Materiały źródłowe

• #1 Acute Liver Failure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482374/

  Acute liver failure is defined as severe acute liver injury for fewer than twenty-six weeks duration with encephalopathy and impaired synthetic function (INR of 1.5 or higher) in a patient without cirrhosis or preexisting liver disease. […] This activity reviews the etiology, evaluation, and management of acute liver failure. […] An extensive workup for the etiology of ALF is recommended, as this guides directed therapy and helps determine the outcome. Viral hepatitis and drug-induced hepatitis are the 2 most common causes of ALF worldwide. Other causes include hypoxia-induced liver injury, acute Budd-Chiari syndrome, veno-occlusive disease, Wilson disease, mushroom ingestion, sepsis, autoimmune hepatitis, acute fatty liver of pregnancy, HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome, heatstroke, and malignant infiltration (with metastasis from breast cancer, small cell lung cancer, and lymphoma) of the liver.

• #2 Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/acute-liver-failure-in-adults-etiology-clinical-manifestations-and-diagnosis

  Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis […] This topic will review the etiology, clinical manifestations, and diagnosis of acute liver failure in adults. […] ETIOLOGY […] Viral hepatitis […] Acetaminophen and other hepatotoxins […] Idiosyncratic drug reactions […] Hypoperfusion […] Acute liver failure refers to the development of severe acute liver injury with impaired synthetic function (INR of ≥1.5) and altered mental status in a patient without cirrhosis or preexisting liver disease. […] A commonly used cutoff to define acute liver failure is an illness duration of <26 weeks. [...] Acute liver failure may also be diagnosed in patients with previously undiagnosed Wilson disease, vertically acquired or reactivation of hepatitis B virus, or autoimmune hepatitis, in whom underlying cirrhosis may be present, provided the disease has been recognized for <26 weeks.

• #3 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://hpbsurgery.ucsf.edu/condition/acute-liver-failure-alf

  Acute liver failure (ALF) (also called fulminant hepatic failure) is a rare condition characterized by the abrupt onset of severe liver injury, manifest as a profound liver dysfunction as well as a confusional state called hepatic encephalopathy in individuals with no prior history of liver disease. The lack of prior liver disease is critical to the definition of ALF. […] Despite its relative rarity, ALF is important because it is associated with a high mortality. […] The incidence of ALF is poorly defined but estimated to be approximately 2,000 cases per year in the United States, making it far less common than chronic liver disease. […] Liver injury from drugs and toxins is currently the most common cause of ALF in the US. […] Acetaminophen poisoning is by far the leading single cause of ALF in the US and is responsible for nearly 50% of all cases.

• #4 Acute liver failure: Management update and prognosis | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-acute-liver-failure-management-update-articulo-S2255534X24000628

  Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. […] The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. […] Acute liver failure (ALF) is a complex, multisystemic, unpredictable, and rapidly progressing syndrome caused by numerous etiologies (viral infections, herbal medicine and drugs, autoimmune diseases, genetic and/or environmental factors). […] The probability of spontaneous recovery or transplant-free survival (TFS) is related to etiology and HE grade. […] The main causes of death are sepsis and cerebral edema. […] The mortality rate is 25 to 30% and the main causes of death are sepsis and cerebral edema.

• #5 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://transplantsurgery.ucsf.edu/condition/acute-liver-failure-alf

  Acute liver failure (ALF) (also called fulminant hepatic failure) is a rare condition characterized by the abrupt onset of severe liver injury, manifest as a profound liver dysfunction as well as a confusional state called hepatic encephalopathy in individuals with no prior history of liver disease. The lack of prior liver disease is critical to the definition of ALF. […] Despite its relative rarity, ALF is important because it is associated with a high mortality. […] The incidence of ALF is poorly defined but estimated to be approximately 2,000 cases per year in the United States, making it far less common than chronic liver disease. […] Liver injury from drugs and toxins is currently the most common cause of ALF in the US. […] Acetaminophen poisoning is by far the leading single cause of ALF in the US and is responsible for nearly 50% of all cases.

• #6 Acute liver failure – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1010

  Acute liver failure is a rare, life-threatening, potentially reversible condition defined by jaundice, coagulopathy, and hepatic encephalopathy. […] The aetiology and the interval from onset of jaundice to the development of encephalopathy have a significant impact on prognosis. […] Aetiology is established by history, serological assays, and exclusion of alternative causes, including acute presentations of chronic liver diseases. […] ALF may be classified as hyperacute, acute, or subacute, depending on the interval from the onset of jaundice to the development of encephalopathy. […] 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. […] Key diagnostic factors include presence of risk factors, hepatotoxic drugs, chronic alcohol misuse, jaundice, coagulopathy, and signs of hepatic encephalopathy.

• #7 Acute liver failure – Symptoms, Causes, Images, and Treatment Options

  https://www.epocrates.com/online/diseases/1010/acute-liver-failure

  Acute liver failure is a rare, life-threatening, potentially reversible condition defined by jaundice, coagulopathy, and hepatic encephalopathy. […] The etiology and the interval from onset of jaundice to the development of encephalopathy have a significant impact on prognosis. […] Etiology is established by history, serological assays, and exclusion of alternative causes, including acute presentations of chronic liver diseases.

• #8 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  Numerous causes of fulminant hepatic failure exist, but hepatotoxicity due to acetaminophen and idiosyncratic drug reactions is the most common cause in the United States. For nearly 15% of patients, the cause remains indeterminate. […] Drug-related hepatotoxicity is a leading cause of emergent liver transplantation; in Western nations, DILI is the primary cause of acute liver failure in adults. […] The most important step in the assessment of patients with acute liver failure is to identify the cause, as certain causes demand immediate and specific treatment. […] The development of liver failure represents the final common outcome of a wide variety of potential causes, as the broad differential diagnosis suggests. […] The etiology of this intracranial hypertension (ICH) is not fully understood, but it is considered to be multifactorial.

• #9 Acute Liver Failure | Cleveland Clinic

  https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/acute-liver-failure

  Acute liver failure has many etiologies. The most common cause of ALF in the U.S. and Western Europe is drug-induced liver injury. In developing countries, viral hepatitis is the predominant cause of ALF. Identifying the etiology of ALF is important for defining the treatment approach and prognosis. For example, the timely use of antidotes for several forms of acute liver injury depends on identifying the inciting agent. Drug-induced liver injury accounts for about 50% of ALF cases in the U.S. Many over-the-counter medications, dietary supplements, weight loss medications, and prescription medications can lead to acute liver injury. Acetaminophen hepatotoxicity is the most common cause of ALF in the U.S. and Western Europe. It results from excessive ingestion of acetaminophen either from suicidal ideations or inadvertent use of supratherapeutic doses for pain control. Viral hepatitis is the most common cause of ALF worldwide and is the predominant cause of ALF in developing countries. Hepatitis A, B, and E infections have been implicated, as well as other rare viral causes including herpes simplex virus, Epstein-Barr virus, cytomegalovirus, and parvoviruses. Mushroom poisoning, though rarely seen, is an important cause of ALF. Autoimmune hepatitis can present as ALF. Any condition that results in acute ischemic injury to the liver can lead to ALF. Pregnancy specific liver diseases can result in ALF and may be associated with significant morbidity and mortality.

• #10 Acute Liver Failure: Summary of a Workshop

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3381946/

  Acute liver failure (ALF) is a rare but challenging clinical syndrome with multiple causes; a specific etiology cannot be identified in 15% of adult and 50% of pediatric cases. […] The causes of ALF include viral hepatitis, drug-induced and toxin-induced liver disease, metabolic errors, ischemia, and miscellaneous rare causes. […] The most frequent single cause of ALF was acetaminophen overdose accounting for 46% of cases. […] The distribution of etiologies differs around the world. In Africa and Asia, viral hepatitis is the leading cause of ALF, and cases of hepatitis E as well as hepatitis A and B are common. […] Acetaminophen, shock, and hepatitis A have favorable outcomes, with spontaneous recovery rates of 58% to 64%, compared to drug-induced, autoimmune, and indeterminate ALF (20% to 25%).

• #11 A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure

  https://www.mdpi.com/2077-0383/12/23/7451

  Acute liver failure (ALF) is a rare and specific form of severe hepatic dysfunction characterized by coagulopathy and hepatic encephalopathy in a patient with no known liver disease. […] In this review, we provide a comprehensive update on the etiology, diagnosis, and management of ALF. […] Drug-induced liver injury (DILI) is the primary cause of ALF in the United States of America (USA), Europe, and Australia, while acute hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis E virus (HEV) are the primary causes in Asia and Africa. […] Acetaminophen is the most common medication associated with ALF and is responsible for 45.7% of ALF cases in North America, and 65.4% in the UK. […] In Europe, it is reported that 8% of all liver transplantations (LT) are performed due to ALF, and of those ALF cases, 19% are caused by viral hepatitis, 18% by DILI, 4% have toxic causes, 3% have traumatic or post-operative ALF, while 56% have unknown or other causes.

• #12 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://transplantsurgery.ucsf.edu/condition/acute-liver-failure-alf

  ALF secondary to acetaminophen poisoning may result from the intentional ingestion of a large amount of acetaminophen (as part of a suicide attempt), or from unintentional overdosing due to a so-called „therapeutic misadventure.” […] Scores of drugs other than acetaminophen can also produce severe liver injury. […] Certain mushrooms, notably Amanita phalloides, also called the „death cap”, contain very potent liver toxins. […] In the past, viral hepatitis B (HBV) was one of the leading causes of ALF in the US, but its incidence has been declining. […] Several metabolic diseases may affect the liver and represent rare causes of ALF. […] Autoimmune hepatitis is a relatively rare condition in which the immune system of the affected individual attacks the liver in a process that is broadly analogous to liver transplant rejection, only without the transplant.

• #13 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://hpbsurgery.ucsf.edu/condition/acute-liver-failure-alf

  ALF secondary to acetaminophen poisoning may result from the intentional ingestion of a large amount of acetaminophen (as part of a suicide attempt), or from unintentional overdosing due to a so-called „therapeutic misadventure.” […] In the past, viral hepatitis B (HBV) was one of the leading causes of ALF in the US, but its incidence has been declining. […] Several metabolic diseases may affect the liver and represent rare causes of ALF. […] Autoimmune hepatitis is a relatively rare condition in which the immune system of the affected individual attacks the liver in a process that is broadly analogous to liver transplant rejection, only without the transplant. […] When all is said and done, after an extensive evaluation that includes blood testing, radiological studies, and often even liver biopsy, the cause of ALF in at least 15% of adult cases in the US remain enigmatic. […] The most important antidote is N-acetylcysteine (NAC) that is used for acetaminophen poisoning. […] ALF is a medical emergency and requires prompt medical evaluation and treatment.

• #14 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  Acetaminophen ingestion of more than 10 g simply overwhelms the normal hepatic stores of glutathione, allowing reactive metabolites to escape. […] Chronic alcohol use may greatly increase the susceptibility to hepatotoxicity from acetaminophen because of depleted glutathione stores. […] The HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome occurs in 0.1-0.6% of pregnancies. It is usually associated with preeclampsia and may rarely result in liver failure.

• #15 Acute liver failure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-liver-failure/symptoms-causes/syc-20352863

  Acute liver failure occurs when liver cells are seriously damaged and are no longer able to function. Possible causes include: […] Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. […] Hepatitis A, hepatitis B and hepatitis E increase the risk of acute liver failure. Other viruses that can increase risk include Epstein-Barr virus, cytomegalovirus and herpes simplex virus. […] Some prescription medicines, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, can cause acute liver failure. […] Herbal drugs and supplements, including kava, ephedra, skullcap and pennyroyal, have been linked to acute liver failure. […] Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for one that is safe to eat.

• #16 A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure

  https://www.mdpi.com/2077-0383/12/23/7451

  Acute hepatitis C virus (HCV) infection very rarely progresses to ALF. […] ALF due to non-acetaminophen DILI often presents with less severe transaminase elevations and higher bilirubin levels compared to acetaminophen, and multiorgan failure is less common. […] The most common causes of non-acetaminophen toxicity are antituberculosis drugs (mainly isoniazid), antimicrobials (nitrofurantoin and ketoconazole), antiepileptics (valproic acid, phenytoin), and non-steroidal anti-inflammatory drugs (NSAIDs). […] If any other autoimmune disease is present, suspicion for autoimmune hepatitis (AIH) as the cause of ALF should be considered. […] Approximately 80% of patients with ALF due to AIH are women and ALF due to AIH has particularly poor outcomes and often requires LT. […] In ALF due to Wilson disease, most patients are <20 years of age, and it presents with Coombs-negative hemolytic anemia and high bilirubin to ALP ratio.

• #17 Acute Liver Failure | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-acute-liver-failure-S1665268119316734

  Other commonly implicated agents include HAART, anticonvulsants and isoniazide; methylenedioxymethamphetamine (MDMA, ectasy), an abused recreational drug has also been associated with ALF. […] About 15 to 20% of ALF occur due to no detectable cause in spite of intensive investigations. […] Viral etiology as a cause of ALF has become relatively less common. Hepatitis B and hepatitis A account for 8% and 4% of ALF respectively. […] Hepatitis E virus is of concern to cause ALF in endemic areas like Russia, Pakistan, Mexico or India, and tends to be severe in pregnant women. […] Metabolic disorders like acute fatty liver of pregnancy, Wilsons disease, Reyes syndrome, galactosemia, hereditary fructose intolerance, and tyrosinemia may cause ALF. […] About 17% of ALF of undetermined cause may include non A-E viral hepatitis, other drug toxicity, and possibly unrecognized metabolic and genetic diseases. […] Certain etiologies of ALF have shown poorer outcomes. Idiosyncratic drug injury, acute hepatitis B, autoimmune hepatitis, mushroom poising, Wilsons disease, Budd-Chiari syndrome and indeterminate causes are among those to have an undesirable outcome.

• #18 Acute Liver Failure (ALF) – EMCrit Project

  https://emcrit.org/ibcc/alf/

  Causes of acute liver failure include acetaminophen, other drugs and toxins, viral hepatitis, autoimmune hepatitis, and less common causes such as Wilson’s disease and Budd-Chiari syndrome. […] Common causes include acetaminophen or viral hepatitis. […] Numerous drugs are implicated. Occasional clues to idiosyncratic drug-induced hepatitis may include rash, fever, and/or eosinophilia. […] Alcohol does not cause acute liver failure; rather, this is classified as acute-on-chronic liver failure. […] HAV is usually self-limited, but can cause ALF. […] HBV can cause ALF, especially reactivation of chronic HBV in the context of chemotherapy or immunosuppression. […] Autoimmune hepatitis is also a cause of acute liver failure.

• #19 Acute Liver Failure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482374/

  Drug-induced hepatitis accounts for almost half the cases of ALF in the United States, of which acetaminophen is the most common cause. […] Hepatitis A and E are the leading causes of liver failure, most of which are reported from developing countries. Hepatitis B infection could cause liver failure from both acute infections, as well as, from reactivation of hepatitis B following initiation of immunosuppressive therapy. Co-infection with both hepatitis B and C could lead to ALF, although it is rarely seen with hepatitis C alone. Other viral etiologies of ALF include herpes simplex virus, cytomegalovirus (CMV), Epstein-Barr virus (EBV), Parvoviruses, adenovirus, and varicella-zoster virus. […] The etiology and the incidence of ALF vary in developed countries as compared to developing countries. Hepatitis A, B, and E are the leading causes of ALF worldwide and are mostly seen in the developing countries compared to drug-induced liver injury in developed countries.

• #20 A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure

  https://www.mdpi.com/2077-0383/12/23/7451

  In India, viral hepatitis (HAV, HBV, HEV) is the primary cause of ALF, followed by DILI, mainly due to antituberculosis drugs. […] In China, traditional Chinese medicines, herbal and dietary supplements, and antituberculosis drugs have been identified as the leading causes of DILI. […] Less than 1% of the patients with HAV infection develop ALF, and ALF is mainly seen in elderly patients, who generally have a worse prognosis. […] Overall, ALF due to HAV has a good prognosis with 70% spontaneous or transplant-free survival. […] HBV is the most common viral cause of severe ALF due to either de novo infection, reactivation in a patient with previous HBV infection, or delta superinfection. […] Less than 4% of patients with acute HBV develop ALF. […] Mortality rates for ALF due to HBV are higher than for ALF due to HAV or HEV infections.

• #21 Signs & Symptoms of Liver Failure, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17819-liver-failure

  Acute liver failure happens suddenly, when something overwhelms your liver’s capacity to cope. It’s usually a large toxic load, like poisoning. Sometimes, it’s a severe viral infection. In acute liver failure, your liver rapidly begins to shut down, causing immediate symptoms. This is a medical emergency. […] Acute liver failure usually occurs in people with no prior history of liver disease. It happens when something overwhelmingly injures your liver. This might be an overwhelming toxic load that your liver encounters as it’s filtering your blood. It can also be an acute infection that attacks your liver directly. […] Causes include: Viral infections, including viral hepatitis A, B, D and E. Less commonly, Epstein-Barr Virus, cytomegalovirus (CMV), varicella zoster virus or herpes simplex virus may cause it. Drug overdoses. Acetaminophen overdose is the most common cause of acute liver failure in the U.S. Other medications that may cause it in overdose include NSAIDs (nonsteroidal anti-inflammatory drugs) and certain antibiotics. Pregnancy complications. Rare but serious pregnancy complications can overwhelm your liver, including acute fatty liver of pregnancy, preeclampsia and HELLP syndrome. Genetic disorders. Certain inherited liver diseases may cause acute liver failure if they go untreated, including autoimmune hepatitis and Wilson disease. Miscellaneous causes. Mushroom poisoning, metastatic cancer, septic shock or heatstroke may trigger acute liver failure.

• #22 Acute liver failure – Wikipedia

  https://en.wikipedia.org/wiki/Acute_liver_failure

  Common causes for acute liver failure are paracetamol (acetaminophen) overdose, idiosyncratic reaction to medication (e.g. tetracycline, troglitazone), excessive alcohol consumption (severe alcoholic hepatitis), viral hepatitis (hepatitis A or B is extremely uncommon in hepatitis C), acute fatty liver of pregnancy, and idiopathic (without an obvious cause). […] Reye syndrome is acute liver failure in a child with a viral infection (e.g. chickenpox); it appears that aspirin use may play a significant role. […] Wilson’s disease (hereditary copper accumulation) may infrequently present with acute liver failure. […] Acute liver failure also results from poisoning by the death cap mushroom (Amanita phalloides) as well as other amatoxin-producing fungus species. […] Certain strains of Bacillus cereus, a common species of bacterium implicated as a frequent cause of food poisoning, can cause fulminant liver failure through the production of cereulide, a toxin which destroys the mitochondria in affected hepatocytes, resulting in cell death.

• #23 Acute Liver Failure | Conditions and Treatments | Center for Liver Disease & Transplantation | Columbia University Department of Surgery

  https://columbiasurgery.org/conditions-and-treatments/acute-liver-failure

  Acute liver failure is a rare condition in which the liver rapidly deteriorates and stops functioning within a matter of days. […] It can be caused by overdosing on medication or ingesting toxic substances, and often affects those with no pre-existing liver conditions. […] The following are some of the most common causes of acute liver failure: […] Overdosing on acetaminophen (such as Tylenol) is the most common cause of acute liver failure in the U.S. […] Cancer that begins or spreads to the liver can cause acute liver failure. […] Common herbs such as aloe vera, chaparral, comfrey, ephedra, and kava can be toxic to the liver. […] In rare cases, hepatitis A, B, and E, as well as autoimmune hepatitis, can all cause acute liver failure. […] Rare conditions such as Wilsons disease can cause acute liver failure.

• #24 Liver Failure: Causes, Symptoms, Treatments, Tests & More

  https://www.webmd.com/fatty-liver-disease/digestive-diseases-liver-failure

  Reactions to certain prescription and herbal medications: Some kill cells in your liver. Others damage the duct system that moves bile through it. […] Eating poisonous wild mushrooms: A kind called Amanita phalloides, also known as the death cap, contains toxins that damage liver cells and lead to liver failure within a couple of days. […] Autoimmune hepatitis: As with viral hepatitis, this disease, in which your body attacks your liver, can lead to acute liver failure. […] Wilsons disease: This genetic disease prevents your body from removing copper. It builds up in your liver and damages it. […] Acute fatty liver of pregnancy: In this rare condition, excess fat gathers on your liver and damages it. […] Septic shock: This overwhelming infection in your body can damage your liver or cause it to stop working. […] Budd Chiari syndrome: This rare disease narrows and blocks the blood vessels in your liver. […] Industrial toxins: Many chemicals, including carbon tetrachloride, a cleaner and degreaser, can damage your liver.

• #25 Acute liver failure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-liver-failure/symptoms-causes/syc-20352863

  Liver failure can be caused by autoimmune hepatitis a disease in which the immune system attacks liver cells, causing inflammation and injury. […] Vascular diseases, such as Budd-Chiari syndrome, can cause blockages in the veins of the liver and lead to acute liver failure. […] Rare metabolic diseases, such as Wilson’s disease and acute fatty liver of pregnancy, sometimes cause acute liver failure. […] Cancer that either begins in or spreads to the liver can cause the liver to fail. […] Overwhelming infection, called sepsis, and shock can severely reduce blood flow to the liver, causing liver failure. […] Some cases of acute liver failure have no obvious cause.

• #26 Acute liver failure | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-liver-failure?lang=us

  Acute liver failure (ALF), also known as fulminant hepatic failure, refers to sudden severe liver dysfunction from injury without underlying chronic liver disease (CLD), although sometimes it presents as decompensation of unknown chronic liver disease. […] Causes of acute liver failure include: viral infection, hepatitis B is probably the most common; idiopathic (15%), i.e. cause unknown; drug toxicity, e.g. acetaminophen toxicity, chemotherapeutic agents; toxin exposure, e.g. toxic mushrooms, carbon tetrachloride (industrial chemical), aflatoxin; metabolic disease, e.g. Wilson disease, Reye disease, acute fatty liver of pregnancy, HELLP syndrome; vascular causes, e.g. Budd-Chiari syndrome, right heart failure, shock (i.e. ischemic hepatitis); autoimmune hepatitis.

• #27 Acute Liver Failure: Etiology, Manifestations, and Clinical Management – Fitzgerald Health Education Associates

  https://www.fhea.com/resource-center/acute-liver-failure-etiology-manifestations-and-clinical-management/

  Budd-Chiari syndrome, Wilsons disease, and hemochromatosis are rare genetic disorders that affect the liver. Wilsons disease is a disorder of copper metabolism which can cause liver disease. Budd-Chiari syndrome is a rare condition involving a blockage in the hepatic veins, which leads to liver damage. […] Hemochromatosis is a condition where the body absorbs too much iron from the diet. This leads to an iron overload in the liver and other organs, which can eventually cause liver damage.

• #28 Acute Liver Failure – Core EM

  https://coreem.net/core/acute-liver-failure/

  Viral Hepatitis (A,B,E): Are the predominant causes of acute liver failure in the developing world where vaccination and effective sanitation are less widespread. […] Hepatitis B reactivation can cause acute liver failure in the setting of immunosuppression (i.e. chemotherapy), and is a more common cause of ALF than other viral infections in developed nations. […] Ischemia: Shock, prolonged hypoxia, severe heart failure leading to ischemia can cause acute liver failure. […] Autoimmune hepatitis: Not as uncommon as one might think and should be considered if other known culprits are excluded (though workup will most likely take place once admitted) (1,2). […] Budd Chiari (hepatic venous outflow occlusion). […] Pregnancy (acute fatty liver of pregnancy and HELLP) emergent delivery often indicated.

• #29 Acute Liver Failure Causes & Symptoms

  https://www.blkmaxhospital.com/blogs/know-common-causes-of-acute-liver-failure

  A sudden reduction in blood flow to the liver, often due to cardiac arrest, severe hypotension, or shock, can result in ischemic hepatitis, which may progress to acute liver failure. […] Inherited metabolic disorders such as Wilson’s disease (characterized by copper accumulation in the liver) or Reyes syndrome in children can precipitate acute liver failure. […] Rarely, acute fatty liver of pregnancy (AFLP) can occur in the third trimester, posing a severe risk to both the mother and fetus. […] Severe systemic infections or sepsis can overwhelm the liver, impairing its ability to detoxify the blood and leading to acute liver failure. […] In some cases, the underlying cause of acute liver failure remains unidentified despite thorough investigation.

• #30 Pediatric Acute Liver Failure | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/acute-liver-failure/

  Drugs or toxins: Acetaminophen […] Cardiovascular conditions: Extracorporeal membrane oxygenation, hypoplastic left heart syndrome, shock, asphyxia, myocarditis […] Metabolic disorders: Galactosemia, tyrosinemia, iron storage, mitochondrial condition, hereditary fructose intolerance (HFI) and fatty acid oxidation […] Immune-related conditions: Autoimmune hepatitis, immune dysregulation, immune deficiency, hemophagocytic lymphohistiocytosis (HLH). […] Acute liver failure in toddlers and older children can be caused by: Infections: Hepatitis A, B and D, NANB hepatitis, Epstein-Barr virus, cytomegalovirus, herpes and leptospirosis […] Drugs or toxins: Valproic acid, isoniazid, halothane, acetaminophen, mushroom, phosphorous and aspirin […] Cardiovascular conditions: Myocarditis, heart surgery, cardiomyopathy, Budd-Chiari syndrome […] Metabolic disorders: Fatty acid oxidation, Reye’s syndrome, leukemia […] Immune-related conditions: Autoimmune hepatitis, immune dysregulation, immune deficiency, hemophagocytic lymphohistiocytosis (HLH).

• #31 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://transplantsurgery.ucsf.edu/condition/acute-liver-failure-alf

  ALF may rarely occur in pregnancy, usually during the last trimester and most often in patients with preeclampsia. […] When all is said and done, after an extensive evaluation that includes blood testing, radiological studies, and often even liver biopsy, the cause of ALF in at least 15% of adult cases in the US remain enigmatic. […] The most important antidote is N-acetylcysteine (NAC) that is used for acetaminophen poisoning. […] ALF is a medical emergency and requires prompt medical evaluation and treatment. […] Liver transplant can be life saving for patients with severe ALF. […] Since there are multiple causes of acute liver failure that all lead to essentially the same syndrome, no single measure is likely to be effective in preventing all cases.

• #32 A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure

  https://www.mdpi.com/2077-0383/12/23/7451

  Pregnancy-related ALF occurs in the third trimester in the form of hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, or acute fatty liver of the pregnancy (AFLP). […] ALF after hemi-hepatectomy can be seen after an extensive resection of the liver. […] Secondary causes of ALF may include sepsis, malaria, leptospirosis, rickettsial disease, thyroid disease, Still’s disease, and hemophagocytic syndromes. […] Despite extensive investigation in many patients, the cause of ALF remains unknown.

• #33 Acute liver failure: Management update and prognosis | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-acute-liver-failure-management-update-articulo-S2255534X24000628

  Sudden and severe liver damage in ALF can have different causes, such as drug toxicity, viral infections, autoimmune disorders, genetic disorders, vascular problems, malignancies, and metabolic alterations. […] Paracetamol poisoning (PP) is a worldwide problem, especially due to the increased use of narcotics and paracetamol. […] Non-paracetamol-related causes of ALF can be idiosyncratic or related to drugs, viral hepatitis, autoimmune hepatitis, and dengue, among others. […] The presence of ALF that is associated with the HELLP syndrome and AFLP is an obstetric emergency that requires multidisciplinary management. […] The comprehensive management of patients with liver failure is complex. […] The transplantation decision should be made in a time lapse not over 3 days, through the evaluation of a multidisciplinary team, with the intention of preventing the clinical deterioration that would contraindicate a liver transplant.

• #34 Acute Liver Failure | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/a/acute-liver-failure

  Acute liver failure has many causes. Some causes of acute liver failure are: […] Often the cause of acute liver failure in children cannot be found. One study showed that this was the case for about 44% of all children with acute liver failure. This number is about 63% in children with acute liver failure under 2 years of age. […] Treatment for acute liver failure depends on what caused the disease. Some causes can be treated by medicine and the liver will recover. If the liver does not recover from medication, a liver transplant may be required. […] About 40% of children with acute liver failure need a liver transplant to survive.

• #35 Acute Liver Failure – Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/acute-liver-failure

  Systemic Lupus Erythematosus (SLE) where the patient’s immune system begins destroying their liver cells, causing inflammation and injury and eventually leads to liver failure. […] Vascular disorders of the liver, coronary artery disease or insufficient blood flow to the liver could also lead to acute liver failure due to inadequate blood flow. […] Metabolism syndrome, Wilson’s disease, and Acute fatty liver of pregnancy (AFLP) conditions can also cause acute liver failure. […] An advanced cancer stage if the tumor has spread to the large area of the liver and replace the healthy liver tissues. When this happens, it could lead to acute liver failure. […] Heatstroke or over-exercise in an extremely hot temperature could cause acute liver failure. […] Some acute liver failure may not have visible causes.

• #36 Causes and Outcomes of Acute Liver Failure in China | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080991

  Causes and Outcomes of Acute Liver Failure in China […] No extensive investigation has been performed and thus no representative data are available regarding acute liver failure (ALF) in China. This study aims to investigate the causes and outcomes of ALF in China and establish a prognostic model. […] Of the 177 patients included in this study, 112 (63.28%) eventually died. The common causes of ALF were drug toxicity (43.50%), indeterminate etiology (29.38%) and acute viral hepatitis (11.30%). Additionally, traditional Chinese herbs predominated in the causes of drug-induced ALF (30/77). […] Traditional Chinese medicine was a major cause of ALF in China. The spontaneous mortality of ALF was high, whereas the rate of liver transplantation was significantly low. […] The etiology of ALF showed worldwide variation. Some previous studies reported that synthetic pharmaceuticals (e.g. acetaminophen and phenprocoumon) were the most common cause of ALF in the United States and Europe, while in the Mediterranean region, around 40% of cases with ALF are caused by hepatotropic viruses, most frequently by HBV. According to our investigation, the most frequent etiology of ALF in China were drugs, which was in accordance with other reports from western developed countries. However, unlike the overwhelming majority of ALF induced by acetaminophen in western countries, traditional Chinese herbs dominated in the causes in China.

• #37 Acute Liver Failure – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/acute-liver-failure

  Acute liver failure is caused most often by drugs and hepatitis viruses. […] Overall, the most common causes of acute liver failure are viruses, primarily hepatitis B, and drugs and toxins, most commonly acetaminophen. […] In countries with poor sanitation, viral hepatitis is usually considered the most common cause; in countries where there is effective sanitation, toxins are usually considered the most common cause. […] The most common toxin is acetaminophen; toxicity is dose-related. […] Less common causes include vascular disorders, metabolic disorders, and autoimmune hepatitis. […] The cause cannot be determined in up to 20% of cases. […] The most common causes of acute liver failure are viral hepatitis (in countries where sanitation is poor) and drugs and toxins (in countries that have effective sanitation).

• #38 Evaluation of drug-induced liver injury as etiology for acute liver failure in Brazil | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-evaluation-drug-induced-liver-injury-as-S1665268121000090

  Little is known about the etiology of acute liver failure (ALF) in Latin America. The objective of this paper is to investigate the main etiologies of ALF in Brazil, including Drug Induced Liver Injury (DILI) using stringent causality criteria. […] 325 individuals had ALF mainly for unknown reasons (34%), DILI (27%) and AIH (18%). Reassessment of the 89 cases of DILI, using stringent causality criteria, revealed that in only 42 subjects could DILI be confirmed as the cause of ALF. […] Undetermined etiology and DILI are the main causes of ALF in Brazil. However, APAP toxicity and DILI due to HDS are mostly uncommon. […] The etiology of ALF in these patients is presented in Fig. 1. The majority of the cases were undetermined (IND-ALF) (34%), either DILI (DILI-ALF) or APAP toxicity (27%) and AIH (AIH-ALF) (18%) ALF. DILI was the most common cause of ALF in certain states of Brazil, particularly the Southern and Southeastern.

• #39 Acute Liver Failure (21.10.2011)

  https://di.aerzteblatt.de/int/archive/article/109839

  An estimated 200 to 500 patients develop life-threatening acute liver failure (ALF) in Germany each year. […] This article summarizes our current knowledge of the causes, clinical course, and treatment of ALF. […] A shift is currently taking place in Germany with respect to the predominant causes of ALF: The leading cause was formerly acute viral hepatitis, but now more cases of ALF are induced by toxic substances, while there is also a growing incidence of cryptogenic subacute ALF. […] Various etiological factors may lead to ALF, and it may be very difficult to identify the cause in an individual case. […] In the early 1980s acute hepatitis B virus (HBV) infection was viewed as the most frequent cause of ALF, but in the intervening three decades damage of the liver by toxic substances has assumed increasing importance, with acetaminophen (paracetamol) the primary culprit.

• #40 Acute Liver Failure: Evidence-Based Evaluation and Management – emDocs

  https://www.emdocs.net/acute-liver-failure-evidence-based-evaluation-and-management/

  Acute liver failure is the clinical manifestation of sudden and severe hepatic injury, and has a variety of underlying etiologies, including drug toxicity, viral infections, autoimmune and genetic disorders, thrombosis, malignancy, heat injury, and ischemia. […] The most common cause of ALF in the U.S. is acetaminophen toxicity, treated by N-acetylcysteine. […] The underlying etiology of ALF is not only established through history and laboratory testing, but also by the exclusion of alternative causes, including acute presentations of chronic liver diseases. […] Key historical risk factors for ALF include age > 40 years, female gender, poor nutritional status, pregnancy, chronic hepatitis, the use of multiple acetaminophen-containing medications for chronic pain. […] Drug-induced hepatotoxicity is a diagnosis of exclusion, any drug identified as the possible cause of ALF should be immediately stopped.

• #41 Acute liver failure – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1010

  Risk factors include chronic alcohol misuse, poor nutritional status or fasting, female sex, age 40 years, pregnancy, chronic hepatitis B, chronic pain and narcotic use, herbal and dietary supplement hepatotoxicity, Wilson’s disease, paracetamol and antidepressant therapy, chronic hepatitis C, and HIV and hepatitis C co-infection.

• #42 Acute Liver Failure (21.10.2011)

  https://di.aerzteblatt.de/int/archive/article/109839

  In Germany, epidemiological data of this nature are sparse and usually retrospective. […] In a retrospective study of 134 patients diagnosed with ALF (International Normalized Ratio [INR] 1.5; encephalopathy without pre-existing chronic liver disease) between 2002 and 2008, 39% of cases were found to have been caused by toxic substances primarily acetaminophen and 23% by acute infection with hepatotropic viruses. […] Acetaminophen toxicity does not inevitably lead to ALF, but various risk factors increase the probability of acute liver damage even at therapeutic doses. […] Viral hepatitides, above all acute HBV infection, remain the cause of a high proportion of cases of ALF. […] The rarer causes of ALF include idiosyncratic toxic impairment. […] In as many as 2% of American ALF patients the cause is a fulminant first manifestation of Wilson disease. […] Further causes of ALF are listed in Table 1.

• #43 Defining and Managing Acute Liver Failure | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/back-basics/defining-and-managing-acute-liver-failure

  Acute liver failure (ALF) is defined by the following criteria: […] Survival without liver transplantation varies on the etiology. […] Common causes of ALF in the United States. […] The liver enzyme pattern can give preliminary clues to the etiology of ALF. […] Although improvements in medical care have significantly lowered mortality rates, LT is being implemented in approximately 30% of patients with ALF, and offers a life-saving treatment. […] Mortality in ALF is related to cerebral edema and progressive multi-organ dysfunction.

• #44 Causes and Outcomes of Acute Liver Failure in China | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080991

  The spontaneous death rates of ALF were reported to range from 10% to 90% in different cohorts. The mortality of ALF without liver transplantation in our study arrived at 63.28%. […] Liver transplantation remained the only treatment option in ALF when standard medical therapy failed. In western developed countries, rates of transplant ranged from 25% to 30% in patients with ALF, but based on our study, the rate was as low as 0% in China. […] In conclusion, traditional Chinese medicine was a major cause of ALF in China. The spontaneous mortality of ALF was high, whereas the rate of liver transplantation was significantly low. The established prognostic model of ALF had early applicability and superior sensitivity and specificity.

• #45 Acute Liver Failure – Core EM

  https://coreem.net/core/acute-liver-failure/

  There is clear evidence for preventing acute liver failure in patients with acute acetaminophen overdose. […] There is less clear evidence that NAC may be helpful in patients with acute liver failure from non-acetaminophen related causes (though there is also little harm in giving it). […] If transplant surgery is not available in-house, acute liver failure patients should be transferred immediately.

• #46 Acute Liver failure

  https://rare-liver.eu/patients/understand-your-diagnosis/acute-liver-failure/

  Causes of acute liver failure in childhood vary by age and can be broadly categorized as infectious, immunologic, metabolic, and toxin- or drug-related. Viral hepatitis, particularly herpes simplex, is common in neonates, metabolic disease is more common in infants, and autoimmune hepatitis and acetaminophen toxicity are more common in older children. In recent years, modern molecular genetic methods have revealed new genetic causes of acute liver failure in children. […] In 15-25 percent of cases in adults and up to 50 percent in children, no cause can be identified.

• #47 Acute Liver Failure: Evidence-Based Evaluation and Management – emDocs

  https://www.emdocs.net/acute-liver-failure-evidence-based-evaluation-and-management/

  Identification of the underlying cause of ALF is necessary, as treatment varies. […] An underlying etiology of viral hepatitis may affect management of the patient with ALF. […] The most prevalent cause of ALF in the U.S. is acetaminophen toxicity, and there is an effective antidote available, N-acetylcysteine (NAC). […] The management of ALF involves: Identification of the etiology of ALF whenever possible and initiation of specific treatment. […] The most common etiologies in adults and children, from most to least common, are provided in Table 1.

Zobacz więcej