Acute hepatic insufficiency
The acute hepatic insufficiency (or IHA) is an acute deterioration engraves function hépatocellulaire by cytolytic attack or cholestase.
Etiologies
In France, the viral hepatitis B is the most frequent etiology. Come then the toxic and medicamentous causes.
Nontoxic etiologies
- acute Viral hepatitis
- gravidic acute Steatosis
- autoimmune chronic Hepatitis
- Syndrome of Budd-Chiari
- malignant Infiltrations
- Syndrome of Reye
- Septicaemia
- Disease of Wilson
Toxic etiology
Private clinic
Latency period of duration variable. Then appearance of an asthenia, anorexia, nauseas and vomiting and embarrassment of the hypochondre right.Increase in the serum bilirubine and appearance of a Ictère.
Appearance of a hypoglycemia, of a lactic acidosis and reached coagulation and impaired renal function occur in the serious cases.
Occurred of hemorrhages gastrointestinales due to the reduction in the synthesis of the factors of coagulation vitamin K dependant.
The serious cases can evolve to a Hépatite fulminans, characterized by the progressive appearance of a Encéphalopathie.
Evolution
The IHA is accompanied by an important morbidity and a mortality. Encephalopathy, cerebral edema, coagulopathy, complications hemodynamic and septic are the crucial factors of the forecast.
Treatment
The medical assumption of responsibility is symptomatic and requires a hospitalization with monitoring in unit of specialized intensive care.N-acétylcystéine (used in the Intoxication with paracetamol) would be also effective in the IHA of other etiologies.
Orthotopic hepatic transplantation allows a rate of survival from 65% to one year.