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Last week I asked about confusing #GI topics for internists, and the consensus was that acute on chronic liver failure (#AoCLF) has been causing ample confusion (🤞 not from NH3). Plus, I've been consulted every week for AoCLF, despite none actually having it. So, a 🧵

So, what IS AoCLF? Same thing as acute liver failure (#ALF), right?

NO! 🤷‍♂️

There's no clear consensus, but generally you need to have:

▶️Decompensated cirrhosis
▶️Acute change 2/2 sudden inflammatory state (infection, acute hepatitis, etc)
▶️End organ damage

Plus, there must be a relationship b/w the instigating event & worsening liver disease. Can't blame the UTI from 2w ago.

👉The most common etiology of AoCLF is bacterial infection, and so start by looking there (and don't forget occult SBP!)…

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