Hepatic Failure

Definition:
It occur due to severe cause of hepatic encephalopathy.
Types of Hepatic Failure:

1. Fulminant hepatic failure.
2. Subfulminant hepatic failure.

1. Fulminant hepatic failure:

Defined as severe hepatic failure with development of hepatic encephalopathy within 8 weeks after the onset of acute liver disease.

Causes:

In the absence of evidence of pre-existing in chronic liver disease that also lead to hepatic encephalopathy.

2. Subfulminant hepatic failure:
It is term used when encephalopathy occur between 8 weeks and 6 months after the onset of acute liver disease and carries an equally poor prognosis.
Causes:
About 70% cases are caused  by acute viral hepatitis.
50% due to hepatitis B.
Other causes are hepatitis A. E & D.

Clinical Features:
Jaundice.
Hepatic encephalopathy.
Small live on examination.

Investigation:
Aminotransferases.
Prothrombin time.
Decreased Coagulation Factors.
Electrocardiography.

* Liver biopsy is contraindicated.

Management:

1. Hepatic Encephalopathy.
2. Cerebral Edema.
3. Nutritions.
4. Cardiovascular functions.
5. Hemorrhage.
6. Infections.
7. Renal failure.
8. Acetylcysteine.
9. Liver Transplantaion.

1. Hepatic Encephalopathy:

It occur due to nitrogenous substances e.g. Ammonia it enters in portal circulation that by-pass the liver and lead to cerebral dysfunction.

* Because liver becomes unable to detoxify them.

2. Cerebral Edema:

It is major cause of the death in Hepatic failure.

Its due to signs present of Increased Intracranial Pressure (ICP).

3. Nutitions:

Maintain glucose and other diet balance.

4. Cardiovascular functions:

To maintain the blood pressure, pulse and urine output.

5. Hemorrhage:

Impaired homeostasis due to failure of coagulation factor production can result in bleeding from any site especially from GIT.

* It should need to manage by Different drugs.

6. Infection:

For infection use the broad spectrum drugs.

7. Renal failure:

Perform Dialysis, if there is renal failure.

8. Acetylcysteine:

It is an anidot of Paracetamol (Local Name Pk)

It is helpful for managing Liver / Hepatic failure.

9. Liver Transplantation:

It is perform at the end stage of Hepatic failure.