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Insuficiencia hepática aguda

R Todd Stravitz1, William M Lee2

  • 1Hume-Lee Transplant Center of Virginia Commonwealth University, Richmond, VA, USA.

Lancet (London, England)
|September 10, 2019
PubMed
Resumen
Este resumen es generado por máquina.

La insuficiencia hepática aguda, una condición grave de lesión rápida de las células hepáticas, se presenta con aminotransferasas elevadas y mentación alterada. Las mejoras en el manejo han reducido la mortalidad, y el trasplante de hígado sigue siendo una opción vital.

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Área de la Ciencia:

  • Hepatología
  • Médico interno
  • Toxicología

Sus antecedentes:

  • La insuficiencia hepática aguda (IAH) es una afección rara y grave caracterizada por una lesión rápida de los hepatocitos sin enfermedad hepática preexistente.
  • Se presenta con aminotransferasas elevadas, alteración de la mente y coagulopatía.
  • La diferenciación entre la FAL y la cirrosis descompensada es crucial para un tratamiento adecuado.

Objetivo del estudio:

  • Describir las principales características, causas y métodos de diagnóstico de la insuficiencia hepática aguda.
  • Discutir las estrategias de manejo actuales y su impacto en los resultados de los pacientes.
  • Para resaltar el papel del trasplante de hígado en casos graves.

Principales métodos:

  • Revisión de la literatura existente y opinión de expertos sobre la insuficiencia hepática aguda.
  • Análisis de agentes etiológicos comunes, incluida la toxicidad de los medicamentos (paracetamol), la isquemia, la hepatitis viral y la autoinmune.
  • Se hace hincapié en los criterios de diagnóstico, incluidos los antecedentes farmacológicos y las pruebas serológicas.

Principales resultados:

  • Un patrón consistente de elevación rápida de la aminotransferasa, alteración de la mentación y alteración de la coagulación define la ALF.
  • Las causas comunes incluyen toxicidad por paracetamol, hepatitis viral y daño hepático inducido por medicamentos de diversas fuentes.
  • A pesar de su rareza y de que los ensayos a gran escala son limitados, la mejora del tratamiento ha disminuido las tasas de mortalidad.

Conclusiones:

  • La insuficiencia hepática aguda requiere un diagnóstico y un tratamiento rápidos, teniendo en cuenta diversas etiologías.
  • Si bien el tratamiento médico ha mejorado los resultados, el trasplante de hígado sigue siendo una intervención crítica para salvar la vida de casi el 30% de los pacientes.
  • Se necesita más investigación, pero los enfoques actuales guiados por expertos mejoran la supervivencia.