Acute Liver Failure

Acute Liver Failure

Liver failure is one of the most severe and life-threatening conditions. Liver is a vital organ and the largest organ in the abdomen. The liver works like a large factory that storage nutrients, detoxify toxin for our body, and produce the immune-mediated proteins. When the liver functions do not perform properly, other than a damaged liver, it may also affect other organs. If a liver failure occurs, it is difficult to reverse the liver function to its original state.

Symptoms of acute liver failure

• Yellowish skin and whites’ part of the eyes (jaundice)
• Right upper quadrant pain
• Swollen abdomen
• Nausea and vomiting
• Feeling malaise
• Confusion
• Altered level of consciousness
• Musty breath from wastes remaining in the body
• Tremors

Causes 

Acute liver failure occurs when the liver cells are severely damaged and can no longer function properly. The possible causes of acute liver failure are as follows:

• An overdose is the most common cause of acute liver failure. The most commonly occur situation is overdosing drugs, especially paracetamols, for suicide. 
• If the patient has severe allergic reactions to antibiotics, NSAIDs, and anticonvulsants, it could affect the liver and lead to acute liver failure. 
• Some types of dietary supplements or herbal products lead to acute liver failure. 
• Hepatitis B and other types of viruses such as Hepatitis A or E can also result in acute liver failure. 
• Chemical substances may cause acute liver failure such as industrial chemicals found in refrigerant and wax solvents, varnish, and other materials can cause acute liver failure. 
• Systemic Lupus Erythematosus (SLE) where the patient's immune system begins destroying their liver cells, causing inflammation and injury and eventually leads to liver failure. 
• Vascular disorders of the liver, coronary artery disease or insufficient blood flow to the liver could also lead to acute liver failure due to inadequate blood flow. 
• Metabolism syndrome, Wilson's disease, and Acute fatty liver of pregnancy (AFLP) conditions can also cause acute liver failure. 
• An advanced cancer stage if the tumor has spread to the large area of the liver and replace the healthy liver tissues. When this happens, it could lead to acute liver failure. 
• Heatstroke or over-exercise in an extremely hot temperature could cause acute liver failure. 
• Some acute liver failure may not have visible causes.

Complications

• Cerebral edema – This condition causes pressure to the brain, which could cause an altered level of consciousness and seizures.  
• Abnormal bleeding – Acute liver failure patients tend to have slower blood coagulation than others as their livers cannot produce coagulant substance. This leads to bleeding conditions in different body organs, mainly Gastrointestinal Hemorrhage due to increased systolic blood pressure in the upper abdomen.   
• Infections – A patient with acute liver failure is more likely to develop an infection due to a weakened immune system. It could result from infections in the bloodstream, respiratory tract, and urinary tract.
• Acute liver failure - Acute liver failure may occur with liver failure in patients with drug allergy or exposure to some toxins. It could also result from a complication that occurs after the infections. 

When to see a doctor

Acute liver failure can occur suddenly even in those who may not know about it or do not have a liver disease history. It is also a life-threatening condition if it doesn't receive prompt treatment. Suppose you or your loved ones have symptoms similar to acute liver failure conditions such as jaundice, swollen abdomen, altered level of consciousness, along with other factors as mentioned above that could lead to acute liver failure, in that case, it is highly advised to seek medical attention immediately. 

Prevention

• Strictly follow doctor advice on the medicines – Consult the doctor and inform the history of drug allergy and current prescriptions and drugs. Avoid using alternative supplements such as herbal supplements and dietary supplements. Always consult the doctor before start taking these supplements.  
• Avoid risky behaviors – Do not share syringes. Avoid unsafe intercourse or always wear condoms every time during the intercourse. For tattoo or body piercing, choose a shop that is clean and comes with safety measures. 
• Vaccination – As Thailand has a high prevalence of the Hepatitis B virus, it is vital to undergo hepatitis B testing at least once in a lifetime. If you are unimmune to Hepatitis B, it is advised to get a Hepatitis B vaccination. Patients with acute liver disease should undergo immunity screening for Hepatitis A virus, and if they are unimmune they should also receive the vaccination.  
• Avoid being in contact with others' blood or body fluids - By using the same syringes intentionally or mistakenly or in contact with the patient's blood or body fluids through wounds or other area could also spread hepatitis virus infections. Using the same razor blades or toothbrushes can also cause infections.  
• Avoid exposure to chemical substances - When there is a need to use pesticides and other chemical substances, always remember to wear gloves, long sleeves, shirts, hats, and masks to avoid chemical exposure.
• Maintain the weight - Obesity may lead to a condition called nonalcoholic fatty liver disease, including hepatitis and cirrhosis. 

Diagnosis

Methods to diagnose acute liver disease are as follow: 

• History taking and physical examination -This will help to examine signs, symptoms, and risk factors of acute liver failure. A physical examination will be used as a medical assessment for the severity level of acute liver failure.  
• Blood test – Blood tests will help determine how well the liver can function through liver enzymes and blood coagulation level tests. This will help indicate the level of liver function. Tests will also be performed to determine the cause of liver failure, including tests to assess different types of hepatitis, immune diseases, or levels of toxins, or some types of drug.  
• Radiography testing - The Radiography testing will examine the liver's anatomy and shape to detect any abnormalities such as tumor or cancer cells. It will also assess abnormal vascular connections to the liver. The doctor will select radiography testing types, whether it's ultrasound, CT scan, or MRI scan, as seen appropriate.
• Liver biopsy – If the cause of liver failure cannot be specified, the doctor may suggest a liver biopsy to analyze the cause of the liver failure. The liver biopsy can be performed in two methods: Percutaneous Needle Biopsy or Coronary Artery Angiography. As liver biopsy risk is relatively high, the doctor must decide to perform a liver biopsy for each patient.

Treatment

The treatment will be based on the cause of the acute liver disease, such as the doctor may prescribe an antiviral drug for hepatitis B patients. The doctor may also prescribe the antidote to those who overdose on paracetamol. Sometimes the doctor may prescribe anti-inflammatory medication and immunosuppressants for autoimmune liver disease. However, suppose the disease's cause cannot be treated or is unable to revive liver functions. In that case, the doctor will consider the patient to undergo the liver transplantation process accordingly.