Acute liver failure overview: Difference between revisions
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{{Acute liver failure}} | {{Acute liver failure}} | ||
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==Overview== | ==Overview== | ||
'''Acute liver failure''' is the appearance of severe complications that occur rapidly after the first signs of liver disease (such as [[jaundice]]), and indicates that the liver has sustained severe damage (loss of function of 80-90% of liver cells). The complications that can as a result of acute liver failure are [[hepatic encephalopathy]], [[cerebral edema]], [[infections]], [[bleeding disorders]], and [[kidney failure]]. | '''Acute liver failure''' is the appearance of severe complications that occur rapidly after the first signs of liver disease (such as [[jaundice]]), and indicates that the liver has sustained severe damage (loss of function of 80-90% of liver cells). The complications that can as a result of acute liver failure are [[hepatic encephalopathy]], [[cerebral edema]], [[infections]], [[bleeding disorders]], and [[kidney failure]]. | ||
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==References== | ==References== | ||
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[[Category:Organ failure]] | [[Category:Organ failure]] | ||
[[Category:Causes of death]] | [[Category:Causes of death]] | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
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Revision as of 14:04, 1 June 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Acute liver failure is the appearance of severe complications that occur rapidly after the first signs of liver disease (such as jaundice), and indicates that the liver has sustained severe damage (loss of function of 80-90% of liver cells). The complications that can as a result of acute liver failure are hepatic encephalopathy, cerebral edema, infections, bleeding disorders, and kidney failure.
The definition of acute liver failure is as follows: Evidence of a coagulation abnormality, usually an International Normalized Ratio (INR) > 1.5, and any degree of mental alteration (encephalopathy) in a patient without preexisting cirrhosis and with an illness of <26 weeks duration. [1]
Historical Perspective
Trey and Davidson coined the term fulminant hepatic failure in 1970, to describe this reversible condition of severe liver injury. They described a condition that involved the development of encephalopathy within 8 weeks of the appearance of the first symptoms, and an absence of pre-existing liver disease.[2]
Classification
Acute liver failure is classified into three subcategories; hyperacute , acute, and subacute depending upon the time lapsed between the appearance of jaundice, to the development of encephalopathy. In can also be classified into fulminant and subfulminant based upon the time that has lapsed from the start if illness to the onset of encephalopathy.
Pathophysiology
Acute liver failure results from the loss of normal function of hepatic tissue which occurs over a short period of time. It results in the loss of the metabolic, secretory, and regulatory effects of the liver cells. This results in the rapid accumulation of toxic substances, which then manifests in the patient as an altered sensorium, cerebral edema, hemodynamic abnormalities, and even multiorgan failure.
Causes
There are various causes that can lead to the development of acute liver failure, the most common of which is acetaminophen overdose usually as a consequence of attempted suicide. Other toxins such as alcohol, poisonous mushrooms, and other medications can also lead to the development of acute liver failure. It can also be idiopathic, or as a consequence of other diseases or conditions such as; Wilson's disease, autoimmune hepatitis, Reye syndrome, viral hepatitis, parvovirus B19 infection, and acute fatty liver of pregnancy.
Differentiating Acute liver failure from other Diseases
There are some diseases or conditions which have a similar presentation to acute liver failure. These include tyrosenemia, fructose intolerance, being affected by the toxin from bacillus cereus, and the HELLP syndrome of pregnancy.
Risk Factors
Certain conditions can put a person at risk for developing acute liver failure. These include having certain infections, vascular disorders, autoimmune conditions, metabolic diseases, and primary cancers or malignancies.
Natural History, Complications and Prognosis
Acute liver failure is a serious condition which can rapidly progress to death if left untreated. Complications of the illness include cerebral edema, brain herniation, multi-organ failure, systemic inflammatory response syndrome, metabolic derangements, coagulopathy, hemodynamic instability, coma, and death.Several prognostic scoring systems have been devised to predict mortality and to identify who will require early liver transplant. Mortality due to acute liver failure used to be as high as 80%, however this statistic has decreased with the advent of liver transplantation, and better intensive care. There are several prognostic indicator scores used for the prediction of mortality, and to assess the suitability of the patient for transplantation. These include kings college hospital criteria, MELD score, APACHE II and Clichy criteria.
History and Symptoms
A thorough history should be obtained, with special attention given to a history of ingesting medications or other toxins. Symptoms can include symptoms such as fatigue, nausea, vomiting, abdominal distention, diarrhea, disorientation, and an increased bleeding tendency