RT Book, Section
A1 Kim, Brian
A1 Kim-Schluger, Leona
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136415251
T1 Liver Failure: Acute and Chronic
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136415251
RD 2024/04/20
AB KEY  POINTSAcute  liver  failure  (ALF)  is  defined  as  the  rapid  and  severe  development  of  liver  dysfunction,  marked  by  encephalopathy  and  coagulopathy  in  an  individual  without  a  prior  history  of  cirrhosis  or  liver  disease.Acetaminophen  is  the  most  common  cause  of  ALF  in  the  United  States,  and  prompt  administration  of  N-acetylcysteine  helps  to  decrease  mortality  in  acetaminophen  hepatotoxicity.  N-acetylcysteine  may  also  have  some  benefit  in  nonacetaminophen  hepatotoxicity.Supportive  care  remains  the  mainstay  of  ALF  management.  Spontaneous  survival  rate  from  ALF  is  40%  and  liver  transplantation  (LT)  remains  the  only  definitive  therapy  for  patients  who  are  unable  to  achieve  timely  regeneration  of  liver  mass  to  maintain  life  despite  adequate  supportive  care.Cirrhosis  is  characterized  by  progressive  hepatic  fibrosis  that  can  lead  to  consequences  of  portal  hypertension  including  variceal  hemorrhage,  ascites,  renal  failure,  and  encephalopathy.The  combination  of  pharmacologic  therapy  and  endoscopic  variceal  ligation  is  effective  in  controlling  bleeding  in  up  to  90%  of  patients  presenting  with  acute  variceal  hemorrhage.Hepatic  encephalopathy  is  a  frequent  reason  for  hospital  admissions.  Common  precipitants,  such  as  infection,  dehydration,  and  bleeding,  should  be  ruled  out  in  any  patient  presenting  with  hepatic  encephalopathy.