Scottish Intensive Care Society
ICM Induction programme ©
Liver failure |
Definition |
Acute |
Encephalopathy within eight weeks of onset of jaundice |
Subacute |
Encephalopathy within two to six months of onset of symptoms |
Chronic |
Gradual destruction of liver tissue resulting in impaired function |
Table 1. Categories of liver failure.
Liver failure
Intensive care is important to two groups of patients with liver disease - those with acute liver failure (often due to paracetamol poisoning) and those with the complications of chronic liver disease - such as variceal bleeding, acute decompensation and encephalopathy. While fulminant hepatic failure due to paracetamol overdose is declining in the UK, chronic liver disease is increasing, largely due to alcohol consumption. The etiology and pathophysiology of acute and chronic liver failure have significant differences, and require different therapeutic approaches.
Causes of liver failure
Acute |
Paracetamol (commonest cause in UK) |
Viral Hepatitis |
Drug reactions (e.g. rifampicin, MDMA, Isoniazid, flucloxacilin, augmentin) |
chronic |
Alcohol abuse (commonest cause in the UK) |
Primary biliary cirrhosis |
Viral hepaitits |
Primary sclerosing cholangitis |
α1 antitrypsin deficiency |
Wilson's disease |
Haemochromatosis |
Non alcoholic fatty liver disease (often associated with diabetes) |
Table 2. Causes of acute and chronic liver failure.
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