Acute liver failure

ACUTE LIVER FAILURE
PHUNG HUY HOANG, MD
Resident in Internal Medicine
Pham Ngoc Thach University of Medicine
January, 2018

OVERVIEW
APPROACH
PROGNOSIS
MANAGEMENT
COMPLICATIONS
PREVENTION

OVERVIEW
ACUTE LIVER FAILURE
PHUNG HUY HOANG, MD
January, 2018

DEFINITION
• Coagulation abnormality (usually INR > 1.5)
• Any degree of mental alteration (encephalopathy)
• Virtually unique clinical feature: cerebral edema
• Without preexisting cirrhosis
• Illness of < 26 weeks’ duration
• Exceptions: Wilson disease, vertically acquired HBV, autoimmune hepatitis, Budd-
Chiari syndrome, HDV superinfection in patients with chronic HBV infection
(present with ALF despite presence of unrecognized underlying chronic liver disease or
cirrhosis)
• Wendon J., Panel m., Cordoba J., et al. (2017), J Hepatol, 66 (5), pp. 1047-1081
• William M., Lee M., Larson A. M., et al. (2011), "AASLD position paper: The management of acute liver failure: Update“
• Larson A. M. (2012), Schiff’s Diseases of The Liver, Eugene R. Schiff, Willis C. Maddrey, Michael F. Sorrell, Editors, Wiley-Blackwell, pp. 445-472

CLASSIFICATION
NOT particularly helpful since they do not have prognostic significance distinct
from the cause of the illness
• Willars C., Wendon J. (2014), Oh’s Intensive Care Manual, Andrew D Bersten , Neil Soni, Editors, Elsevier, pp. 501-519
7 days
21-28 days
26 weeks
Hyperacute
Acute
Subacute
Acetaminophen overdose, hepatitis A, and
B,…
Hepatitis ABE, idiosyncratic drug
reactions,…
Idiosyncratic drug reaction, seronegative
hepatitis,…
Interval from onset of disease (usually jaundice) to onset of
encephalopathy

Wendon J., Panel m., Cordoba J., et al. (2017), J Hepatol, 66 (5), pp. 1047-1081

Kuntz E., Kuntz H.-D. (2008), Hepatology Textbook And Atlas, Springer, pp. 380-396

Wendon J. (2015), Principles of Critical Care, Gregory A. Schmidt Jesse B. Hall, John P. Kress, Editor, McGraw Hill Education, pp. 1022-1026

ETIOLOGY
• Diﬀerent etiologies typically have a specifc
time frame
• Etiological diagnosis: strongest
determinant of outcome1,2
1. William M., Lee M., Larson A. M., et al. (2011), "AASLD position paper: The management of acute liver failure: Update“
2. Ziv Y. H., Collins M. H., Rothenberg M. E. (2016), Yamada’s Textbook of Gastroenterology, Daniel K. Podolsky, Michael Camilleri, J. Gregory Fitz, Editors, Wiley
Blackwell, pp. 1973-1988
3. Karvellas C. J., Stravitz R. T. (2018), Zakim and Boyer’s Hepatology: A Textbook of Liver Disease, Arun J. Sanyal, et al., Editors, Elsevier, pp. 301-323

ETIOLOGY
Drugs and toxins
Viruses (Hepatotropic, Nonhepatotropic)
Autoimmune diseases
Metabolic diseases
Vascular causes
Infiltrative diseases
Indeterminate (up to 10-15%*)
(*) Spengler E., Fontana R. J. (2018), Handbook of Liver Disease, Lawrence S. Friedman , Paul Martin, Editors, Elsevier Saunders, pp. 18-33

INFECTION
• Hepatitis A, B (±D), E
• Hemorrhagic fever viruses, CMV, HSV, EBV,
adenovirus, VZV, Parvovirus B19
• Leptospira, listeria, malaria. M. tuberculosis,
rickettsia, syphilis
DRUGS/TOXINS
• Dose-related: Acetaminophen, Carbon tetrachloride,
Amanita poisoning, Bacillus cereus emetic toxin,
Cyanobacteria microcystins, sulfonamide,
tetracycline
• Idiosyncratic: Reye’s syndrome (salicylic acid),
Herbal medications, Prescription medications (i.e.,
isoniazid, halothane, troglitazone, bromfenac,
valproic acid)
VASCULAR
• Budd–Chiari syndrome, Sinusoidal obstruction
syndrome Ischemic (shock) liver
METABOLIC/GENETIC
• Galactosemia
• Fructose intolerance
• Tyrosinemia
• Neonatal iron storage disease
• Wilson disease
• α1-Antitrypsin deficiency
NEOPLASTIC
• Metastases: breast, melanoma, lung, lymphoma
PREGNANCY-RELATED
• Acute fatty liver of pregnancy
• HELLP syndrome
MISCELLANEOUS
• Autoimmune hepatitis
• Heat stroke
• Primary graft nonfunction in liver transplant recipients
INDETERMINATE

Ziv Y. H., Collins M. H., Rothenberg M. E. (2016), Yamada’s Textbook of Gastroenterology, Daniel K. Podolsky, Michael Camilleri, J. Gregory Fitz, Editors, Wiley Blackwell,
pp. 1973-1988

O’Grady J. (2016), Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, Mark Feldman, Lawrence S. Friedman, Lawrence J. Brandt, Editors, Elsevier Saunders, pp. 1591-1602

Larson A. M. (2012), Schiff’s Diseases of The Liver, Eugene R. Schiff, Willis C. Maddrey, Michael F. Sorrell, Editors, Wiley-Blackwell, pp. 445-472

Karvellas C. J., Stravitz R. T. (2018), Zakim and Boyer’s Hepatology: A Textbook of Liver Disease, Arun J. Sanyal, et al., Editors, Elsevier, pp. 301-323

• Larson A. M. (2012), Schiff’s Diseases of The Liver, Eugene R. Schiff, Willis C. Maddrey, Michael F. Sorrell, Editors, Wiley-Blackwell, pp. 445-472
Drug classes associated with acute liver failure: Halothane, antituberculosis, anticonvulsants, antibiotics, antineoplastic,
antiretroviral, MDMA (ectasy), NSAIDs

O’Grady J. (2016), Sleisenger and Fordtran’s Gastrointestinal
and Liver Disease, Mark Feldman, Lawrence S. Friedman,
Lawrence J. Brandt, Editors, Elsevier Saunders, pp. 1591-
1602

Murphy N. (2013), Critical Care Medicine - Principles Of Diagnosis And Management In The Adult, Joseph E. Parrillo , R. Phillip Dellinger, Editors, Elsevier Saunders, pp.
1309-1334.

PATHOPHYSIOLOGY
• Characteristics:
• Massive hepatocyte necrosis
• OR without histologic evidence of hepatocellular necrosis (acute fatty liver of
pregnancy and Reye’s syndrome)
• Abrupt loss in hepatic metabolic and immunologic functions  encephalopathy,
coagulopathy, infection, multi-organ failure

Ziv Y. H., Collins M. H., Rothenberg M. E. (2016), Yamada’s Textbook of Gastroenterology, Daniel K. Podolsky, Michael Camilleri, J. Gregory Fitz, Editors, Wiley Blackwell, pp. 1973-
1988

Fontana R. J., Bari K. (2018), Schiff’s Diseases of The Liver, Eugene R. Schiff, Willis C. Maddrey, K.
Rajender Reddy, Editors, Wiley-Blackwell, pp. 411-431.

Fontana R. J., Bari K. (2018), Schiff’s Diseases of The Liver, Eugene R. Schiff, Willis C. Maddrey, K. Rajender Reddy, Editors, Wiley-Blackwell, pp. 411-431.

COMPLICATIONS
Multiorgan
failure (renal,
circulatory,
respiratory,…
)
Hemorrhage
Infection
HE/Cerebral
edema
Hypoglycae
mia
Acid-base
disorders

APPROACH
ACUTE LIVER FAILURE
PHUNG HUY HOANG, MD
January, 2018

ALF DIAGNOSIS ESTABLISHED
• Clinical or laboratory evidence of acute hepatitis
• PT prolonged ≥ 4-6 seconds (INR ≥ 1.5)
• Any evidence of altered sensorium
ALF may be mistaken for cirrhosis and opportunity to be considered for transplantation
losts

HISTORY AND PHYSICAL EXAMINATION
• Review of possible exposures to viral infection and drugs (prescribed and OTC) or
other toxins
• History of abnormal LFTs
• Mental status examination
• Stigmata of chronic liver disease (palmar erythema, spider angiomata, caput medusae,
gynecomastia, testicular atrophy, ascites/portal hypertension,…)
• Jaundice
• Right upper quadrant tenderness
• Palpate and percuss area of liver
• Enlarged = viral hepatitis, malignant infiltration, congestive heart failure, acute
Budd-Chiari syndrome
• Loss of liver volume due to massive hepatocyte loss

LABORATORY EXAMINATION
William M., Lee M., Larson A. M., et al. (2011), "AASLD position paper: The management of acute liver failure: Update"

• Complete blood count:
• Leukocytosis: can be seen with acute hepatitis from any etiology (high risk for
infection)
• Thrombocytopenia: DIC, acute on chronic process.
• Hemolytic anemia with Coombs (-): classically in fulminant Wilson disease.
• Blood type and screen: two drawn independently needed for transplant evaluation, may
require blood products as part of supportive care.
• Acidosis,  arterial lactate = poor prognostic marker.
• Arterial ammonia: >200µg/dL = strongly associated with cerebral herniation.
• Toxicology screen (serum, urine): etiology of ALF and determine appropriateness of
transplant candidacy (active drug abusers: not candidates for transplant)
• Acetaminophen level

• Viral serologies: anti-HAV IgM, HBsAg, anti-HBc IgM, anti-HEV, anti-HCV, HSV-1 and
HSV-2 IgM, VZV, CMV IgM
• Ceruloplasmin: low or normal consistent with Wilson disease. Levels may be normal
since it is an acute phase reactant.
• Uric acid: if Wilson disease is suspected, levels may be low.
• Autoimmune markers: ANA, ASMA, IgG levels.
• Pregnancy test in females.
• HIV status (HIV-1, HIV-2)
• Amylase and lipase.

• Imaging techniques
• Liver US with Doppler
• Abdominal CT scan with contrast or MRI with gadolinium (malignant infltration,
Budd–Chiari syndrome, portal vein thrombosis)
• Non-contrast head CT: rule out other causes of changes in mental status (not
helpful to identify cerebral edema)

Murphy N. (2013), Critical Care Medicine - Principles Of Diagnosis And Management In The Adult, Joseph E. Parrillo , R. Phillip Dellinger, Editors, Elsevier Saunders,
pp. 1309-1334.

LIVER BIOPSY
• Indications: limited
• History of cancer or significant hepatomegaly: malignant infiltration should be
excluded by imaging or liver biopsy
• Performed preferably by a transjugular route, in a centre experienced in its use, and
with access to a histopathologist with liver experience
Wendon J., Panel m., Cordoba J., et al. (2017), J Hepatol, 66 (5), pp. 1047-1081

PROGNOSIS
ACUTE LIVER FAILURE
PHUNG HUY HOANG, MD
January, 2018

UNOS (United Network for Organ Sharing) Criteria for Status I Listing
King’s College Criteria (KCH)
MELD score (Model for End-stage Liver Disease)
ALFSG (Acute Liver Failure Study Group Model)
French Clichy Criteria
APACHE II (Acute Physiology and Chronic Health Evaluation) scoring
system

Aditi A., Crippin J. S. (2012), The Washington Manual of Critical Care, Marin H. Kollef , Warren Isakow, Editors, Lippincott Williams & Wilkins, pp. 376-386

Murphy N. (2013), Critical Care Medicine - Principles Of Diagnosis
And Management In The Adult, Joseph E. Parrillo , R. Phillip
Dellinger, Editors, Elsevier Saunders, pp. 1309-1334.

OTHER INDICATORS OF POOR PROGNOSIS
• Etiology
• Idiosyncratic drug injury
• Acute hepatitis B (and other non-hepatitis A viral infections)
• Autoimmune hepatitis
• Mushroom poisoning
• Wilson disease
• Budd-Chiari syndrome
• Indeterminate cause
• Coma Grade on Admission: III or IV

MANAGEMENT
ACUTE LIVER FAILURE
PHUNG HUY HOANG, MD
January, 2018

PRINCIPLES
• Supportive care
• Nutrition: Patients with ALF  resting energy expenditure  enteral or
parenteral nutrition warranted
• Venous thrombosis prophylaxis
• Specific therapies
• Treatment of complications
• Liver transplantation: should be considered in all patients (King’s College
criteria, modified King’s College criteria)

LIVER TRANSPLANTATION
• Urgent hepatic transplantation: prognostic indicators suggest a high likelihood of death
• Living donor or auxiliary liver transplantation: considered in the setting of limited
organ supply (remains controversial)
• King’s College Criteria or French Clichy Criteria
• CONTRAINDICATIONS:
• Severe cardiopulmonary disease or multiorgan failure
• Septic shock
• Extrahepatic malignant disease
• Extensive thrombotic disease
• Irreversible brain injury or brain death: CPP < 40 mmHg for >2 hours; Sustained ICP > 50
mmHg
• Active substance abuse, repeated suicide attempts, or inadequate social support may
preclude transplant candidacy

LIVER SUPPORT SYSTEM
• ARTIFICIAL SUPPORT = adsorben (plasmapheresis, molecular absorbents
recirculation system-MARS)
• BIOARTIFICIAL SUPPORT (HepatAssistTM (Arbios, formerly Circe, Waltham MA),
extracorporeal liver support device (ELADTM; Vital Therapies, San Diego, CA), modular
extracorporeal liver support system (MELSTM; Charité, Berlin, Germany), bioartificial
liver support system (BLSSTM; Excorp Medical, Minneapolis MN), and the Amsterdam
Medical Center bioartificial liver (AMCBALTM; AMC, Amsterdam, The Netherlands)
Currently available liver support systems are not recommended outside
of clinical trials; their future in the management of acute liver failure
remains unclear

COMPLICATIONS
ACUTE LIVER FAILURE
PHUNG HUY HOANG, MD
January, 2018

HEPATIC ENCEPHALOPATHY/CEREBRAL EDEMA
• Hepatic encephalopathy occurs in the presence or absence of cerebral edema
• Cerebral edema and intracranial hypertension: most serious complications of ALF
(> 20% of death)  uncal herniation, death (differentiated from that of cirrhosis)
• Cerebral edema  ischemic + hypoxic brain injury  long-term neurological deficits in
survivors
• Risk of cerebral edema increases with the severity of encephalopathy
•  arterial NH3 > 200 μmol/L = increased risk of developing ICH
• Infections, hyperthermia:  risk of HE
• Pathogenic mechanisms: not entirely understood (osmotic disturbances,  cerebral
blood flow due to loss of cerebrovascular autoregulation, inflammation and/or infection)
• Clinical signs: often unreliable and occur very late
• Head CT: should be considered in grades 3 or 4 HE  cerebral edema or intracranial
bleeding

HIGH RISK FOR CEREBRAL EDEMA
• < 40 years of age
• Very low or high JV O2 sat
• Serum NH3 > 150 M
• Severe hyponatremia <130 mmol/L
• Grade 3/4 HE
• Acute renal failure
• Requiring vasopressors to maintain MAP
• Murphy N. (2013), Critical Care Medicine - Principles Of Diagnosis And Management In The Adult, Joseph E. Parrillo , R. Phillip Dellinger, Editors, Elsevier
Saunders, pp. 1309-1334.

Willars C., Wendon J. (2014), Oh’s Intensive Care Manual, Andrew D Bersten , Neil Soni, Editors, Elsevier, pp. 501-519

Karvellas C. J., Stravitz R. T. (2018), Zakim and Boyer’s Hepatology: A
Textbook of Liver Disease, Arun J. Sanyal, et al., Editors, Elsevier, pp. 301-
323

Karvellas C. J., Stravitz R. T. (2018), Zakim and Boyer’s Hepatology: A Textbook of Liver
Disease, Arun J. Sanyal, et al., Editors, Elsevier, pp. 301-323

Willars C., Wendon J. (2014), Oh’s Intensive Care Manual, Andrew D Bersten , Neil Soni, Editors, Elsevier, pp. 501-519
CCP = MAP - ICP

MANAGEMENT (1)
• Consider admitted to ICU ± transfer to transplant center
• Head of bed at 30 degrees, correct factors  ICP (quiet room with minimal
suctioning/noxious stimuli, intratracheal lidocaine before respiratory suctioning, treat agitation,
monitor for and treat seizures, correct hypoxemia, volume overload, hypotension)
• Intracranial pressure monitoring; Neurological checks q4h
• Avoid narcotics and sedatives (if patient agitated  more important to keep patient calm)
• Seizures ( ICP, cerebral hypoxia  cerebral edema):
• Phenytoin: treatment (loading 20 mg/kg with dose adjusted in the setting of renal
failure followed by maintenance dosing)
• Prophylactic phenytoin: NOT recommended
• Short-acting BZD: phenytoin-refractory cases

MANAGEMENT (2)
• Mannitol (0.5g/kg IV; repeated 1–2 times as needed if serum osmolality < 320
mosm/L): contraindicated in renal failure
• Prophylactic induction of hypernatremia = hypertonic saline (to a sodium level of
145-155 mEq/L): recommended for highest risk of cerebral edema
• Lactulose: ±
• Early stages of encephalopathy (orally or rectally) to effect a bowel purge (should
not be administered to the point of diarrhea)
• May lead to colonic distension = unfavorable in transplant setting)
• Endotracheal intubation: high-grade HE (grade III or IV)
• Corticosteroids: should NOT be used to control elevated ICP in patients with ALF
• Hyperventilation: NO role

Gonzalez S. A., Keeffe E. B. (2012), Handbook of Liver Disease, Lawrence S. Friedman , Emmet B. Keeffe, Editors, Elsevier Saunders, pp. 20-33

COAGULOPATHY
• Mechanism:
• Loss of hepatocellular function   synthesis of coagulation (Factor II, V, VII, IX,
and X) and fibrinolysis factors and inhibitors +  breakdown of activated
factors
• Abnormalities in platelet count ( thrombopoietin), function, and morphology
• Consumption of clotting factors and platelets
• GI bleeding: from superfcial gastric erosions and stress ulcers
• Key feature of ALF + important prognostic indicator
• Risk of severe hemorrhage: 10%1,2 (gastrointestinal tract, nasopharynx, lungs,
puncture sites, and retroperitoneum)
1. Spengler E., Fontana R. J. (2018), Handbook of Liver Disease, Lawrence S. Friedman , Paul Martin, Editors, Elsevier Saunders, pp. 18-33
2. Hay J. E. (2010), Practical Gastroenterology and Hepatology - Liver and Biliary Disease, Nicholas J. Talley, Keith D. Lindor, Hugo E. Vargas, Editors, Blackwell
Publishing, pp. 113-123.

COAGULOPATHY
MANAGEMENT
• Expectant (thrombogenic and thrombolytic pathways that may balance each other!)
• Vitamin K 10 mg (IV or SC): 3 days for all patients
• Platelet transfusions, FFP, cryoprecipitate:
• Active bleeding
• Need for invasive procedures (liver biopsy, placement of an intracranial monitoring
device, CVC,…)
Goal: PLT > 50.000/mm3, INR < 1.5, Fibrinogen > 100 mg/dL
• Recombinant factor VII: may be used with caution and only under certain conditions
• Prophylactic acid suppression = H2RA or PPIs (1st line), sucralfate (2nd line): ICU
patient
• Plasma exchange may also be used to correct coagulopathy
(*) William M., Lee M., Larson A. M., et al. (2011), "AASLD position paper: The management of acute liver failure: Update"

Karvellas C. J., Stravitz R. T. (2018), Zakim and Boyer’s Hepatology: A Textbook of Liver Disease, Arun J. Sanyal, et al., Editors, Elsevier, pp. 301-323
Model of rebalanced hemostasis in acute liver failure

INFECTION
• One of the major causes of death
• 80% of patients with FHF*
• Mechanism:
• Kupffer cell malfunction   clearance of gut-derived bacteria + endotoxin
• Impaired uptake   fibronectin (important co-factor made by the liver needed
for opsonization)
• Neutrophil malfunction (phagocytosis, opsonization, mobility): may be related to
 serum complement levels
• Defective lymphocyte function  cell-immunity
• NOT ONLY from gut-derived organisms but also from Gram-positive organisms
(*) Aditi A., Crippin J. S. (2012), The Washington Manual of Critical Care, Marin H. Kollef , Warren Isakow, Editors, Lippincott Williams & Wilkins, pp. 376-386

Karvellas C. J., Stravitz R. T. (2018), Zakim and Boyer’s Hepatology: A Textbook
of Liver Disease, Arun J. Sanyal, et al., Editors, Elsevier, pp. 301-323

INFECTION
• Periodic surveillance cultures (detect bacterial and fungal pathogens as early as
possible)
• Antibiotic treatment:
• Low threshold for initiation of broad-spectrum coverage should be maintained =
surveillance culture results or at earliest sign of active infection or deterioration
(progression to high grade HE or elements of the SIRS)
• Empiric: 3rd generation cephalosporin/FQ + vancomycin
• Systemic antifungal therapy (amphotericin, ﬂuconazole, or caspofungin):
prolonged antibiotics, MICU stay, renal failure, emergent transplantation
• Prophylactic antibiotics and antifungals: NOT been shown to improve overall
outcomes in ALF
• Granulocyte colony-stimulating factor (GCSF): ±

CARDIOVASCULAR DYSFUNCTION
• Low systemic and pulmonary vascular resistance
• Compensatory increase in cardiac output
• Increased metabolic rate
• Abnormal oxygen transport and uptake
• Impaired responses to adrenocorticotropic hormone (ACTH)
# septic shock pathologic state

CARDIOVASCULAR DYSFUNCTION
MANAGEMENT
• Supplemental oxygen.
• Hemodynamic monitoring of central pressures
• Blood transfusions if needed ( oxygen carrying capacity)
• Fluid resuscitation and maintenance of adequate intravascular volume
• Blood pressure support:
• Systemic vasopressor support (norepinephrine or dopamine)  maintain MAP ≥
75mmHg1.
• Dobutamine: considered if severe LV dysfunction (may worsen hypotension)
• Vasopressin: should be AVOIDED (effects on  cerebral blood ﬂow and intracranial
hypertension)
• Hydrocortisone trial (200-300 mg/day): persistent hypotension despite fluid
resusciation and vassopressor (not reduce mortality but does  vasopressor requirements2)
1. William M., Lee M., Larson A. M., et al. (2011), "AASLD position paper: The management of acute liver failure: Update“
2. Wendon J., Panel m., Cordoba J., et al. (2017), J Hepatol, 66 (5), pp. 1047-1081

RENAL FAILURE
• Pathophysiology
• Direct nephrotoxicity (eg, Acetaminophen, etc.)
• Hepatorenal syndrome (intense renal vasoconstriction  systemic vasodilation)
• Hypovolemia
• Impaired hepatic urea production  underestimation of renal impairment
• Key early prognostic indicator
• MANAGEMENT:
• Fluid resuscitation and maintenance of adequate intravascular volume
• Avoidance of nephrotoxic agents
• Dialysis support when needed: continuous mode (CVVH – avoid heparin if
possible) rather than an intermittent mode (limit ﬂuctuations in systemic pressure
and cerebral perfusion pressure)

METABOLIC DERANGEMENT
• Hypoglycemia: defective gluconeogenesis +  hepatic glycogen production +
inadequate hepatic uptake of insulin
• Hypophosphatemia: ATP consumption/rapid hepatocyte regeneration +  urinary loss
• Acidosis (important predictor of mortality) and alkalosis (hyperventilation)
• Electrolyte and metabolic derangements: contribute to progressive HE +  risk of
cerebral edema

PREVENTION
ACUTE LIVER FAILURE
PHUNG HUY HOANG, MD
January, 2018

• Before onset of chemotherapy or immunosuppressive therapy + HBsAg (+)
• Prophylactic oral nucleoside or nucleotide antiviral therapy (several weeks before)
• Antiviral maintenance:
• HBV-DNA < 2000 UI/mL: 6 months after completion of chemotherapy or
immunosuppressive therapy
• HBV-DNA > 2000 UI/mL: until HBV DNA undetectable + ALT levels
normalized
• Limiting availability of bulk acetaminophen
• Psychiatric assistance: depression and have attempted suicide
• Patient education: accidental overdose
(*) Bansal M. B. (2014), Mount Sinai Expert Guides - Hepatology, Jawad Ahmad, Scott L. Friedman, Henryk Dancygier, Editors, Wiley Blackwell, pp. 280-293.

O’Grady J. (2016), Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, Mark Feldman, Lawrence S. Friedman, Lawrence J. Brandt, Editors, Elsevier Saunders, pp.
1591-1602

REFERENCES
ACUTE LIVER FAILURE
PHUNG HUY HOANG, MD
January, 2018

1. Fontana R. J., Bari K. (2018), "Acute Liver Failure", Schiff’s Diseases of The Liver, Eugene R. Schiff, Willis C. Maddrey, K.
Rajender Reddy, Editors, Wiley-Blackwell, pp. 411-431.
2. Larson A. M. (2012), "Acute Liver Failure", Schiff’s Diseases of The Liver, Eugene R. Schiff, Willis C. Maddrey, Michael F. Sorrell,
Editors, Wiley-Blackwell, pp. 445-472.
3. Aditi A., Crippin J. S. (2012), "Fulminant Hepatic Failure", The Washington Manual of Critical Care, Marin H. Kollef , Warren
Isakow, Editors, Lippincott Williams & Wilkins, pp. 376-386.
4. Bansal M. B. (2014), "Acute Liver Failure", Mount Sinai Expert Guides - Hepatology, Jawad Ahmad, Scott L. Friedman, Henryk
Dancygier, Editors, Wiley Blackwell, pp. 280-293.
5. Hay J. E. (2010), "Acute Liver Failure", Practical Gastroenterology and Hepatology - Liver and Biliary Disease, Nicholas J. Talley,
Keith D. Lindor, Hugo E. Vargas, Editors, Blackwell Publishing, pp. 113-123.
6. Karvellas C. J., Stravitz R. T. (2018), "Acute Liver Failure", Zakim and Boyer’s Hepatology: A Textbook of Liver Disease, Arun J.
Sanyal, et al., Editors, Elsevier, pp. 301-323.
7. Kuntz E., Kuntz H.-D. (2008), "Acute and chronic liver insufficiency", Hepatology Textbook And Atlas, Springer, pp. 380-396.
8. Murphy N. (2013), "Diagnosis and Management of Liver Failure in the Adult", Critical Care Medicine - Principles Of Diagnosis
And Management In The Adult, Joseph E. Parrillo , R. Phillip Dellinger, Editors, Elsevier Saunders, pp. 1309-1334.
9. O’Grady J. (2016), "Acute Liver Failure", Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, Mark Feldman, Lawrence
S. Friedman, Lawrence J. Brandt, Editors, Elsevier Saunders, pp. 1591-1602.
10. Spengler E., Fontana R. J. (2018), "Acute liver failure", Handbook of Liver Disease, Lawrence S. Friedman , Paul Martin, Editors,
Elsevier Saunders, pp. 18-33.
11. Wendon J. (2015), "Acute Liver Failure", Principles of Critical Care, Gregory A. Schmidt Jesse B. Hall, John P. Kress, Editor,
McGraw Hill Education, pp. 1022-1026.

12. Wendon J., Panel m., Cordoba J., et al. (2017), "EASL Clinical Practical Guidelines on the management of acute (fulminant) liver
failure", J Hepatol, 66 (5), pp. 1047-1081.
13. Willars C., Wendon J. (2014), "Liver failure", Oh’s Intensive Care Manual, Andrew D Bersten , Neil Soni, Editors, Elsevier, pp.
501-519.
14. William M., Lee M., Larson A. M., et al. (2011), "AASLD position paper: The management of acute liver failure: Update".
15. Ziv Y. H., Collins M. H., Rothenberg M. E. (2016), "Acute liver failure", Yamada’s Textbook of Gastroenterology, Daniel K.
Podolsky, Michael Camilleri, J. Gregory Fitz, Editors, Wiley Blackwell, pp. 1973-1988.

Acute liver failure

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