Focused Assessment of the Patient with Possible Acute Liver Failure
Examination
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Asterixis? Ask the patient to hold the arms outstretched with the wrists extended and fingers spread apart, and eyes closed, for 30 seconds or longer. The sign is positive if after a brief latent period, there is a sudden lapse of maintenance of the posture. | |||
Hepatic foetor? | |||
Signs of chronic liver disease? | |||
Right upper quadrant tenderness? | |||
Liver enlargement (seen in early viral hepatitis, alcoholic hepatitis, malignant infiltration, congestive heart failure, acute Budd-Chiari syndrome)? | |||
Splenomegaly? | |||
Ascites (Chapter 24)? |
Grading of hepatic encephalopathy | |
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Grade | Clinical features |
Subclinical | Impaired work, personality change, sleep disturbance Abnormal findings on psychomotor testing |
Grade 1 | Mild confusion, agitation, apathy, oriented in time and place Fine tremor, asterixis |
Grade 2 | Drowsiness, lethargy, disoriented in time Asterixis, dysarthria |
Grade 3 | Sleepy but rousable, disoriented in time and place Hyperreflexia, hyperventilation |
Grade 4 | Responsive only to painful stimuli or unresponsive |