Hepatic Failure

Pearls and Pitfalls

• Hepatic failure affects nearly every organ system: neurologic, cardiovascular, gastrointestinal, renal, hematologic, endocrine, and immune.

• Although there are many causes of hepatic failure, few have specific treatments.

• The most common causes of death are cerebral edema, sepsis, and multisystem organ failure.

• Liver transplantation is often the only durable therapy.

The liver plays a central role in substrate and toxin metabolism, protein synthesis, and both innate and acquired immunity. This makes hepatic failure in the surgical patient an extraordinary management challenge. Acetaminophen toxicity is the most common etiology of fulminant hepatic failure in the United States and United Kingdom, but a variety of etiologies can cause hepatic failure (Table 22-1 ). Untreated hepatic failure is highly lethal and, with a few exceptions, much of the current treatment of hepatic failure is supportive. The most common causes of death after liver failure are cerebral edema...