Acute liver failure

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 29, 2016
StartDiseasesAcute liver failure

The liver is an essential organ that is responsible for processing everything that you consume. When the liver is damaged, your body cannot properly convert food to energy and filter out harmful substances, so acute liver failure is a very serious medical condition. It is also referred to as acute hepatic failure or fulminant hepatic failure.

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Definition & Facts

Acute liver failure occurs when the liver loses function rapidly, over the course of a few weeks or days. Unlike chronic liver failure, there are few warning signs or symptoms before the failure occurs, and it does not take months for the failure to progress.

The basic difference between chronic and acute liver failure is that if a patient has acute liver failure, he or she will have a significant decline in brain function within 8 weeks of first becoming jaundiced. It is a life threatening condition that requires immediate hospitalization.

Symptoms & Complaints

Typically, the first symptom of acute liver failure is just a feeling of fatigue, nausea, and malaise. At this stage, it is difficult to tell if the symptoms are due to liver issues. However, the next symptom is normally yellow skin or eyes, which is called jaundice, and this is normally the first noticeable sign that the liver is not functioning properly.

Urine may appear dark, due to the inability of the liver to process liquid. The stomach cavity can also begin to accumulate fluid and swell up, along with extremities such as the feet. Fluid begins to build up in the skull, putting pressure on the brain, so people with acute liver failure may feel groggy, sleepy, or confused.

Eventually, hepatic encephalopathy will set in if the liver failure is not treatable, causing brain damage and a loss of cognitive function due to toxic buildup in the bloodstream. The hepatic encephalopathy and fluid around the brain can cause general issues with motor control and cognition. Eventually, a coma may set in, and death can occur.

Causes

When the liver encounters some toxic substances that a person has consumed, it may get damaged while attempting to filter them. Typically, the liver can regenerate damaged cells, but if the damage happens too fast, the liver is unable to function properly. Acute liver failure happens because something has damaged the liver faster than the liver can heal itself.

Most acute liver failure is not the result of a pre-existing liver condition, and in the United States, the prevailing cause of acute liver failure is an overdose of acetaminophen. Other medications, such as anticonvulsants, antibiotics, and anti-inflammatory drugs can cause acute liver failure if they are taken in improper amounts.

Taking too many herbal supplements, particularly of kava, pennyroyal, ephedra, or skullcap, can damage the liver enough to cause acute liver failure. Certain types of poisonous wild mushrooms may trigger liver failure if they are accidentally eaten.

There are also many medical conditions that cause the liver to fail. Viruses, such as the hepatitis virus, Epstein-Barr virus, herpes simplex virus, and cytomegalovirus may all be responsible for liver failure. Other conditions that can damage the liver enough to cause failure include liver cancer, Budd-Chiari syndrome, and Wilson’s disease. Sometimes, a liver may suddenly fail without any apparent cause.

Diagnosis & Tests

An extensive medical history is one of the most useful diagnostic tools, because the doctor may be able to link the acute liver failure symptoms to a specific action in the past, such as taking a lot of acetaminophen. However, if the acute liver failure is causing the loss of brain function, it can be tricky for a doctor to get the information that he or she needs.

There are many different tests to examine how well the liver is functioning. Blood tests can see how long it takes for blood to clot and check for unusually high toxin levels in the blood. A liver biopsy, in which a tiny piece of the liver is removed for examination, can provide more information about the liver and, the biopsy can possibly tell the doctor why the liver is failing. Ultrasounds and other imaging tests may also give the doctor helpful information about the state of the liver because liver damage is apparent with these methods.

Treatment & Therapy

Treatment for acute liver failure typically involves intensive care in a hospital. First of all, doctors will try to treat the underlying cause of the liver failure. If the acute liver failure is due to consuming some sort of toxic medication or food, treating the issue may prevent the liver damage from worsening. There are antidotes available to reverse the poisoning caused by mushrooms, and acetylcysteine is an antidote for acetaminophen overdose.

For patients with hepatitis, antiviral therapy can help to halt the liver failure. Treatments will also be administered for the severe complications that can arise from liver failure. Medications may be prescribed to relieve any pressure on the brain from swelling, reduce overall fluid buildup, and stop any extreme bleeding.

If the patient is undergoing kidney failure, dialysis can help to prevent further issues. For some cases of acute liver failure, the liver may be too severely damaged to ever heal, and the only treatment option is a liver transplant. In order to get a transplant, patients have to be put on the waiting list for the United Network for Organ Sharing. People with acute liver failure have the highest priority on the list, and the waiting time is roughly 48 to 72 hours.

Prevention & Prophylaxis

Preventing acute liver failure usually requires avoiding risky behavior that could result in liver damage. Avoid unprotected sex, needle sharing, or unregulated tattoo shops in order to avoid getting viruses that could cause liver failure.

Always read and follow instructions on medication to prevent an overdose. It is important to avoid drinking alcohol while taking acetaminophen, because this combination can really hurt the liver.

Being cautious when around environmental toxicants such as insecticides, and chemicals may help to prevent harming the liver with these toxins. Getting both the hepatitis A vaccine and the hepatitis B vaccine prevents hepatitis A and hepatitis B and can also greatly reduce risks of acute liver failure.