| Liver failure | |
|---|---|
| Other names | Hepatic insufficiency, liver dysfunction |
 | |
| A person with massiveascites andcaput medusae due to cirrhotic liver failure | |
| Specialty | Gastroenterology,hepatology  |
| Symptoms | abdominal inflammation,fluid retention,hyperglycemia,nausea,vomiting,jaundice, acute or chronicfatigue,hyponatremia,hypokalemia,respiratory alkalosis,metabolic acidosis,bilirubinuria,glycosuria,pruritus |
| Risk factors | Excessive consumption ofalcohol, fatty foods; obesity;Type 2 Diabetes; sharing or reusing syringes; having tattoos or body piercings |
Liver failure is the inability of theliver to perform its normalsynthetic andmetabolic functions as part of normalphysiology. Two forms are recognised,acute andchronic (cirrhosis).[1] Recently, a third form of liver failure known asacute-on-chronic liver failure (ACLF) is increasingly being recognized.[2]
Acute liver failure is defined as "the rapid development ofhepatocellular dysfunction, specificallycoagulopathy and mental status changes (encephalopathy) in a patient without known prior liver disease".[3]:1557[4]
The disease process is associated with the development of a coagulopathy of liveraetiology, and clinically apparent altered level of consciousness due tohepatic encephalopathy. Several important measures are immediately necessary when the patient presents for medical attention.[5] The diagnosis of acute liver failure is based on a physical exam, laboratory findings, patient history, and past medical history to establish mental status changes, coagulopathy, rapidity of onset, and absence of known prior liver disease respectively.[3]:1557
The exact definition of "rapid" is somewhat debatable, and different sub-divisions exist, which are based on the time from onset of first hepatic symptoms to onset of encephalopathy. One scheme defines "acute hepatic failure" as the development of encephalopathy within 26 weeks of the onset of any hepatic symptoms. This is sub-divided into "fulminant hepatic failure", which requires onset of encephalopathy within 8 weeks, and "subfulminant", which describes onset of encephalopathy after 8 weeks but before 26 weeks.[6] Another scheme defines "hyperacute" as onset within 7 days, "acute" as onset between 7 and 28 days, and "subacute" as onset between 28 days and 24 weeks.[3]:1557
Chronic liver failure usually occurs in the context ofcirrhosis, itself potentially the result of many possible causes, such as excessivealcohol intake,hepatitis B orC, autoimmune, hereditary and metabolic causes (such asiron orcopper overload,steatohepatitis ornon-alcoholic fatty liver disease).[citation needed]
"Acute on chronic liver failure (ACLF)" is said to exist when someone withchronic liver disease develops features of liver failure. A number of underlying causes may precipitate this, such as alcohol misuse or infection. People with ACLF can be critically ill and requireintensive care treatment, and occasionally a liver transplant. Mortality with treatment is 50%.[7]
| Authority control databases: National |
|---|