Acute liver failure surgery

Jump to navigation Jump to search

Acute liver failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute Liver Failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acute liver failure surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute liver failure surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute liver failure surgery

CDC on Acute liver failure surgery

Acute liver failure surgery in the news

Blogs on Acute liver failure surgery

Directions to Hospitals Treating Acute liver failure

Risk calculators and risk factors for Acute liver failure surgery

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

Overview

Liver transplantation remains the only definitive therapy in patients of acute liver failure who fail to regenerate liver tissue to maintain life. Whole organ liver transplantation (deceased liver) or living donor liver transplantation(LDLT) can also be opted.[1]

Surgery

  • Drainage of ascites
  • While many people who develop acute liver failure recover with supportive treatment, liver transplantation is often required in people who continue to deteriorate or have adverse prognostic factors.
  • "Liver dialysis" (various measures to replace normal liver function) is evolving as a treatment modality and is gradually being introduced in the care of patients with liver failure.

Liver Transplantation

The King's College criteria were described in a publication in 1989 by J.G. O'Grady and colleagues. The criteria were stratified into acetaminophen and non-acetaminophen causes of acute liver failure, due to the different operating characteristics of parameters correlating with prognosis in the two causes.

King's College Hospital criteria

for liver transplantation in acute liver failure[2]

Patients with paracetamol toxicity

pH <7.3 or
Prothrombin time >100 seconds and
serum creatinine level >3.4 mg/dL (>300 μmol/l)
if in grade III or IV encephalopathy

Other patients

Prothrombin time >100 seconds or
Three of the following variables:

  • Age <10 yr or >40 yr
  • Cause:
    • non-A, non-B hepatitis
    • halothane hepatitis
    • idiosyncratic drug reaction
  • Duration of jaundice before encephalopathy >7 days
  • prothrombin time >50 seconds
  • Serum bilirubin level >17.6 mg/dL (>300 μmol/l)

References

  1. Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Annals of Internal Medicine. 137 (12): 947–54. PMID 12484709. Retrieved 2012-10-26. Unknown parameter |month= ignored (help)
  2. O'Grady JG, Alexander GJ, Hayllar KM, Williams R (1989). "Early indicators of prognosis in fulminant hepatic failure". Gastroenterology. 97 (2): 439–45. PMID 2490426.

Template:WH Template:WS