Liver Failure - Unraveling Causes, Symptoms, and Hope for Healing

Introduction

The liver performs various important bodily functions, including eliminating harmful substances, making proteins for blood clotting and oxygen transportation, storing glucose, and producing bile, which is essential in food digestion. But when the liver can no longer perform these functions, it is called liver failure. Liver failure is a life-threatening condition and requires immediate medical attention. If a liver failure occurs suddenly over days or weeks, it is called acute liver failure. If the liver failure occurs over months or years and progresses slowly over time, it is called chronic liver failure.

What Are the Causes of Liver Failure?

Acute Liver Failure - This occurs in persons who do not have a history of any liver diseases.

• Drug-Induced Hepatitis - It is the most common cause of acute liver failure. Acetaminophen (Paracetamol) is the drug that causes most acute liver failure cases. Intentional overdose or consuming more than the recommended dose for many days (unintentional) can cause acute liver failure.

• Viral Hepatitis - Hepatitis A, hepatitis B, and hepatitis E are the other most common reasons for acute liver failure. Other viral infections that can cause acute liver functions include herpes simplex virus, Epstein-Barr virus, cytomegalovirus (CMV), Varicella-zoster virus, adenovirus, and Proviruses.

• Autoimmune Hepatitis - The body’s own immune system attacks the liver cells and causes inflammation.

• Hypoxia-Induced liver injury.

• Toxins - Consuming a poisonous mushroom and an industrial chemical called carbon tetrachloride causes acute liver failure.

• Veno-Occlusive Diseases - Budd-Chiari syndrome is a disease affecting the veins of the liver. It can lead to acute liver failure.

• Cancer - When cancers like breast cancer, lung cancer, and lymphoma spread to the liver, it may lead to acute liver failure.

• Metabolic Diseases - Such as acute fatty liver of pregnancy and Wilson disease, sometimes lead to acute liver failure.

• Heat Stroke - when the body cannot control its temperature, body temperature increases exponentially in a small interval of time.

• Shock - A serious complication of infection called sepsis can reduce blood circulation to the liver, causing liver failure.

Chronic Liver Failure - It is the most common type of liver failure.

• Alcoholic Liver Disease - Individuals with severe alcohol consumption tend to develop disorders like liver cirrhosis, alcoholic hepatitis, and alcoholic fatty liver. Eventually, these can cause chronic liver failure.

• Chronic Viral Hepatitis - Chronic hepatitis B, C, and D infections are the most common causes of chronic liver failure.

• Non-Alcoholic Fatty Liver Disease (NAFLD) - The presence of obesity, cholesterol, and diabetes can increase the disease severity in non-alcoholic fatty liver disease. Sometimes it can lead to liver fibrosis.

• Autoimmune Diseases - Autoimmune hepatitis and primary biliary cirrhosis are the autoimmune diseases that can cause chronic liver failure.

What Are the Symptoms of Liver Failure?

• Acute Liver Failure:

  • Vomiting.

  • Diarrhea.

  • Jaundice (yellow discoloration of skin and eyes).

  • Pain on the right side of the abdomen.

  • Fatigue.

  • Blood in the stool.

  • Ascites (swelling of the stomach).

  • Loss of appetite.

  • Disorientation.

• Chronic Liver Failure:

  • Hepatic encephalopathy - as the liver functions are impaired, levels of ammonia increase in the body, causing impaired consciousness.

  • Jaundice.

  • Fatigue.

  • Weight loss.

  • Loss of appetite.

  • Ascites.

  • Esophageal Varices - When blood flow to the liver is blocked, abnormal and large veins develop in the esophagus.

What Are the Complications of Liver Failure?

The complications of acute liver failure are as follows;

• Cerebral Edema - Fluid build-up in the brain increases pressure inside the brain, which causes disorientation, seizures, and mental confusion. It is the most common cause of death in acute liver failure.

• Kidney Failure - In drug-induced acute liver failure, kidney failure also occurs.

• Infections - Urinary and respiratory tract infections and infection in the blood (sepsis) are likely to occur.

• Coagulopathy (Bleeding Disorders) - As the liver fails to make the proteins responsible for clotting, blood clotting is compromised. Bleeding in the digestive tract is more common.

The complications of chronic liver failure are as follows;

• Portal Hypertension - As the blood flow to the liver is blocked, the pressure inside the veins of the liver increases, causing portal hypertension.

• Hepatic Encephalopathy - When the liver cannot eliminate the wastes properly, ammonia (which is a waste product) accumulates in the body. It can alter the mental status causing changes in memory and concentration, anxiety, change in sleep patterns, and behavior changes.

• Bacterial Infection - Bacterias like E. coli and streptococcus pneumoniae infect the ascites fluid in the abdomen and spread to the lining of the digestive tract. It is the most painful complication of chronic liver failure.

• Kidney Failure - Chronic liver failure is followed by kidney failure.

• Bleeding Disorders - When the liver is damaged, it fails to make the proteins necessary for blood clotting. This leads to bleeding disorders.

• Liver Cancer - Chronic liver infections like hepatitis, cirrhosis, and nonalcoholic fatty liver disease increases the risk of liver cancer.

What Is the Diagnosis of Liver Failure?

• Blood Tests - Serum tests to rule out viral hepatitis are done. In alcoholic liver disease, two enzymes called alanine aminotransferase (ALT) and aspartate aminotransferase (AST) will be higher than normal.

• Radiologic Investigations - An ultrasound scan of the abdomen is the most common diagnostic method for liver diseases. Computerized tomography (CT) and magnetic resonance imaging (MRI) are also recommended.

• Biopsy of the Liver - A small piece of tissue from the liver is removed to examine to understand the cause of liver failure.

What Is the Treatment for Liver Failure?

Acute Liver Failure:

• For Acetaminophen overdose, N- acetylcysteine (NAC) is given.

• Antivirals for Hepatitis B. There are no effective antivirals for Hepatitis A and E, so supportive care is given.

• Steroids for autoimmune hepatitis.

• Penicillin for mushroom toxicity.

• Anticoagulation therapy for Budd-Chiari Syndrome.

• Liver transplant for Wilson disease.

• Kidney transplant for patients with kidney failure.

Chronic Liver Failure:

• Esophageal varices are treated with vasopressors (drugs that increase pressure inside blood vessels) like Octreotide and Terlipressin.

• Hepatic encephalopathy is treated with Rifaximin and Lactulose. These drugs can decrease the levels of ammonia in the body.

• Kidney failure is treated with Norepinephrine and Octreotide.

• Cutting alcohol consumption is essential in treating alcoholic liver disease.

• Liver cancer is treated by resecting the lesion in the initial stages and with a drug called Sorafenib in case of metastasis (spread of cancer to other organs).

Conclusion

With proper diagnosis and treatment, recovery from liver failure is possible. But with some lifestyle modifications like controlling obesity, taking a healthy diet, and reducing alcohol intake, one can reduce the chance of getting liver disease. And also, taking hepatitis vaccines and being careful while taking medicines like Acetaminophen is important. By sticking to these simple precautions, everyone can have a healthy liver and, thus, a healthy life.