Acute hepatic failure, also called fulminant hepatic failure (FHF), is an uncommon liver disorder characterized by an acute onset of severe hepatic dysfunction resulting in jaundice, encephalopathy, and coagulopathy that frequently progresses to cause cerebral edema, multiorgan failure, and eventually death. More than two decades ago, before the advent of liver transplantation, mortality from FHF approached 80%. Currently, liver transplantation is offered as salvage therapy for select patients with FHF, resulting in 1-year survival rates of 40%–80%. Despite the encouraging results from liver transplantation, patients suffering from hepatic failure are among the most difficult patients to manage while awaiting for liver donation, and, unfortunately, many succumb to their disease before receiving a liver. Patients with cirrhosis frequently present to the intensive care unit in hepatic failure; however, they differ from FHF in regard to pathophysiology, management, and prognosis. This chapter is limited to the discussion of patients with FHF.
KeywordsLiver Transplantation Hepatic Encephalopathy Cerebral Edema Acute Tubular Necrosis Fulminant Hepatic Failure
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