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  • Acute Liver Failure

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    Hendrik
    46 vizualizări9 pagini
    1. Acute liver failure is defined as an acute hepatic disease accompanied by coagulopathy, advanced stage encephalopathy, and coma in patients without prior liver disease that develops within 8 weeks. 2. Clinical syndromes of acute liver failure include encephalopathy, renal and electrolyte abnormalities, respiratory and cardiovascular disorders, coagulation disorders, GI bleeding, hypoglycemia, and sepsis. 3. Encephalopathy is a pathological brain condition resulting from various neurological and/or psychological symptoms that are potentially reversible in the context of severe acute or chronic liver disease. It can range from mild lack of awareness to coma.

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    1. Acute liver failure is defined as an acute hepatic disease accompanied by coagulopathy, advanced stage encephalopathy, and coma in patients without prior liver disease that develops within 8 weeks. 2. Clinical syndromes of acute liver failure include encephalopathy, renal and electrolyte abnormalities, respiratory and cardiovascular disorders, coagulation disorders, GI bleeding, hypoglycemia, and sepsis. 3. Encephalopathy is a pathological brain condition resulting from various neurological and/or psychological symptoms that are potentially reversible in the context of severe acute or chronic liver disease. It can range from mild lack of awareness to coma.

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    46 vizualizări9 pagini

    Acute Liver Failure

    Încărcat de

    Hendrik
    1. Acute liver failure is defined as an acute hepatic disease accompanied by coagulopathy, advanced stage encephalopathy, and coma in patients without prior liver disease that develops within 8 weeks. 2. Clinical syndromes of acute liver failure include encephalopathy, renal and electrolyte abnormalities, respiratory and cardiovascular disorders, coagulation disorders, GI bleeding, hypoglycemia, and sepsis. 3. Encephalopathy is a pathological brain condition resulting from various neurological and/or psychological symptoms that are potentially reversible in the context of severe acute or chronic liver disease. It can range from mild lack of awareness to coma.

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    © All Rights Reserved
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    din 9

    Level of

    competence 2

    ACUTE LIVER FAILURE


    Lecture of GEH System
    2010

    Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo Hospital Teaching


    Internal Medicine, Faculty of Medicine, Hasanuddin University

    Definition

    Acute hepatic disease + coagulopathy


    (INR >1.5) + encephalopathy (w/o history
    of prior liver disease)
    FULMINANT : develops within 8 weeks
    SUBFULMINANT (late onset) : between 8
    weeks & 6 month

    = ACUTE HEPATIC FAILURE/ FULMINANT


    HEPATITIS
    Acute severe impairement of
    liver function accompanied
    by coagulopathy, advance
    stage of encephalopathy and
    coma in patients who had
    liver disease for less than 8
    weeks.

    TERMINOLOGY
    onset of jaundice to the development of
    encephalopathy

    HYPERACU
    TE LV

    interval of
    < 7 days

    ACUTE LV

    SUBACUTE
    LV

    interval 8interval 428 days


    12 weeks

    Pathogenesis
    etiolog
    y

    dama
    ge
    Oxydativ
    e stress

    y
    or
    at &
    m s
    m tor ic
    a
    fl ia x
    In ed oto ces
    m cyt tan
    bs
    su

    Massive
    inflow
    calcium

    Celluler &
    subcellule
    r
    biomembr
    an
    Severe

    disorder
    s cell
    mileu

    death

    Lipid
    peroxidati
    on

    CLINICAL SYNDROME

    Encephalopathy
    Renal, electrolyte, acid-base
    abnormality
    Respiratory disorders
    Cardiovascular disorders
    Coagulation disorders
    GI & other bleeding
    Hypoglycemia
    Sepsis

    ENCHEPHALOPAT
    Y

    PORTAL SYSTEMIC ENCEPHALOPATHY =PS


    (S.Sherlock 1954)

    Pathological noninflammatory brain


    lesion resulting from
    heterogens pathological
    effects,involves various
    neurological and/or
    psychicPRECONDITION
    symptoms
    :
    Severe (acute or chronic) liver
    disease
    And/or
    Portosystemic collateral
    circulation

    Total
    Cerebral
    dysfuncti
    on

    Neurological
    & mental
    symptoms
    potentially
    reversibble

    HEPATIC
    ENCEPHALOPA
    THY

    Moderat
    e to
    coma

    Acute or
    chronic
    liver
    disease

    Hepatic encephalopathy scale


    Grade

    Neurologic status

    No abnormality detect

    Trivial lack of awareness, shortened attention span,


    impairement noted on arithmetic testing

    Lethargy,disorentation in time, clear personality


    change, inappropriatebehavior

    Very drowsy, semocomatose but responsive to stimuli,


    confused,grossdisorientation intime or space,
    bizzarebehavior

    Comatose, unresponsive to painful stimuli w/wo


    abnormalmovements (e.g. decorticate or decerebrate
    posturing)

    Bacterial
    and/or fungal
    infection&
    sepsis (13%)

    Neurologic
    complicatio
    n (67%)

    DEATH

    Progressive
    respiratory
    & renal
    failure
    (50%)

    GI
    hemorrhage
    (13%)

    Hemodyna
    mic
    complicatio
    n (8%)

    Avunduk C. In Manual of Gastroenterology diagnosis & therapy. 4 th Edition. Lippincott Williams &
    Willkins. 2009;p104.

    DIAGNOSIS
    AST, ALT
    Bilirubin,
    PT/APTT

    Serum
    antibody,
    viral DNARNA titers

    Liver biopsy

    PROGNOSIS
    POO
    R

    PT >100sec
    Stage III-IV
    encephalopathy
    Arterial pH<7.3
    Age<10 or>40y
    Jaundice <7days
    before onset
    enchepalopathy
    PT>50sec
    Serum billirubin
    >18mg%

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