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Acute Liver Injury - Causes, Symptoms, and Treatment

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Acute Liver Injury - Causes, Symptoms, and Treatment

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Acute liver injury is the damage to the liver cells and loss of liver function. This happens too fast, within a few days to a few weeks.

Written by

Dr. Janani R S

Medically reviewed by

Dr. Jagdish Singh

Published At August 3, 2022
Reviewed AtNovember 10, 2022

Introduction:

Acute liver injury happens in a healthy individual without any underlying liver disease. It occurs at a rapid speed within a few days to a few weeks and leads to acute liver failure. The factors that cause acute liver injury are due to viral infection or due to taking medications that contain Acetaminophen, herbal medicines, and some medications that are prescribed by the doctor, like NSAIDs (non-steroidal anti-inflammatory drugs), exposure to some chemicals used in varnishes, and autoimmune diseases. External acute liver injury can be due to a blunt blow from a fall, road accidents, or a fight, and injuries that cause deep cuts to the liver with a sharp instrument.

What Is Acute Liver Injury?

Acute liver injury is primarily caused by an overdose of Acetaminophen. It is a severe and life-threatening condition. It damages the liver cells and results in acute liver failure if not detected and treated early. Acetaminophen is a painkiller and fever medicine. It is safe to take the medication for the prescribed time only. Overdose of Acetaminophen can lead to acute liver failure. Acute liver injury is also caused by taking prescribed medications like NSAIDs, painkillers, anti-convulsant (medications used for seizures or fits), herbal medicines, and also external forces from an accident, a fall, or a fight also injure the liver. The acute liver injury also causes coagulopathy (excess bleeding or clotting of blood). Clotting is a thickening of the blood.

What Causes Acute Liver Injury?

  • Acetaminophen overdose causes damage at a cellular level and causes mitochondrial dysfunction. Mitochondria are called the powerhouse of the cell, and it gives energy to the cells. During Acetaminophen overdose, there is oxidative stress in the mitochondria. Oxidative stress is the overproduction of free radicals, and there is an imbalance between antioxidants and free radicals. The free radicals are unstable oxygen-containing molecules that react easily with any molecules. This is called oxidation. Oxidation can create both good and bad effects on the cells. The antioxidants react with the free radicals and make them less effective. These free radicals, during a normal condition, fight against infections and protect the cells. In acute liver injury, the antioxidant becomes less, and there are more free radicals. These free radicals injure and damage the proteins, fatty tissues, and DNA (deoxyribonucleic acid -DNA contains the genetic information that helps in the development and function of a living organism). This, in turn, causes damage to the tissues and organs. Hence there is damage to the liver.

  • Consuming wild mushrooms, which contain harmful substances called amanitins, damages the liver cells.

  • Viral hepatitis also causes acute liver damage.

  • During external injury, a blow from a blunt force due to an accident, fight, or performing sports activity injures the liver and causes bleeding.

What Are the Symptoms of Acute Liver Injury?

  • Pain in the right upper region above the stomach.

  • Jaundice (yellowish discoloration of the skin and eyes).

  • Ascites (enlarged stomach due to excess fluid accumulation).

  • Feeling weak and tired.

  • Disorientation, loss of concentration, and confusion.

  • Easy bruising and bleeding.

  • Loss of appetite.

  • Dark-colored urine.

  • Pale-colored stools.

  • Vomiting.

  • Encephalopathy (damage to the brain cells and leads to confusion, altered behavior, lethargy, and drowsiness).

Who Is at Risk of Getting Acute Liver Injury?

  • People who take Acetaminophen beyond the prescribed time or dose.

  • Taking herbal medicines for a long time.

  • Patients who are taking NSAIDs and anti-convulsants for a long time.

  • Patients with autoimmune disease.

  • People who get exposed to chemicals like varnishes and a few aerosol chemicals.

How Is Acute Liver Injury Diagnosed?

  • Complete Blood Count: This is a blood test where all the components of the blood like red blood cells, white blood cells, platelets, and hemoglobin are checked. Changes in any of these components denote an infection.

  • Liver Function Tests (LFT): Liver function tests are a group of tests performed to rule out liver disease. Liver enzymes like alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and lactate dehydrogenase (LD) are checked. Proteins like albumin and globulin, bilirubin, and prothrombin tests are done. Changes in the normal values of these components confirm liver damage or disease.

  • Ultrasound Scan: A high-frequency sound wave is used to capture images of structures or organs inside the body. An ultrasound scan of the abdomen helps to find the liver disease.

  • CT Scan: Computed tomography (CT) is a series of X-ray images taken from different angles of the body. It provides a detailed image of the structures captured. CT scan helps find out liver disease.

  • MRI Scan: Magnetic resonance imaging (MRI) uses a combination of a strong magnetic field and high-frequency radio waves to take a detailed picture of the internal structures in our body. This scan provides a more detailed image of the structure to find out the disease.

  • Liver Biopsy: Liver biopsy involves the removal of a very small part of the liver tissue to view the changes at a microscopic level. The result of this test provides the details of the type of the disease. This is a confirmatory test.

How to Treat Acute Liver Injury?

The liver has a self-healing property. The liver can regenerate along with medications to control the symptoms.

  • Medications: Medications like N-acetylcysteine reverse the harmful effects of Acetaminophen overdose. It is also used in treating mushroom poisoning.

  • Antibiotics: Antibiotics are given to prevent infections. There is liver dysfunction, and the patient is more prone to infection.

  • Fluid Infusions: Fluids are administered through veins to achieve electrolyte balance and keep the blood pressure within normal limits.

  • Liver Transplant: A liver transplant is considered in severe liver damage and liver failure cases.

  • Acute Liver Injury Due to External Force:

    • Hospitalization and fluid infusion therapy.

    • Blood transfusions when there is moderate blood loss.

    • In severe cases, surgical intervention is done to empty the fluids or blood in the stomach.

    • To find the source and stop bleeding by placing stents (a tubular structure), placing rubber bands over the vessel to stop bleeding, and injecting blood clotting solution to stop bleeding.

What Are the Complications of Acute Liver Injury?

  • Cerebral Edema: It is the excess fluid accumulation in the brain.

  • Prone to Infections: The liver plays an important role in the immune system. When there is liver dysfunction, the defense mechanism is compromised, resulting in infections.

  • Internal Bleeding: Bleeding in the gastrointestinal tract, as the damaged liver does not form the required amount of clotting factors for the blood to clot.

  • Organ Damage: Acetaminophen causes damage to the kidney and causes kidney failure.

What Is the Prognosis of Acute Liver Injury?

The prognosis is good if the liver damage is limited and without complications. If there is severe liver damage, the prognosis is poor.

How to Prevent Acute Liver Injury?

  • Do not take medications beyond the prescribed time and dose.

  • Take Acetaminophen medication for the prescribed time only.

  • Exercise regularly and maintain a healthy weight.

  • Eat a healthy balanced diet containing equal proportions of carbohydrates, proteins, fibers, and vitamins and minerals.

  • Avoid eating wild mushrooms.

  • Get vaccinated against hepatitis B.

  • Use a sterile needle. Do not share needles.

  • Practice safe sex.

  • Visit a doctor immediately if you come in contact with another person's blood.

  • Keep your working space ventilated if you use aerosol sprays or other toxic chemicals.

Conclusion:

Acute liver injury is a severe life-threatening condition. It occurs quickly, within a few days to a few weeks. Though it is less common than chronic liver disease, it causes severe damage to the liver and leads to acute liver failure. Treatment involves administering medications to reverse the harmful effects due to drug overdose. Though this is a life-threatening condition, getting appropriate treatment and following a healthy lifestyle the liver damage can be reversed.

Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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acute liver failureacute liver injury
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