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Acute Liver Failure: Causes, Symptoms, Complications, Treatment

What is Acute Liver Failure?

Acute liver failure is a condition that arises due to sudden abnormality in the liver function which leads to coagulopathy.  It is characterized by abnormal swelling of the abdomen and encephalopathy. Prompt diagnosis and treatment of this condition can prevent further complications.

Acute Liver Failure

Symptoms

  • Encephalopathy
  • Pain in upper right side of the stomach
  • Abdominal swelling
  • Nausea
  • Vomiting
  • Sleepiness
  • Confusion
  • Jaundice

Causes

Acute liver failure develops when the liver cells are significantly damaged and are not able to function properly. The reasons for liver damage are listed below:

  1. Overdose of Acetaminophen: Acute liver failure can occur if the individual takes more than recommended dose of acetaminophen for a long-term. One should seek immediate medical attention in cases of Acetaminophen overdose.
  2. Hepatitis and other Viruses: Hepatitis A, B or E virus can cause acute liver failure. Other viruses that may cause acute liver failure includes herpes simplex virus, Epstein-Barr virus, and cytomegalovirus.
  3. Medications: Certain prescribed medicines like antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), or anti-convulsant may cause acute liver failure.
  4. Toxins: Carbon tetrachloride is an industrial chemical found in refrigerants, solvents for waxes or varnishes that can cause acute liver failure. Toxins present in Amanita phalloides (wild mushroom) can also cause acute liver failure.
  5. Infection: Sepsis and shock can disrupt the blood flow to the liver, thereby causing acute liver failure.
  6. Vascular Diseases: Blockage in the blood vessels of the liver due to vascular diseases such as Budd-Chiari syndrome can leads to acute liver failure.
  7. Metabolic Disease: Metabolic diseases such as Wilson’s disease and acute fatty liver during pregnancy may also lead to acute liver failure.

Risk Factors

The factors that can increase the risk of developing acute liver failure are listed below:

  • Poor nutritional status
  • Chronic alcohol abuse
  • Female gender
  • Pregnancy
  • Alternative medicine hepatotoxicity
  • Age more than 40 years

Complications

The complications associated with acute liver failure are:

  • Jaundice
  • Abnormal swelling and bleeding
  • Low blood sugar levels
  • Swelling in the brain
  • Confusion

Investigations

  1. Blood Tests: Blood tests, such as liver function tests are performed to determine the functioning of the liver. Prothrombin time test helps to measure the time taken for the blood to form a clot. In case of acute liver failure, there may be an increase in the prothrombin time.
  2. Biopsy: Liver biopsy involves removing a small piece of liver tissue and analyzing it to determine the cause and extent of liver damage.
  3. Other Investigations: Ultrasound of the liver can help to determine the extent of liver damage. Other imaging procedures, such as CT-scan (computerized tomography) and MRI (magnetic resonance imaging) may be recommended to obtain a clear picture of blood vessels and to understand the cause and extent of liver failure.

Treatment

Acute liver failure is a medical emergency and the patients are usually treated in the intensive care unit. The treatment is aimed at restoring the liver function and preventing further damage and complications. The treatment options available for acute liver failure include the following:

  1. Medications: Acetylcysteine is prescribed to treat acute liver failure caused by acetaminophen overdosage. Drugs that can reverse the effects of toxins and reduce liver damage are prescribed depending on the cause of liver failure.
  2. Liver Transplant: If the liver failure cannot be reversed with medications and other treatment procedures, the doctor may suggest the liver transplant.

Medications may be prescribed to control the symptoms of acute liver failure.

Prevention

  • If the patient has any history of liver disease, the doctor should be informed.
  • Stick to the prescribed doses of acetaminophen or other medications. The doctor should be informed about the medical history of the patient as well as about any other OTC (over the counter) drugs.
  • Get vaccinated against hepatitis B and hepatitis A viruses.
  • Avoid alcohol consumption or limit alcohol intake to one drink a day for women of all age groups and men older than 65 years. Young men should limit their alcohol intake to two drinks a day.
  • Avoid eating wild mushrooms because it can be difficult to trace the difference between the safe and poisonous mushroom.
  • Avoid unhealthy behaviors like using illicit intravenous drugs and sharing needles, unprotected sex, and smoking.
  • Do not share razor blades and toothbrushes to prevent infection. Be careful about accidental needle prick injury, improper cleanup of blood or body fluids may spread hepatitis viruses.
  • Be careful with aerosol sprays. While using aerosol cleaner, the person should wear a mask and the room should be well ventilated. Mask and gloves should be used while spraying insecticides, fungicides, paints, and other toxic chemicals.
  • Maintain a healthy weight. Overweight or obesity can cause liver diseases such as hepatitis, fatty liver disease, and cirrhosis.

Diet

The following dietary modifications can prevent the risk and decrease the progression of acute liver failure:

  • Decrease the intake of proteins, as the affected liver cannot metabolize the proteins, thereby resulting in increased risk of waste buildup in the body.
  • Cut back on salt, as it can further deteriorate abdominal distension.
  • Limit the intake of food products that are high in fats and sugars.

Remedies

The following remedies can be employed to improve acute liver failure:

  • Increase the intake of carbohydrates in comparison to the amount of protein intake.
  • Take vitamins and other health supplements.
  • Have a balanced diet rich in grains, fruits, vegetables, beans, lean meat, milk, and oils.

Frequently Asked Questions:

1. Can cigarette smoking result in acute liver failure?

Yes. Heavy cigarette smoking for longer periods of time can cause damage to the liver cells and increases the risk of liver failure.

2. Is the damage to the liver in acute liver failure reversible?

Yes. Liver is the only organ in the human body that can regenerate. With the right treatment and effective prevention of complications, liver damage can be healed.

3. Can natural medicines extracted from plants can cause liver damage?

Yes. Use of certain natural medicines for a long period of time or in excess amount may lead to liver damage. Therefore, care should be taken while using natural medicines.

4. Can autoimmune diseases cause acute liver failure?

In some conditions, the immune system may produce cells that attack the liver cells resulting in autoimmune acute liver failure.

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