Acute liver failure

Acute liver failure is the sudden development of liver parenchymal injury resulting in coagulopathy (INR > 1.5) in a patient who lacks underlying chronic liver disease. Progression to encephalopathy in such a patient is known as fulminant hepatic failure (FHF). The etiologies of acute liver failure include:

• Viruses: Hepatitis viruses A, B, C, D and E, rarely herpes simplex, varicella-zoster, and CMV.

• Drugs/toxins: Paracetamol, isoniazid, phenytoin, halothane, carbon tetrachloride, mushrooms (Amanita spp.).

• Ischemia: Blood flow to the liver may be reduced in shock, resulting in hepatocellular damage.

• MODS: Ischemia and endotoxemia stimulate Kupffer cells to produce cytokines which then act on the hepatocytes resulting in injury.

The leading causes of FHF, in order of frequency, are paracetamol toxicity, cryptogenic (unknown), other drug toxicity, hepatitis B, and hepatitis A.

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