Liver failure occurs when large parts of the liver become damaged and can not be repaired, making the liver unable to function properly.
Acute liver failure is life threatening and needs emergency medical attention. It often develops slowly over many years, this is called chronic liver disease.
It can also develop quickly in just a few days, there are many causes of acute liver failure.
These include paracetamol poisoning, infections (eg, hepatitis B or hepatitis C), acute fatty liver of pregnancy and a number of rare genetic conditions. For some people with liver failure, the cause is unknown.
What are the functions of the liver?
- Eliminate toxic substances from the body, including alcohol.
- It helps ensure that the blood coagulates properly.
- Storage of substances, for example, iron and glycogen (used to store glucose) as energy.
- It helps the body fight against infections.
- Release of bile, which passes to the intestine (intestine) to help break down (digest) fats.
How common is liver failure?
Acute liver failure is very rare. In the United Kingdom, 775 liver transplants were performed in April 2012 to April 2013. The number of transplants has increased in recent years.
In Scotland, acute liver failure affected approximately 6 in 1 million people between 1992 and 2009. The most common cause was an overdose of paracetamol.
Liver failure is caused by damage to the cells in the liver. There are many possible causes of acute liver failure.
Often no cause is found but the most common causes are:
Acetaminophen overdose: Taking too much paracetamol is a relatively common cause of acute liver failure.
An overdose can occur either by taking a large amount of paracetamol or taking doses higher than recommended for a few days or more.
Medicines: Some prescription medications can cause acute liver failure, but this is very rare.
Some examples of medications that can rarely cause acute liver failure include some antibiotics, nonsteroidal anti-inflammatory drugs, and some medications used for epilepsy (anticonvulsants).
Herbal supplements: Some medicinal herbs and supplements have been linked to causing liver failure.
Illegal drugs : Drugs such as ecstasy and cocaine can occasionally cause liver failure.
Infections: Viral hepatitis infections (eg, hepatitis B or hepatitis C) can cause liver failure.
Other viruses that can cause acute liver failure include Epstein-Barr virus, cytomegalovirus and herpes simplex virus.
Liver cancer: Cancer that starts in the liver or spreads to the liver from other parts of the body can cause liver failure.
Poisons (toxins): Toxins that can cause acute liver failure include some poisonous fungi.
Autoimmune hepatitis: This is a disease in which the defense system of your body (immune system) attacks your liver, causing inflammation and damaging the liver cells.
Diseases of the veins in the liver: Some diseases (for example, Budd-Chiari syndrome) can cause blockages in the veins of the liver, which can lead to acute liver failure.
Metabolic diseases: Some rare metabolic diseases can cause acute liver failure.
These include hemochromatosis, alpha-1 antitrypsin deficiency, Wilson’s disease, fructose intolerance, galactosemia, and tyrosinemia.
Reye’s syndrome: This is a rare condition that mainly affects children and young adults. It can cause brain damage and liver failure, the cause is not known.
Acute liver failure can occur in a person who already has chronic liver disease when liver function suddenly worsens. This is called acute-chronic liver failure.
The three most common causes of chronic liver disease in the UK are obesity, hepatitis infection and alcohol abuse.
Several chronic liver diseases gradually lead to liver cirrhosis. Often there is no identified cause for liver function to suddenly get worse.
However, known triggers include an infection or drinking alcohol.
What are the symptoms of liver failure?
In the early stages, chronic liver disease may not cause any symptoms. There may be vague symptoms such as:
- Feeling sick (nausea)
- Loss of appetite
- Feeling tired.
Chronic liver disease or more advanced acute liver failure can cause severe symptoms. These may include:
- Your skin and the whites of your eyes may turn yellow (jaundice).
- Your belly (abdomen) may swell due to an accumulation of fluid (ascites). Your liver and spleen may also be enlarged.
- Easy bleeding and bruising without any injury.
- Your body can become very dry (dehydrated).
- The palms of your hands can turn red (palms of the liver).
- You can develop a liver flap.
Hepatic failure can also cause other symptoms due to complications of liver failure. These include:
- Bleeding from the bowel: it can make you vomit blood (hematemesis) or your stools become very dark or black (this is caused by the digested blood that passes through your bowel and into your stool).
- Brain function: It can seriously affect the way our brain works and can cause drowsiness and confusion, and have memory and concentration problems, as well as hallucinations.
- It can cause a coma: The severe difficulty with brain functions caused by liver failure is called hepatic encephalopathy.
How is liver failure diagnosed?
The first tests are blood tests (including liver function tests) to see how your liver is working.
Blood tests will also be used to detect possible underlying causes of liver failure, such as viral hepatitis.
The scans are organized to observe the structure of your liver and look for other possible causes of liver failure.
These scans may include an ultrasound, a CT scan, or an MRI.
Some people with liver failure will need a liver biopsy to help find out the cause of liver failure.
The cause of liver failure may need specific treatment. It is essential to avoid drinking alcohol, even if alcohol abuse is not the cause of liver failure.
Any medication that has caused liver failure should be discontinued immediately.
Medications are used to reduce the effects of liver failure in your body. These include medications to reduce stomach acid (for example, a proton pump inhibitor).
Often help with food intake is needed using a tube that passes through the nose into the stomach (nasogastric tube) or a tube that is placed directly through the skin in the stomach (feeding tube).
Other treatments may be needed to treat any complication of liver failure, such as excess fluid in the brain (cerebral edema), reduced ability to clot the blood, brain dysfunction (hepatic encephalopathy), or acute kidney injury.
A liver transplant can save lives if you have an adequate donor liver graft.
Several artificial liver devices have been developed and can close the gap until a liver is available for transplantation or until liver failure recovers.
What are the complications of liver failure?
Hepatic failure can cause various complications, which are often very serious and require urgent medical attention.
Complications of liver failure include:
- Reduced protection against infection.
- Accumulation of fluid in your brain (cerebral edema).
- Esophageal varices These are dilated veins in the throat leading to the stomach. They can cause massive bleeding and this can be life threatening.
- Bleeding (hemorrhage) from other parts of the intestine.
- Acute kidney injury.
- Severe respiratory problems (respiratory failure).
What is the perspective?
The prognosis depends on the cause of the liver failure, the severity of the symptoms and any complications.
The prognosis of acute liver failure has improved a lot. In the past, most people with acute liver failure died, but now many survive as a result of improvements in intensive medical care.