acute liver failure

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acute liver failure

A condition characterised by an abrupt onset of the signs (e.g., jaundice) and symptoms (e.g., ascites) due to hypoalbuminaemia of a liver incapable of maintaining its normal activity and metabolic functions, which indicates severe damage to 80–90% of native tissue.

Aetiology
Acute hepatitis (autoimmune, drugs, toxin, viral), decompensated chronic liver disease (haemochromatosis, Wilson’s disease), acute exacerbation of chronic liver disease (e.g., autoimmune hepatitis), hepatic infiltration by cancer (most commonly lymphoma).

Acute liver failure, hepatitic vs toxic
Pattern of necrosis
Coagulative vs Lytic

Distribution 
Uniform vs Patchy

Inflammation  
± ++ to +++

acute liver failure

The development of severe liver damage with encephalopathy and jaundice within eight weeks of the onset of liver disease. Coagulopathy, electrolyte imbalance, and cerebral edema are common. Death is likely without liver transplantation. Synonym: fulminant hepatic failure; fulminant hepatitis

Etiology

The most common causes of acute liver failure are viral hepatitis, acetaminophen overdose (and other drug reactions), trauma, ischemia, acute fatty liver of pregnancy, and autoimmune disorders.

Symptoms

Early symptoms are often nonspecific and mFay include nausea, vomiting, dizziness, lightheadedness, or drowsiness. As liver injury becomes more obvious, bile permeates the skin, producing jaundice. Alterations in mental status (lethargy or coma) and bleeding caused by coagulopathy may develop.

Diagnosis

The diagnosis is suggested by jaundice and altered mental status in addition to elevations in liver function tests and prolongation of the protime and international normalized ratio (INR).

Patient care

Affected patients should be hospitalized, usually in intensive care under very close monitoring. General patient care concerns apply. Airway support and mechanical ventilation are often needed. Fluids and/or pressors, such as dopamine, may be needed to maintain blood pressure and cardiac output. Nutritional support with a low salt, protein-restricted diet, and most calories supplied by carbohydrates, blood product infusions (fresh frozen plasma and platelets), and lactulose are usually administered. Potassium supplements help to reverse the affects of high aldosterone levels; potassium-sparing diuretics increase urine volume. Ascitic fluid is removed by paracentesis or shunt placement to relieve abdominal discomfort and aid respiratory effort. Portal hypertension requires shunt placement to divert blood flow, and variceal bleeding is treated with vasoconstrictor drugs, balloon tamponade, vitamin K administration, and perhaps surgery (to ligate bleeding portal vein collateral vessels).

Medications that are normally metabolized by the liver and medications that may injure the liver further should be avoided. Patients who have overdosed on acetaminophen may benefit from the administration of acetylcysteine if it can be administered within 12 hr of a single ingestion.

Liver transplantation is the definitive treatment for acute liver failure. Early transplant evaluation should be carried out for every patient for whom there is a donated organ available. Without transplantation, the mortality from acute liver injury may reach 80%.

The patient’s level of consciousness should be assessed frequently, with ongoing orientation to time and place. Girth should be measured daily. Signs of anemia, infection, alkalosis, and GI bleeding should be documented and reported immediately. A quiet atmosphere is provided. Physical restraints are applied as minimally as possible, with chemical restraint prohibited. If the patient is comatose, the eyes are protected from corneal injury using artificial tears and/or eye patches.

The prognosis for the illness should be discussed in a sensitive but forthright fashion and emotional support provided to family members. Agency social workers, the hospital chaplain, and other support personnel should be involved in the patient’s care as appropriate to individual needs.

See also: failure
References in periodicals archive ?
Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs.
Paracetamol (PCT) is one of the leading pharmacological causes of acute hepatic failure.
2 Acute Hepatic Failure###2 Acute Hepatic Failure (ATT
17 Though the disease is self-limiting in most of the cases, yet in some cases the illness is complicated by development of Acute Hepatic failure and other extra hepatic complications.
This is because the blood supply to the liver is already compromised due to PV thrombosis, and embolization of the hepatic artery may result in hepatic infarction and/or acute hepatic failure, especially in patients with limited hepatic reserve.
In conclusion, we report four cases of acute hepatic failure, which developed in patients who had received immunosuppressive agents for their rheumatologic conditions.
Patients who developed encephalopathy after the onset of icterus were considered to have acute hepatic failure [6].
Subgroup 2 included patients who were thought to have died directly from deterioration of acute hepatic failure.
Acute hepatic failure associated with low-dose sustained release niacin.
Transcatheter arterial steroid injection therapy (TASIT) via the hepatic artery to reduce hepatic macrophage activity in patients with severe acute hepatic failure has been tried with some success24.

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