Acute liver failure pathophysiology

Jump to navigation Jump to search

Acute liver failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute Liver Failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acute liver failure pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute liver failure pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute liver failure pathophysiology

CDC on Acute liver failure pathophysiology

Acute liver failure pathophysiology in the news

Blogs on Acute liver failure pathophysiology

Directions to Hospitals Treating Acute liver failure

Risk calculators and risk factors for Acute liver failure pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Acute liver failure results from the loss of normal function of hepatic tissue which occurs over a short period of time. It results in the loss of the metabolic, secretory, and regulatory effects of the liver cells. This results in the rapid accumulation of toxic substances, which then manifests in the patient as an altered sensorium, cerebral edema, hemodynamic abnormalities, and even multiorgan failure.

Pathophysiology

Acute liver failure is caused due to extensive damage to the liver tissue, causing severe compromise of its function. The effects of acute liver failure are due to the loss of its metabolic, secretory and regulatory effects. This results in accumulation of toxic substances and causes deleterious effects. The major cause of morbidity and mortality in patients of liver failure is due to the development of cerebral edema which causes altered sensorium and increased intracranial pressure. Cerebral edema is mediated due to damage to blood brain barrier. Acute liver failure causes increased ammonia concentrations due to the failure of the detoxification system that occurs through the liver. The increased levels of ammonia in combination with the glutamate produced by the astrocytes of brain, causes excess levels of glutamine to be produced through the enzyme glutamine synthetase. The accumulation of glutamine in high concentrations is what causes cerebral edema. In acute liver failure, there are also increased levels of nitric oxide in the circulation. Nitric oxide is a potent vasodilator, and causes a disruption of the cerebral blood flow. This in turn disrupts cerebral auto regulation. Multiorgan failure occurs due to severe hypotension which is caused by the decreased systemic vascular resistance.

Specific Conditions

Acetaminophen Toxicity

  • Acetaminophen is the leading cause of acute liver failure.
  • Acetaminophen causes dose related toxicity.
  • Toxic doses can be as low as 3-4 g/day but most toxic ingestion's are of >10 g/day.

Other Drugs

  • Drugs other than acetaminophen also cause acute liver failure.
  • These constitute 13% of cases of acute liver failure in US. [1]
  • They cause idiosyncratic drug hepatotoxicity.
  • They usually present within six months of drug initiation.

Mushroom Poisoning

  • This is mainly caused by the genus Amanita (Amanita phalloides).[2]
  • Presentations may vary from case to case and it constitutes a medical emergency.
  • Patients may recover from traditional medical treatment, or may require transplantation in more severe cases.

Viral Hepatitis

Autoimmune Hepatitis

Ischemic Injury

  • This condition is called shock liver. It is a common occurrence in the ICU with a prevalence of 10%.[4]
  • Shock liver results from severe hypotension due to any causes such as heart failure, severe vaso-constriction due to drugs like niacin and cocaine.
  • Early recovery frequently occurs, but the long term outcome depends on the underlying cause of the ischemia.

HELLP Syndrome

Malignancy

Pathology

In the majority of acute liver failure (ALF) there is widespread hepatocellular necrosis beginning in the centrizonal distribution and progressing towards portal tracts. The degree of parenchymal inflammation is variable and is proportional to duration of disease[6].

References

  1. 1.0 1.1 Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Annals of Internal Medicine. 137 (12): 947–54. PMID 12484709. Retrieved 2012-10-27. Unknown parameter |month= ignored (help)
  2. Catalina MV, Núñez O, Ponferrada A, Menchén L, Matilla A, Clemente G, Bañares R (2003). "[Liver failure due to mushroom poisoning: clinical course and new treatment perspectives]". Gastroenterología Y Hepatología (in Spanish; Castilian). 26 (7): 417–20. PMID 12887855. Retrieved 2012-10-27.
  3. 3.0 3.1 Schiødt FV, Davern TJ, Shakil AO, McGuire B, Samuel G, Lee WM (2003). "Viral hepatitis-related acute liver failure". The American Journal of Gastroenterology. 98 (2): 448–53. doi:10.1111/j.1572-0241.2003.t01-1-07223.x. PMID 12591067. Retrieved 2012-10-27. Unknown parameter |month= ignored (help)
  4. Fuhrmann V, Jäger B, Zubkova A, Drolz A (2010). "Hypoxic hepatitis - epidemiology, pathophysiology and clinical management". Wiener Klinische Wochenschrift. 122 (5–6): 129–39. doi:10.1007/s00508-010-1357-6. PMID 20361374. Retrieved 2012-10-27. Unknown parameter |month= ignored (help)
  5. Woolf GM, Petrovic LM, Rojter SE, Villamil FG, Makowka L, Podesta LG, Sher LS, Memsic L, Vierling JM (1994). "Acute liver failure due to lymphoma. A diagnostic concern when considering liver transplantation". Digestive Diseases and Sciences. 39 (6): 1351–8. PMID 8200270. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  6. Boyer JL, Klatskin G (1970). "Pattern of necrosis in acute viral hepatitis. Prognostic value of bridging (subacute hepatic necrosis)". N. Engl. J. Med. 283 (20): 1063–71. PMID 4319402.

Template:WH Template:WS