Acute and chronic liver insufficiency

Abstract

3 Acute liver insufficiency ᭤ J. W. Morgagni (1761) was probably the first to describe acute yellow atrophy of the liver, i. e. hepatic coma. Acute liver failure can be seen as identical to the "acute yellow atrophy" described by K. Rokitansky in 1842. This acute and severe clinical picture was subsequently termed "bilious dyscrasia" (P. J. Horaczek, 1844), "icterus gravis" (C. Ozanam, 1849), "acholia" (F. Th. Frerichs, 1858), "hepatolysis" (R. Ehrmann, 1922), "hepatodystrophy" (G. Herxheimer, 1935) or "liver dystrophy" (R. Böhmig, 1949). The terms "hepatargia" (H. I. Quincke, 1899) and "hepatic coma" were used to denote the final stage, which usually sets in at the end of acute or chronic liver failure. • Acute liver failure in the course of acute viral hepatitis was termed "fulminant hepatitis" by W. Lucke ´et al. (1946), who also defined a subacute form with a less severe course. ( 35) DefinitionAcute liver failure (ALF) is defined as an acute clinical picture with jaundice due to a most severe disorder in the liver function and/or massive liver cell necrosis which, without any pre-existing liver disease, culminates in hepatic coma (ϭ endogenous coma) within 8 weeks. Potentially, the condition is fully reversible (C. Trey et al., 1970). • In addition, coagulopathy must also be present (D. F. Schafer et al., 1989).