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Acute Pancreatitis I: Introduction01:27

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Chronic Pancreatitis I: Introduction01:24

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Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
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Acute-on-chronic Liver Failure.

Shiv Kumar Sarin1, Ashok Choudhury2

  • 1Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India. sksarin@ilbs.in.

Current Gastroenterology Reports
|October 18, 2016
PubMed
Summary
This summary is machine-generated.

Acute-on-chronic liver failure (ACLF) involves rapid liver function decline in chronic liver disease patients due to acute insults. Early intervention and multidisciplinary care improve survival rates up to 50%.

Keywords:
ACLFInflammationOrgan failure (OF)SIRS

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Area of Science:

  • Hepatology
  • Critical Care Medicine
  • Immunology

Background:

  • Acute-on-chronic liver failure (ACLF) is a distinct clinical syndrome characterized by acute deterioration of liver function in patients with pre-existing chronic liver disease.
  • ACLF differs from acute liver failure and decompensated cirrhosis due to its specific timing, presence of a treatable acute precipitant, and potential for self-recovery.
  • The condition is marked by a deregulated inflammatory response, progressing from systemic inflammatory response syndrome (SIRS) to a compensatory anti-inflammatory response syndrome (CARS) and subsequent immunoparalysis, increasing sepsis and multi-organ failure risk.

Purpose of the Study:

  • To define the core concept and characteristics of ACLF.
  • To outline the critical timeframes and presentation patterns crucial for management.
  • To discuss current therapeutic strategies and emerging research areas for improving patient outcomes.

Main Methods:

  • Literature review and synthesis of current understanding of ACLF pathophysiology and clinical management.
  • Analysis of the role of acute insults, inflammatory pathways (SIRS/CARS), and organ failure in ACLF.
  • Evaluation of treatment modalities including specific therapies for HBV-ACLF, alcoholic hepatitis, autoimmune hepatitis, and the role of liver transplantation.

Main Results:

  • ACLF is defined by acute hepatic insult leading to liver failure (jaundice, encephalopathy, coagulopathy, ascites) with potential extrahepatic organ failure.
  • Early identification and mitigation of the acute insult, alongside timely interventions like nucleoside analogues or steroids, can lead to recovery.
  • A 90-day transplant-free survival rate of up to 50% is achievable with appropriate management.
  • A protocol-based, multidisciplinary approach involving critical care hepatology and early liver transplant consideration is vital for improving outcomes.

Conclusions:

  • Early recognition of the acute insult and prompt, multidisciplinary management are crucial for improving survival in ACLF.
  • Liver transplantation, considered early before multi-organ involvement, significantly impacts outcomes.
  • Emerging research in regenerative medicine, cell-based therapies, immunotherapy, and gut microbiota modulation holds promise for future ACLF treatments.