Non-Intensive Care Unit Management of Acute and Acute on Chronic Liver Failure

Acute liver failure (ALF) is defined by the occurrence of hepatic encephalopathy as the consequence of severe liver injury in a patient without pre-existing chronic liver disease, an exception being a fulminant presentation with hepatic encephalopathy of a patient with previously asymptomatic Wilson’s disease. ALF must be distinguished from acute on chronic liver failure (ACLF), a relatively recently described clinical entity in which an acute decompensation of chronic liver disease is accompanied by multi-organ failure and an high short-term mortality rate, mimicking that of ALF. An excessive systemic inflammatory response plays a crucial role in poor outcomes related to both of these liver failure syndromes. Close monitoring of organ function and support of failing organs, along with the identification and correction of the aetiology of the underlying liver insult and reversal of harmful systemic inflammation, are crucial if patient outcomes are to be optimised. This chapter focuses on the non-intensive care unit (ICU) management of these separate clinical entities of ALF and ACLF, including both aetiology-related and general supportive medical measures of proven value.