Keeffe Emmet B
División de Gastroenterología y Hepatología, Departmento de Medicina, Stanford University School of Medicine, Stanford, CA, USA.
Rev Gastroenterol Mex. 2005 Jan-Mar;70(1):56-62.
Acute liver failure, also called fulminant hepatic failure, is characterized by sudden hepatic synthetic dysfunction associated with coagulopathy and hepatic encephalopathy. Acute liver failure has most recently been defined based on the timing from onset of jaundice to encephalopathy as follows: 1) hyperacute (1-7 days); 2) acute (8-28 days), and 3) subacute (29-60 days). Rapid onset of encephalopathy in hyperacute liver failure is paradoxically associated with highest rate of spontaneous recovery, and subacute liver failure is associated with worst prognosis. The etiology of liver failure is established by history, serologic assays, and exclusion of alternative causes. Acute liver failure is most frequently caused by drug hepatotoxicity, including acetaminophen toxicity and idiosyncratic drug reactions, with viral hepatitis playing a lesser role in recent surveys. A substantial number of cases have an indeterminate etiology. Major complications of acute liver failure that require active intervention include metabolic disorders, coagulopathy, cerebral edema, renal failure, and infection. The focus of management of acute liver failure is comprehensive supportive care in an intensive care unit and assessment of the need for liver transplantation.
急性肝衰竭，也称为暴发性肝衰竭，其特征为突然出现的肝脏合成功能障碍，并伴有凝血功能障碍和肝性脑病。急性肝衰竭最近根据从黄疸出现到发生脑病的时间定义如下：1）超急性（1 - 7天）；2）急性（8 - 28天），以及3）亚急性（29 - 60天）。超急性肝衰竭中脑病的快速发作与最高的自发恢复率自相矛盾地相关，而亚急性肝衰竭则与最差的预后相关。肝衰竭的病因通过病史、血清学检测以及排除其他病因来确定。急性肝衰竭最常见的病因是药物肝毒性，包括对乙酰氨基酚毒性和特异质性药物反应，在最近的调查中，病毒性肝炎的作用较小。相当数量的病例病因不明。急性肝衰竭需要积极干预的主要并发症包括代谢紊乱、凝血功能障碍、脑水肿、肾衰竭和感染。急性肝衰竭的治疗重点是在重症监护病房进行全面的支持治疗，并评估肝移植的必要性。
