Skip to Main Content

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 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. ...

Pop-up div Successfully Displayed

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