17 Questions
Match the following assessment and management measures at ALF presentation with their corresponding goals:
Exclude cirrhosis, alcohol-induced liver injury or malignant infiltration = Immediate measures to rule out other causes Initiate early discussions with tertiary liver/transplant centre = Assessing need for transplantation Determine aetiology to guide treatment = Assessing need for LTx Determine grade of evidence and recommendation = Assessing disease severity
Match the following causes of Acute Liver Failure (ALF) with their corresponding categories:
Drug related = Hepatic/primary ALF Budd–Chiari syndrome = Extrahepatic/secondary liver failure Autoimmune = Hepatic/primary ALF Infections = Extrahepatic/secondary liver failure
Match the following aetiologies of ALF with their corresponding disease groups:
Acute viral hepatitis = Hepatic/primary ALF Toxin-induced ALF = Hepatic/primary ALF Pregnancy related = Hepatic/primary ALF Systemic diseases = Extrahepatic/secondary liver failure
Match the following types of ALF with their corresponding characteristics:
Hepatic/primary ALF = Caused by liver cell damage Extrahepatic/secondary liver failure = Caused by systemic diseases Acute liver failure = Caused by liver cell damage and systemic diseases ACLF = Caused by multiple organ dysfunction
Match the following measures in ALF assessment and management with their corresponding goals related to liver transplantation:
Initiate early discussions with tertiary liver/transplant centre = Assessing need for transplantation Determine aetiology to guide treatment = Assessing need for LTx Exclude cirrhosis, alcohol-induced liver injury or malignant infiltration = Assessing contraindications for transplantation Determine grade of evidence and recommendation = Assessing disease severity
Match the following aetiologies with their corresponding types of Acute Liver Failure (ALF):
Viral = HBV, HAV, HEV, and VZV, HSV-1 and -2 Autoimmune = Autoimmune hepatitis and other autoimmune conditions Drug-induced = Paracetamol overdose and other medications Indeterminate = Unknown causes of ALF
Match the following laboratory tests with their corresponding purposes in ALF assessment:
PT, INR or factor V and full coagulation screen = Assessing coagulopathy and liver function Viral serological screen = Diagnosing viral causes of ALF Toxicology screen in urine and paracetamol serum level = Detecting drug-induced ALF Arterial blood gas and lactate = Assessing disease severity and complications
Match the following criteria with their corresponding uses in ALF management:
King's College criteria = Determining the need for emergency liver transplantation HE grade = Assessing neurological status and encephalopathy INR and serum creatinine levels = Monitoring liver function and kidney function Cultures and antibiotic therapy = Managing infections and preventing sepsis
Match the following treatments with their corresponding uses in ALF management:
N-Acetylcysteine (NAC) = Treatment of paracetamol-induced ALF Glucose infusions = Preventing hypoglycemia and supporting liver function Stress ulcer prophylaxis = Preventing gastrointestinal bleeding Corticosteroids = Treating autoimmune hepatitis and other autoimmune conditions
Match the following complications with their corresponding associations with ALF:
Infections and sepsis = Worsening neurological outcomes and mortality Coagulopathy = Increased risk of bleeding and mortality Encephalopathy = Fluctuating neurological status and deep coma Multi-organ failure = Poor prognosis and high mortality rate
Match the following hepatic encephalopathy (HE) features with their corresponding characteristics:
Asterixis = Flapping tremor of the hands and feet Hyperreflexia = Increased deep tendon reflexes Clonus = Sustained muscle contraction Coma = Deep and prolonged loss of consciousness
Match the following aetiologies with their corresponding causes of Acute Liver Failure (ALF):
Viral = Hepatitis B, A, E Drugs = Paracetamol, anti-tuberculous, chemotherapy, statins, NSAIDs, phenytoin, carbamazepine, ecstasy, flucloxacillin Toxins = Amanita phalloides, phosphorus Vascular = Budd–Chiari syndrome, hypoxic hepatitis
Match the following ALF classifications with their corresponding timeframes from development of jaundice to development of HE:
Hyperacute = <7 days Acute = 7-14 days Subacute = 14-28 days Chronic = >28 days
Match the following symptoms with their corresponding severity levels in ALF:
Intracranial hypertension = +++ Jaundice = ++ Coagulopathy = + HE = +/-
Match the following coagulopathy levels with their corresponding prognoses in ALF:
Good = High chance of spontaneous recovery Moderate = Moderate chance of spontaneous recovery Poor = Low chance of spontaneous recovery
Match the following liver diseases with their corresponding associations with ALF:
Wilson disease = Principal aetiology Autoimmune = Principal aetiology Lymphoma = Other aetiology Malignancy = Other aetiology
Match the following pregnancy-related conditions with their corresponding associations with ALF:
Pre-eclamptic liver rupture = Principal aetiology HELLP = Principal aetiology Fatty liver of pregnancy = Principal aetiology Budd–Chiari syndrome = Other aetiology
Assess your knowledge on the immediate measures to take when managing acute liver failure, including determining the aetiology to guide treatment and the need for liver transplantation. This quiz covers the primary and secondary causes of acute liver failure and the role of tertiary liver and transplant centers.
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