Liver and intrahepatic bile ducts - nontumor
General concepts
Hepatic failure

Topic Completed: 1 March 2018

Revised: 20 November 2019

Copyright: (c) 2002-2019,, Inc.

PubMed Search: Hepatic failure[TI] liver Review[ptyp]

Anthony W.H. Chan, F.R.C.P.A.
Page views in 2019: 1,244
Page views in 2020 to date: 185
Cite this page: Chan A. Hepatic failure. website. Accessed February 17th, 2020.
Definition / general
  • Characterized by acute and severe hepatic abnormalities with a high short term mortality (Gut 2017;66:541)
  • May occur with or without preexisting chronic liver disease
  • Various clinical definitions exist:
    • Acute hepatic failure
    • Acute on chronic hepatic failure
      • Europe (EASL CLIF): acute liver decompensation (ascites, encephalopathy, gastrointestinal bleeding or bacterial infection) in preexisting chronic liver disease defined by the chronic liver failure sequential organ failure assessment [CLIF-SOFA] score and 28 day mortality > 15% (Gastroenterology 2013;144:1426)
      • Asia Pacific (APASL): jaundice (serum bilirubin level of ≥ 5 mg/dL) and coagulopathy (INR ≥ 1.5 or prothrombin activity of > 40%), which are complicated within 4 weeks by clinical ascites or encephalopathy in patients with previously diagnosed or undiagnosed chronic liver disease (including cirrhosis) (Gut 2017;66:541)
  • Acute hepatic failure may also refer to fulminant hepatic failure, fulminant hepatitis or massive hepatic necrosis
Clinical features
  • Jaundice
  • Coagulopathy
  • Hepatic encephalopathy
  • In patients with acute on chronic hepatic failure, clinical features of cirrhosis may also be present
Case reports
Gross images

Images hosted on PathOut server:

Contributed by W.H. Chan, FRCPA

Acute heptic failure

Images hosted on other servers:

Explanted liver with large areas of hemorrhage and necrosis

Microscopic (histologic) description
  • Panacinar hepatic necrosis with collapse of reticulin framework
  • Variable inflammatory infiltrate, depending on etiology
  • Variable ductular reaction
  • Microscopic features of cirrhosis in patients with acute on chronic hepatic failure
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by W.H. Chan, FRCPA

Panacinar hemorrhagic necrosis

Prominent ductular reaction

Collapse of reticulin framework

Images hosted on other servers:

Post isoflurane anesthesia

Explanted liver
massive necrosis and
architectural collapse

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