Hepatic Failure/GI/Endocrine Emergencies

Liver assist devices: The molecular adsorbent recirculating system (MARS) has been studied for the

treatment of ALF. In a large propensity-matched study of 104 patients who received MARS for ALF

(matched 4:1 to 416 controls), MARS significantly increased the odds of 21-day transplant-free survival

(OR 1.9; 95% CI, 1.07–3.39; p=0.03).

Orthotopic liver transplantation is the only definitive treatment for patients with ALF.

The advances in liver transplantation have improved ALF survival to greater than 60%.

Predictive models of survival and need for liver transplantation are useful to identify the patients most

likely to benefit from liver transplantation.

50% or greater when acetaminophen, hepatitis A, acute ischemic injury, or pregnancy is the cause,

whereas other causes confer less than 25% transplant-free survival. In addition, transplant-free survival

is significantly decreased when patients present with grade III or grade IV encephalopathy compared

with grade I or grade II encephalopathy.

King’s College criteria, developed from a cohort of about 600 patients with ALF, incorporate parameters

such as cause of ALF and clinical parameters, including degree of encephalopathy and liver function

tests, in order to evaluate the decision to perform transplantation versus provide medical therapy.

MELD score may also be used for prognostication. Patients meeting King’s College criteria or MELD

score greater than 25 are at high risk of poor outcomes.

AP is responsible for 275,000 hospitalizations per year in the United States.

annual cost of $2.6 billion.

Incidence is estimated at 5–30 cases per 100,000.

AP is classified according to disease severity. Overall, about 20% of patients with AP have a severe

course with an overall mortality rate of approximately 5%.

The clinical diagnosis of AP is based on characteristic symptoms (i.e., abdominal pain and nausea),

together with elevated serum concentrations of pancreatic enzymes. According to the Acute Pancreatitis

Classification Working Group definition, two of the following three criteria must be met for a patient to

be given a diagnosis of AP:

Abdominal pain consistent with AP. This is typically persistent epigastric pain, sometimes

radiating to the back.

Serum lipase (or amylase) concentrations greater than 3 times the upper limit of normal

Imaging CT, magnetic resonance imaging [MRI], or transabdominal ultrasonography) consistent

with pancreatitis

Mild AP: Tends to be self-limiting with no organ failure or necrosis. There is also the absence of

local and systemic complications.