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Acute liver failure

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Medical Emergency - Acute liver failure is a medical emergency, needing treating promptly to prevent permanent liver failure!

What is it?

Also known as fulminant hepatic failure, it is defined as:

  1. a potentially reversible liver injury,
  2. with hepatic encephalopathy,
  3. without any other pre existing liver disease.

Signs and Symptoms

Basically, all the normal signs of liver failure, such as jaundice, and then a development of hepatic encephalopathy - mood changes, confusion, coma. The speed these symptoms arrive determines the type of failure:

  • Hyperacute - encephalopathy within 7 days after other liver failure symptoms.
  • Acute - encephalopathy within 30 days.
  • Subacute - encephalopathy within 3 months.

Also, you can get:

  • Clotting problems - Very common, and the liver stops making coagulation factors, so Prothrombin time increases.
  • Renal failure - Quite common. Because liver not making urea, blood urea levels not representative to level of renal failure. It's something to do with portal hypertension, and the kidney blood supply getting screwed.

Look for the hepatic flap in the hands during in your abdominal examination.

Differential

There can be a variety of causes:

Management

Its pretty basic, either supportive care, or liver transplant.

The guidelines for liver transplant

In paracetamol toxicity do a transplant if:

  • in grade III or IV encephalopathy
  • and pH <7.3
  • or Prothrombin time >100 seconds and

serum creatinine level >3.4 >300 μmol/l

In other patients do a transplant if Prothrombin time >100 seconds, or 3 of below are true:

  • 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)