alexa Acute liver failure | Argentina | PDF | PPT| Case Reports | Symptoms | Treatment

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Acute Liver Failure

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  • Acute liver failure

     Acute liver failure (ALF) is a rare syndrome defined by a rapid decline in hepatic function characterised by jaundice, coagulopathy (INR >1.5), and hepatic encephalopathy in patients with no evidence of prior liver disease.The interval from the onset of jaundice to the development of encephalopathy occurs within 24 to 26 weeks and may further classify ALF into categories based on hyperacute, acute, or subacute presentations.Although clinical jaundice is considered a defining feature of ALF, it may not always be present, particularly in hyperacute presentations. The term acute liver failure is preferred over fulminant hepatic failure or acute hepatic necrosis, although these terms have been used historically to classify hepatic failure. 

    Typical symptoms

    Yellowing of your skin and eyeballs (jaundice), Pain in your upper right abdomen, Abdominal swelling, Nausea, Vomiting, A general sense of feeling unwell (malaise), Disorientation or confusion Sleepiness.

  • Acute liver failure

     Therapeutic aspects

    Treatments for acute liver failure Acute liver failure treatments may include: Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin and may reduce liver damage. Liver transplant. When acute liver failure can't be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor. Treatments for complications Control signs and symptoms you're experiencing and try to prevent complications caused by acute liver failure. This care may include: Relieving pressure caused by excess fluid in the brain. 

  • Acute liver failure

     Statistics

    There is significant geographic variation in the etiology and prognosis of acute liver failure (ALF). The aim of the present study was to determine the causes and short-term outcomes of ALF in Argentina, evaluate the performance of prognostic criteria and identify clinical prognostic factors of death. We performed a retrospective analysis of 154 adult patients with ALF admitted to six liver transplant (LT) programs from June 2005 to December 2011. The most frequent causes of ALF were viral hepatitis B (46 patients; 30%), autoimmune hepatitis (AIH) (40; 26%) and indeterminate (40; 26%). No acetaminophen overdose was reported. One hundred eleven patients (72%) were included in the waiting list, and LT was performed in 83 patients (54%). Overall survival was 72%. Multivariate logistic regression identified two independent variables associated with adverse outcome on admission: MELD score≥ 29 and encephalopathy grade≥ 3. In direct comparison by ROC curve analysis, MELD score (c-statistic [95% confidence interval], 0,830; [0.73-0.93]) had better prognostic accuracy to predict outcome than Clichy (0.719; [0.58-0.85]) or King's College Criteria (KCC) (0.631; [0.49-0.77]). To conclude, hepatitis B and AIH are the most frequent causes of FHF in our series, and no cases of acetaminophen overdose were identified. Presence of MELD score ≥29 and encephalopathy grade ≥3 on admission were associated with death. MELD score at admission showed the highest prognostic accuracy.

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