ACUTE LIVER FAILURE

Acute hepatic disease + coagulopathy (INR

>1.5) + encephalopathy (w/o history of prior liver
disease)
FULMINANT : develops within 8 weeks
SUBFULMINANT (late onset) : between 8
weeks & 6 month

= ACUTE HEPATIC FAILURE/ FULMINANT

HEPATITIS
TERMINOLOGY

Acute severe impairement of liver

function accompanied by
coagulopathy, advance stage of
encephalopathy and coma in
patients who had liver disease for
less than 8 weeks.

onset of jaundice to the development of

encephalopathy

HYPERACUT
E LV

interval of <
7 days

ACUTE LV

SUBACUTE
LV

interval 8-28
interval 4-12
days
weeks

Pathogenesis
etiolog
y

damag
e
Oxydative
stress

Massive
inflow
calcium

Celluler &
subcelluler
biomembra
n

Severe
disorders
cell mileu

death

Lipid
peroxidation

CLINICAL SYNDROME

Encephalopathy
Renal, electrolyte, acid-base
abnormality
Respiratory disorders
Cardiovascular disorders
Coagulation disorders
GI & other bleeding
Hypoglycemia
Sepsis

ENCHEPHALOPATY
Pathological noninflammatory brain lesion
resulting from heterogens
pathological
effects,involves various
neurological and/or psychic
symptoms
PRECONDITION :
Severe (acute or chronic) liver disease
And/or
Portosystemic collateral circulation

PORTAL SYSTEMIC ENCEPHALOPATHY =P

(S.Sherlock 1954)
Total
Cerebral
dysfunctio
n

Neurological &
mental
symptoms
potentially
reversibble

HEPATIC
ENCEPHALOPAT
HY

Moderate
to coma

Acute or
chronic
liver
disease

Hepatic encephalopathy scale

Grade

Neurologic status

No abnormality detect

Trivial lack of awareness, shortened attention span,

impairement noted on arithmetic testing

Lethargy,disorentation in time, clear personality change,

inappropriatebehavior

Very drowsy, semocomatose but responsive to stimuli,

confused,grossdisorientation intime or space,
bizzarebehavior

Comatose, unresponsive to painful stimuli w/wo

abnormalmovements (e.g. decorticate or decerebrate
posturing)

Neurologic
complication
(67%)
Bacterial and/or
fungal infection&
sepsis (13%)

DEATH

Progressive
respiratory &
renal failure
(50%)

GI
hemorrhage
(13%)

Hemodynami
c
complication
(8%)

Avunduk C. In Manual of Gastroenterology diagnosis & therapy. 4th Edition. Lippincott Williams & Willkins. 2009;p104.

DIAGNOSIS

PROGNOSIS
POOR

AST, ALT
Bilirubin,
PT/APTT

Serum
antibody, viral
DNA-RNA titers

Liver biopsy

PT >100sec
Stage III-IV
encephalopathy
Arterial pH<7.3
Age<10 or>40y
Jaundice <7days before
onset enchepalopathy
PT>50sec
Serum billirubin >18mg%