Acute liver failure

Acute liver failure

Definition:

Acute liver failure occurs when your liver rapidly loses its ability to function. More commonly, liver failure develops slowly over the course of years. But in acute liver failure, liver failure develops in a matter of days.

Acute liver failure can cause many complications, including excessive bleeding and increasing pressure in the brain. Another term for acute liver failure is fulminant hepatic failure.
Acute liver failure is a medical emergency that requires hospitalization. Some causes of acute liver failure can be reversed with treatment. But in other situations, a liver transplant may be the only cure for acute liver failure.

Symptoms:

Signs and symptoms of acute liver failure may include:

• A yellowing of your skin and eyeballs (jaundice)
• Pain in the upper right area of your abdomen
• Nausea
• Vomiting
• A general sense of not feeling well
• Difficulty concentrating
• Disorientation or confusion
• Sleepiness

When to see a doctor
Acute liver failure can develop quickly in an otherwise healthy person, and it is life-threatening. If you or someone you know suddenly develops a yellowing of the eyes or skin, tenderness in the upper abdomen or any unusual changes in mental state, personality or behavior, seek medical attention right away.

Causes:

Acute liver failure occurs when liver cells are damaged significantly and no longer able to function. Acute liver failure has many potential causes, including:

• Acetaminophen overdose. Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. Acute liver failure can occur if you take a very large dose of acetaminophen all at once, or it can occur if you take higher-than-recommended doses every day for several days, especially in people with chronic liver disease.
• Prescription medications. Some prescription medications, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, can cause acute liver failure.
• Herbal supplements. Herbal drugs and supplements, including kava, ephedra, skullcap and pennyroyal, have been linked to acute liver failure.
• Hepatitis and other viruses. Hepatitis A, hepatitis B and hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include Epstein-Barr virus, cytomegalovirus and herpes simplex virus.
• Toxins. Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for edible species.
• Autoimmune disease. Liver failure can be caused by autoimmune hepatitis — a disease in which your immune system attacks liver cells, causing inflammation and injury.
• Diseases of the veins in the liver. Vascular diseases, such as Budd-Chiari syndrome, can cause blockages to form in the veins of the liver and lead to acute liver failure.
• Metabolic disease. Rare metabolic diseases, such as Wilson's disease and acute fatty liver of pregnancy, infrequently cause acute liver failure.
• Cancer. Cancer that begins in your liver or cancer that spreads to your liver from other places in your body can cause your liver to fail.

Many cases of acute liver failure have no apparent cause.

Complications:

Acute liver failure often causes complications, including:

• Excessive fluid in the brain (cerebral edema). Excessive fluid causes pressure to build in your brain, which can displace brain tissue outside of the space it normally occupies (herniation). Cerebral edema can also deprive your brain of oxygen.
• Bleeding disorders. A failing liver isn't able to produce sufficient amounts of clotting factors, which help blood to clot. Bleeding from ulcers in the gastrointestinal tract or other locations is difficult to control because blood doesn't clot quickly.
• Infections. People with acute liver failure are at an increased risk of developing a variety of infections, particularly in the blood and in the respiratory and urinary tracts.
• Kidney failure. Kidney failure often occurs following liver failure, especially in cases of acetaminophen overdose, which damages both your liver and your kidneys.

Treatments and drugs:

 People with acute liver failure are treated in the intensive care unit of a hospital. When it's possible, your doctor will work to treat your acute liver failure. But in many cases, the treatment involves controlling complications and giving your liver time to heal.
Treatments for acute liver failure
Acute liver failure treatments may include:

• Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin.
• Liver transplant. Acute liver failure can't be reversed in many cases. In these situations, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor.

Treatments for complications
Your doctor will work to control signs and symptoms you're experiencing and try to prevent complications caused by acute liver failure. This care may include:

• Relieving excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.
• Screening for infections. Your medical team will take periodic samples of your blood and urine to be tested for signs of infection. If your doctor suspects that you have an infection, you'll receive medications to treat the infection.
• Preventing severe bleeding. People with acute liver failure often develop bleeding ulcers in the gastrointestinal tract. Your doctor can give you medications to reduce the risk of bleeding. If you lose a lot of blood, you may require blood transfusions.