++

This chapter discusses the ED presentation, evaluation, and treatment of acute and chronic liver disease, including acute hepatitis, chronic (cirrhotic) liver disease, and fulminant liver failure. Specific entities addressed in this chapter include hepatic-related coagulopathy, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. Cholecystitis and biliary colic are addressed in Chapter 82, Pancreatitis and Cholecystitis, and variceal hemorrhage is addressed in Chapter 78, Upper Gastrointestinal Bleeding.

++

Acute and chronic hepatitis in the U.S. are primarily caused by alcohol and/or viral infection. Liver failure can be the result of viral hepatitis or alcoholic liver disease, or it can be caused by toxins, such as acetaminophen or mushroom poisoning.

++

In 2005, chronic liver disease and cirrhosis caused 28,175 deaths of which 45% were alcohol related.1 In 2006, the Centers for Disease Control and Prevention estimates that there were 46,000 new hepatitis B virus (HBV) infections, 32,000 new hepatitis A virus (HAV) infections, and 19,000 new hepatitis C virus (HCV) infections. Between 2001 and 2006, there were an estimated 5000 deaths from HBV and 8000 to 10,000 deaths from HCV annually in the U.S.2 The pronounced difference in total deaths reflects an important difference in the natural history of these two forms of hepatitis: only 6% to 10% of patients infected with HBV become chronically ill, whereas up to 85% of patients with HCV infection develop chronic disease.3,4 Vaccination against HBV (adults and children) and HAV (primarily children) has reduced the incidence of acute hepatitis and liver failure in this country dramatically (Table 83-0.1).

++
Table Graphic Jump Location
Table 83-0.1 Hepatitis Disease Burden in the U.S., 2005–2006 
++

Alcoholic hepatitis is a waxing and waning illness often superimposed on chronic or cirrhotic alcoholic liver disease. In the U.S., alcoholism is present in 10% of men and 3% of women. Approximately 20% of all alcoholics will develop alcoholic hepatitis and/or cirrhosis in their lifetime.5

++

Acetaminophen ingestion causes approximately 42% of acute liver failure annually.6 Other important toxic causes of hepatitis and liver failure are poisonous mushrooms, herbal remedies, and prescription medications.

++

Acute hepatitis is caused by an infectious, toxic, or metabolic injury to hepatocytes. This inital injury leads to cellular death and potential scarring in the liver. In chronic ...

Want access to your institution's subscription?

Sign in to your MyAccess Account while you are actively authenticated on this website via your institution (you will be able to tell by looking in the top right corner of any page – if you see your institution’s name, you are authenticated). You will then be able to access your institute’s content/subscription for 90 days from any location, after which you must repeat this process for continued access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess account, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessMedicine Full Site: One-Year Subscription

Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessMedicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.