This document summarizes hepatic insufficiency and liver failure. It defines acute liver failure as the rapid development of liver dysfunction leading to coagulopathy and encephalopathy in a patient without known liver disease. Acute liver failure can be categorized as fulminant (encephalopathy within 8 weeks) or subfulminant (encephalopathy after 8 weeks but before 26 weeks). Chronic liver failure usually occurs in the context of cirrhosis due to various causes such as hepatitis, alcohol, or autoimmune disease. Complications of liver failure include cerebral edema, bleeding disorders, infections, and kidney failure. Treatment options include medications to reverse toxicity, liver transplantation, treatments for complications, and screening for infections.

1. KURSK STATE MEDICAL UNIVERSITY
DEPARTMENT OF PATHOPHYSIOLOGY
LOGANATHAN ASHOK KUMAR
GROUP: 20
4TH YEAR 7TH SEMESTER.

2. INTRODUCTION
 Hepatic insufficiency is the inability of
the liver to perform its
normal synthetic and metabolic function
as part of normal physiology.

3. Epidemiology:
 In 2005, ALF accounted for 6% of liver-
related deaths and 7% of orthotopic liver
transplants (OLT) in the United States.

4. TYPES:
 acute and chronic.
 “Acute” liver failure is defined as "the rapid development of
hepatocellular dysfunction, specifically coagulopathy and
mental status changes (encephalopathy) in a patient without
known prior liver disease.
 encephalopathy within 26 weeks of the onset of any hepatic
symptoms.

5. acute:
 "fulminant hepatic failure", which requires
onset of encephalopathy within 8 weeks.
 ‘’subfulminant", which describes onset of
encephalopathy after 8 weeks but before
26 weeks.

6. Acute:
 Another scheme defines "hyperacute"
as onset within 7 days, "acute" as onset
between 7 and 28 days, and "subacute"
as onset between 28 days and 24
weeks.

7. Chronic
 Chronic liver failure usually occurs in the
context of cirrhosis, itself potentially the
result of many possible causes, such as
excessive alcohol intake, hepatitis
B or C, autoimmune, hereditary and
metabolic causes (such
as iron or copper overload, Steato
hepatitis or non-alcoholic fatty liver
disease).

8. Pathogenesis:

9. Cirrhosis
 • The three main characteristics of cirrhosis are (1)
involvement of most or all of the liver, (2) bridging
fibrous septa, and (3) parenchymal nodules
containing a mix of senescent and replicating
(often stem/progenitor cell-derived) hepatocytes.
 • Cirrhosis usually is an end-stage process that
may have multiple causes. The most frequent are
chronic hepatitis B and C and alcoholic and
nonalcoholic steatohepatitis. Less frequent causes
are autoimmune and biliary diseases and
metabolic conditions such as hemochromatosis.

10.  • The main complications of cirrhosis are
related to decreased liver function, portal
hypertension, and increased risk for
evelopment of hepatocellular carcinoma

11. CAUSES:
 Acetaminophen overdose
 Prescription medications (antibiotics, nonsteroidal anti-
inflammatory drugs and anticonvulsants)
 Herbal supplements
 Hepatitis and other viruses
 Toxins (mushroom Amanita phalloides)
 Autoimmune disease
 Diseases of the veins in the liver (Budd-Chiari
syndrome)
 Metabolic disease (Wilson's disease and acute fatty liver of
pregnancy)
 Cancer
 Alcohol

12. SIGNS:
Signs and symptoms of acute liver failure
may include:
 Yellowing of skin and eyeballs (jaundice)
 Pain in your upper right abdomen
 Abdominal swelling
 Nausea
 Vomiting
 A general sense of feeling unwell (malaise)
 Disorientation or confusion
 Sleepiness.

13. CLINICAL PICTURE

14. COMPLICATIONS:
 Excessive fluid in the brain (cerebral
edema)
 Bleeding and bleeding disorders
 Infections
 Kidney failure

15. Treatments liver failure:
 Medications to reverse poisoning. Acute
liver failure caused by acetaminophen
overdose or mushroom poisoning is treated
with drugs that can reverse the effects of
the toxin and may reduce liver damage.
 Liver transplant. When acute liver failure can't
be reversed, the only treatment may be a liver
transplant. During a liver transplant, a surgeon
removes your damaged liver and replaces it
with a healthy liver from a donor.

16. Treatments for
complications:
 Relieving pressure caused by excess
fluid in the brain. Cerebral edema caused
by acute liver failure can increase pressure
on your brain. Medications can help reduce
the fluid buildup in your brain.
 Screening for infections. Your medical
team will take periodic samples of your
blood and urine to be tested for infection. If
your doctor suspects that you have an
infection, you'll receive medications to treat
the infection.

17.  Preventing severe bleeding. Your doctor
can give you medications to reduce the risk
of bleeding. If you lose a lot of blood, your
doctor may perform tests to find the source
of the blood loss, and you may require
blood transfusions.

18.  THANK YOU..