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2015 ; 5
(Suppl 1
): S104-15
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Management in acute liver failure
#MMPMID26041950
Shalimar
; Acharya SK
J Clin Exp Hepatol
2015[Mar]; 5
(Suppl 1
): S104-15
PMID26041950
show ga
Acute liver failure (ALF) is a rare, potentially fatal complication of severe
hepatic illness resulting from various causes. In a clinical setting, severe
hepatic injury is usually recognised by the appearance of jaundice,
encephalopathy and coagulopathy. The central and most important clinical event in
ALF is occurrence of hepatic encephalopathy (HE) and cerebral edema which is
responsible for most of the fatalities in this serious clinical syndrome. The
pathogenesis of encephalopathy and cerebral edema in ALF is unique and
multifactorial. Ammonia plays a central role in the pathogenesis. The role of
newer ammonia lowering agents is still evolving. Liver transplant is the only
effective therapy that has been identified to be of promise in those with poor
prognostic factors, whereas in the others, aggressive intensive medical
management has been documented to salvage a substantial proportion of patients. A
small fraction of patients undergo liver transplant and the remaining are usually
treated with medical therapy. Therefore, identification of the complications and
causes of death in such patients, and use of appropriate prognostic models to
identify those who need liver transplant and those who can be managed with
medical treatment is a vital component of therapeutic strategy. In this review,
we discuss the various pathogenetic mechanisms and treatment options available.
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