Acute liver failure resident survival guide: Difference between revisions

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==Definitions==
===Acute Liver Failure===
Evidence of coagulation abnormality (INR ≥1.5) and any degree of alteration in mental status in the absence of pre exisiting [[chronic liver disease]], [[cirrhosis]] and any illness of <26 weeks duration is defined as acute liver failure.<ref name="Trey-1970">{{Cite journal  | last1 = Trey | first1 = C. | last2 = Davidson | first2 = CS. | title = The management of fulminant hepatic failure. | journal = Prog Liver Dis | volume = 3 | issue =  | pages = 282-98 | month =  | year = 1970 | doi =  | PMID = 4908702 }}</ref><ref name="Polson-2005">{{Cite journal  | last1 = Polson | first1 = J. | last2 = Lee | first2 = WM. | title = AASLD position paper: the management of acute liver failure. | journal = Hepatology | volume = 41 | issue = 5 | pages = 1179-97 | month = May | year = 2005 | doi = 10.1002/hep.20703 | PMID = 15841455 }}</ref>  Few exceptions that are included in spite of their presentation with cirrhosis are [[Wilson disease]], vertically-acquired [[HBV]], and [[autoimmune hepatitis]] if they have been recognized for <26 weeks.  When the above presentation duration is up to 26 weeks, acute liver failure is the better terminology to be used when compared to terms like fulminant hepatic failure, fulminant hepatitis or necrosis, hyperacute, acute and subacute liver failure.     
===Hepatic Encephalopathy===
Based on their clinical manifestation, different grades of [[hepatic encephalopathy]] are defined as follows<ref name="Conn-1977">{{Cite journal  | last1 = Conn | first1 = HO. | last2 = Leevy | first2 = CM. | last3 = Vlahcevic | first3 = ZR. | last4 = Rodgers | first4 = JB. | last5 = Maddrey | first5 = WC. | last6 = Seeff | first6 = L. | last7 = Levy | first7 = LL. | title = Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. | journal = Gastroenterology | volume = 72 | issue = 4 Pt 1 | pages = 573-83 | month = Apr | year = 1977 | doi =  | PMID = 14049 }}</ref>
{|class="wikitable"
! Grades!! Clinical Features
|-
| I|| Changes in behavior, minimal changes in level of consciousness
|-
| II|| Inappropriate behavior, gross disorientation, drowsiness, possibly asterixis
|-
| III|| Marked confusion, incoherent speech, mostly sleeping but arousable to vocal stimuli
|-
| IV|| Comatose, unresponsive to pain, decorticate or decerebrate posturing
|-
|}


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*[[Cocaine]]<ref name="Campos Franco-2002">{{Cite journal  | last1 = Campos Franco | first1 = J. | last2 = Martínez Rey | first2 = C. | last3 = Pérez Becerra | first3 = E. | last4 = González Quintela | first4 = A. | title = [Cocaine related fulminant liver failure]. | journal = An Med Interna | volume = 19 | issue = 7 | pages = 365-7 | month = Jul | year = 2002 | doi =  | PMID = 12224146 }}</ref>
*[[Idiosyncratic drug reaction|Idiosyncratic hypersensitivity reactions]]<ref name="Lee-2008">{{Cite journal  | last1 = Lee | first1 = WM. | title = Etiologies of acute liver failure. | journal = Semin Liver Dis | volume = 28 | issue = 2 | pages = 142-52 | month = May | year = 2008 | doi = 10.1055/s-2008-1073114 | PMID = 18452114 }}</ref>
*[[Mushroom poisoning]]<ref name="Erden-2013">{{Cite journal  | last1 = Erden | first1 = A. | last2 = Esmeray | first2 = K. | last3 = Karagöz | first3 = H. | last4 = Karahan | first4 = S. | last5 = Gümüşçü | first5 = HH. | last6 = Başak | first6 = M. | last7 = Cetinkaya | first7 = A. | last8 = Avcı | first8 = D. | last9 = Poyrazoğlu | first9 = OK. | title = Acute liver failure caused by mushroom poisoning: a case report and review of the literature. | journal = Int Med Case Rep J | volume = 6 | issue =  | pages = 85-90 | month =  | year = 2013 | doi = 10.2147/IMCRJ.S53773 | PMID = 24294010 }}</ref>
*[[Shock]] or [[hypoperfusion]]<ref name="Bynum-1979">{{Cite journal  | last1 = Bynum | first1 = TE. | last2 = Boitnott | first2 = JK. | last3 = Maddrey | first3 = WC. | title = Ischemic hepatitis. | journal = Dig Dis Sci | volume = 24 | issue = 2 | pages = 129-35 | month = Feb | year = 1979 | doi =  | PMID = 428301 }}</ref>


===Common Causes===
===Common Causes===
*[[Autoimmune hepatitis]]<ref name="Ostapowicz-2002">{{Cite journal  | last1 = Ostapowicz | first1 = G. | last2 = Fontana | first2 = RJ. | last3 = Schiødt | first3 = FV. | last4 = Larson | first4 = A. | last5 = Davern | first5 = TJ. | last6 = Han | first6 = SH. | last7 = McCashland | first7 = TM. | last8 = Shakil | first8 = AO. | last9 = Hay | first9 = JE. | title = Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. | journal = Ann Intern Med | volume = 137 | issue = 12 | pages = 947-54 | month = Dec | year = 2002 | doi =  | PMID = 12484709 }}</ref>
*[[Acetaminophen toxicity]]<ref name="Gill-2001">{{Cite journal  | last1 = Gill | first1 = RQ. | last2 = Sterling | first2 = RK. | title = Acute liver failure. | journal = J Clin Gastroenterol | volume = 33 | issue = 3 | pages = 191-8 | month = Sep | year = 2001 | doi =  | PMID = 11500606 }}</ref>
*[[Viral hepatitis]]<ref name="Uemoto-2000">{{Cite journal  | last1 = Uemoto | first1 = S. | last2 = Inomata | first2 = Y. | last3 = Sakurai | first3 = T. | last4 = Egawa | first4 = H. | last5 = Fujita | first5 = S. | last6 = Kiuchi | first6 = T. | last7 = Hayashi | first7 = M. | last8 = Yasutomi | first8 = M. | last9 = Yamabe | first9 = H. | title = Living donor liver transplantation for fulminant hepatic failure. | journal = Transplantation | volume = 70 | issue = 1 | pages = 152-7 | month = Jul | year = 2000 | doi =  | PMID = 10919593 }}</ref>
*[[Shock]] or [[hypoperfusion]]<ref name="Bynum-1979">{{Cite journal  | last1 = Bynum | first1 = TE. | last2 = Boitnott | first2 = JK. | last3 = Maddrey | first3 = WC. | title = Ischemic hepatitis. | journal = Dig Dis Sci | volume = 24 | issue = 2 | pages = 129-35 | month = Feb | year = 1979 | doi =  | PMID = 428301 }}</ref>


==Do's==
==Do's==

Revision as of 18:23, 9 December 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Definitions

Acute Liver Failure

Evidence of coagulation abnormality (INR ≥1.5) and any degree of alteration in mental status in the absence of pre exisiting chronic liver disease, cirrhosis and any illness of <26 weeks duration is defined as acute liver failure.[1][2] Few exceptions that are included in spite of their presentation with cirrhosis are Wilson disease, vertically-acquired HBV, and autoimmune hepatitis if they have been recognized for <26 weeks. When the above presentation duration is up to 26 weeks, acute liver failure is the better terminology to be used when compared to terms like fulminant hepatic failure, fulminant hepatitis or necrosis, hyperacute, acute and subacute liver failure.

Hepatic Encephalopathy

Based on their clinical manifestation, different grades of hepatic encephalopathy are defined as follows[3]

Grades Clinical Features
I Changes in behavior, minimal changes in level of consciousness
II Inappropriate behavior, gross disorientation, drowsiness, possibly asterixis
III Marked confusion, incoherent speech, mostly sleeping but arousable to vocal stimuli
IV Comatose, unresponsive to pain, decorticate or decerebrate posturing

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes


Do's

Dont's

References

  1. ↑ Trey, C.; Davidson, CS. (1970). "The management of fulminant hepatic failure". Prog Liver Dis. 3: 282–98. PMID 4908702.
  2. ↑ Polson, J.; Lee, WM. (2005). "AASLD position paper: the management of acute liver failure". Hepatology. 41 (5): 1179–97. doi:10.1002/hep.20703. PMID 15841455. Unknown parameter |month= ignored (help)
  3. ↑ Conn, HO.; Leevy, CM.; Vlahcevic, ZR.; Rodgers, JB.; Maddrey, WC.; Seeff, L.; Levy, LL. (1977). "Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial". Gastroenterology. 72 (4 Pt 1): 573–83. PMID 14049. Unknown parameter |month= ignored (help)
  4. ↑ Campos Franco, J.; Martínez Rey, C.; Pérez Becerra, E.; González Quintela, A. (2002). "[Cocaine related fulminant liver failure]". An Med Interna. 19 (7): 365–7. PMID 12224146. Unknown parameter |month= ignored (help)
  5. ↑ Lee, WM. (2008). "Etiologies of acute liver failure". Semin Liver Dis. 28 (2): 142–52. doi:10.1055/s-2008-1073114. PMID 18452114. Unknown parameter |month= ignored (help)
  6. ↑ Erden, A.; Esmeray, K.; Karagöz, H.; Karahan, S.; Gümüşçü, HH.; Başak, M.; Cetinkaya, A.; Avcı, D.; Poyrazoğlu, OK. (2013). "Acute liver failure caused by mushroom poisoning: a case report and review of the literature". Int Med Case Rep J. 6: 85–90. doi:10.2147/IMCRJ.S53773. PMID 24294010.
  7. ↑ 7.0 7.1 Bynum, TE.; Boitnott, JK.; Maddrey, WC. (1979). "Ischemic hepatitis". Dig Dis Sci. 24 (2): 129–35. PMID 428301. Unknown parameter |month= ignored (help)
  8. ↑ Ostapowicz, G.; Fontana, RJ.; Schiødt, FV.; Larson, A.; Davern, TJ.; Han, SH.; McCashland, TM.; Shakil, AO.; Hay, JE. (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Ann Intern Med. 137 (12): 947–54. PMID 12484709. Unknown parameter |month= ignored (help)
  9. ↑ Gill, RQ.; Sterling, RK. (2001). "Acute liver failure". J Clin Gastroenterol. 33 (3): 191–8. PMID 11500606. Unknown parameter |month= ignored (help)
  10. ↑ Uemoto, S.; Inomata, Y.; Sakurai, T.; Egawa, H.; Fujita, S.; Kiuchi, T.; Hayashi, M.; Yasutomi, M.; Yamabe, H. (2000). "Living donor liver transplantation for fulminant hepatic failure". Transplantation. 70 (1): 152–7. PMID 10919593. Unknown parameter |month= ignored (help)


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