What is liver failure?

Liver failure is the medical condition in which the liver is no longer to perform its normal activities.

What are different types of liver failure?

There are mainly 2 types of liver failure:

  • Acute – Sudden onset of liver failure over few days or weeks is called acute liver failure.
  • Chronic – A slow onset of liver failure (over months/years) is called chronic liver failure or cirrhosis of liver.

Who is at risk of developing liver failure?

The following are the risk factors of acute liver failure –

  • Overdose of medications – Pain Medications (acetaminophen), antibiotics, herbal medications
  • Liver Infections – Hepatitis A, B, E, Infections with Ebstein Barr Virus, Cytomegalovirus.
  • Alcoholic Liver disease due to excessive use of alcohol
  • Autoimmune diseases
  • Metabolic diseases of liver – Hemochromatosis, Wilson’s disease
  • Fatty liver
  • Bile duct obstruction
  • Exposure of some chemicals
  • Others – Budd Chiari Syndrome
  • Cancer of liver

What are the symptoms of liver failure?

There are general symptoms of liver failure:

Nausea, Loss of appetite, Fatigue, body pains

Initial symptoms of liver failure include:

  • Jaundice – yellow discoloration of whites of eyes & skin

Symptoms which occur at later stage:

  • Liver enlargement may give rise to pain in upper abdomen
  • Ascites – Distension (fullness) of abdomen due to fluid accumulation
  • Swelling of feet (edema)
  • Bruising on skin
  • Visible veins on the abdomen in spider like fashion
  • Redness of palms
  • Breast enlargement
  • Fruity odour from mouth
  • Enlargement of spleen
  • Blood in vomitus (due to esophageal varices)
  • Hepatic Encephalopathy – The patient starts talking irrelevant & is not oriented to people & activities around him
  • Coma – In advanced stages of liver failure, patient becomes unconscious & goes in coma.

How is liver failure diagnosed?

Liver failure is diagnosed on the basis of patient’s signs/symptoms.

Blood tests, such as, level of bilirubin, liver enzymes, coagulation profile, complete blood counts, hepatitis virus serology, immunoglobulin levels are usually done in patients of liver failure. Other blood tests are also done depending on the patient profile.

USG abdomen is done to assess changes in the liver. CT scan/MRI can be done to see detailed changes.

Liver Biopsy may be done in some patients.

Upper GI endoscopy may be done in some patients with enlarged veins of esophagus/stomach.

Is liver failure permanent?

It is irreversible and permanent if cirrhosis has occurred. Liver transplant is an option for patients with permanent liver damage. Otherwise, it can be reversed.

What is the treatment of liver failure?

Treatment for liver failure depends on the cause of liver failure & other factors, such as, age, other physical parameters & other infections. The patients of liver failure are treated in the liver unit or in the ICU.

The reversible liver failure because of medication overdose, poisoning etc, can be treated and liver function can be brought back to normal.

For irreversible liver damage, liver transplant can be useful treatment option.

Conservative management – Prevention/management of bleeding, drainage of ascetic fluid (fluid in the abdomen to relieve abdominal distension), nutritional support (adequate proteins/vitamins), adequate fluid management, psychological support. Medications are given to the patients depending upon the underlying cause of the disease.

Management of hepatic encephalopathy

  • Management of hemetemesis – blood in vomiting due to rupture of enlarged veins of esophagus/stomach
  • Management of heart complications, kidney complications due to liver failure
  • Management of bacterial & fungal infections in the body (due to low immunity of the patient)

How can liver failure be prevented?

  • Liver failure can be prevented if the underlying cause is diagnosed & treated at an early stage.
  • Liver can be protected against hepatitis infection with the help of Vaccination.
  • Alcoholic liver disease can be prevented by drinking alcohol in moderation.
  • Prescribed medications should not be taken in excess dose.