Definition:
Acute liver failure (or fulminant liver failure) is the appearance of severe complications rapidly after the first signs of liver disease (such as jaundice), and indicates that the liver has sustained severe damage (loss of function of 80-90% of liver cells).
Diagnosis:
All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have immediate measurement of prothrombin time and careful evaluation of their mental status.
Treatment:
Treatment involves admission to hospital; often intensive care unit admission or very close observation are needed. Supportive treatment is with enough nutrition, optimalisation of the fluid balance, mechanical ventilation and intracranial pressure monitoring (in severe encephalopathy), and treatment aimed at removing the underlying cause (such as acetylcysteine for paracetamol poisoning).
Symptoms and Signs:
Over the next few days to weeks, the condition worsens to coma, with development of ascites, cerebral edema, and decorticate and decerebrate posturing. Gastrointestinal (GI) bleeding may occur due to the severe coagulopathy. Liver size may be normal, small, or large, and the liver may shrink with deterioration of the overall condition of the patient.
Causes:
Common causes for acute liver failure are paracetamol (acetaminophen) overdose, idiosyncratic reaction to medication (like tetracycline, troglitazone), excessive alcohol intake (severe alcoholic hepatitis), viral hepatitis (hepatitis A or B - it is extremely uncommon in hepatitis C), acute fatty liver of pregnancy, and idiopathic (without an obvious cause).
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