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Acute Liver Failure







Introduction of acute liver failure 
Acute liver failure occurs when many cells in the liver die or become very damaged in a short amount of time. 
The liver is the second largest organ in the body and performs several different functions. 
The liver processes everything you eat and drink, which it converts into energy and nutrients for your body to use. It filters out harmful substances, such as alcohol, from your blood, and helps your body to fight off infection. 
Acute liver failure, also known as fulminant hepatic 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. In many situations, though, a liver transplant may be the only cure. 

Symptoms of acute liver failure 
Symptoms of acute liver failure can be like those of a virus. Signs and symptoms of acute liver failure may include: 
  • Jaundice Yellowing of your skin and eyeballs, 
  • Pain in your upper right abdomen. 
  • Abdominal swelling. 
  • Nausea. 
  • Vomiting. 
  • A general sense of feeling unwell (malaise). 
  • Disorientation or confusion. 
  • Sleepiness. 
These symptoms can also be attributed to other problems or disorders, which can make liver failure hard to diagnose. Some people don’t show any symptoms until their liver failure has progressed to a fatal stage. You may be disorienteddrowsy, or even slip into a coma by the time you reach this stage. 

Causes of Acute liver failure 
Acute liver failure, also known as fulminant hepatic failure, can occur even if you don’t have a preexisting liver disease. Acute liver failure has many causes. Acetaminophen (such as Tylenol) is one common medicine that can affect how the liver works. 
Other causes of acute liver failure are: 
  • Acetaminophen 
  • Metabolic conditions (problems with the physical and chemical processes inside the liver that must happen for a person to live) 
  • Infections / viruses 
  • Immunological dysfunction 
  • Cardiovascular conditions (which cause a lack of blood supply to the liver) 

Complications of Acute liver failure 
Acute liver failure often causes complications, including: 
  • Excessive fluid in the brain (cerebral edema). Too much fluid causes pressure to build up in your brain. 
  • Bleeding and bleeding disorders. A failing liver cannot make enough clotting factors, which help blood to clot. Bleeding in the gastrointestinal tract is common with this condition. It may be difficult to control. 
  • Infections. People with acute liver failure are more likely to develop infections, particularly in the blood and in the respiratory and urinary tracts. 
  • Kidney failure. Kidney failure often occurs after following liver failure, especially if you had an acetaminophen overdose, which damages both your liver and your kidneys. 

Prevention of acute liver failure 
Reduce your risk of acute liver failure by taking care of your liver.  
Preventive measures include: 
  • Limit the alcohol use 
  • Practicing safe sex 
  • Not engaging in drug use or needle sharing 
  • Getting vaccinated for hepatitis A and B 
  • Protecting your skin from toxic chemicals 
  • Using aerosol spray cans in ventilated areas so that you don’t inhale the fumes 

Diagnosis of acute liver failure 
If you’re experiencing symptoms, seek help from your doctor. Be sure to let them know if you have a history of alcohol abuse, genetic abnormalities, or other medical conditions. 
Tests and procedures used to diagnose acute liver failure include: 
  • Physical examination: your doctor will examine your abdomen to see if liver is enlarged. 
  • Blood tests. Blood tests are done to determine how well your liver works. A prothrombin time test measures how long it takes your blood to clot. With acute liver failure, blood doesn't clot as quickly as it should. 
  • Imaging tests. Your doctor may recommend an ultrasound exam to look at your liver. Such testing may show liver damage and help your doctor determine the cause of your liver problems. Your doctor may also recommend abdominal computerized tomography (CT) scanning or magnetic resonance imaging (MRI) to look at your liver and blood vessels. These tests can look for certain causes of acute liver failure, such as Budd-Chiari syndrome or tumors. They may be used if your doctor suspects a problem and ultrasound testing is negative. 
  • Liver biopsy. Your doctor may recommend removing a small piece of liver tissue called liver biopsy. Doing so may help your doctor understand why your liver is failing. Since people with acute liver failure are at risk of bleeding during biopsy, the doctor may perform a trans-jugular liver biopsy. The doctor makes a tiny incision on the right side of your neck, and then passes a thin tube into a neck vein, through your heart and into a vein exiting your liver. Your doctor then inserts a needle through the catheter and retrieves a sample of liver tissue. 

Treatment for acute liver failure 
Treatment for acute liver failure depends on what caused the disease and what is the stage of disease.  
Acute liver failure treatments may include: 
  • Supportive care. There are some patients who will get better on their own if they receive treatment for their symptoms. Many patients whose condition is caused by a virus get better on their own. Their liver is able to reform itself into a healthy organ.  
  • Medications. Acute liver failure caused by acetaminophen overdose is treated with a medication called acetylcysteine. This medication may also help treat other causes of acute liver failure. Mushroom and other poisonings also may be 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 your damaged liver and replaces it with a healthy liver from a donor. 

Outlook 
Historically mortality has been high, being in excess of 80%. In recent years the advent of liver transplantation and multidisciplinary intensive care support have improved survival significantly. At present overall short-term survival with transplant is more than 65%.

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