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Summary A comprehensive Approach to Liver Failure
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This provides an approach to liver failure including pathophysiology, aetiology, understanding the signs and why they occur, investigations and much more.
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Liver FailureMain definition:
- Inability of the liver to perform its normal synthetic and metabolic function as part of normal
physiology.
- Two forms are recognised:
o Acute Liver failure
o Chronic Liver Failure
Definitions:
- Acute Hepatic Failure:
o Liver failure occurring suddenly in the previously healthy liver
o Fulminant hepatic failure:
Clinical syndrome resulting from massive necrosis of liver cells leading to
severe impairment of liver function:
o Acute-on-chronic hepatic failure:
More commonly it occurs as a result of decompensation of chronic liver
disease
- Chronic Hepatic Failure:
o Usually occurs in the context of cirrhosis, itself potentially the result of many
possible causes including excessive alcohol intake, Hepatitis B and C.
o Other causes may include autoimmune, hereditary and metabolic (iron or copper
overload – Haemachromatosis and Wilson’s Disease)
, Acute Hepatic Failure:
Definition:
- Liver failure occurring suddenly in the previously healthy liver
- Loss of function of 80-90% of cells
- Hepatocellular dysfunction is determined by looking at the 3 main liver function tests:
o Albumin (protein synthesis affected)
o INR (presents with coagulopathy and bleeding )
o Ammonia (presenting with cerebral oedema, hepatic encephalopathy and asterixes)
Classification:
- Hyperacute: within 1 week
- Acute: 1-4 weeks
- Sub-acute: 4-12 weeks
Causes:
- Infections:
o Viral hepatitis, yellow fever
- Drugs:
o Paracetamol overdose, halothane, isoniazid.
- Toxins:
o Amanita phalloides mushroom, carbon tetrachloride.
- Vascular:
o Budd-Chiari syndrome, veno-occlusive disease.
- Others:
o Alcohol hepatitis (excess ETOH intake), primary biliary cirrhosis, haemochromatosis,
autoimmune hepatitis, α1-antitrypsin deficiency, Wilson's disease, malignancy
VITAMIN C
V = vascular (budd chiari, veno-occlusive disease)
I = Infectious/Inflammatory (Hep B, Hep C)
T = toxins (paracetamol overdose, ETOH excess intake, carbon tetrachloride, some weird mushroom)
A = Autoimmune (haemachromatosis, Wilsons disease, autoimmune hepatitis)
M = metabolic
I = idiopathic/iatrogenic (isoniazide INH, Halothane)
N = neoplasms (malignancy)
C = congenital
Signs:
- Jaundice
- Hepatic encephalopathy
- Asterixis
- Fetor hepaticus
- Signs of chronic liver disease
suggest acute-on-chronic hepatic
failure.
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