ACUTE HEPATIC FAILURE

Question 1

Overview (4)

Answer 1

• Hepatic failure characterized by encephalopathy and coagulopathy
• Develops in less than 2 weeks in a patient with a previously normal liver or in patients with an acute exacerbation of underlying liver disease
• Cases that evolve at a slower pace (2-12 weeks) —> subacute hepatic failure
• It is an infrequent complication of acute liver damage from any cause and occurs as a result of massive liver cell necrosis

Question 2

Most common causes (2)

Answer 2

• Viral hepatitis
• Paracetamol overdose

Question 3

Presentation

Answer 3

Hepatic encephalopathy of varying severity, accompanied by severe jaundice and a marked coagulopathy

Question 4

Criteria for transfer to a special unit (5)

Answer 4

• INR > 3
• Metabolic acidosis
• Hepatic encephalopathy
• PT in seconds > interval of overdose in hours
• Refractory hypotension despite resuscitation

Question 5

Complications (6)

Answer 5

• Cerebral edema
• Hypoglycemia
• Hypotension
• Severe bacterial and fungal infections
• Renal failure (hepatorenal syndrome)
• ARDS and hypoxia

Question 6

Managment (4)

Answer 6

• Supportive treatment
• Emergency liver transplantation offers life-saving treatment, depending on the cause, and transplantation offered only based on severity (grade IV encephalopathy), of which 80% might otherwise die
• If paracetamol overdose: N-acetlycysteine (antidote)
• Treatment of hepatic encephalopathy