Acute liver failure is a severe condition seen in individuals without previous hepatic disease, and it is characterized by rapidly progressive liver injury, hepatic encephalopathy, and impaired synthetic function, which results in coagulopathy.
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3. INTRODUCTION
Acute liver failure refers to an acute,
severe liver injury with concurrent
encephalopathy and impaired synthetic
liver function.
In order to diagnose, patients must not
have underlying liver disease or cirrhosis
prior to insult.
Typically, time course of illness is less
than 26 weeks.
7. Diagnosis requires three
components
1. Encephalopathy
3. Elevated liver enzymes
2. Coagulopathy
INR ≥1.5
Patients may also
present with jaundice,
hepatomegaly,
abdominal tenderness,
and thrombocytopenia.
8. Etiology of disease can determined
though history, physical exam, laboratory
tests, and imaging studies (CT
abdomen/pelvis, MRI, abdominal US). A
liver biopsy may be necessary.
10. Treatment
03
Cerebral edema risk of elevated
intracranial pressure (ICP) and
brainstem herniation (a major
cause of morbidity and mortality).
Consider monitoring ICP in patients
with advancing encephalopathy.
Treat elevated ICP with mannitol.
04
Liver transplantation.
Eighty percent 1-year
survival posttransplant
01
Patients should be watched closely
as they can quickly decompensate.
Eligibility for liver transplant should
be considered early, although 40% of
patients will recover with supportive
care (nutritional support and treating
complications).
02
Encephalopathy—monitor with
neurologic checks every 2 hours.
Consider lactulose therapy,
although not shown to improve
overall outcomes.
