ACUTE LIVER FAILURE

Dr. Sanjay Singh Negi

Acute liver failure is an uncommon, life-threatening condition in which there would be a compromise in your liver function due to the damage to the liver cell called hepatocytes. The mortality rate of acute liver failure is between 56% and 80%.

It can develop rapidly within days or weeks. Acute liver failure is most commonly seen in young people and has a high mortality rate. Timely diagnosis and prompt treatment play an integral role in the acute liver failure.

Identifying the cause is the most important step in the assessment because certain causes require a more specific and immediate management. Such causes include drug toxicity, mainly due to over dosage of acetaminophen; it is the leading cause of acute liver failure worldwide. The main role of intensive care therapy is organ support

Symptoms

The common signs and symptoms of acute liver failure include:

  • Fatigue
  • Nausea
  • Vomiting
  • Confusion
  • Drowsiness
  • Upper right abdominal pain
  • Swelling near the abdomen
  • Signs of jaundice (yellowness of skin and eyeballs)

Causes

Many cases of acute liver failure apparently don’t have any cause. However the most common causes of acute liver failure include:

  • Cancer
  • Acetaminophen toxicity
  • Toxins of wild mushrooms
  • Viruses such as hepatitis A, B, C
  • Herbal supplements (kava, ephedra, and pennyroyal)
  • Autoimmune hepatitis (immune system attacks liver cells)
  • Metabolic diseases such as Wilson’s disease, pregnancy, and acute fatty liver
  • Prescription drugs (antibiotics, anticonvulsants, non-steroidal anti-inflammatory drugs, etc.)

Risk factors

The risk factors for acute liver failure include:

  • Use of illicit drugs
  • Obesity / over weight
  • Consumption of large amounts of alcohol
  • Bile duct disorders (primary biliary cirrhosis)
  • Failure to get vaccinated
  • Age and gender (women between 35-60 years, men between 30-40 years)

Complications

Acute liver failure often causes complications, such as:

  • Kidney failure- due to the over dosage of acetaminophen your liver gets harmed and is followed by kidney failure.
  • Cerebral edema (excessive fluid in the brain) – due to the excessive fluid buildup in the brain the brain tissue is displaced. This causes oxygen deprivation.
  • Infections- Infections related to blood, respiratory and urinary system is common.
  • Coma- Disorientation, mental confusion, and difficulty in concentrating progress to coma if the liver doesn’t restore to its normal function.
  • Bleeding disorders- In liver failure your liver doesn’t produce enough clotting factors. Therefore, there can be bleeding disorders especially in the gastrointestinal tract

Diagnosis

Diagnostic tests and procedures for acute liver failure include:

  • Blood tests: Prothrombin time test helps to determine how long it takes for your blood to clot. With acute liver failure, blood does not clot as quickly as it does in normal condition.
  • Imaging tests: Ultrasound testing is recommended to evaluate your liver. This test reveals liver damage if present and is helpful for your doctor to determine the cause.
  • Liver tissue examination: Your doctor would order for a liver biopsy. In a liver biopsy, a small piece of liver tissue is removed and examined which let to understand the underlying cause of acute liver failure.
  • (Writes : Sr. ConsultantDirector, HPB Surgery and Liver TransplantationDigestive & Liver Care (Gastroenterology – GI Care)

    BLK Super Speciality Hospital,New Delhi

    Visiting Professor -College of Medical Science,Bharatpur)

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