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Related Concept Videos

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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

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Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
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Acute Pancreatitis I: Introduction01:27

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Pancreatitis is inflammation of the pancreas, an organ located behind the stomach. It can be either acute or chronic.
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Acute Kidney Injury I: Introduction01:22

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Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
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Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
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Update on acute-on-chronic liver failure.

Cristina Solé1, Elsa Solà1

  • 1Servicio de Hepatología, Hospital Clínic Barcelona. Universitat de Barcelona. Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Ciber de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España.

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Acute-on-chronic liver failure (ACLF) is a serious liver condition with high mortality. Management focuses on organ support and transplantation, with new treatments under investigation.

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Area of Science:

  • Hepatology
  • Internal Medicine
  • Critical Care Medicine

Background:

  • Acute-on-chronic liver failure (ACLF) is a syndrome of acute decompensation in patients with chronic liver disease.
  • It is characterized by organ failures and high mortality, affecting up to 30% of hospitalized cirrhosis patients.
  • Common triggers include bacterial infections, alcohol, and viral hepatitis, but a precipitating factor is often unidentified.

Purpose of the Study:

  • To define Acute-on-chronic liver failure (ACLF) and its characteristics.
  • To review the current understanding of ACLF pathophysiology, precipitating factors, and management.
  • To highlight the need for new treatment strategies.

Main Methods:

  • Literature review and synthesis of existing data on ACLF.
  • Analysis of the pathophysiology, focusing on the role of inflammation.
  • Overview of current management strategies and emerging treatments.

Main Results:

  • ACLF involves acute decompensation of chronic liver disease, leading to organ failure and significant mortality.
  • An excessive inflammatory response is implicated in ACLF pathophysiology.
  • Current management relies on organ support and liver transplantation, with limited data on novel therapies.

Conclusions:

  • ACLF is a critical condition requiring further research into its mechanisms and effective treatments.
  • Effective management strategies are needed beyond current supportive care and transplantation.
  • Immunomodulatory treatments and liver support systems show potential but require more data.