Keeffe EB

Language: Spanish
References: 16
Page: 56-62
PDF size: 46.62 Kb.

ABSTRACT

Acute liver failure, also called fulminant hepatic failure, is characterized by sudden hepatic synthetic dysfunction associated with coagulopathy and hepatic encephalopathy. Acute liver failure has most recently been defined based on the timing from onset of jaundice to encephalopathy as follows: 1) hyperacute (1-7 days); 2) acute (8-28 days), and 3) subacute (29-60 days). Rapid onset of encephalopathy in hyperacute liver failure is paradoxically associated with highest rate of spontaneous recovery, and subacute liver failure is associated with worst prognosis. The etiology of liver failure is established by history, serologic assays, and exclusion of alternative causes. Acute liver failure is most frequently caused by drug hepatotoxicity, including acetaminophen toxicity and idiosyncratic drug reactions, with viral hepatitis playing a lesser role in recent surveys. A substantial number of cases have an indeterminate etiology. Major complications of acute liver failure that require active intervention include metabolic disorders, coagulopathy, cerebral edema, renal failure, and infection. The focus of management of acute liver failure is comprehensive supportive care in an intensive care unit and assessment of the need for liver transplantation.

REFERENCES

1. Keeffe EB. Acute liver failure. In: McQuaid KR, Friedman SL, Grendell JH (eds.). Current diagnosis and treatment in gastroenterology. 2nd Ed. New York: Lange Medical Books/McGraw-Hill; 2003, p. 536-45.

2. Riordan SM, Williams R. Fulminant hepatic failure. Clin Liver Dis 2000; 4: 25-45.

3. Hoofnagle JH, Carithers RL Jr, Shapiro C, et al. Fulminant hepatic failure: summary of a workshop. Hepatology 1995; 21: 240-52.

4. Trey C, Davidson LS. The management of fulminant hepatic failure. In: Popper H, Schaffner F (eds.). Progress in liver disease. New York: Grune and Stratton;1970, p. 282-98.

5. Bernuau J, Rueff B, Benhamou J-P. Fulminant and subfulminant liver failure: definitions and causes. Semin Liver Dis 1986; 6: 97-106.

6. O’Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet 1993; 342: 273-5.

7. Lee WL. Acute liver failure. N Engl J Med 1993; 329: 1862-72.

8. Schiødt FV, Atillasoy E, Shakil AO, et al. Etiology and outcome for 295 patients with acute liver failure in the United States. Liver Transpl Surg 1999; 5: 29-34.

9. Shakil AO, Kramer D, Mazariegos GV, et al. Acute liver failure: clinical features, outcome analysis, and applicability of prognostic criteria. Liver Transpl 2000; 6: 163-9.

10. Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002; 137: 947-54.

11. Teo EK, Ostapowicz GA, Hussain M, et al. Hepatitis B infection in patients with acute liver failure in the United States. Hepatology 2001; 33: 972-6.

12. Umemura T, Tanaka E, Lee WM, et al. The role of SEN virus infection in various liver diseases from different geographic regions (Abstract). Hepatology 2002; 36: 646A.

13. Bernal W, Wendon J. Liver transplantation in adults with acute liver failure. J Hepatol 2004; 40: 192-7.

14. O’Grady JG, Alexander GJM, Hayllar KM, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97: 439-45.

15. Bernuau J, Samuel D, Durand F, et al. Criteria for emergency liver transplantation in patients with acute viral hepatitis and factor V below 50% of normal: a prospective study (Abstract). Hepatology 1991; 14: 49A.

16. Millis JM, Cronin DC, Johnson R, et al. Initial experience with the modified extracorporeal liver-assist device for patients with fulminant hepatic failure: system modifications and clinical impact. Transplantation 2002; 74: 1735-46.