LIVER FAILURE

The liver has many critical functions that when it is damaged, it causes many significant damage to the body.  Liver failure occurs when large parts of the liver become damaged beyond repair and the liver is no longer able to function.

Most often, liver failure occurs gradually and over many years, called a chronic liver failure. However, a more rare condition known as acute liver failure occurs rapidly (in as little as 48 hours) and can be difficult to detect initially.

What Causes Liver Failure?

The most common causes of chronic liver failure (where the liver fails over months to years) include:

  • Hepatitis B
  • Hepatitis C
  • Long-term alcohol consumption
  • Cirrhosis
  • Hemochromatosis (an inherited disorder that causes the body to absorb and store too much iron)
  • Malnutrition

The causes of acute liver failure, when the liver fails rapidly, however, are often different. These include:

  • Acetaminophen (Tylenol) overdose
  • Viruses including hepatitis A, B, and C (especially in children)
  • Reactions to certain prescription and herbal medications
  • Ingestion of poisonous wild mushrooms

The initial symptoms of liver failure are often ones that can be due to any number or conditions. Because of this, liver failure may be initially difficult to diagnose.

Early symptoms include:

  • Nausea
  • Loss of appetite
  • Fatigue
  • Diarrhea

However, as liver failure progresses, the symptoms become more serious, requiring urgent care. These symptoms include:

  • Jaundice or yellowish color of the skin
  • Bleeding easily, such as vomiting blood or severe rectal bleeding
  • Swollen abdomen or ascites
  • Mental disorientation or confusion (known as hepatic encephalopathy)
  • Sleepiness
  • Coma

DIAGNOSIS

The precise diagnosis of liver disease involves a history and physical examination performed by a health care professional. Understanding the symptoms and the patient’s risk factors for liver disease will help guide any diagnostic tests that may be considered.

Liver disease can have physical findings that affect almost all body systems including the heart, lungs, abdomen, skin, brain and cognitive function, and other parts of the nervous system. The physical examination often requires evaluation of the entire body.

Blood tests:

Blood tests are helpful in assessing liver inflammation and function.

Specific liver function blood tests include:

  • AST and ALT ( transaminase chemicals released with liver cell inflammation);
  • GGT and alkaline phosphatase (chemicals released by cells lining the bile ducts);
  • bilirubin; and
  • protein and albumin
  • complete blood count (CBC), patients with end stage liver disease may have bone marrow suppression and low red blood cells, white blood cells and platelets. As a result, patients with cirrhosis may have bleeding;
  • INR blood clotting function may be impaired due to poor protein production and is a sensitive measure of liver function;
  • lipase to check for pancreas inflammation;
  • electrolytes, BUN and creatinine to assess kidney function; and
  • ammonia blood level assessment is helpful in patients with mental confusion to determine whether liver failure is a potential cause.

Imaging studies

Imaging studies may be used to visualize, not only the liver, but other nearby organs that may be diseased. Examples of imaging studies include:

  • CT scan (computerized axial tomography),
  • MRI (magnetic resonance imaging), and
  • ultrasound (sound wave imaging, which is especially helpful in assessing the gallbladder and bile ducts.

Liver Biopsy

Liver biopsy may be considered to confirm a specific diagnosis of liver disease. Under local anesthetic, a long thin needle is inserted through the chest wall into the liver, where a small sample of liver tissue is obtained for examination under a microscope.

 

RECOMMENDED MEDICATIONS

The goal of treatment is to stop or slow the progression of damage to the liver and minimize and quickly treat any other complications and coexisting conditions, such as portal hypertension and hemorrhage. Treatment plans include a multifaceted and individualized approach that varies depending on the underlying cause of liver disease and liver failure. For example:

  • Treatment of alcoholism includes abstaining from alcohol, which often requires participation in an alcohol treatment program.
  • Treatment of hepatitis may include corticosteroid drugs for autoimmune hepatitis or interferon, a medication used to treat a hepatitis infection.

Liver transplant may be an option for some people with liver failure. This major surgical procedure involves using a healthy donor liver to replace a severely diseased liver.

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