Acute hepatic failure/es - Revision history

Ostermayer: Created page with "==Antecedentes=="

2026-01-12T21:58:04Z

Created page with "==Antecedentes=="

Ostermayer: Created page with "===Ictericia==="

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Created page with "===Ictericia==="

← Older revision		Revision as of 21:55, 12 January 2026
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	~~<div lang="en" dir="ltr" class="mw-content-ltr">~~		===[[Special:MyLanguage/Jaundice\|Ictericia]]===
	===[[Special:MyLanguage/Jaundice\|~~Jaundice~~]]===
	~~</div>~~

	<div lang="en" dir="ltr" class="mw-content-ltr">		<div lang="en" dir="ltr" class="mw-content-ltr">

Ostermayer: Created page with "===Encefalopatía (cambio en el estado mental)==="

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Created page with "===Encefalopatía (cambio en el estado mental)==="

← Older revision		Revision as of 21:55, 12 January 2026
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	===Definiciones===		===Definiciones===

	~~<div lang="en" dir="ltr" class="mw-content-ltr">~~		*Insuficiencia hepática hiperaguda: la encefalopatía ocurre dentro de los 7 días del inicio de la ictericia; este subgrupo es probable que sobreviva con manejo médico a pesar de la alta incidencia de edema cerebral<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>
	*~~Hyperacute liver failure~~: ~~encephalopathy occurs within~~ 7 ~~days of the onset of jaundice~~; ~~this subset is likely to survive with medical management despite the high incidence of~~ cerebral ~~edema~~<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>		*Insuficiencia hepática aguda: intervalo de 8-28 días desde la ictericia hasta la encefalopatía; este subgrupo tiene una alta incidencia de edema cerebral y un peor pronóstico sin trasplante de hígado<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>
	*~~Acute liver failure~~: ~~interval of~~ 8-28 ~~days from jaundice to encephalopathy~~; ~~this subset has a high incidence of~~ cerebral ~~edema and a poorer prognosis without liver transplant~~<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>		*Insuficiencia hepática subaguda: intervalo de 5-12 semanas desde el inicio de la ictericia hasta el inicio de la encefalopatía; este subgrupo tiene una menor incidencia de edema cerebral, pero un mal pronóstico<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>
	*~~Subacute liver failure~~: ~~interval of~~ 5-12 ~~weeks from the onset of jaundice to the onset of encephalopathy~~; ~~this subset has a lower incidence of~~ cerebral ~~edema~~, ~~but a poor prognosis~~<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>
	~~</div~~>

	{{Acute hepatitis causes}}		{{Acute hepatitis causes}}
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	~~<div lang~~=~~"en" dir~~=~~"ltr" class~~=~~"mw-content-ltr">~~		===Otras Causas Raras de Insuficiencia Hepática Aguda===
	===~~Other Rare Causes of Acute Liver Failure===~~
	~~</div>~~

	~~<div lang="en" dir="ltr" class="mw-content-ltr">~~		*'''[[Special:MyLanguage/Wilson's disease\|Wilson's disease]]''': elevaciones inexplicadas en las pruebas de función hepática, síntomas neuropsiquiátricos, anillos de Kayser-Fleischer en el examen ocular
	*'''[[Special:MyLanguage/Wilson's disease\|Wilson's disease]]''': ~~unexplained elevations in LFTs~~, ~~neuro-psychiatric symptoms~~, Kayser-Fleischer ~~rings on eye exam~~		*'''[[Special:MyLanguage/Autoimmune hepatitis\|Autoimmune hepatitis]]''': más común en mujeres, enfermedad hepática sin explicación, puede tener antecedentes familiares de otros trastornos autoinmunes
	*'''[[Special:MyLanguage/Autoimmune hepatitis\|Autoimmune hepatitis]]''': ~~more common in women~~, ~~liver disease without explanation~~, ~~may have family history of other autoimmune disorders~~		*'''[[Special:MyLanguage/Hemochromatosis\|Hemochromatosis]]''': antecedentes familiares de enfermedad hepática y enfermedad cardíaca
	*'''[[Special:MyLanguage/Hemochromatosis\|Hemochromatosis]]''': ~~family history of liver disease and cardiac disease~~		*'''[[Special:MyLanguage/Budd-Chiari\|Budd-Chiari]]''': historia de trastorno hipercoagulable, dolor abdominal y ascitis
	*'''[[Special:MyLanguage/Budd-Chiari\|Budd-Chiari]]''': ~~history of hypercoagulable disorder~~, abdominal ~~pain, and ascites~~
	~~</div>~~


	~~<div lang~~=~~"en" dir~~=~~"ltr" class~~=~~"mw-content-ltr">~~		==Características clínicas==
	=~~=Clinical Features==~~
	~~</div>~~

	~~<div lang="en" dir="ltr" class="mw-content-ltr">~~		[[File:Jaundice08.jpg\|thumb\|Ictericia de la piel]]
	[[File:Jaundice08.jpg\|thumb\|~~Jaundice of the skin~~]]		[[File:SpiderAngioma.jpg\|thumb\|Angioma en araña]]
	[[File:SpiderAngioma.jpg\|thumb\|~~Spider angioma~~]]		[[File:Hepaticfailure.jpg\|thumb\|\|Ascitis secundaria a [[Special:MyLanguage/cirrhosis\|cirrosis]].]]
	[[File:Hepaticfailure.jpg\|thumb\|\|~~Ascites secondary to~~ [[Special:MyLanguage/cirrhosis\|~~cirrhosis~~]].]]		[[File:Jaundice.jpg\|thumb\|Ictericia pediátrica con ictericia de la esclera.]]
	[[File:Jaundice.jpg\|thumb\|~~Pediatric jaundice with icterus of sclera~~.]]		*Hallazgos comunes en la insuficiencia hepática aguda
	*~~Common findings in acute liver failure~~		**[[Special:MyLanguage/hepatomegaly\|Hepatomegalia]] dolorosa
	**~~Tender~~ [[Special:MyLanguage/hepatomegaly\|~~hepatomegaly~~]]		**[[Special:MyLanguage/Jaundice\|Ictericia]]
	**[[Special:MyLanguage/Jaundice\|~~Jaundice~~]]		**[[Special:MyLanguage/Hepatic encephalopathy\|Encefalopatía hepática]]
	**[[Special:MyLanguage/Hepatic encephalopathy\|~~Hepatic encephalopathy~~]]
	**Asterixis		**Asterixis
	*~~Common findings in chronic liver failure~~		*Hallazgos comunes en la insuficiencia hepática crónica
	**[[Special:MyLanguage/Ascites\|~~Ascites~~]]		**[[Special:MyLanguage/Ascites\|Ascitis]]
	**Caput medusae		**Caput medusae
	**~~Palmar erythema~~		**Eritema palmar
	**~~Spider angiomata~~		**Angiomas en araña
	**~~Gynecomastia~~		**Ginecomastia
	**~~Testicular atrophy~~		**Atrofia testicular
	**~~Parotid gland enlargement~~		**Enlargement de la glándula parótida
	**~~Muscular atrophy~~		**Atrofia muscular
	**~~May also have~~ [[Special:MyLanguage/jaundice\|~~jaundice~~]], [[Special:MyLanguage/hepatic encephalopathy\|~~encephalopathy~~]], ~~and~~ asterixis ~~as in acute liver failure~~		**También puede tener [[Special:MyLanguage/jaundice\|ictericia]], [[Special:MyLanguage/hepatic encephalopathy\|encefalopatía]], y asterixis como en la insuficiencia hepática aguda
	~~</div>~~


	~~<div lang~~=~~"en" dir~~=~~"ltr" class~~=~~"mw-content-ltr">~~		==Diagnóstico diferencial==
	=~~=Differential Diagnosis==~~
	~~</div>~~


	~~<div lang="en" dir="ltr" class="mw-content-ltr">~~		===[[Special:MyLanguage/Encephalopathy\|Encefalopatía]] (cambio en el estado mental)===
	===[[Special:MyLanguage/Encephalopathy\|~~Encephalopathy~~]] (~~altered~~ mental ~~status~~)===
	~~</div>~~

	~~<div lang="en" dir="ltr" class="mw-content-ltr">~~		*[[Special:MyLanguage/Hypoglycemia\|Hipoglicemia]]
	*[[Special:MyLanguage/Hypoglycemia\|~~Hypoglycemia~~]]		*[[Special:MyLanguage/Hypoxia\|Hipoxia]]
	*[[Special:MyLanguage/Hypoxia\|~~Hypoxia~~]]		*[[Special:MyLanguage/Intracerebral hemorrhage\|Hemorragia intracerebral]] o masa
	*[[Special:MyLanguage/Intracerebral hemorrhage\|~~Intracerebral hemorrhage~~]] ~~or mass~~		*[[Special:MyLanguage/Meningitis\|Meningitis]]/[[Special:MyLanguage/encephalitis\|encefalitis]]
	*[[Special:MyLanguage/Meningitis\|Meningitis]]/[[Special:MyLanguage/encephalitis\|~~encephalitis~~]]		*[[Special:MyLanguage/CVA\|Accidente cerebrovascular]]
	*[[Special:MyLanguage/CVA\|~~CVA~~]]		*[[Special:MyLanguage/Alcohol intoxication\|Intoxicación alcohólica]]
	*[[Special:MyLanguage/Alcohol intoxication\|~~Alcohol intoxication~~]]		*[[Special:MyLanguage/Myxedema coma\|Coma mixédemico]]
	*[[Special:MyLanguage/Myxedema coma\|~~Myxedema coma~~]]		*[[Special:MyLanguage/Wernicke encephalopathy\|Encefalopatía de Wernicke]]
	*[[Special:MyLanguage/Wernicke encephalopathy\|Wernicke ~~encephalopathy~~]]
	*[[Special:MyLanguage/Sepsis\|Sepsis]]		*[[Special:MyLanguage/Sepsis\|Sepsis]]
	*[[Special:MyLanguage/Seizure\|~~Seizure~~]]/post-ictal ~~state~~		*[[Special:MyLanguage/Seizure\|Convulsión]]/estado post-ictal
	*[[Special:MyLanguage/Uremia\|Uremia]]		*[[Special:MyLanguage/Uremia\|Uremia]]
	*[[Special:MyLanguage/Electrolyte abnormality\|~~Electrolyte abnormality~~]]		*[[Special:MyLanguage/Electrolyte abnormality\|Anomalía electrolítica]]
	*[[Special:MyLanguage/Acute hepatic failure\|~~Acute hepatic failure~~]]		*[[Special:MyLanguage/Acute hepatic failure\|Insuficiencia hepática aguda]]
	~~</div>~~

Ostermayer: Created page with "Insuficiencia hepática aguda"

2026-01-12T21:52:57Z

Created page with "Insuficiencia hepática aguda"

New page

<languages/>

==Antecedentes==

[[File:Liver vascular anatomy.png|thumb|Anatomía vascular del hígado.]]

===Definiciones===

<div lang="en" dir="ltr" class="mw-content-ltr">
*Hyperacute liver failure: encephalopathy occurs within 7 days of the onset of jaundice; this subset is likely to survive with medical management despite the high incidence of cerebral edema<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>
*Acute liver failure: interval of 8-28 days from jaundice to encephalopathy; this subset has a high incidence of cerebral edema and a poorer prognosis without liver transplant<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>
*Subacute liver failure: interval of 5-12 weeks from the onset of jaundice to the onset of encephalopathy; this subset has a lower incidence of cerebral edema, but a poor prognosis<ref>O’Grady, JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. July 1993, Volume 342, Issue 8866, Page 273-275</ref>
</div>

{{Acute hepatitis causes}}

{{Drug or Toxin Related Liver Disease}}

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===Other Rare Causes of Acute Liver Failure===
</div>

<div lang="en" dir="ltr" class="mw-content-ltr">
*'''[[Special:MyLanguage/Wilson's disease|Wilson's disease]]''': unexplained elevations in LFTs, neuro-psychiatric symptoms, Kayser-Fleischer rings on eye exam
*'''[[Special:MyLanguage/Autoimmune hepatitis|Autoimmune hepatitis]]''': more common in women, liver disease without explanation, may have family history of other autoimmune disorders
*'''[[Special:MyLanguage/Hemochromatosis|Hemochromatosis]]''': family history of liver disease and cardiac disease
*'''[[Special:MyLanguage/Budd-Chiari|Budd-Chiari]]''': history of hypercoagulable disorder, abdominal pain, and ascites
</div>

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==Clinical Features==
</div>

<div lang="en" dir="ltr" class="mw-content-ltr">
[[File:Jaundice08.jpg|thumb|Jaundice of the skin]]
[[File:SpiderAngioma.jpg|thumb|Spider angioma]]
[[File:Hepaticfailure.jpg|thumb||Ascites secondary to [[Special:MyLanguage/cirrhosis|cirrhosis]].]]
[[File:Jaundice.jpg|thumb|Pediatric jaundice with icterus of sclera.]]
*Common findings in acute liver failure
**Tender [[Special:MyLanguage/hepatomegaly|hepatomegaly]]
**[[Special:MyLanguage/Jaundice|Jaundice]]
**[[Special:MyLanguage/Hepatic encephalopathy|Hepatic encephalopathy]]
**Asterixis
*Common findings in chronic liver failure
**[[Special:MyLanguage/Ascites|Ascites]]
**Caput medusae
**Palmar erythema
**Spider angiomata
**Gynecomastia
**Testicular atrophy
**Parotid gland enlargement
**Muscular atrophy
**May also have [[Special:MyLanguage/jaundice|jaundice]], [[Special:MyLanguage/hepatic encephalopathy|encephalopathy]], and asterixis as in acute liver failure
</div>

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==Differential Diagnosis==
</div>

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===[[Special:MyLanguage/Encephalopathy|Encephalopathy]] (altered mental status)===
</div>

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*[[Special:MyLanguage/Hypoglycemia|Hypoglycemia]]
*[[Special:MyLanguage/Hypoxia|Hypoxia]]
*[[Special:MyLanguage/Intracerebral hemorrhage|Intracerebral hemorrhage]] or mass
*[[Special:MyLanguage/Meningitis|Meningitis]]/[[Special:MyLanguage/encephalitis|encephalitis]]
*[[Special:MyLanguage/CVA|CVA]]
*[[Special:MyLanguage/Alcohol intoxication|Alcohol intoxication]]
*[[Special:MyLanguage/Myxedema coma|Myxedema coma]]
*[[Special:MyLanguage/Wernicke encephalopathy|Wernicke encephalopathy]]
*[[Special:MyLanguage/Sepsis|Sepsis]]
*[[Special:MyLanguage/Seizure|Seizure]]/post-ictal state
*[[Special:MyLanguage/Uremia|Uremia]]
*[[Special:MyLanguage/Electrolyte abnormality|Electrolyte abnormality]]
*[[Special:MyLanguage/Acute hepatic failure|Acute hepatic failure]]
</div>

<div lang="en" dir="ltr" class="mw-content-ltr">
===[[Special:MyLanguage/Jaundice|Jaundice]]===
</div>

<div lang="en" dir="ltr" class="mw-content-ltr">
*[[Special:MyLanguage/Hepatic dysfunction|Hepatic dysfunction]]
*[[Special:MyLanguage/Biliary disease|Biliary disease]] (e.g. [[Special:MyLanguage/Choledocholithiasis|CBD obstruction]])
*[[Special:MyLanguage/hemolytic anemia|Hemolysis]]
*[[Special:MyLanguage/Pregnancy|Pregnancy]]
*Congenital diseases (e.g. [[Special:MyLanguage/inborn errors of metabolism|inborn errors of metabolism]]; (more likely to present in early childhood)
</div>

{{Hepatomegaly DDX}}

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==Evaluation==
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===Labs===
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*[[Special:MyLanguage/LFTs|LFTs]]
**AST and ALT
***Enzymes found mainly in hepatic cells, though ALT is more specific to the liver than AST
***Extreme elevation in AST (>3000U/L, or >40x upper limit of normal) is consistent with acetaminophen toxicity or ischemic injury
***Moderate elevations (10-40x upper limit of normal) is consistent with viral hepatitis
***Mild elevations (<10x upper limit of normal) is consistent with alcoholic hepatitis
**Alkaline Phosphatase
***Found in bile canaliculi (but also in placenta, ileal mucosa, bone, and kidney)
***Elevated in diseases of cholestasis
***Rare for levels to be >3x normal limit in acute liver failure
**Bilirubin
***Elevated in diseases of cholestasis
***In obstructive diseases, the direct bilirubin will usually be about 50% of the total bilirubin; if indirect bilirubin is higher, more suggestive of hemolysis or problem with conjugation
*Coagulation Studies
**Reflects the liver’s ability to synthesize clotting factors
**INR >6.5 or PT >20 seconds indicates patients at high risk for death
*Albumin
**Reflects synthetic function of the liver
**Has a long half-life (20 days) and may not be decreased early in disease
*Ammonia
**Elevated as a result of impaired clearance
**Poor correlation between degree of elevation and severity of encephalopathy symptoms
*Chemistry Panel
**Electrolyte abnormalities may indicate malnutrition or dehydration
**Creatinine is used as a prognostic indicator
**Need to check a glucose because patients with liver failure are prone to hypoglycemia
*CBC
**Not useful in diagnosing the cause of liver failure, but helpful in determining coexisting [[Special:MyLanguage/infection|infection]], [[Special:MyLanguage/anemia|anemia]], [[Special:MyLanguage/thrombocytopenia|thrombocytopenia]]
*[[Special:MyLanguage/Viral hepatitis|Viral hepatitis]] Serologies
**Consider for all patients with undifferentiated liver failure
**IgM anti-HBc may be the only positive marker in acute Hepatitis B infection
**Anti-HCV and HCV RNA are present in both chronic and acute Hepatitis C infections, so it is difficult to differentiate based on serologies, but presence of HCV RNA in the absence of anti-HCV is more suggestive of acute infection<ref>Bailey, C, Hern HG. Hepatic Failure: An Evidence-Based Approach In The Emergency Department. Emergency Medicine Practice. Vol. 12, No. 4, 2014.</ref>
**Only need to test for IgM anti-HEV in patients who are symptomatic and have just travelled from areas where Hepatitis E is endemic
</div>

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===Imaging===
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*Consider [[Special:MyLanguage/RUQ US|RUQ US]] or CT in patients with jaundice to evaluate for a mechanical obstruction
*Otherwise, tailor imaging towards specific complaints
</div>

{{Ascites Evaluation}}

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==Management==
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*Treatment is mostly supportive and tailored towards the specific etiology
*Early consideration regarding transporting patient to a transplant center given potential for rapid deterioration
*Symptom specific supportive treatment options
**[[Special:MyLanguage/Hepatic encephalopathy|Encephalopathy]]: consider [[Special:MyLanguage/lactulose|lactulose]] of [[Special:MyLanguage/neomycin|neomycin]]
**[[Special:MyLanguage/Seizures|Seizures]]: consider [[Special:MyLanguage/phenytoin|phenytoin]] over [[Special:MyLanguage/benzodiazepines|benzodiazepines]] (prevent benzodiazepine oversedation secondary to decreased hepatic clearance)
**[[Special:MyLanguage/Increased ICP|Intracranial Hypertension]]: elevated head of bed, [[Special:MyLanguage/mannitol|mannitol]], short-term hyperventilation; hypothermia may be a bridge to transplant; no benefit from steroids
**[[Special:MyLanguage/liver disease induced coagulopathy|Coagulopathy]]
***Prophylactic normalization of the INR is not necessary unless procedure (such as paracentesis) is planned; then can give [[Special:MyLanguage/Vitamin K|Vitamin K]]
***Recommend [[Special:MyLanguage/platelet transfusion|platelet transfusion]] to 10K for asymptomatic patients, and to 50-70K for patients undergoing invasive procedures
**See [[Special:MyLanguage/Acetaminophen toxicity|Acetaminophen toxicity]] for specifics regarding treatment of acetaminophen toxicity
**See [[Special:MyLanguage/Spontaneous Bacterial Peritonitis|Spontaneous Bacterial Peritonitis]] for specifics regarding diagnosis and treatment of SBP
</div>

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==Disposition==
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*Admission to ICU with early consideration for transportation to transplant center
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==See Also==
</div>

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*[[Special:MyLanguage/Jaundice|Jaundice]]
*[[Special:MyLanguage/Cirrhosis|Cirrhosis]]
*[[Special:MyLanguage/Acute hepatitis|Acute hepatitis]]
*[[Special:MyLanguage/Hepatic encephalopathy|Hepatic encephalopathy]]
</div>

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==References==
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<references/>
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[[Category:GI]]
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