Acute liver failure is a rare and life-threatening disease that usually happens in patients who do not have cirrhosis or preexisting liver disease.
Symptoms that may be signs your liver is failing include:
- Yellowing skin and eyes (jaundice)
- Abdominal distension from fluid accumulation (ascites)
- Right upper quadrant pain or tenderness
- Enlarged liver (hepatomegaly)
- Fatigue
- Feeling unwell (malaise)
- Lethargy
- Loss of appetite
- Nausea
- Vomiting
- Itching
- Difficulty sleeping
- Confusion
- Comatose
What Causes Liver Failure?
There are many different causes for acute liver failure, including:
- Drugs
- Acetaminophen (paracetamol)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Antibiotics
- Anticonvulsants
- Azole antifungals
- Herbal medications and dietary supplements
- Chemotherapy drugs
- Idiosyncratic drug reactions (uncommon reactions to drugs)
- Viruses
- Hepatitis A, B, C, D, and E
- Herpes simplex virus
- Varicella zoster virus
- Epstein-Barr virus
- Adenovirus
- Cytomegalovirus
- Alcoholic hepatitis (in which case it is considered to be acute-on-chronic liver failure)
- Autoimmune hepatitis
- Toxins
- Mushroom poisoning (most often Amanita phalloides)
- Carbon tetrachloride
- Wilson disease
- Ischemic hepatopathy
- Budd-Chiari syndrome
- Veno-occlusive disease
- Acute fatty liver of pregnancy/HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome
- Invasive cancer (most often breast cancer, small cell lung cancer, lymphoma, melanoma, or myeloma)
- Removal of part of the liver (partial hepatectomy)
- Sepsis
- Heat stroke
- Hemophagocytic lymphohistiocytosis (primarily occurs in children)
- Hypoperfusion of the liver
How Is Liver Failure Diagnosed?
Acute liver failure is diagnosed with a patient history and physical examination, along with the following tests:
- Blood tests:
- Prothrombin time/INR
- Blood chemistries (sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose, calcium, magnesium, phosphate, lactate dehydrogenase)
- Liver blood tests (AST, ALT, alkaline phosphatase, GGT, total and direct bilirubin, albumin)
- Complete blood count with differential
- Acetaminophen level
- Blood toxicology screen
- Viral hepatitis serologies
- Pregnancy test in women
- Autoimmune markers
- Blood type and screen
- HIV testing
- Amylase and lipase
- Arterial blood gas
- Arterial lactate
- Arterial ammonia
- Urine tests
- Urine toxicology screen
- Urinalysis to look for protein in the urine in women who are pregnant
- Ceruloplasmin level in patients suspected of having Wilson disease
- Anti-hepatitis D virus antibodies in patients with acute or chronic hepatitis B
- Anti-hepatitis E virus antibodies for patients with travel to endemic areas such as Russia, Pakistan, Mexico, India, or Africa
- Imaging studies
- Abdominal Doppler ultrasonography
- Abdominal computed tomography (CT) scan
- Venography
- Magnetic resonance imaging and venography (MRI/MRV)
- Echocardiogram
- Liver biopsy
What Is the Treatment for Liver Failure?
Treatment for acute liver failure involves treating the underlying cause. Treatments may include:
- Acetaminophen toxicity
- Hepatitis B infection
- Antiviral therapy with a nucleos(t)ide analogue
- Mushroom poisoning
- Early administration of activated charcoal
- Administration of silibinin and penicillin G
- Budd-Chiari syndrome
- Transjugular intrahepatic portosystemic shunt placement
- Surgical decompression
- Thrombolysis
- Herpes simplex virus infection
- Wilson disease
- Liver transplantation
- Plasma exchange to remove copper may act as a temporizing measure
- Autoimmune hepatitis
- Glucocorticoids
- Liver transplantation for patients who develop encephalopathy
- Acute fatty liver of pregnancy
- No specific medical treatment
- Treatment is generally prompt delivery (usually emergent) once the mother has been stabilized
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References
https://www.uptodate.com/contents/acute-liver-failure-in-adults-etiology-clinical-manifestations-and-diagnosis?search=liver%20failure&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4
https://www.uptodate.com/contents/acute-liver-failure-in-adults-management-and-prognosis?search=liver%20failure&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838908/
https://www.uptodate.com/contents/acute-liver-failure-in-adults-management-and-prognosis?search=liver%20failure&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838908/