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Administer N -acetylcysteine
0%
0/2
ERCP
Evaluation for emergent liver transplantation
100%
2/2
Hepatic artery embolization
Portohepatic shunt procedure
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This patient has fulminant liver failure, likely from acute hepatitis B infection from dirty needle exposure. Emergent liver transplant may be required for fulminant liver failure that progresses despite supportive cares. In the setting of hepatitis B infection, acute liver failure is a rare event. Less than 1% of infected adults have a severe reaction resulting in fulminant liver failure and death in several weeks after exposure to the hepatitis B virus. Due to the threatening nature of liver failure, patients must seek immediate supportive medical care and be evaluated for a liver transplant. Wilkins et al. discuss the diagnosis and treatment of hepatitis B. Hepatitis B virus is transmitted in blood and secretions. Acute infection may cause nonspecific symptoms, such as fatigue, poor appetite, nausea, vomiting, abdominal pain, low-grade fever, jaundice, and dark urine. Other clinical signs include hepatomegaly and splenomegaly. Fewer than 5 percent of adults acutely infected with hepatitis B virus progress to chronic infection. Lam et al. discuss caring for pregnant women and newborns with hepatitis B or C. When hepatitis B virus is perinatally acquired, an infant has approximately a 90 percent chance of becoming a chronic carrier and, when chronically infected, has a 15 to 25 percent risk of dying in adulthood from cirrhosis or liver cancer. However, early identification and prophylaxis is 85 to 95 percent effective in reducing the acquisition of perinatal infection. Illustration A reviews the trends in serologies after infection with hepatitis B. Incorrect Answers: Answer 1: N-Acetylcysteine may be administered in acetaminophen overdose and may improve transplant-free survival in other forms of acute liver failure with mild encephalopathy, but definitive therapy is liver transplantation. Answer 2: ERCP would be helpful in an ascending cholangitis caused by an obstructive stone, but has no role for fulminant viral hepatitis. Answer 4: Hepatic artery embolization may be used for some primary hepatic tumors and neuroendocrine tumors that metastasize to the liver, but would not be helpful in fulminant liver failure from viral hepatitis. Answer 5: A portohepatic shunt may be used in cases of worsening portal hypertension but does not have a role in acute liver failure.
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