Management of acute liver failure

Abstract

In the management of a patient presenting with acute liver failure it is essential to identify both the cause and the type of liver failure (Table I). Patients may have established chronic liver disease and develop liver failure during intercurrent infections or variceal haemorrhage, or they may have no previous history of liver disease. With the latter group the presentation-is then either as fulminant liver failure (encephalopathy within 8 weeks of onset of symptoms) or with a slower course (encephalopathy developing within 6 months of onset) which has been termed late-onset hepatic failure. The measures discussed in this paper apply only to those with no antecedent history of liver disease in whom regeneration of the liver to a normal structure is seen in the survivors. Paradoxically in fulminant hepatic failure (FHF) the prognosis is better the more rapid the onset of encephalopathy, as measured from the first appearance of jaundice.