Acute liver failure (ALF) is a condition that can rapidly progress to multiorgan failure. This article focuses on the diagnosis and management of ALF. We provide a detailed review of the common etiologies of ALF, including acetaminophen overdose, viral hepatitis, drug-induced liver injury, Wilson's disease, and autoimmune hepatitis. The article then addresses how to recognize ALF and reviews the role of common laboratory and imaging tests in establishing this diagnosis. The remainder of the article details the management of hepatic and extrahepatic organ dysfunctions in ALF. The article concludes with a discussion regarding the prognostication of patients with ALF and the criteria for considering liver transplantation.
Mycoplasma and Ureaplasma infections have been described as a cause of hyperammonemia syndrome leading to devastating neurological injury in the post-transplant period, most commonly in lung transplant recipients. The occurrence of significant hyperammonemia caused by other urease-producing organisms remains unclear. We describe a case of disseminated cryptococcosis presenting with profound hyperammonemia in a 55-year-old orthotopic liver transplant recipient. Through a process of elimination, other potential causes for hyperammonemia were excluded revealing a probable association between hyperammonemia and disseminated cryptococcosis.
Hepatorenal syndrome type 1 (HRS) is an advanced form of decompensated cirrhosis characterized by rapid-onset kidney failure. Acute-on-chronic liver failure (ACLF)-defined as acute liver decompensation followed by organ failure (OF)-is a common and concerning condition for many hospitalized patients (pts) with HRS. Terlipressin (TERLI), a vasopressin analogue, is an effective treatment for acute kidney injury in pts with HRS, however ACLF severity may impact treatment response. Pooled data from 3 North American-centric, Phase III, randomized, placebo (PBO)controlled studies were analyzed to determine if baseline ACLF grade affected the treatment response to TERLI in pts with HRS.
METHODS:A retrospective analysis using pooled data from the OT-0401, REVERSE, and CONFIRM Phase III studies was performed to compare the incidence of HRS reversal by baseline ACLF grade in pts treated with TERLI + albumin vs PBO + albumin for up to 14 days. Severity of ACLF was graded according to the number of OFs (ACLF grade 0-1, grade 2, and grade 3). The incidence of HRS reversal was defined as at least 1 serum creatinine value of ≤1.5 mg/dL while on treatment.
Cirrhosis and chronic liver disease cause a myriad of systemic health problems mostly caused by the presence of portal hypertension. Esophageal varices are one result of portal hypertension. They can rupture and bleed, which can be catastrophic in already coagulopathic liver failure patients. We present a patient who presented with decompensated liver failure for transplant. He developed a severe and refractory gastrointestinal bleed and was put on an octreotide infusion to increase splanchnic flow and decrease portal pressures. He subsequently developed complete heart block. Understanding the mechanisms of octreotide is imperative due to its frequent use in medically complex patients
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