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Acute Liver Failure



Introduction

Acute liver failure is a medical emergency that occurs when your liver rapidly loses its ability to function. Most often, liver failure develops slowly over the course of years, usually due to long-term alcohol use or infection with the hepatitis virus. But acute liver failure can develop in a matter of days.

Many cases of acute liver failure follow an acetaminophen (Tylenol) overdose. Less commonly, acute liver failure results from a viral infection, poisoning or an underlying condition affecting blood flow in your liver.

The first goal in treating acute liver failure is to manage the problems caused by a failing liver, such as the buildup of toxins in your bloodstream. Then, your liver may be able to heal on its own, or you may need a liver transplant to make a recovery.

Signs and symptoms

Before your liver fails, you may have signs and symptoms that suggest liver disease, such as:
  • A yellowing of your skin and eyeballs (jaundice).
  • Tenderness in the upper right area of your abdomen.
As your condition worsens, a condition called encephalopathy may develop. Encephalopathy refers to brain and nervous system damage that results from your liver's inability to metabolize toxins into harmless substances. These toxins build up in your body, causing signs and symptoms.

Signs and symptoms of encephalopathy include changes in mental state, behavior and personality, such as the following:
  • Confusion, forgetfulness, disorientation and delirium.
  • Sleepiness or decreased responsiveness.
  • Muscle tremors and stiffness.
  • Uncontrollable or dysfunctional movement, such as difficulty with handwriting.
  • Mood changes or agitation.
In severe cases, people with acute liver failure lose consciousness and become comatose.

People with acute liver failure also have bleeding problems because a failing liver can't produce sufficient amounts of substances that help blood clot. So, even minor cuts on your skin can cause severe bleeding.

Causes

Your liver is a large, multilobed organ located on the right-hand side of your abdomen.

Several common functions of your liver include:
  • Filtering toxins, bacteria and waste products from your blood.
  • Producing many substances, including proteins that help your blood clot (clotting factors) and bile, which breaks down fats.
  • Storing vitamins, iron, sugar and cholesterol.
When your liver fails, its ability to perform any of these functions is hampered.

Causes of acute liver failure include:
  • Drugs. Acetaminophen (Tylenol, others) overdose is the most common cause of acute liver failure. Many other medications, including herbal supplements such as kava extract, can cause drug reactions that lead to liver failure; however, these types of reactions are rare.
    Using recreational drugs like Ecstasy and cocaine also can lead to acute liver failure.
  • Viruses. Hepatitis A and hepatitis B are the viruses that most often cause acute liver failure in the U.S., while hepatitis E is a more common cause in countries where the virus is endemic, especially among pregnant women.
    Other viruses associated with acute liver failure include cytomegalovirus, herpes simplex virus, Epstein-Barr virus, hemorrhagic fever viruses and paramyxovirus.
  • Toxins. Toxins from bacteria and industrial chemicals, such as carbon tetrachloride, can damage your liver. The wild mushroom Amanita phalloides, which is sometimes mistaken for other edible species, is poisonous and causes acute liver failure.
  • Autoimmune disease. Autoimmune hepatitis is a disease in which your immune system attacks liver cells, causing inflammation and injury.
  • Vascular disease. Conditions that cause blockages to form in the veins of the liver can cause acute liver failure. These include portal vein thrombosis, Budd-Chiari syndrome and veno-occlusive disease.
  • Metabolic disease. Rare metabolic diseases, such as Wilson's disease, acute fatty liver of pregnancy and Reye's syndrome infrequently cause acute liver failure.
  • Cancer. Malignant tumors that grow in your liver or cancer that spreads to your liver from another organ can cause your liver to fail.
In about 15 percent of cases of acute liver failure, there's no identifiable cause.

Treatment

People with acute liver failure are usually admitted to an intensive care unit in a hospital for continual monitoring. Depending on the cause of acute liver failure and your signs and symptoms, treatment may include:
  • Reversing poisoning with an antidote. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin.
  • Relieving cerebral edema. Acute liver failure can lead to brain swelling (cerebral edema), which increases pressure on your brain. If you have severe cerebral edema, your doctor will give you medications through a vein in your arm to help reduce the fluid buildup in your brain.
  • Screening for infections. Screening your blood, urine and sputum for signs of infection is important because people with acute liver failure are especially susceptible to developing infections. If your doctor suspects that you have an infection, you'll receive antibiotics or antifungal medications.
  • Preventing severe bleeding. People with acute liver failure often develop bleeding ulcers in the gastrointestinal tract. Your doctor will give you medications to help abate the bleeding. If you're losing a lot of blood, you'll need blood transfusions.
Additional treatments may include fluid, electrolyte and glucose supplementation.

Liver transplantation
Your liver is one of the few organs in your body that has the ability to regenerate — meaning that if part of your liver is removed or damaged, your liver can grow back to approximately its original size. But sometimes, the liver damage may be so severe that your liver can't regenerate. Liver transplantation is necessary in such cases.

Liver transplantation usually involves surgically placing a whole liver or part of a liver from a deceased donor into a recipient. Living-donor transplants are another type of transplant in which part of a living donor's liver is given; both partial livers regenerate after being transplanted.

Liver transplantation is a lengthy surgery and complications, such as infection, bleeding and even death are possible. In some cases, the new liver may be rejected by your body.

The wait for a liver donation can be long, so researchers are working on alternatives to donated livers, such as artificial livers and machines that can perform liver functions. Currently, their use is mostly limited to clinical trials.

Prevention

Here are a few ideas to help you reduce your risk of developing acute liver failure:
  • Follow dosing instructions. If you take acetaminophen or other medications, be sure to check the package insert for instructions on the recommended dosage. If you use tobacco products or drink regularly, check with your doctor before taking any drugs.
  • Don't use recreational drugs. They're often addictive and can cause a multitude of health problems, including liver failure.
  • Stay up-to-date on your vaccinations. Make sure that you've received all recommended vaccinations, including the hepatitis B series. If you're traveling abroad for an extended period of time, ask your doctor whether you should receive the hepatitis A series.
  • Plan for pregnancy. Several rare disorders of pregnancy can cause acute liver failure, so be sure to see your doctor for regular prenatal care. If you're living in an area where hepatitis E is endemic, make sure that you have access to safe drinking water. If you contract hepatitis E while you're pregnant, you're at risk of developing acute liver failure.


Information obtained from National Institute of Health
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