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Réanimation métabolique de l’insuffisance hépatique aiguë

  • C. Paugam-Burtz
Part of the Le point sur ... book series (POINT)

Résumé

L’insuffisance hépatique aiguë (IHA) est une pathologie rare: elle correspond à une perte de la fonctionnalité du foie survenant chez un patient avec un parenchyme hépatique antérieurement sain. Elle se distingue donc des décompensations hépatiques aiguës des hépatopathies chroniques (cirrhose le plus souvent) qui surviennent comme leurs noms l’indiquent sur un foie pathologique. L’insuffisance hépatique est dite sévère si le taux de prothrombine est inférieur à 50 %. L’hépatite grave est caractérisée par l’association d’une IHA est d’une encéphalopathie. On estime que seuls 10 % des patients souffrant d’hépatite aiguë développent une forme sévère et moins de 1 % d’entre eux une forme grave. D’un point de vue nosologique, le délai qui sépare le début de l’ictère de l’apparition de l’encéphalopathie permet de caractériser des formes fulminantes (délai inférieur à 15 jours) et subfulminantes (délai 15 jours-3 mois). L’IHA se complique très fréquemment d’une part d’un syndrome de défaillance multiviscérale avec défaillance hémodynamique, rénale, pulmonaire et hématologique et d’autre part d’oedème cérébral, substratum physiopathologique de l’encéphalopathie (1). D’un point de vue thérapeutique, la transplantation hépatique (TH) a révolutionné la prise en charge de ces affections. On estime que la survie globale des formes graves d’IHA est passée de moins de 20 % entre 1973 et 1982 à presque 60 % entre 2003 et 2006 (2).

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Copyright information

© Springer-Verlag France 2011

Authors and Affiliations

  • C. Paugam-Burtz

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