Acute and Chronic Liver Failure
Acute Liver Failure (ALF) is a rare condition that occurs when the liver dysfunctions (Pyleris, Giannikopoulos and Dabos 2010). According to Antoine et al. (2013), this may lead to encephalopathy in patients with no history of liver disease. In most ALF cases, hepatocellular necrosis occurs. This begins from centrizonal distribution towards portal tracts. ALF mostly affects young people. Inflammation of the parenchymal is dependent on the duration. Centrilobular is associated with ischemic injuries, chloroform ingestion or poisonous implications, periportal with eclampsia while midzonal is common with yellow fever. Chronic Liver Failure (CLF) occurs with the damage of hepatocytes and regeneration of liver parenchyma. Formation of scar tissues in the liver inhibits regeneration of liver cells and this leads to exacerbated haemodynamic derangement (Jalan et al. 2011). This paper discusses the differences between acute and chronic liver failure, the similarities and lastly, whether their management is similar.
ALF has visible symptoms in a span of 8-26 weeks. These symptoms may be encephalopathy, cerebral edema, hypotension or melena. Contrariwise, the symptoms of CLF can take up to 10 years to emerge depending on the level of liver degeneration. These symptoms may include severe jaundice, intestinal bleeding and blood clotting problems. There are some differences between the pathophysiology of CLF and ALF. The prognosis of the two conditions is a challenge to medical practitioners and thus, it leads to occasional misdiagnosis (Tripodi and Mannucci 2011).
The management of CLF and ALF is slightly different. CLF is managed through proper nutritional intakes, alcohol abstinence and in rare cases, a liver transplant. However, liver transplant is discouraged in CLF due to the risk of clinical bleeding (Stravits and Larson 2012). Proper management of ALC calls for hemodynamics, proper infections assessment, intensive care support, nutrition maintenance, fluid management and specific therapy depending on the client’s liver failure. Monitoring the client’s metabolic parameters also comes in handy. Management of ALF is dependent on the cause and requires a team of hepatologists, transplant surgeons and intensivists. Tests such as coagulation studies, serum glucose level, drug screening and blood count will reveal the cause of ALF for proper management (Bernal and Wendon 2013).
Antoine, D, Bateman, N, Coyle, J, Dear, J, Gray, A, Goldring, C, Lewis, P, Moggs, J, Masson, M, Park, K, Platt, V, Thanacoody, R, Webb, D, 2013. Hepatology, Mechanistic biomarkers provide early and sensitive detection of acetaminophen-induced acute liver injury at first presentation to hospital. Volume 58, Issue 2, Pages 777–787.
Bernal, W, Wendon, J December 26 2013. Acute Liver Failure. The New England Journal of Medicine, 2525-2534.
Jalan, R., Gines, P., Olson, J.C., Mookerjee, R.P., Moreau, R., Garcia-Tsao, G., Arroyo, V. and Kamath, P.S., 2012. Acute-on chronic liver failure. Journal of hepatology, 57(6), pp.1336-1348.
Pyleris, E., Giannikopoulos, G. and Dabos, K., 2010. Pathophysiology and management of acute liver failure. Annals of Gastroenterology, 23(4), pp.257-265.
Tripodi, A. and Mannucci, P.M., 2011. The coagulopathy of chronic liver disease. New England Journal of Medicine, 365(2), pp.147-156.