Akutno zatajenje jetre progresivan je klinički sindrom obilježen brzim nastankom jetrene disfunkcije s posljedičnom disfunkcijom brojnih drugih organskih sustava. Kriteriji kojima ga definiramo razlikuju se od adultnih jer razvoj jetrene encefalopatije pogotovo u ranim stadijima nije jednostavno prepoznati posebno u novorođenčadi i dojenčadi, a ona i ne mora biti prisutna u početku, stoga nije nužna za postavljanje dijagnoze. Uzroci nastanka akutnog zatajenja jetre brojni su te ovise o dobi djeteta, a u gotovo 50% unatoč iscrpnim dijagnostičkim postupcima uzrok ostaje nerazjašnjen. Klinička slika u djece često je nespecifična (umor, mialgija, bol u trbuhu, mučnina i povraćanje), a žutica može, ali i ne mora biti odmah prisutna. U ranom stadiju nastupa bolesti fizikalni status kao i neurološki mogu biti u potpunosti normalni, no poznavajući nepredvidivost i moguću brzinu pogoršanja stanja, koje može u nekoliko sati rezultirati multiorganskim zatajenjem i komom, ključno je promptno pacijenta transportirati u transplantacijski centar. Zbrinjavanje bolesnika vodi multidisciplinarni tim, a odvija se u Jedinici intenzivnog liječenja zbog mogućnosti kontinuiranog praćenja vitalnih funkcija i neurološkog statusa. Iako se jedan manji dio pacijenata u potpunosti oporavi uz simptomatsko liječenje, većina ipak zahtijeva transplantaciju jetre. Koje je optimalno vrijeme za transplantaciju jetre te je li ona zaista potrebna ili postoji mogućnost spontanog oporavka, vječna su pitanja koja more liječnike koji zbrinjavaju takve pacijente. Dok se ne pronađe dobar prognostički model za utvrđivanje ishoda s ili bez transplantacije jetre preostaje nam individualna procjena svakog slučaja.Acute liver failure is a progressive clinical syndrome characterized by the rapid onset of liver dysfunction with consequent dysfunction of other organ systems. The diagnostic criteria differ from adults because the development of liver encephalopathy, especially in the early stages, is not easy to recognize, especially in newborns and infants, and it may not be present initially, so it is not necessary for diagnosis. The causes of acute liver failure are numerous and age dependent, and in almost 50% of cases despite exhaustive diagnostic testing the cause remains unknown. The clinical picture in children is often nonspecific (fatigue, myalgia, abdominal pain, nausea, and vomiting), and jaundice may or may not be present immediately. In the early stages of the disease, physical and neurological status can be completely normal, but knowing the unpredictability of this condition, which can result in multiorgan failure and coma in a few hours, it is crucial to transport the patient promptly to the transplant center. Patient care is led by a multidisciplinary team, and takes place in the Intensive care unit due to the possibility of continuous monitoring of vital functions and neurological status. Although a small proportion of patients achieve full recovery with symptomatic treatment, most still require a liver transplant. What is the
optimal time for a liver transplant and whether it is really needed or there is a possibility of spontaneous recovery, are eternal questions for the doctors who care for such patients. Until a good prognostic model for predicting survival with or without transplant is established, we are left with an individual assessment of each case
