Hepatic failure
| Hepatic failure | |
| ICD-10 | K72.9 |
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| DiseasesDB | 5728 |
| MeSH | D017093 |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Liver failure; fulminating hepatic failure
Overview
Liver failure is the inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology.
Historical Perspective
Classification
Three forms are recognized:
- Acute liver failure - development of hepatic encephalopathy (confusion, stupor and coma) and decreased production of proteins (such as albumin and blood clotting proteins) within four weeks of the first symptoms (such as jaundice) of a liver problem. "Hyperacute" liver failure is said to be present if this interval is 7 days or less, while "subacute" liver failure is said to be present if the interval is 5-12 weeks.
- Chronic liver failure - usually occurs in the context of cirrhosis, itself potentially the result of many possible causes, such as excessive alcohol intake, hepatitis B or C, autoimmune, hereditary and metabolic causes (such as iron or copper overload or non-alcoholic fatty liver disease).
- Acute on Chronic Liver Failure - acute hepatic decompensation observed in patients with preexisting chronic liver disease characterized by one or more extrahepatic organ failures with a significantly increased risk of death.[1]
Pathophysiology
- Hyperammonemia is result in cerebral edema.
- Brain edema is thought to be both cytotoxic and vasogenic in origin.
- Cytokine profiles are also deranged.
- Elevated serum concentrations of bacterial endotoxins, tumor necrosis factor–alpha (TNF-α), interleukin (IL)–1, and IL-6 have been found in fulminant hepatic failure[2].
Causes
Drugs
- Beractant
- Carfilzomib
- Caspofungin acetate
- Cefadroxil
- Ceftazidime
- Chlordiazepoxide
- Dactinomycin
- diclofenac (patch)
- Didanosine
- Diflunisal
- Efavirenz
- Fulvestrant
- gadoxetate
- Gemcitabine
- Indinavir
- Interferon gamma
- Ixabepilone
- Meropenem
- Micafungin sodium
- Nitisinone
- Oxaprozin
- Oxazepam
- Sorafenib
- Sulfasalazine
- Trovafloxacin mesylate
- Zafirlukast
Differential Diagnosis
Autoimmune hepatitis must be differentiated from other diseases that cause jaundice, nausea and vomiting, abdominal pain, arthragia, and hepatomegaly such as Hepatitis A,B,C, E, drug induced hepatitis, CMV hepatitis, EBV hepatitis, alcoholic hepatitis, Primary biliary cirrhosis and Primary sclerosing cholangitis.[3][4][5][6][7][8][9][10][11]
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Prognosis
The King's College criteria (KCC) may be used.
Contraindicated medications
Severe hepatic failure is considered an absolute contraindication to the use of the following medications:
- Carvedilol
- Conjugated estrogens/bazedoxifene
- Diclofenamide
- Dronedarone
- Nebivolol
- Rosuvastatin
- Simvastatin
- Spironolactone
- Sulfamethoxazole/Trimethoprim
- Doxorubicin Hydrochloride
- Tipranavir
The ALFSG index is a newer option that may be more accurate.[12]
References
- ↑ Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, Durand F, Gustot T, Saliba F, Domenicali M, Gerbes A, Wendon J, Alessandria C, Laleman W, Zeuzem S, Trebicka J, Bernardi M, Arroyo V (June 2013). "Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis". Gastroenterology. 144 (7): 1426–37, 1437.e1–9. doi:10.1053/j.gastro.2013.02.042. PMID 23474284.
- ↑ Wijdicks EF (October 2016). "Hepatic Encephalopathy". N. Engl. J. Med. 375 (17): 1660–1670. doi:10.1056/NEJMra1600561. PMID 27783916.
- ↑ Selmi C, Bowlus CL, Gershwin ME, Coppel RL (2011). "Primary biliary cirrhosis". Lancet. 377 (9777): 1600–9. doi:10.1016/S0140-6736(10)61965-4. PMID 21529926.
- ↑ Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ (2009). "Primary biliary cirrhosis". Hepatology. 50 (1): 291–308. doi:10.1002/hep.22906. PMID 19554543.
- ↑ Koff RS (1998). "Hepatitis A". Lancet. 351 (9116): 1643–9. doi:10.1016/S0140-6736(98)01304-X. PMID 9620732.
- ↑ Ciocca M (2000). "Clinical course and consequences of hepatitis A infection". Vaccine. 18 Suppl 1: S71–4. PMID 10683554.
- ↑ Fargo MV, Grogan SP, Saguil A (2017). "Evaluation of Jaundice in Adults". Am Fam Physician. 95 (3): 164–168. PMID 28145671.
- ↑ Leevy CB, Koneru B, Klein KM (1997). "Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease". Gastroenterology. 113 (3): 966–72. PMID 9287990.
- ↑ Hov JR, Boberg KM, Karlsen TH (2008). "Autoantibodies in primary sclerosing cholangitis". World J. Gastroenterol. 14 (24): 3781–91. PMC 2721433. PMID 18609700.
- ↑ Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ (1987). "Gall stones in sickle cell disease in the United Kingdom". Br Med J (Clin Res Ed). 295 (6592): 234–6. PMC 1247079. PMID 3115390.
- ↑ Malakouti M, Kataria A, Ali SK, Schenker S (2017). "Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do?". J Clin Transl Hepatol. 5 (4): 394–403. doi:10.14218/JCTH.2017.00027. PMC 5719197. PMID 29226106.
- ↑ Rutherford A, King LY, Hynan LS, Vedvyas C, Lin W, Lee WM; et al. (2012). "Development of an accurate index for predicting outcomes of patients with acute liver failure". Gastroenterology. 143 (5): 1237–43. doi:10.1053/j.gastro.2012.07.113. PMC 3480539. PMID 22885329.