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Liver failure

Definition
  • A decline in liver function leading to coagulopathy, jaundice, and encephalopathy.
Classification
  • Acute Liver Failure (ALF): Rapid deterioration within 8 weeks in a patient without pre-existing liver disease.
  • Chronic Liver Failure: Gradual decline over months to years, often due to chronic liver diseases.
  • Acute-on-Chronic Liver Failure (AoCLF): Acute deterioration in a patient with pre-existing chronic liver disease.
Aetiology
  • Acute Liver Failure: Paracetamol overdose, viral hepatitis (A, B, E), drugs (e.g. amoxicillin-clavulanic acid), toxins.
  • Chronic Liver Failure: Chronic alcohol consumption, viral hepatitis (B, C, D), non-alcoholic fatty liver disease (NAFLD), cirrhosis.
Clinical Features
  • Jaundice and scleral icterus.
  • Ascites and peripheral oedema.
  • Hepatic encephalopathy: Altered consciousness, asterixis (‘flapping tremor’).
  • Coagulopathy: Easy bruising, prolonged bleeding.
Investigations
  • Liver function tests (LFTs): Elevated transaminases (ALT, AST), raised bilirubin, decreased albumin.
  • INR: Prolonged.
  • Viral hepatitis serology.
  • Imaging: Ultrasound, CT, or MRI of the liver to detect structural abnormalities.
Management
  • Supportive care: Nutritional support, treat coagulopathy (vitamin K, fresh frozen plasma).
  • Specific treatments: N-acetylcysteine for paracetamol overdose, antiviral therapy for viral hepatitis.
  • Encephalopathy: Lactulose, rifaximin, avoidance of sedative drugs.
  • Transplantation: Liver transplant may be needed for some patients.
Complications
  • Hepatorenal syndrome: Renal failure due to severe liver damage.
  • Hepatic encephalopathy: Accumulation of toxins in the brain due to liver dysfunction.
  • Variceal haemorrhage: Due to portal hypertension.
Prognosis
  • Depends on the cause and severity. ALF has a high mortality rate without prompt treatment.
  • Chronic liver failure can progress to cirrhosis and hepatocellular carcinoma.

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