Document Detail


Acute liver failure.
MedLine Citation:
PMID:  21346565     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these. RECENT FINDINGS: The clinical presentation in ALF ranges from slightly altered conscious level with profound coagulopathy to coma with a catastrophic failure of multiple organs, including uncontrollable cerebral edema and brain death, which is rarely seen in decompensated cirrhosis. Interestingly, ALF patients who recover as the liver is regenerating, usually do not suffer from hepatic or extrahepatic sequelae. In contrast patients surviving acute-on-chronic liver failure will return to a state with incompensated cirrhosis, and eventually need transplantation for survival.In the management of ALF, the use of noradrenalin in combination with continuous high-dose renal replacement therapy, terlipressin, hypertonic sodium chloride, and mannitol can ameliorate systemic vasodilation and attenuate brain edema. Furthermore, liver assist devices seem to improve extrahepatic organ dysfunction and survival. SUMMARY: Insight into the of pathopysiological mechanisms of ALF that lead to cardiovascular instability, brain edema and development of multiorgan failure has advanced and resulted in improved survival. The role of liver assisting is still unknown but preliminary results indicate a positive effect on survival.
Authors:
Fin Stolze Larsen; Peter Nissen Bjerring
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-22
Journal Detail:
Title:  Current opinion in critical care     Volume:  -     ISSN:  1531-7072     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Hepatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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