WITH MEDICAL CARE ALONE. Definition:

12. The most common cause of viral-induced Acute Live Faliure is: A.Hepatitis A. B.Hepatitis B. C.Hepatitis C. D.Hepatitis E. E.A&D. BO5s:

13. The most common cause of viral-induced Acute Live Faliure is: A.Hepatitis A. B.Hepatitis B. C.Hepatitis C. D.Hepatitis E. E.A&D. BO5s:

14. Subacute compared with acute acute Live Failure is characterized by all except: A.Simulates chronic liver disease. B.Has better prognosis. C.Caused more by idiosyncratic drug reaction. D.Has less encephalopathy. E.Has less coagulopathy. BO5s:

15. Subacute compared with hyperacute acute Live Failure is characterized by all except: A.Simulates chronic liver disease. B.Has better prognosis. C.Caused more by idiosyncratic drug reaction. D.Has less encephalopathy. E.Has less coagulopathy. BO5s:

16. Encephalopathy in acute liver failure differs from that in chronic liver disease by: A.Antibiotics has clear beneficial role. B.Lactulose has deleterious effects. C.Intra-cranial hypertension plays no important role. D.Hypothermia has no any benefits. E.Grading is different. BO5s:

17. Encephalopathy in acute liver failure differs from that in chronic liver disease by: A.Antibiotics has clear beneficial role. B.Lactulose has deleterious effects. C.Intra-cranial hypertension plays no important role. D.Hypothermia has no any benefits. E.Grading is different. BO5s:

18. Management of intra-cranial hypertension in acute liver failure include the following except: A.IV Manitol. B.Hypothermia. C.Indomethacin D.Thiopentone. E.IV hypotenic saline. BO5s:

19. Management of intra-cranial hypertension in acute liver failure include the following except: A.IV Manitol. B.Hypothermia. C.Indomethacin D.Thiopentone. E.IV hypotenic saline. BO5s:

20. The following contribute to intracranial hypertension in acute liver failure except: A.Hyperamonemia. B.Hyponatremia. C.Hypoglycemia. D.Infections. E.Renal failure. BO5s:

21. The following contribute to intracranial hypertension in acute liver failure except: A.Hyperamonemia. B.Hyponatremia. C.Hypoglycemia. D.Infections. E.Renal failure. BO5s: