Liver and intrahepatic bile ducts - nontumor
General concepts
Hepatic failure

Author: Anthony W.H. Chan, FRCPA

Revised: 10 March 2018, last major update March 2018

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

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

Cite this page: Chan, A.W.H. Hepatic failure. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/liverhepaticfailure.html. Accessed December 11th, 2018.
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)
Terminology
  • Acute hepatic failure may also refer to fulminant hepatic failure, fulminant hepatitis or massive hepatic necrosis
Epidemiology
Etiology
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
demonstrating
massive necrosis and
architectural collapse