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1. www.medicinemcq.com
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2. Most
common
cause – 70 %
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3. 
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Amanita phalloides (mushroom) poisoning
Paracetamol toxicity – common in Europe
and North America
Reye's syndrome
Acute fatty liver of pregnancy
Wilson's disease
Shock
Malignant disease of the liver
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4.  Hemolysis,
Elevated Liver
enzymes, Low Platelets
 Severe, life-threatening
complication of PET
 Delivery - only known
treatment
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5. IgM anti-HBc
 IgM anti-HAV
 Anti-HCV, cytomegalovirus, herpes
simplex, Epstein-Barr virus
 Caeruloplasmin, serum copper, urinary
copper, slit-lamp eye examination
 Autoantibodies: ANA, ASMA, LKM
 Doppler ultrasound of liver

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6. 
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Encephalopathy and cerebral edema
Hypoglycemia
Metabolic acidosis
Infection (bacterial, fungal)
Renal failure
Multi-organ failure (hypotension and
respiratory failure)
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7. Cerebral
disturbance
› Cardinal manifestation
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8.  Synthesized
predominantly
› Gut microorganisms
 Detoxified
in astrocytes to osmotically
active glutamine
 Contribute to
› Hepatic encephalopathy
› Cerebral edema
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9. Lactulose
Nonabsorbable
antibiotics
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oral
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10. Causes
intracranial
hypertension
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11.  Results
from astrocyte swelling
rather than a leaky blood
brain barrier (vasogenic
cerebral edema)
 Corticosteroids are not
recommended
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12.  Decreasing
consciousness
 Hyperventilation
 Systemic hypertension
 Pupillary abnormalities
 Decerebrate posturing,
 Uncal herniation and death
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13.  Gold
standard for measuring and
monitoring ICH
› < 25 mm
Hg
 Neuroimaging
- not reliable in
diagnosing early ICH
› To exclude other problems
(e.g., intracranial bleeding or stroke)
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14.  Requires
correction of
underlying coagulopathy
 Portal of entry for infectious
organisms
 Can precipitate intracranial
hemorrhage
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15. First-line
therapy for
intracranial hypertension
Elevate head of the bed
to 30 degrees
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16. IV
hypertonic saline
IV thiopental
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17. External
cooling blankets
In refractory cerebral
edema
Require an ICP monitor
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18. Main
cause of death
in ALF
Signs - frequently
absent
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19. Lung
Urinary
tract
Blood
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20. Gram-positive
cocci
Staphylococci
Streptococci
Enteric
GNB
Candida
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21.  Propofol
and benzodiazepines
are most commonly used
 Propofol decreases cerebral
blood flow and lowers
intracranial pressure
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22. Recommended
empirically in all
patients
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23. In
patients who have
significant
hypofibrinogenemia (100
mg/dL)
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24. Aminocaproic
acid in
hyperfibrinolytic state
› Diffuse mucosal and
puncture wound oozing
› Increased clot lysis time
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25.  Recombinant
factor VIIa
› when FFP has failed to correct
PT/INR
› Volume overloaded
 Given
before invasive procedures
with a high risk of bleeding
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26. Incidence
of upper
GI bleeding
decreased
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27.  Checked
every 1–2 hrs
 High risk for hypoglycemia
 Hyperglycemia exacerbate
intracranial hypertension
 Insulin infusions - glucose levels
< 50 mg/dL
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28.  CPP
= Mean arterial pressure – ICP
 Correct hypovolemia before
vasopressors
› Norepinephrine preferred to
dopamine
› Hydrocortisone improve the
vasopressor response to
norepinephrine
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29.  Exacerbates
ICP
 Treat aggressively with cooling
blankets, fans, or other
noninvasive devices
 NSAIDs and acetaminophen are
not recommended
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30.  Urine
sodium
› low (10 mEq/L) in prerenal azotemia
and functional renal failure
(hepatorenal syndrome)
› high in acute tubular necrosis
 Casts
and renal tubular cells in the
urine suggest ATN
 IV fluid challenge (1L) to exclude
prerenal azotemia
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31. Monitor
once or twice
daily
Hyponatremia
› Exacerbate edema
› Avoided strictly
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32. May
be
needed
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33.  Paracetamol
poisoning - NAC
 Amanita - Penicillin G and NAC
 HSV – Acyclovir
 AIH - Methylprednisolone
 HBV - Lamivudine
 AFLP/HELLP - Delivery of fetus
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34. 
Reduce the toxin load
› Gastric lavage
› Instillation of charcoal
Hemodialysis - remove toxins from the
serum
 Lower entero-hepatic toxin load Uncertain

› pencillin, cytochrome c, and silymarin
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35. Life-saving
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