Introduction:
Acute hepatocellular failure is a rare and life-threatening condition. These cause massive hepatocyte necrosis, leading to liver dysfunction and multiple organ failures, and death.
What Is Acute Hepatocellular Failure?
Acute hepatocellular failure, ALF (acute liver failure), is also known as fulminant hepatic failure. It can occur in patients without preexisting liver conditions and cause deterioration of liver function within days. It is a serious condition that can lead to multiple organ failures and even death can if it is not diagnosed and treated at the right time.
Acute hepatocellular failure is a condition that affects the anticoagulant and procoagulant cascade along with effects on coagulation derived from liver cirrhosis development. The coagulation factors that are affected are the plasma concentration of coagulation first with the shortest half-life, coagulation factors V and VII, and factors II, X, and VII are affected subsequently. Factor VIII along with vWf is usually elevated. Acute liver failure occurs as a complication of viral hepatitis infection. In fact, hepatitis C is considered o be the main cause of liver failure.
What Causes Acute Hepatocellular Failure?
- Acetaminophen - This is the main cause of acute liver failure. It is found in most painkillers, over-the-counter drugs, and prescription medications. Outside the US, this drug is widely known as Paracetamol. Overdose of these medications can cause acute liver failure.
- Herbal Supplements: Supplements such as ephedra, skullcap, pennyroyal, and kava can also lead to this condition.
- Over-The-Counter Medications: Including NSAIDs (non-steroidal anti-inflammatory drugs) and anticonvulsants can also cause this condition.
- Toxins: Poisonous wild mushroom Amanita phalloides, which is mistaken as one of the safe eatables.
- Carbon Tetrachloride: An industrial chemical found in refrigerants, solvents in varnishes, and waxes may also cause this condition.
- Cancer: Liver cancer is also responsible for its failure.
- Metabolic Disease: Diseased conditions like hepatitis and Wilson's disease also may cause acute liver failure.
- Acute Fatty Liver of Pregnancy: This is an obstetric emergency in which maternal liver dysfunction leads to fetus complications and death.
- Shock: Sepsis (serious infection) and shock can severely affect the blood flow to the liver, causing its failure.
- Heatstroke: Extreme physical activity in hot and humid environments can trigger the condition.
- Vascular Disease: Such as Budd-Chiari syndrome, which causes blocks in the veins of the liver, can lead to failure.
What Are the Signs and Symptoms of Acute Hepatocellular Failure?
- Nausea.
- Vomiting.
- Sleeplessness.
- Tremors (involuntary rhythmic shaking movement of one or more body parts).
- Abdominal pain and swelling.
- Ascites (fluid in the tummy).
- Confusion or deterioration.
- Jaundice (yellowish coloration of skin, white of eyes, and mucous membranes).
- Malaise (general feeling of being unwell).
- Right upper abdominal pain below the ribs.
- Diarrhea.
- Loss of appetite.
Who Is at High Risk of Getting Acute Hepatocellular Failure?
The condition which results in a high risk of getting acute hepatocellular failure are:
- Taking too much Acetaminophen.
- Chronic alcoholism.
- Having infectious conditions like Wilson's disease, hepatitis, and herpes simplex virus.
- Having poor blood flow to the liver.
How to Prevent Acute Hepatocellular Failure?
- Restrict the amount of taking the medications like Acetaminophen.
- Do not mix any other medications along with Acetaminophen; check with your healthcare provider.
- Stop consuming alcohol if you have any liver problems.
- Consult with the healthcare provider on the dosage of vaccines for hepatitis A and hepatitis B. Do get vaccinated.
- Avoid coming in contact with persons who are already affected by hepatitis.
- Avoid traveling to places where the rate of hepatitis infection is more.
- Avoid eating contaminated food and water.
How Is Acute Hepatocellular Failure Diagnosed?
- It is a serious condition that requires immediate care. Keeping a check on past medical history, over-the-counter medications, and drug abuse.
- A physical check-up is done to rule out the signs of hepatitis, jaundice, fatigue, or abdominal pain.
- Blood tests are done to analyze the working capacity of the liver. Prothrombin test measures how fast the blood clots; with the reduced capacity of functioning of the liver, the clotting of blood is delayed.
- Tests for mental alertness (test is done to check the capacity of thinking, responding to tasks, and problem-solving capacity).
- Imaging tests such as ultrasound to determine the cause of the liver problems.
- CT (computed tomography) scan and MRI (magnetic resonance imaging) scan to check on the blood vessels. These tests can also look for Budd-Chiari syndrome or tumors.
- Liver biopsy.
The severity of liver disease in acute liver failure is evaluated with the ALFED model; the SOFA score is used for grading organ dysfunction or failing organ systems. The early dynamic score in acute liver failure is mentioned below:
- HE, persistent or progressed to ≥ 2 – 2.
- INR, persistent or increased to ≥5 – 1.
- Arterial ammonia, persistent or increased level ≥ 123 µmol/L — 2.
- Serum bilirubin, persistent or increased to ≥ 15 mg/dl – 1.
What Is the Treatment for Acute Hepatocellular Failure?
Its treatment is mostly based on the underlying cause,
- If an Acetaminophen overdose is detected, then probably activated charcoal should be given; this will help in lowering the absorption of medication in the gastrointestinal tract.
- N-acetylcysteine is also given in terms of Acetaminophen overdose, you can take medication orally, or an Intravenous form is given.
- If auto-immune hepatitis causes the condition, steroids are administered.
- If hepatitis is the cause, medications according to the type of hepatitis are given.
If all the above treatment options do not resolve the condition, a liver transplant is recommended.
There are future innovations of treatment that would ease the process and also give successful results, which will, in turn, be able to reduce the death rate due to the unavailable of the liver for liver transplant:
- Auxiliary Liver Transplantation: In this, the part or piece of the liver is removed and replaced with a similarized graft, allowing the liver to regenerate without the need for immunosuppressant drugs. This is a difficult procedure that needs more time to evaluate.
- Xenotransplantation: Transplantation of human liver with other nonhuman sources or animal liver. Experiment transplantation from pigs was done for many years, but the results were not successful.
- Hepatocyte Transplantation: Transplanting only cells of the liver helps delay the need for a liver transplant. In some cases, it leads to complete recovery also.
- Artificial Hepatic Assist Device: A man-made device that can do the job of the liver. A well-controlled trial showed system extracorporeal liver support helped people with failure of the liver without a transplant. It is also known as high-volume plasma exchange.
What Are the Complications For Acute Hepatocellular Failure?
- Abnormal bleeding.
- Jaundice.
- Bacterial and fungal infection.
- Delirium and confusion.
- Swelling of the brain.
- Low sugar levels in the blood.
- Abnormal swelling.
- Multiple organ failure.
Conclusion:
Healthcare providers need to recognize the early signs of acute liver failure to give appropriate life-saving interventions. It is a serious condition and needs medical care right away. The success of the treatment given completely depends on the cause, comorbidity, extent of liver damage, age of the patient, habits, and response to the treatment.
