"improving intensive care in Scotland"

Liver failure

Intensive care is important to two groups of patients with liver disease - those with acute liver failure (often due to paracetamol poisoning) and those with the complications of chronic liver disease - such as variceal bleeding, acute decompensation and encephalopathy. While fulminant hepatic failure due to paracetamol overdose is declining in the UK, chronic liver disease is increasing, largely due to alcohol consumption. The etiology and pathophysiology of acute and chronic liver failure have significant differences, and require different therapeutic approaches.




Liver failure



Encephalopathy within eight weeks of onset of jaundice


Encephalopathy within two to six months of onset of symptoms


Gradual destruction of liver tissue resulting in impaired function

Table 1. Categories of liver failure.


Causes of liver failure


Paracetamol (commonest cause in UK)

Viral Hepatitis

Drug reactions (e.g. rifampicin, MDMA, Isoniazid, flucloxacilin, augmentin)


Alcohol abuse (commonest cause in the UK)

Primary biliary cirrhosis

Viral hepaitits

Primary sclerosing cholangitis

α1 antitrypsin deficiency

Wilson's disease


Non alcoholic fatty liver disease (often associated with diabetes)

Table 2. Causes of acute and chronic liver failure.

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