Acute Liver Failure: Causes, Diagnosis, and Treatment
Learn about acute liver failure, a serious condition characterized by rapid loss of liver function. Discover its types, causes such as viral hepatitis and drug-induced liver injury, diagnosis methods, and treatment options including intensive care, liver transplantation, and management of underlying causes like autoimmune hepatitis. Understanding acute liver failure is crucial for timely intervention and improved patient outcomes.
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Presentation Transcript
Liver failure Iva Hoffmanov Department of Internal Medicine Second Faculty of Medicine, Charles University and Motol University Hospital
FUNCTION OF THE LIVER metabolising the breakdown products of digestion ~ intermediary metabolism ~ energy metabolism bile production harmful compounds detoxification (xenobiotic biotransformation) modifications of hormones and vitamins endocrine function (EPO, calcidiol, insulin-like growth factors) immune function (acute phase reactants synthesis, Kupffer cells) 2
Liver failure - types acute liver failure acute on chronic liver failure (ACLF) chronic liver failure = end stage liver disease (cirrhosis)
Acute liver failure = rapid loss of liver function presented by encephalopathy and coagulopathy (INR > 1,5) in a patient without preexisting liver disease fulminant (< 4 weeks) subacute (4-26 weeks)
Acute liver failure caused by viral hepatitis (A, E, B) autoimmune hepatitis toxic hepatitis paracetamol (acetaminophen) Amanita phalloides ischemic hepatitis Budd-Chiari syndrome acute Wilson disease 30 % not explained
Acute liver failure - diagnosis combination of clinical signs increasing icterus lethargy to coma + simple laboratory examination: elevated bilirubin level elevated aminotransferase levels elevated ammonia level hypoglycemia acidosis prolonged prothrombin time (INR 1.5) (hypoalbuminemia)
Acute liver failure - treatment emerging situation intensive care unit correction of acid-base disturbances, electrolyte disorders, hypoglycemia and coagulopathy, correction of hypovolemia ATB (risk of secondary infection) supportive treatment of organ failure: mechanical ventilation, elimination (CVVHD, extracorporeal liver-assist devices: MARS/Prometheus) TREATMENT OF THE UNDERLYING CAUSE antivirotics (tenofovir, entecavir HBV) corticoids (autoimmune hepatitis) plasmapheresis, silibinin (mushrooms) N-acetylcystein (acetaminophen) 1/ exclude end-stage liver cirrhosis acute alcoholic hepatitis 2/ determining the cause of acute liver failure history serology, imunology, biochemistry, toxikology, USG/CT transjugular liver biopsy 3/ differentiate patients who are likely to benefit from liver transplantation from those who are likely to recover spontaneously
Acute liver failure indication for LTx King s College Criteria
ACLF = acute on chronic liver failure = an abrupt and life-threatening worsening of chronic liver disease (cirrhosis) associated with the concomitant extrahepatic organ failure(s) kidney coagulation brain circulation lung precedes an acute insult: acute alcoholic hepatitis acute viral hepatitis (or reactivation of hepatitis B) relaps of autoimmune hepatitis sepsis major surgery major trauma
ACLF = acute on chronic liver failure decompensation of liver cirrhosis icterus / hyperbilirubinemia encefalopathy ascites + other organ s failure
ACLF diagnosis Scoring system CLIF-C organ failure (Chronic Liver Failure Consorcium)
ACLF - treatment as an acute liver failure prognosis is much worse indication for LTx is difficult initially, 3-7 days of intensive treatment consider general contraindication to LTx evaluate CLIF-C-ACLF scoring system : increased urgency for LTx urgency for LTx no indication for LTx
Chronic liver failure icterus, hemorrhagic diathesis M: chest hair, gynecomastia flapping tremor foetor hepaticus liver examination: size consistency tenderness splenomegaly ascites
Thank you for your attention.
