Acute Liver Failure
Acute liver failure (ALF) is a broad term and encompasses both fulminant hepatic failure (FHF) and subfulminant hepatic failure. It is a rare but potentially fatal disease, especially if complicated by hepatic encephalopathy and impaired protein synthesis. Incidence of acute liver failure is low only about 2000 cases annually occurring in the US.
Viral Hepatitis - HBV and HCV
More than 350 million people worldwide are inflicted by Hepatitis B Virus and about 170 million by Hepatitis C. 20% of those patients with chronic viral hepatitis might develop liver cirrhosis which might end in the need of a liver transplantation (LTx).
Today many patients in hepatology who develop acute liver failure recover with supportive treatment but with continued deterioration or having adverse prognostic factors, orthotopic liver transplantation (OLT) is often required. Approximately 6% of OLTs performed in the United States are for fulminant hepatic failure (FHF). Prior to orthotopic liver transplantation (OLT) for FHF, the mortality rate was generally greater than 80%. However, with improved intensive care, the prognosis is much better now than in the past, with some series reporting approximately a survival rate of 60%.
Infectious Acute Liver Failure
In many countries viral hepatitis is a common cause for FHF, especially hepatitis A and hepatitis B, it is extremely uncommon in hepatitis C. Survival rates in HAV patients with FHF are about 50-60%, much more favourable than the outcome for patients with other hepatitis. These patients account for a substantial proportion (10-20%) of the pediatric liver transplants in some countries despite the relatively mild infection that is observed in many children infected with HAV. In the developing world, acute HBV infection dominates as a cause of FHF.
Another cause for an infectious acute liver failure may be a sepsis.
Other causes for acute liver failure include:
- Acute Fatty Liver (as a result of pregnancy, tetracyclines, alcohol or Reye syndrome)
- Multi Organ/Liver Failure after heart surgery
- The HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome occurs in 0.1-0.6% of pregnancies and usually is associated with preeclampsia.
- Wilson's Disease (hereditary copper accumulation) may infrequently present with acute liver failure. Without OLT, this is almost uniformly fatal.
- Ischemic Liver Failure after surgical procedures and occlusion of hepatic artery.
- Cryptogenic Acute Liver Failure (for nearly 15% of patients in the US, the cause of the acute liver failure remains indeterminate)
Acute Liver Failure or Fulminant Hepatic Failure
- infectious - viral (A, B, C, D, E), sepsis
- toxic-acute (paracetamol, alcohol, mushroom poisoning and other)
- other acute - acute fatty liver (pregnancy, tetracyclines, alcohol, Reye syndrome)
- other acute - multi organ (liver) failure after heart surgery
- ischemic (surgical procedures, occlusion of hepatic artery)
- vasculary (heart failure; Budd Chiari syndrome)
- toxic-acute (intoxication with strongly albumin bound substances)
- Adult-onset Still disease
- Fructose intolerance
- HELLP syndrome of pregnancy
- Hemorrhagic viruses (Ebola virus, Lassa virus, Marburg virus)
- Idiopathic drug reaction (hypersensitivity)
- Neonatal iron storage disease
Contact us regarding "Acute Liver Failure"
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