Acute Liver Failure

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

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.

In many instances, your doctor would provide the treatment that focuses on symptomatic improvement while treating your liver damage simultaneously. The treatment options for acute liver failure include:

Drug therapy to reverse poisoning: Acetaminophen and mushroom poisoning will damage the liver cells. To counteract the toxicity, your doctor would administer certain drugs to reduce your liver damage.
Liver transplant: If the drug therapy fails the only treatment strategy to correct the acute liver failure would be a liver transplantation. A healthy liver from the donor is replaced with your damaged liver, and it has a success rate.

You must take care of your liver to avoid further deterioration of the liver, follow the tips that help reduce the risk:

  • Avoid consuming wild variety of mushrooms
  • Avoid alcohol consumption this helps in reducing the strain on your liver
  • Maintain a healthy weight; obesity causes fatty liver disease, cirrhosis of the liver, and hepatitis
  • Perform moderate exercises; this helps in stimulating the digestion and elimination of toxins from the body, which in turn relieves the strain on the liver.
When to call a doctor

Call your doctor if:

  • You find blood in vomiting
  • You feel difficulty in breathing
  • You notice yellowing of skin and eyes
  • You experience changes in the mental status

A person is eligible to transplant a liver if the following conditions are met

  • End-stage liver disease
  • Should follow the transplantation procedures and issues
  • Absence of liver disease, a healthy liver
  • No alcohol consumption
Liver transplant expenses

The average cost of liver transplant in India especially in private centers is 18 lakhs and in a few government centers would range between 5 to 7 lakhs. The liver transplant cost differs from hospital to hospital.

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