Acute liver failure (patient information)

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 * Associate Editor-in-Chief: Jinhui Wu, MD

Overview
Acute liver failure is an uncommon condition in which the rapid deterioration of liver function results in coagulopathy and alteration in the mental status of a previously healthy individual. It often affects young people and carries a very high mortality. Drug-related hepatotoxicity due to acetaminophen and diosyncratic drug reactions is the most common cause of acute liver failure in the United States. Other causes include hepatitis viruses infectious, Hepatic vascular diseases, autoimmune disease, metabolic diseases, and primary or secondary hepatocellular carcinoma. Usual signs and symptoms include nausea or vomiting, loss of appetite, fatigue, diarrhea, jaundice, bleeding, even confusion or coma. Abdominal CT or MRI scan and biopsy are the helpful test for diagnosis of acute liver failure. Treatment options depend on the underlying cause. It includes medications to reverse poisoning, treatment for virus infections, treatments on the compliatons, even liver transplant. The prognosis of acute liver failure depends on the underlying cause and the complications.

what are the symptoms of acute liver failure?
The initial symptoms of liver failure are difficult to diagnose because they can be due to any conditions. However, as liver failure progresses, the symptoms become more serious. Signs and symptoms of acute liver failure may include:


 * Nausea or vomiting
 * Loss of appetite
 * Fatigue
 * Diarrhea
 * Jaundice
 * Bleeding easily
 * Swollen abdomen
 * Disorientation or confusion
 * Sleepiness, even coma

what are the causes of acute liver failure?
Drug-related hepatotoxicity due to acetaminophen and diosyncratic drug reactions is the most common cause of acute liver failure in the United States. Other causes include hepatitis viruses infectious, Hepatic vascular diseases, autoimmune disease, metabolic diseases, and primary or secondary hepatocellular carcinoma.

Who is at risk for acute liver failure?

 * Drug-related hepatotoxicity due to acetaminophen and idiosyncratic drug reactions is the most common cause of acute liver failure in the United States.
 * Acetaminophen
 * Antibiotics: ampicillin-clavulanate, ciprofloxacin, doxycycline, erythromycin, isoniazid, nitrofurantoin, tetracycline.
 * Antivirals: Fialuridine
 * Antidepressants: Amitriptyline, nortriptyline
 * Antidiabetics: Troglitazone
 * Antiepileptics: Phenytoin, valproate
 * Anesthetic agents: Halothane
 * Lipid-lowering medications: Atorvastatin, lovastatin, simvastatin
 * Immunosuppressive agents: Cyclophosphamide, methotrexate
 * Nonsteroidal anti-inflammatory agents (NSAIDs)
 * Salicylates (Reye syndrome)
 * Oral hypoglycemic agents: Troglitazone
 * Others: Disulfiram, flutamide, gold, propylthiouracil


 * Viruses infectious diseases
 * Hepatitis A virus, Hepatitis B virus, Hepatitis D virus, or Hepatitis E virus.
 * Other atypical viruses can cause viral hepatitis and fulminant hepatic failure, including cytomegalovirus, hemorrhagic fever viruses, herpes simplex virus, paramyxovirus and Epstein-Barr virus.


 * Vascular diseases
 * Ischemic hepatitis
 * Hepatic vein thrombosis (Budd-Chiari syndrome)
 * Hepatic veno-occlusive disease
 * Portal vein thrombosis


 * Autoimmune disease
 * Autoimmune hepatitis


 * Metabolic diseases
 * Acute fatty liver of pregnancy
 * Alpha1 antitrypsin deficiency
 * Reye syndrome
 * Tyrosinemia
 * HELLP syndrome


 * Malignancy
 * Primary liver tumor: Hepatocellular carcinoma
 * Secondary liver tumor: Extensive hepatic metastases or infiltration from breast cancer, lung cancer, melanoma, lymphoma, leukemia.


 * Long term alcohol consumption

Diagnosis

 * Complete blood cell (CBC) count, PT and/or international normalized ratio (INR): These tests may indicate thrombocytopenia and measures how long it takes for your blood to clot. If you have acute liver failure, your blood doesn't clot as quickly as it should.
 * Hepatic enzymes: This test is to determine how well your liver function is.
 * Serum bilirubin, ammonia, glucose, lactate, creatinine.
 * Arterial blood gases (ABGs): These may reveal hypoxemia.
 * Viral serologies
 * Acetaminophen level
 * Abdominal CT or MRI scan and biopsy: CT or MRI scans are often used to diagnose acute liver failure. These scans can also be used to guide biopsy and a biopsy sample is usually removed and looked at under a microscope. Tests of the liver tissue may help your doctor understand why your liver is failing.

When to seek urgent medical care?
Acute liver failure can develop quickly and life-threatening in an otherwise healthy person. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:


 * A yellowing of the eyes or skin
 * Tenderness in the upper abdomen
 * Any unusual changes in mental state, personality or behavior.

Treatment options
Acute liver failure is a serious disorder amd the patients are always treated in the intensive care unit (ICU) of a hospital. Treatment options depend on the underlying cause. Acute liver failure treatments may include:


 * Diet: Patients with acute liver failure are fed via a feeding tube, nothing by mouth (NPO). They may require large amounts of IV glucose to avoid hypoglycemia.
 * Medications to reverse poisoning: Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin.
 * Treatment for infections: If your doctor suspects that you have an infection of some viruses, you'll receive medications to treat the infection.
 * Relieving excess fluid in the brain: Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.
 * Preventing severe bleeding: Patients with acute liver failure often develop bleeding ulcers in the gastrointestinal tract. The doctor will give you medications to reduce the risk of bleeding. If you lose a lot of blood, you may require blood transfusions.
 * Liver transplant: If acute liver failure can't be reversed, the only treatment may be a liver transplant. During this procedure, the treatment team remove your damaged liver and replaces it with a healthy liver from a donor.

Diseases with similar symptoms

 * Tyrosinemia
 * Fructose intolerance
 * B cereus toxin
 * HELLP syndrome of pregnancy

Where to find medical care for acute liver failure?
Directions to Hospitals Treating acute liver failure

Prevention of acute liver failure

 * Get vaccinated: Get a hepatitis vaccine or an immunoglobulin shot to prevent hepatitis A or hepatitis B.
 * Eat a proper diet from all of the food groups.
 * Maintain a healthy weight: Obesity can cause a condition called nonalcoholic fatty liver disease, which may include fatty liver, hepatitis and cirrhosis.
 * Avoidance of alcohol abuse. Avoid alcohol when you are taking acetaminophen (Tylenol).
 * Practice proper hygiene. Be sure to wash your hands thoroughly before you touch any food and after you use the bathroom.
 * Don't handle any blood or blood products.
 * Don't share any personal toiletry items, including toothbrushes and razors.
 * If you get a tattoo or a body piercing, make sure the conditions are sanitary and all equipment is aseptic.
 * Be sure to use protection (condoms) when having sex.
 * If you use illegal intravenous drugs, don't share needles with anyone.

What to expect (Outook/Prognosis)?
The prognosis of acute liver failure depends on:


 * The underlying cause of acute liver failure: The prognosis of acute liver failure caused by cancers is worse than other causes.
 * The development of complications is the other factor that largely determines survival.

Possible complications

 * Seizures and coma.
 * hemorrhage due to impaired coagulation that manifests in patients with acute liver failure.
 * Infection.
 * Renal failure.