Hepatic Failure


 * Acute liver failure - life-threatening failure of liver functions (synthetic, biotransformation) occurring within 8 weeks of the first symptoms, the main feature being hepatic encephalopathy.
 * Chronic liver failure' - gradual development of symptoms.

Causes
The most common causes of acute failure:
 * 1) viral hepatitis (so-called fulminant) – especially VHA, VHB;
 * 2) intoxication with drugs (paracetamol, halothane) or toxic substances (mushroom poisoning, drugs – ecstasy);
 * 3) metabolic disorders (Wilson's disease, Reye's syndrome);
 * 4) venostasis (acute Budd-Chiari syndrome, shock, P failure).

The cause is massive necrosis of hepatocytes.

The cause of chronic liver failure is liver cirrhosis (most often alcoholic), liver tumors and liver metastases



Clinical Manifestations

 * vague symptoms (nausea, weakness, nausea, abdominal pain, ...), later icterus, bleeding manifestations, infectious complications, metabolic complications (ABR and electrolyte disorders, hypoglycaemia) ;
 * a clinically decisive sign of liver failure is a qualitative and quantitative impairment of consciousness - hepatic encephalopathy and cerebral edema (vasogenic and cytotoxic - the main cause of death in ALF).
 * Chronic liver failure is manifested by a slower onset of hepatic encephalopathy with typical tremor and the development of portal hypertension.

Diagnostics

 * Laboratory examination – hyperbilirubinemia, ↑ AST and ALT, prolongation of PT, hypoglycemia, hyperammonemia.
 * Imaging methods - on CT brain edema, best to monitor intracranial pressure (ICP).

Treatment

 * causally possible only in paracetamol poisoning (N-acetylcysteine), in green toadstool poisoning, activated charcoal is administered, forced diuresis is performed, and silibiline and G-PNC are administered;
 * broad-spectrum ATB;
 * treatment of coagulopathy – frozen plasma (replacement of coagulation factors), vitamin K;
 * antiulcer drugs;
 * modification of the internal environment;
 * treatment of hypoglycaemia – glucose infusion;
 * treatment of hepatic encephalopathy (diet, lactulose, ATB);
 * treatment of cerebral edema – elevated head position, diuretics (mannitol, furosemide), controlled hyperventilation, barbiturates;
 * treatment of arrhythmias (arising due to ABR disorders), possible hypotension is treated with catecholamines;
 * treatment of renal failure – discontinuation of nephrotoxic drugs, continuous elimination methods;
 * in case of severe liver failure only liver transplantation possible.

Related Articles

 * Hepatic failure (pediatrics)
 * Liver function tests
 * Hepatitis