Acute liver failure
  • Jan 28, 2017

Acute liver failure, also known as fulminant hepatic failure,  is loss of liver function that occurs rapidly - in days or weeks - usually in a person who has no pre-existing liver disease. It is less common than chronic liver failure, which develops more slowly.
 
Acute liver failure can cause serious complications, including excessive bleeding and increasing pressure in the brain. It's a medical emergency that requires hospitalization.

Depending on the cause, acute liver failure can sometimes be reversed with treatment.

Symptoms

Signs and symptoms of acute liver failure may include:

  • Yellowing of skin and eyeballs (jaundice)

  • Pain in your upper right abdomen

  • Abdominal swelling

  • Nausea

  • Vomiting

  • A general sense of feeling unwell

  • Disorientation or confusion

  • Sleepiness

When to see a doctor

Acute liver failure can develop quickly in an otherwise healthy person, and it is life-threatening. If someone suddenly develops a yellowing of the eyes or skin; tenderness in the upper abdomen; or any unusual changes in mental state, personality or behavior, there is a need to seek medical attention immediately.

Causes

Acute liver failure occurs when liver cells are damaged significantly and are no longer able to function. Potential causes include:
  • Acetaminophen / Paracetamol overdose. Taking too much acetaminophen or Paracetamol is a common cause of acute liver failure. Acute liver failure can occur after one very large dose of acetaminophen, or after higher than recommended doses every day for several days.
  • Prescription medications. Some prescription medications, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, halothane anaesthetic agent can cause acute liver failure.

  • Herbal supplements. Herbal drugs and supplements, including kava, ephedra, skullcap and pennyroyal, have been linked to acute liver failure.

  • Hepatitis and other viruses. Hepatitis A, hepatitis B and hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include Epstein-Barr virus, cytomegalovirus and herpes simplex virus.

  • Toxins. Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for edible species.

  • Autoimmune disease. Liver failure can be caused by autoimmune hepatitis — a disease in which immune system attacks liver cells, causing inflammation and injury.

  • Diseases of the veins in the liver. Vascular diseases, such as Budd-Chiari syndrome, can cause blockages in the veins of the liver, leading to acute liver failure.

  • Metabolic disease. Rare metabolic diseases, such as Wilson's disease and acute fatty liver of pregnancy, infrequently cause acute liver failure.

  • Cancer. Cancer that either begins in or spreads to liver can cause liver to fail.

  • No Apparent Cause -Many cases of acute liver failure have no apparent cause

Complications

Acute liver failure often causes complications, including:

  • Excessive fluid in the brain (cerebral edema). Excessive fluid causes pressure to build in brain, which can displace brain tissue outside of the space it normally occupies (herniation). Cerebral edema can also deprive brain of oxygen.

  • Bleeding and bleeding disorders. A failing liver isn't able to produce sufficient amounts of clotting factors, which help blood to clot. People with acute liver failure often develop bleeding from the gastrointestinal tract. Bleeding may be difficult to control.

  • Infections. People with acute liver failure are at an increased risk of developing a variety of infections, particularly in the blood and in the respiratory and urinary tracts.

  • Kidney failure. Kidney failure often occurs following liver failure, especially in cases of acetaminophen overdose, which damages both liver and kidneys.

Preparing for Doctor’s appointment

In case of suspicion of acute liver failure, there will be requirement of hospital admission as most people with acute liver failure are treated in an intensive care unit.

Questions to expect from your doctor

To determine the cause of acute liver failure the doctor may ask:

  • When did symptoms begin?

  • What prescription medications are being taken?

  • What over-the-counter medications are being taken?

  • What herbal supplements are being taken?

  • Do you use illegal drugs?

  • Have you been diagnosed with hepatitis?

  • Do you have a history of depression or suicidal thoughts?

  • How much alcohol do you drink?

  • Have you recently started taking new medications?

  • Do you take acetaminophen / paracetamol? How much?

  • Do liver problems run in your family?

Questions that you may ask the doctor

If you have been diagnosed with acute liver failure, here are some questions to ask the doctor:

  • What caused my acute liver failure?

  • Can it be reversed?

  • What are the treatments?

  • Will I need a liver transplant?

  • Does this hospital have a liver transplant unit?

  • Should I transfer to a hospital that performs liver transplants?

Tests and diagnosis

Tests and procedures used to diagnose acute liver failure include:

  • Blood tests. Blood tests to determine how well liver is functioning may include the prothrombin time test, which measures how long it takes for blood to clot. With acute liver failure, blood won't clot as quickly as it should.

  • Imaging tests.  Ultrasound, to evaluate liver. Imaging tests may show liver damage and may help doctor determine the cause of liver problems.

  • Examination of liver tissue. Doctor may recommend a procedure to remove a small piece of liver tissue (liver biopsy). Tests of the liver tissue may help doctor understand why the liver is failing.

Because people with acute liver failure are at risk of bleeding during biopsy, the doctor may perform a transjugular liver biopsy. Through a tiny incision on the right side of your neck, your doctor passes a thin tube (catheter) into a large vein in your neck, through your heart and into a vein exiting your liver. Your doctor then inserts a needle down through the catheter and retrieves a sample of liver tissue.

Treatments and drugs

People with acute liver failure are often treated in the intensive care unit of a hospital. Doctors may try to treat the liver damage itself, but in many cases, treatment involves controlling complications and giving the liver time to heal.

Treatments for acute liver failure

Acute liver failure treatments may include:

  • Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin and may reduce liver damage.

  • Liver transplant. When acute liver failure can't be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes the damaged liver and replaces it with a healthy liver from a donor.

Treatments for complications

Doctors will work to control signs and symptoms you're experiencing and try to prevent complications caused by acute liver failure. This care may include:

  • Relieving pressure caused by excess fluid in the brain. Cerebral oedema caused by acute liver failure can increase pressure on the brain. Medications can help reduce the fluid build up in the brain.

  • Screening for infections. Medical team will take periodic samples of blood and urine to be tested for infection. If your doctor suspects that you have an infection, you'll receive medications to treat the infection.

  • Preventing severe bleeding.  Medications may be given to reduce the risk of bleeding. In case of loss of a lot of blood, doctors may perform tests to find the source of the blood loss, and you may require blood transfusions.

Prevention

Reduce your risk of acute liver failure by taking care of your liver.

  • Follow instructions on medications. If you take acetaminophen or other medications, check the package insert for the recommended dosage, and don't take more than that.

  • Tell your doctor about all your medicines. Even over-the-counter and herbal medicines can interfere with prescription drugs.

  • Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day for women of all ages and men older than 65 and no more than two drinks a day for younger men.

  • Avoid risky behavior. Get help if you use illicit intravenous drugs. Don't share needles. Use condoms during sex. If you get tattoos or body piercings, make sure the shop you choose is clean and safe. Don't smoke.

  • Get vaccinated. If you're at increased risk of contracting hepatitis, if you've been infected with any form of the hepatitis virus or if you have chronic liver disease, talk to your doctor about getting the hepatitis B vaccine. A vaccine is also available for hepatitis A.

  • Avoid contact with other people's blood and body fluids. Accidental needle sticks or improper cleanup of blood or body fluids can spread hepatitis viruses. Sharing razor blades or toothbrushes can also spread infection.

  • Don't eat wild mushrooms. It can be difficult to distinguish an edible mushroom from a poisonous one.

  • Take care with aerosol sprays. When you use an aerosol cleaner, make sure the room is ventilated, or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint and other toxic chemicals. Follow manufacturers' instructions.

  • Watch what gets on your skin. When using insecticides and other toxic chemicals, cover your skin with gloves, long sleeves, a hat and a mask.

  • Maintain a healthy weight. Obesity can cause a condition called non-alcoholic fatty liver disease, which may include fatty liver, hepatitis and cirrhosis.


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