Hepatic failure is characterized by severe liver function impairment and is classified into hyperacute, acute, and subacute stages. Common causes include viral hepatitis, drug toxicity, structural abnormalities, and excessive alcohol consumption, with symptoms such as jaundice, abdominal distension, and confusion. Management focuses on rapid recognition and intensive intervention, including the use of antidotes, plasmapheresis, and liver transplantation as the optimal treatment for survival.

1. HEPATIC
FAILURE
Presented By:
Mr. Nandish. S
Asso. Professor
Mandya Institute of Nursing
Sciences

2. Definition / Meaning:
o It is a clinical syndrome characterized by severe impairment of liver
function associated with hepatic encephalopathy.
o It is the inability of Liver to perform its normal synthetic &
metabolic function.
o It develops within the 8 weeks after the first symptoms of Jaundice.

3. Classification :
Three categories of Liver failure are identified.
1) Hyperacute: duration of jaundice before the onset of
encephalopathy is 0 to 7 days.
2) Acute : duration is 8 to 28 days.
3) Subacute : duration is 28 to 72 days.
* Survival rates are 20 to 50 % depending on the cause.

4. Etiology :
- Viral Hepatitis
- Drugs (Acetaminophen, Isoniazid, Halothane, Paracetaml,
NSAID’s)
- Structural changes / congenital deformities like Budd –Chiari
syndrome (narrows & blocks blood vessel in Liver).
- Excessive alcohol consumption
- Metabolic disturbances like Wilson’s Disease ( Hereditary syndrome
with deposition of Copper in Liver)
- Excessive consumption of Fatty foods, Obesity

5. Clinical Manifestations :
- Abdominal distension / Ascites
- Jaundice
- Profound Anorexia
- Coagulation defects
- Pruritus
- Electrolyte disturbances (Hyponatremia, Hypokalemia, respiratory
alkalosis, metabolic acidosis)
- Glycosuria / Hyperglycemia
- Nausea & Vomiting

6. - Mental confusion
- Diarrhoea
- Loss of appetite
- Fatigue
- blood in the stool
- Fluid buildup in extremities
- Musty or sweet breath odor

7. Diagnostic studies :
- History collection & Physical Education
- Urine Routine
- LFT
- Prothrombin Time
- Bilirubin (Direct & Total)
- Ultrasound
- CT Scan

8. Management :
Aim : rapid recognition of acute liver failure & intensive intervention.
Depending on the degree of liver failure, treatment is planned.
1) Use of antidotes
• N – Acetylcysteine for acetaminophen / paracetamol toxicity
• Penicillin for mushroom poisoning.
2) Plasmapheresis (exchange of plasma).
3) Prostaglandin therapy
4) Extracorporeal Liver Assist Devices (ELAD) & Bioartificial Liver
Assist Devices (BAL). They are used until transplantation is possible.

9. 5) Liver Transplantation (treatment of choice for maximum survival
rate)
6) Intracranial pressure monitoring
7) Sedation
8) Monitor & treat hypoglycemia & Infection.

10. THANK YOU