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Acute liver failure

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  • 2020-12-12 10:54:45
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Seminarwww.thelancet.comVol394September7,2019869AcuteliverfailureRToddStravitz,WilliamMLeeAcuteliverfailureisarareandsevereconsequenceofabrupthepatocyteinjury,andcanevolveoverdaysorweekstoalethaloutcome.Avarietyofinsultstolivercellsresultinaconsistentpatternofrapid-onsetelevationofaminotransferases,alteredmentation,anddisturbedcoagulation.Theabsenceofexistingliverdiseasedistinguishesacuteliverfailurefromdecompensatedcirrhosisoracute-on-chronicliverfailure.Causesofacuteliverfailureincludeparacetamoltoxicity,hepaticischaemia,viralandautoimmunehepatitis,anddrug-inducedliverinjuryfromprescriptiondrugs,andherbalanddietarysupplements.Diagnosisrequirescarefulreviewofmedicationstaken,andserologicaltestingforpossibleviralexposure.Becauseofitsrarity,acuteliverfailurehasnotbeenstudiedinlarge,randomisedtrials,andmosttreatmentrecommendationsrepresentexpertopinion.Improvementsinmanagementhaveresultedinlowermortality,althoughlivertransplantation,usedinnearly30%ofpatientswithacuteliverfailure,stillprovidesalife-savingalternativetomedicalmanagement.IntroductionThetermacuteliverfailureappliestoauniqueandinfrequentlyobservedsyndromeofsevereinjurytolivercells,whichleadstoalteredcoagulationandmentationintheabsenceofchronicliverdisease.Acuteliverfailureisunexpectedandhasarapidonset,affectingpreviouslyhealthyindividuals,withafrequentlyfataloutcome.Despitehavingdiversecauses(figure1),acuteliverfailureischaracterisedbyremarkablysimilarclinicalfeatures.Theprincipalmanifestationsofacuteliverfailureare

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