Acute hepatocellular failure in a patient ofcirrhosis of liver is precipitated by -
Acute upper gastrointestinal haemorrhage This is the most common gastrointestinal emergency, accounting for 50-170 admissions to hospital per 100 000 of the population each year in the UK. The moality of patients admitted to hospital is about 10% but there is some evidence that outcome is better when individuals are treated in specialised units. Risk scoring systems have been developed to stratify the risk of needing endoscopic therapy or of having a poor outcome . The advantage of the Blatchford score is that it may be used before endoscopy to predict the need for intervention to treat bleeding. Low scores (2 or less) are associated with a very low risk of adverse outcome. Clinical assessment Haematemesis is red with clots when bleeding is rapid and profuse, or black ('coffee grounds') when less severe. Syncope may occur and is caused by hypotension from intravascular volume depletion. Symptoms of anaemia suggest chronic bleeding. Melaena is the passage of black, tarry stools containing altered blood; it is usually caused by bleeding from the upper gastrointestinal tract, although haemorrhage from the right side of the colon is occasionally responsible. The characteristic colour and smell are the result of the action of digestive enzymes and of bacteria on haemoglobin. Severe acute upper gastrointestinal bleeding can sometimes cause maroon or bright red stool. Alcoholism Central nervous system disorders Vestibular neuronitis Migraine Raised intracranial pressure Meningitis Gastroduodenal Peptic ulcer disease Gastric cancer Gastroparesis The acute abdomen Appendicitis Cholecystitis Pancreatitis Intestinal obstruction Metabolic Diabetic ketoacidosis Addison's disease Uraemia Infections Hepatitis Gastroenteritis Urinary tract infection Drugs NSAIDs Opiates Digoxin Antibiotics Cytotoxins are causes for gastrointestinal bleeding Ref Davidson edition23rd pg 780
Upper gastrointestinal bleeding
Large carbohydrate meal
Poal vein thrombosis
Intravenous albumin infusion
G.I.T