Liver Necrosis - Types, Causes, Prevention

Introduction

The largest vital organ of the human body is the liver. The liver does more than five hundred functions of the body; it performs both endocrine (a complex network of glands and organs) and exocrine (a gland that makes sweat, tears, milk, and digestive fluids) functions. The main function includes detoxification, the production of bile which aids in digestion, protein production, filtration, removing toxins, and their conversion to waste products. The liver is made up of many cells known as hepatocytes.

What Is Liver Necrosis?

Loss of cells or cell death is termed necrosis. The liver is made up of cells called hepatocytes. The condition in which these hepatocytes get necrosed (affected by dead cells) is termed liver necrosis. It may appear as ballooning degeneration, apoptotic bodies (little sealed sacs containing information), or coagulative necrosis(accidental cell death). Under pathologic conditions, necrosis always occurs as a result of various styles of tissue injury. It is a common finding in acute and chronic liver conditions.

What Are Different Types of Necrosis?

The different types of liver necrosis are:

Apoptosis Necrosis: Necrosis of single cells is mostly the underlying cause of hepatitis.

Focal or Spotty Necrosis: Necrosis involves small clusters of hepatocytes caused by viral hepatitis, autoimmune or drug-induced.

Zonal Necrosis:

• Centrilobular: Necrosis occurs around the central vein in conditions like ischemia, and drug-induced or post-surgical injury.

• Periportal: Necrosis occurs in the periportal zone caused by a hepatitis condition.

Confluent Necrosis:

• Localized: Only a part of the liver is necrosed, caused by localized ischemia and transarterial embolization treatment.

• Submissive: Total hepatocellular necrosis caused by conditions like hepatitis (viral, autoimmune, or drug-induced), acute allograft failure (acute rejection of the transplanted graft), and fulminant Wilson’s disease (rare hereditary disorder).

How Does Necrosis Occur?

Necrosis occurs when the cells get too little flow of fresh blood. This can be caused due to any kind of injury to the tissue, any effect of radiation, or the result of chemical contact. When large tissue is necrosed due to lack of blood supply, this may lead to gangrene. It is an irreversible process. Necrosis in cases of acute or toxic injury to the liver with sudden or precipitous onset causes a marked elevation in serum aminotransferase levels; the rise may go up to 400 to 800 U/L.

What Are the Signs and Symptoms of Liver Necrosis?

• Nausea and vomiting.

• Fatigue.

• Mild to severe abdominal pain.

• Somnolence (sleepy) and mental clouding, a fog-like feeling or being half-awake.

• Rare cases of itching.

• In later stages, jaundice appears (jaundice is a yellowish discoloration of mucous membrane, skin, and whites of the eye).

• Ascites (fluid-filled in the abdomen).

• Severe pain in the abdomen.

• Malaise (general feeling of discomfort).

• Insomnia (sleeplessness).

• Tremors and chills (in cases of indications of fever).

What Are the Causative Agents of Liver Necrosis?

The agents that cause liver necrosis include:

• Extreme alcoholism.

• Acetaminophen: High doses of this drug and its exposure to lung tissue can lead to necrosis.

• Aspirin.

• Cocaine.

• Niacin.

• Methotrexate.

• High doses of Amiodarone.

• Terbutaline.

• Direct toxins like phosphorous.

• Pennyroyal oil.

Sometimes the hepatic injury is not the direct cause of the drug on the liver but an indirect effect of ischemic hepatic necrosis, which is caused by severe heart failure, hypoxia (low oxygen level in blood), hypotension, shock, or hyperthermia (abnormally high temperature).

• Shock: Sepsis (life-threatening condition occurring due to infection) and shock can affect the blood flow to the liver, and this may cause liver necrosis leading to liver failure.

• Heat Stroke: Overexertion and physical activity in a hot environment can trigger impaired blood flow to the cells and cause necrosis and later failure of the liver.

How Is the Diagnosis Made for Liver Necrosis?

• Blood Test: Abnormal levels of liver enzymes in the blood. An increase in bilirubin, alkaline phosphatase, alanine aminotransferase, etc., can be seen in the blood report.

• Imaging Tests:

  • MRI (magnetic resonance imaging).

  • CT scan (computed tomography).

  • X-rays and ultrasounds are done to identify the state of the liver.

• Liver Biopsy: Thin needle is used to take the sample of liver tissue and then it is analyzed under the microscope to check for the presence of the underlying cause of the disease.

What Are the Steps to Control Liver Necrosis?

• Removing the underlying cause.

• Avoid taking more drugs, especially the overdosage of drugs that have Acetaminophen.

• Avoid consuming more alcohol.

• Make lifestyle changes- have a healthy lifestyle.

• Avoid risky behavior.

• Avoid taking recreational drugs.

• Avoid coming in contact with people who are already infected.

• Get vaccinated for hepatitis.

• Maintain a healthy weight.

• Avoid taking self-injecting drugs and avoid having unsafe sex.

What Preventive Measures Should be Taken for Liver Necrosis?

The preventive measures taken for liver necrosis are:

• By preventing liver exposure to a high dose of drugs like Acetaminophen, and Aspirin, this condition can be avoided.

• Moderate alcohol consumption.

• Avoiding the agents and exposure to recreational drugs that can lead to liver damage.

• Maintaining a healthy lifestyle.

• Taking a healthy diet.

• Getting vaccinated.

• Avoid all the causes and habits which may lead to liver damage in the long run.

Can Liver Necrosis Be Reversed?

The only organ in the body is the liver that is capable of regenerating itself by replacing the damaged tissue with new cells rather than the scar tissue. One of the examples is acetaminophen overdose that can destroy half of the liver cells of an individual in less than a week. With all these complications, the liver can repair itself completely and within a month, the patient shows no signs of damage. Therefore, the liver necrosis is reversible in many instances and that depends on the cause and if treated early. When the liver gets overwhelmed sometimes, it cannot repair itself completely if it’s still under attack from a virus, drug or alcohol.

Conclusion:

Necrosis of the liver is an indicator of acute or chronic ongoing injury. The pattern and extent of the present necrosis guide towards determining and confirming the underlying cause and severity of the liver injury. Necrosis of liver tissue before or after liver transplantation is a matter of concern. Total hepatectomy is indicated in cases of acute liver failure with fulminant necrosis. Removal of necrotic tissue can improve acidosis and the hemodynamic state of the liver, but in another aspect of a multiorgan failure, liver transplantation remains the only option.