Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Fulminant Hepatic Failure 593

➣pregnancy

■Wilson’s disease

➣family history

➣neuropsychiatric symptoms

■Environmental heat illness

➣heat stroke

■Mushroom poisoning

➣mushroom ingestion, usually Amanita phalloides

■Malignant infiltration of liver

➣known primary cancer

Signs & Symptoms

■Jaundice

■Ascites

■Stigmata of chronic liver disease

■Encephalopathy

■Irritability

tests

Basic Tests

■elevated aminotransferases, often >1000 U/L

■elevated serum bilirubin

■elevated INR

■possible decreased pH

■possible increased serum creatinine

Special Tests

■Viral hepatitis:

➣anti-HAV IgM

➣HBsAg, anti-HBs IgM

➣anti-HDV, if HBsAg positive

➣anti-HCV (delayed appearance), HCV RNA (early appearance)

■Acetaminophen

➣acetaminophen level

■Pregnancy

➣serum beta-HCG

■Wilson’s disease

➣serum ceruloplasmin

➣24-hr urine copper

➣slit lamp for Kayser-Fleischer rings

■Autoimmune hepatitis