Liver and intrahepatic bile ducts - nontumor
General concepts
Hepatic failure

Topic Completed: 1 March 2018

Revised: 16 March 2020

Copyright: 2002-2020,, 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: 351
Cite this page: Chan A. Hepatic failure. website. Accessed March 28th, 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

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

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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