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[edit | edit source]

The most common causes of acute failure:

viral hepatitis (so-called fulminant) – especially VHA, VHB;
intoxication with drugs (paracetamol, halothane) or toxic substances (mushroom poisoning, drugs – ecstasy);
metabolic disorders (Wilson's disease, Reye's syndrome);
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

Icterus

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.

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

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.

PASTOR, Jan. Langenbeck's medical web page [online]. [cit. 2010]. <http://langenbeck.webs.com>.