Internal Medicine

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

592 Foreign Bodies and Bezoars Fulminant Hepatic Failure

■After an episode of esophageal impaction, a complete endoscopy

should be performed within 1–2 weeks to determine the cause of

narrowing and to perform dilation if necessary

■To prevent recurrence of bezoars

➣Treat with enzyme therapy (cellulase) and pro-motility agents

➣Patients with trichobezoars should undergo counseling

complications and prognosis

■A foreign body can result in perforation, obstruction, infection, aspi-

ration, and death

■Prognosis is good for those patients without an underlying psychi-

atric disorder

Fulminant Hepatic Failure..............................

GABRIEL GARCIA, MD

history & physical

■Fulminant hepatic failure: acute severe liver injury occurring with

no prior history of liver disease and leading to coagulopathy and

encephalopathy within 8 weeks of the onset of illness, or within

2 weeks after the onset of jaundice

■Subfulminant hepatic failure: acute liver failure with encephalopa-

thy developing 2 to 12 weeks after the onset of jaundice

■Viral hepatitis:

➣family history

➣injection drug use

➣transfusion

➣dialysis

➣high-risk sexual activity

➣nasal drug use

■Acetaminophen toxicity

➣overdose with suicide intention

➣excessive therapeutic use with chronic alcohol use

■Drug-induced liver disease

➣prescription

➣over the counter

➣herbal drugs

■Toxins

➣occupational exposure, hobbies

■Fatty liver of pregnancy/HELLP syndrome