Hepatic failure: Difference between revisions

	WikiDoc Resources for Hepatic failure
Articles
Most recent articles on Hepatic failure Most cited articles on Hepatic failure Review articles on Hepatic failure Articles on Hepatic failure in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Hepatic failure Images of Hepatic failure Photos of Hepatic failure Podcasts & MP3s on Hepatic failure Videos on Hepatic failure
Evidence Based Medicine
Cochrane Collaboration on Hepatic failure Bandolier on Hepatic failure TRIP on Hepatic failure
Clinical Trials
Ongoing Trials on Hepatic failure at Clinical Trials.gov Trial results on Hepatic failure Clinical Trials on Hepatic failure at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Hepatic failure NICE Guidance on Hepatic failure NHS PRODIGY Guidance FDA on Hepatic failure CDC on Hepatic failure
Books
Books on Hepatic failure
News
Hepatic failure in the news Be alerted to news on Hepatic failure News trends on Hepatic failure
Commentary
Blogs on Hepatic failure
Definitions
Definitions of Hepatic failure
Patient Resources / Community
Patient resources on Hepatic failure Discussion groups on Hepatic failure Patient Handouts on Hepatic failure Directions to Hospitals Treating Hepatic failure Risk calculators and risk factors for Hepatic failure
Healthcare Provider Resources
Symptoms of Hepatic failure Causes & Risk Factors for Hepatic failure Diagnostic studies for Hepatic failure Treatment of Hepatic failure
Continuing Medical Education (CME)
CME Programs on Hepatic failure
International
Hepatic failure en Espanol Hepatic failure en Francais
Business
Hepatic failure in the Marketplace Patents on Hepatic failure
Experimental / Informatics
List of terms related to Hepatic failure

	Hepatic failure;
ICD-10	K72.9
DiseasesDB	5728
MeSH	D017093

VisualWikitext

Revision as of 15:20, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Liver failure; fulminating hepatic failure

Overview

Liver failure is the inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology.

Historical Perspective

Classification

Two forms are recognised:^[1]

Acute liver failure - development of hepatic encephalopathy (confusion, stupor and coma) and decreased production of proteins (such as albumin and blood clotting proteins) within four weeks of the first symptoms (such as jaundice) of a liver problem. "Hyperacute" liver failure is said to be present if this interval is 7 days or less, while "subacute" liver failure is said to be present if the interval is 5-12 weeks.
Chronic liver failure usually occurs in the context of cirrhosis, itself potentially the result of many possible causes, such as excessive alcohol intake, hepatitis B or C, autoimmune, hereditary and metabolic causes (such as iron or copper overload or non-alcoholic fatty liver disease).

Pathophysiology

Hyperammonemia is result in cerebral edema.
Brain edema is thought to be both cytotoxic and vasogenic in origin.
Cytokine profiles are also deranged.
Elevated serum concentrations of bacterial endotoxins, tumor necrosis factor–alpha (TNF-α), interleukin (IL)–1, and IL-6 have been found in fulminant hepatic failure^[2].

Causes

Drugs

Differential Diagnosis

Autoimmune hepatitis must be differentiated from other diseases that cause jaundice, nausea and vomiting, abdominal pain, arthragia, and hepatomegaly such as Hepatitis A,B,C, E, drug induced hepatitis, CMV hepatitis, EBV hepatitis, alcoholic hepatitis, Primary biliary cirrhosis and Primary sclerosing cholangitis.^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]

Classification of jaundice based on etiology		Disease	History and clinical manifestations				Diagnosis
			History and clinical manifestations				Lab Findings						Other blood tests	Other diagnostic
			Family history	Fever	RUQ Pain	Pruritis	AST	ALT	ALP	BLR Indirect	BLR Direct	Viral serology	Other blood tests	Other diagnostic
Jaundice	Hepatocellular Jaundice	Infiltrative liver disorders: Hemochromatosis, amyloidosis	+	-	-/+	-	↑	↑	↑/N	↑/N	N	-	Ferritin ↑ (hemochromatosis)	Liver biopsy
		Wilson's disease	+	-	-/+	-	↑	↑	N	↑/N	N	-	↑ Serum ceruloplasmin	Liver biopsy
		Viral hepatitis	-	-/+	-	-	↑	↑	N	↑/N	N	+	Specific viral antibody for each type	-
		Alcoholic hepatitis	-	-/+	-/+	-	↑↑	↑	N	↑/N	N	-	-	-
		Drug induced hepatitis	-	-/+	-	-	↑	↑	N	↑/N	N	-	-	-
		Autoimmune hepatitis	-/+	-	-	-/+	↑	↑	N	↑/N	N	-	Anti-LKM antibody	Liver biopsy
		Cirrhosis	-/+	-/+	-/+	-	↑	↑	↑/N	↑/N	↑/N	-/+	Low platate	Small liver on ultrasond
		Nonalcoholic steatohepatitis	-/+	-	-	-	↑	↑	N	↑/N	N	-	Dyslipidemia	liver biopsy
		Ischemic hepatopathy	-/+	-	-/+	-	↑	↑	N	↑/N	N	-	Cardiovascular risk factors	-
	Cholestatic Jaundice	Common bile duct stone	-/+	-	+	+	N	N	↑	N	↑	-	Dilated ducts on ultrasound	CT/ERCP
		Hepatitis A (cholestatic type)	-	-/+	+	+	N/↑	N/↑	↑	N	↑	+	HAV- Ab	Abdominal ultrasound
		EBV / CMV hepatitis	-	-/+	+	+	N	N	↑	N	↑	+	Positive serology	-
		Primary biliary cirrhosis	-/+	-	-/+	+	N/↑	N/↑	↑	N	↑	-	AMA positive	Liver biopsy
		Primary sclerosing cholangitis	-/+	-	-/+	+	N/↑	N/↑	↑	N	↑	-	↑Autoantibodies (P-ANCA), hypergammaglobulinemia	MRCP, Liver biopsy
		Sickle cell disease	+	-	-	+/-	N/↑	N/↑	↑	N	↑	-	Genetic testing
		Pancreatic carcinoma	+	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	-	CT scan for diagnosis
		AIDS cholangiopathy	-	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	HIV Ab	Ultrasound or ERCP
		Parasites induces cholestasis	-	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	Serology	Ultrasound or ERCP
		Intrahepatic cholestasis of pregnancy	-/+	-	-/+	+	↑	↑	↑	N	↑	-	Thrombocytopenia	Diagnosed clinically
	Isolated Jaundice	Crigler-Najjar type 2	+	-	-	-	N	N	N	↑	↑	-	Genetic testing
		Gilbert	+	-	-	-	N	N	N	↑	↑	-	Genetic testing
		Rotor syndrome	+	-	-	-	N	N	N	N	↑	-	Genetic testing	Liver biopsy
		Dubin-Johnson syndrome	+	-	-	-	N	N	N	N	↑	-	Genetic testing	Liver biopsy
		Hereditary spherocytosis	+	-	-/+	-	N	N	N	↑	N	-	Genetic testing	Osmotic fragility
		G6PD deficiency	+	-	-	-	N	N	N	↑	N	-	Genetic testing
		Thalassemia	+	-	-	-	N	N	N	↑	N	-	Genetic testing
		Paroxysmal nocturnal hemoglobinuria	-	-	-	-	N	N	N	↑	N	-	Flocytometery
		Immune hemolysis	-	-/+	-	-	N	N	N	↑	N	-	Autoantibodies
		Hematoma	-	-/+	-	-	N	N	N	↑	N	-	Anemia	Truma or surgery in history

Prognosis

The King's College criteria (KCC) may be used.

Contraindicated medications

Severe hepatic failure is considered an absolute contraindication to the use of the following medications:

The ALFSG index is a newer option that may be more accurate.^[12]

References

↑ O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet 1993;342:273-5. PMID 8101303.
↑ Wijdicks EF (October 2016). "Hepatic Encephalopathy". N. Engl. J. Med. 375 (17): 1660–1670. doi:10.1056/NEJMra1600561. PMID 27783916.
↑ Selmi C, Bowlus CL, Gershwin ME, Coppel RL (2011). "Primary biliary cirrhosis". Lancet. 377 (9777): 1600–9. doi:10.1016/S0140-6736(10)61965-4. PMID 21529926.
↑ Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ (2009). "Primary biliary cirrhosis". Hepatology. 50 (1): 291–308. doi:10.1002/hep.22906. PMID 19554543.
↑ Koff RS (1998). "Hepatitis A". Lancet. 351 (9116): 1643–9. doi:10.1016/S0140-6736(98)01304-X. PMID 9620732.
↑ Ciocca M (2000). "Clinical course and consequences of hepatitis A infection". Vaccine. 18 Suppl 1: S71–4. PMID 10683554.
↑ Fargo MV, Grogan SP, Saguil A (2017). "Evaluation of Jaundice in Adults". Am Fam Physician. 95 (3): 164–168. PMID 28145671.
↑ Leevy CB, Koneru B, Klein KM (1997). "Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease". Gastroenterology. 113 (3): 966–72. PMID 9287990.
↑ Hov JR, Boberg KM, Karlsen TH (2008). "Autoantibodies in primary sclerosing cholangitis". World J. Gastroenterol. 14 (24): 3781–91. PMC 2721433. PMID 18609700.
↑ Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ (1987). "Gall stones in sickle cell disease in the United Kingdom". Br Med J (Clin Res Ed). 295 (6592): 234–6. PMC 1247079. PMID 3115390.
↑ Malakouti M, Kataria A, Ali SK, Schenker S (2017). "Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do?". J Clin Transl Hepatol. 5 (4): 394–403. doi:10.14218/JCTH.2017.00027. PMC 5719197. PMID 29226106.
↑ Rutherford A, King LY, Hynan LS, Vedvyas C, Lin W, Lee WM; et al. (2012). "Development of an accurate index for predicting outcomes of patients with acute liver failure". Gastroenterology. 143 (5): 1237–43. doi:10.1053/j.gastro.2012.07.113. PMC 3480539. PMID 22885329.