Acute liver failure Dotaz Zobrazit nápovědu
Acute on chronic liver failure (ACLF) can be precipitated by several factors such as bacterial infection, alcohol intake, viral hepatitis, surgery, etc. Identification of precipitating factor is an important part of management of ACLF. A middle aged gentleman was presented with features of acute liver failure and after through history and investigations, he was diagnosed as acute on chronic liver failure. Chronic liver disease was first diagnosed after this event of acute insult. Precipitating factor of ACLF was dengue fever in this case report. Therefore, in endemic area of dengue infection, dengue serology tests which are not routinely done should be advised to identify dengue infection as an acute insult in ACLF.
- Klíčová slova
- ACLF, Acute insult, Dengue infection, Endemic area, Precipitating factor,
- MeSH
- akutní zhoršení chronického selhání jater * MeSH
- dengue * MeSH
- lidé středního věku MeSH
- lidé MeSH
- prognóza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
We describe a case of a 16-year-old girl with Wilson disease, which was initially presented as Coombs-negative haemolytic anaemia and acute liver failure. The diagnosis was based on the findings of low ceruloplasmin serum level and high copper levels both in serum and 24-hour urinary excretion. The patient underwent orthotopic liver transplantation. A DNA-based diagnostic tool confirmed Wilson's disease: the patient was p.H1069Q homozygote. Based on further molecular-genetic examinations in the family, Wilson disease was diagnosed seven days later in one of the patient's asymptomatic brothers. The proband's cousin was confirmed as a carrier of the p.H1069Q mutation (Fig. 1, Ref. 24).
AIM: The study was designed to develop a readily reproducible model of acute liver failure (ALF) in the minipig, to gain an 8-hour therapeutic window to mimic, as closely as possible, acute liver failure in man. METHOD: We used reversible devascularization model of ALF in the minipig involving hepatic artery ligation and establish an end-to-side portocaval anastomosis. Standard laboratory monitoring was complemented with intracranial pressure (ICP) measurement. MATERIAL: Twenty minipigs (weight 25-30 kg) were used for the experiment. The animals were divided into 3 groups: I: 10 animals in an experimental group with ALF; II: 5 animals in an experimental group with ALF and ICP measurement, and III: 5 animals in a control group without ALF. RESULTS: Laboratory testing has shown the significant changes in levels of AST (33.44 +/- 39.96 vs. 1.56 +/- 0.50 mmol/l), lactate (2.97 +/- 1.16 vs. 1.18 +/- 0.61 mmol/l), and ammonia (264.3 +/- 93.05 vs. 42.5 +/- 12.98 mmol/l) between ALF groups and controls (p < 001) 6 h after the operative procedure, and significant changes in hypoglycemia and intracranial pressure were found 4 h after the operative procedure. The difference in Quick values (67.4 +/- 17.03 vs. 75.2 +/- 2.68) was not significant. We assume that the therapeutic window starts 4 h after the beginning of the experiment. CONCLUSION: Our devascularization model of ALF is simple and readily reproducible. The therapeutic window occurring shortly after surgery and persisting for a mean 9 h is suitable to evaluate bioartificial liver devices.
- MeSH
- akutní selhání jater krev etiologie patofyziologie MeSH
- arteria hepatica MeSH
- aspartátaminotransferasy krev MeSH
- intrakraniální hypertenze etiologie MeSH
- kyselina mléčná krev MeSH
- ligace MeSH
- miniaturní prasata MeSH
- modely nemocí na zvířatech MeSH
- portokavální zkrat chirurgický MeSH
- prasata MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- aspartátaminotransferasy MeSH
- kyselina mléčná MeSH
Acute liver failure is a life threatening illness whose mortality rate remains high. For the survival an early diagnosis is crucial as well as the use of specific and supportive therapy and the determination of patient's need for urgent liver transplantation. At the first signs of the disease progression it is necessary to contact a transplantation centre. The patient with acute liver failure should be admitted to intensive care unit of a hospital capable to perform liver transplantation. Liver transplantation is limited by the availability of organs. It is possible to expand the time required for spontaneous liver regeneration or transplantation by using liver supporting systems. The therapy of the acute liver failure is multidisciplinary and should be performed in specialized centers.
- MeSH
- akutní selhání jater diagnóza patofyziologie chirurgie terapie MeSH
- lidé MeSH
- transplantace jater MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: The aim of the study was to determine the influence of fractionated plasma separation and absorption (FPSA) on intracranial pressure (ICP) in acute liver failure (ALF). METHODS: A surgical model of ALF in pigs (35-40 kg) was used. We compared laboratory data and haemodynamic parameters from the ALF control group to the ALF group treated by Prometheus using ANOVA with repeated measures and grouping factors, by calculating the area under the curve, and by the Mann-Whitney rank test. RESULTS: Bilirubin levels differed significantly in favour of the FPSA treatment group: after 6 h 12.81 +/- 6.54 versus 29.84 +/- 9.99, after 9 h 11.94 +/- 4.14 versus 29.95 +/- 12.36 (p < 0.01) and after 12 h 13.88 +/- 6.31 versus 26.10 +/- 12.23 mmol/l (p < 0.05). ICP values differed significantly in favour of the FPSA treatment group: after 9 h 19.1 +/- 4.09 versus 24.1 +/- 2.85 (p < 0.01), after 10 h 21.9 +/- 3.63 versus 25.1 +/- 2.19, after 11 h 22.5 +/- 3.98 versus 26.3 +/- 3.50, and after 12 h 24.0 +/- 4.66 versus 29.8 +/- 5.88 mm Hg (p < 0.05). CONCLUSION: The authors demonstrated that a significant decrease in ICP was found in pigs with ALF following treatment by FPSA.
- MeSH
- akutní selhání jater patofyziologie terapie MeSH
- hemodiafiltrace * MeSH
- intrakraniální tlak * MeSH
- prasata MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- práce podpořená grantem MeSH
To explore the efficacy and safety of a small-volume-plasma artificial liver support system (ALSS) in the treatment of acute-on-chronic liver failure (ACLF). A retrospective analysis was performed. All ACLF patients received ALSS of plasma exchange & double plasma molecular absorb system (PE+DPMAS) treatment, and successfully completed this treatment. Patients were divided into small-volume and half-volume plasma groups. We compared the changes of the indicators on liver function, kidney function, blood coagulation function, and blood ammonia level before and after PE+DPMAS treatment; we compared the short-term and long-term curative effects between small-volume and half-volume plasma groups; and the factors influencing Week 4 and Week 12 mortality of ACLF patients were analyzed. The Week 4 improvement rates were 63.96 % and 66.86 % in the small-volume and half-volume plasma groups, respectively. The Week 12 survival rates in the small-volume-plasma and half-volume plasma groups were 66.72 % and 64.61 %, respectively. We found several risk factors affecting Week 4 and Week 12 mortality. Kaplan-Meier survival curves suggested no significant difference in Week 4 and Week 12 survival rates between the small-volume and half-volume plasma groups (P=0.34). The small-volume-plasma PE+DPMAS treatment could effectively reduce bilirubin and bile acids, and this was an approach with high safety and few complications, similar to the half-volume-plasma PE+DPMAS treatment. The small-volume-plasma PE+DPMAS has the advantage of greatly reducing the need for intraoperative plasma, which is especially of importance in times of shortage of plasma.
One of the therapeutic approaches in acute liver failure is the use of an artificial system replacing hepatic function--bioartificial liver. Its application is the most perspective in fulminant liver failure during preparation for transplantation of the liver (so-called bridge to transplantation) or in case of a non-functioning hepatic graft, and to reduce the mortality and morbidity of patients with acute liver failure where transplantation is not indicated or where a suitable graft was not found. The authors discuss briefly the construction of these systems, analyze different indications of treatment and its results, obscure questions and perspectives of further development.
- MeSH
- akutní selhání jater terapie MeSH
- játra umělá * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
OBJECTIVE: Acute liver failure (ALF) is a rare disease with a bad prognosis. Its start is accompanied by haemodynamic instability. The aim of our study was to evaluate the influence of fractionated plasmatic separation and adsorption (FPSA) on body haemodynamics using a large animal experimental model of ALF. METHODS: ALF was induced by the devascularisation of 21 laboratory pigs. FPSA was applied in 14 animals and seven animals formed a control group. Values of systemic vascular resistance index (SVRI), heart rate (HR), pulmonary artery wedge pressure (PAWP) and cardiac index (CI) at hours 3, 6, 9 and 12 of the experiment were compared. The values from laboratory tests conducted with FPSA-treated vs. untreated ALF animals were compared using Student's t-test, paired or unpaired, as required, and Mann-Whitney U-test using EXCEL and QUATRO spreadsheet applications. RESULTS: We found no significant differences in mean arterial pressure, SVRI, or plasma lactate (p>0.05) in the FPSA-treated group but there was a significant decrease(p<0.05) in intracranial pressure (ICP). Furthermore, we observed a significant decrease in HR at hour 3. A significant increase in CI at hour 9 and a significant decrease in pulmonary artery wedge pressure at hours 6 and 12 were also observed. CONCLUSION: Our study of FPSA application (Prometheus device) for treatment of experimental ALF in a large animal model did not confirm the earlier reported development of changes in body haemodynamics.
- MeSH
- akutní selhání jater patofyziologie terapie MeSH
- hemodiafiltrace škodlivé účinky přístrojové vybavení metody MeSH
- hemodynamika fyziologie MeSH
- modely nemocí na zvířatech MeSH
- prasata MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
Acute liver failure (ALF) is a clinical syndrome resulting from widespread damage of hepatocytes, with extremely high mortality rate. Urgent orthotopic liver transplantation was shown to be the most effective therapy for ALF but this treatment option is limited by scarcity of donor organs. Therefore, hepatocyte transplantation (Tx) has emerged as a new therapeutical measure for ALF, however, the first clinical applications proved unsatisfactory. Apparently, extensive preclinical studies are needed. Our aim was to examine if hepatocytes isolated from transgenic "firefly luciferase" Lewis rats into the recipient liver would attenuate the course of thioacetamide (TAA)-induced ALF in Lewis rats. Untreated Lewis rats after TAA administration showed a profound decrease in survival rate; no animal survived 54 h. The rats showed marked increases in plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, in plasma level of bilirubin and ammonia (NH(3)), and in a significant decrease in plasma albumin. Hepatocyte Tx attenuated the course of TAA-induced ALF Lewis rats which was reflected by improved survival rate and reduced degree of liver injury showing as lowering of elevated plasma ALT, AST, NH(3) and bilirubin levels and increasing plasma albumin. In addition, bioluminescence imaging analyses have shown that in the TAA-damaged livers the transplanted hepatocyte were fully viable throughout the experiment. In conclusion, the results show that hepatocyte Tx into the liver can attenuate the course of TAA-induced ALF in Lewis rats. This information should be considered in attempts to develop new therapeutic approaches to the treatment of ALF.
- MeSH
- akutní selhání jater chemicky indukované mortalita terapie MeSH
- hepatocyty transplantace MeSH
- krysa rodu Rattus MeSH
- míra přežití trendy MeSH
- potkani inbrední LEW MeSH
- thioacetamid toxicita MeSH
- transplantace buněk metody MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- thioacetamid MeSH
Acute liver failure (ALF) is a clinical condition with very high mortality rate. Its pathophysiological background is still poorly understood, which necessitates a search for optimal experimental ALF models with features resembling those of the human disorder. Taking into consideration reproducibility of induction of ALF, adequate animal size, cost of animals, the required time gap between insult and death of animals ("therapeutic window"), potential risk to investigator and other aspects, administration of thioacetamide (TAA) in rats is currently most recommended. However, the fundamental details of this ALF model have not yet been evaluated. This prompted us to investigate, first, the course of ALF as induced by intraperitoneal TAA at doses increasing from 175 to 700 mg/kg BW per day. The animals' survival rate, plasma alanine and aspartate aminotransferase activities, and bilirubin and ammonia levels were determined over the follow-up period. Second, we examined whether Wistar and Lewis rats exhibit any differences in the course of ALF induced by different TAA doses. We found that the optimal dose for ALF induction in rats is 350 mg.kg(-1) i.p., given as a single injection. Wistar rats proved more susceptible to the development of TAA-induced ALF compared with Lewis rats. Collectively, our present findings provide a sound methodological background for experimental studies aimed at evaluation of pathophysiology and development of new approaches in the therapy of ALF.
- MeSH
- akutní selhání jater chemicky indukované patologie MeSH
- druhová specificita MeSH
- játra patologie MeSH
- karcinogeny aplikace a dávkování toxicita MeSH
- krysa rodu Rattus MeSH
- potkani inbrední LEW MeSH
- potkani Wistar MeSH
- thioacetamid aplikace a dávkování toxicita MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Názvy látek
- karcinogeny MeSH
- thioacetamid MeSH
