Definition

Liver failure is a condition in which the liver loses its ability to function properly, and it can develop suddenly (acute) or over a prolonged period (chronic). Acute liver failure can occur within a few days or weeks, with the fastest progression usually occurring within the first 48 hours. On the other hand, chronic liver failure typically results from persistent liver disease that has been present for several years.

Causes

It is important to note that both acute and chronic liver failure can stem from a variety of causes. Factors that can contribute to acute liver failure include paracetamol overdose, prescribed drugs, herbal supplements, hepatitis and other viruses, toxins, autoimmune diseases, liver blood vessel disorders, metabolic diseases, cancer, shock, and heat stroke.

Taken in excess on a single occasion or over several days, paracetamol can cause acute liver failure. In addition, prescription drugs like antibiotics, painkillers, and antiseizures can also cause acute liver failure. Some herbal supplements, such as kava, ephedra, skullcap, and pennyroyal, have been known to be associated with acute liver failure.

Viruses that can lead to liver failure include hepatitis A, hepatitis B, hepatitis E, Epstein-Barr virus, cytomegalovirus, and herpes simplex virus. The Amanita phalloides fungus produces one of the toxins connected with liver failure. Additionally, exposure to carbon tetrachloride, a component of coolers, candles, and varnishes, can result in liver failure.

Many diseases, including Wilson disease, which causes the liver to accumulate copper, and autoimmune hepatitis, where the immune system attacks liver cells, can result in acute liver failure. And the buildup of fat in the liver during pregnancy. Shock-induced acute liver failure is a result of organ failure shocks, which severe infections like sepsis can cause. Acute liver failure can also be linked to heat stroke, a condition that occurs during intense physical activity in hot weather.

On the other hand, chronic liver failure is often a consequence of cirrhosis, which is the hardening of the liver. Hepatitis B, hepatitis C, and conditions like hemochromatosis, a congenital disorder that causes elevated iron levels in the body, can all contribute to cirrhosis.

Risk Factor

The risk factors for liver failure differ depending on the underlying causes. For example, hepatitis E and autoimmune liver disease are more common in women than men. In contrast, hepatitis B and C are often associated with a history of blood transfusion, drug use via a needle (whether prescribed or not), multiple sexual partners, tattoos, and healthcare workers who come into contact with patient body fluids. Excessive alcohol consumption is a significant risk factor for liver failure, especially in the case of chronic liver failure. Family history can help identify congenital diseases like Wilson that cause liver failure.

Symptoms

Symptoms of acute liver failure may include yellowing of the skin and sclera (jaundice), pain in the upper right abdomen, gastrointestinal issues such as vomiting or nausea, decreased appetite, abdominal swelling due to fluid retention (ascites), swollen legs, overall malaise, confusion or disorientation, sleepiness, tremors or shivering in unconscious body parts, blood vomiting from the stomach, upper gastrointestinal bleeding with symptoms like blood in vomit or black feces, and diarrhea. 

Symptoms of chronic liver failure typically become noticeable only in the advanced stages of the disease.

Diagnosis

The diagnosis of liver failure typically begins with questions about the onset of symptoms. Doctors may inquire about various risk factors related to liver failure to determine whether it is acute or chronic. This may involve asking about the patient's history of alcohol usage, medication and drug use, herbal remedies, family history of similar diseases, potential exposure to hepatitis risks such as travel to endemic areas, history of blood transfusions, sexual activity, occupation, piercings, and exposure to toxins like fungi, organic solvents, and phosphorus from fireworks.

Doctors conduct a physical examination of individuals to identify symptoms such as jaundice, pain in the upper right abdomen, high blood pressure with a slow pulse, swelling of the abdomen and legs, as well as signs of blood vomiting or black feces.

Laboratory tests are crucial in confirming the diagnosis, assessing complications, and gauging the patient's recovery. These tests include a complete blood test to evaluate platelet count, blood clotting tests, liver enzymes, bilirubin levels, serum ammonia, blood glucose levels, lactate levels, blood gas analysis, creatinine levels, phosphate levels, autoimmune markers such as antinuclear antibodies (ANA), paracetamol levels, and toxicology screenings for drugs.

Antigen-antibody tests are used to identify virus infections, while blood cultures are helpful when there is a suspicion of bacterial infections. If there is a suspicion of autoimmune liver disease, liver cancer, other cancers affecting different parts of the body, or herpes simplex virus infection, a liver tissue biopsy may be performed.

Ultrasonography (USG) imaging is used to detect the presence of fluid accumulation in the stomach and to evaluate the blood vessels in the liver. CT scans, on the other hand, are employed to visualize the liver and identify any masses or tumors in the surrounding areas. Additionally, CT scans can also be performed on the head to detect bleeding and assess for any internal hemorrhage, which can help determine the cause of unconsciousness, such as in cases of acute liver failure that can lead to potential brain damage.

Management

Liver failure is a serious medical condition that requires immediate attention. In acute cases, it can become a medical emergency. When patients arrive in a coma or unconscious state, healthcare workers take measures to open the airway for breathing. This is often done through intubation, which involves inserting a breathing tube. Additionally, a feeding tube may relieve stomach pressure and provide essential nutrition.

If a patient is conscious, the treatment for liver failure will depend on what caused it. If the cause is toxicity from substances like paracetamol or fungal exposure, specific antidotes may be given. However, regardless of the cause, there is a high chance that the patient will need intensive care in the Intensive Care Unit (ICU).

Your doctor might advise a liver transplant if there isn't enough healthy liver tissue for it to function correctly. However, this procedure can only be performed at a national referral center in Indonesia.

Complications

One of the complications of liver failure is brain swelling due to fluid accumulation. This occurs when the blood vessels in the liver narrow, accumulating fluid in the brain, abdomen, and feet. The accumulation in the head is hazardous and can be fatal. Additionally, liver failure can result in blood clotting disorders since many factors essential for blood clotting are produced in the liver. Lowered immune system function can lead to complications such as pneumonia and urinary tract infections. Furthermore, liver failure may impact kidney function, potentially causing kidney failure as a complication.

Prevention

Preventing liver failure involves adopting various strategies:

• Use medications according to the prescribed dosage, as the package instructions indicate
• Inform your physician about all medications consumed, including over-the-counter, unprescribed, or herbal medications, as they can interact with prescribed drugs
• Limit or abstain from alcohol consumption, adhering to a maximum of one glass per day for women and two glasses per day for men
• Avoid risky behaviors such as using illicit drugs, sharing needles, engaging in unprotected sex, and practice caution during tattooing or piercing by choosing clean and safe locations
• Receive vaccinations for hepatitis viruses
• Prevent contact with others' blood or body fluids by avoiding sharing needles, razors, or toothbrushes
• Avoid consuming wild mushrooms, as distinguishing between toxic and non-toxic varieties can be challenging
• Exercise caution when using aerosol sprays like bug killers, fungicides, paint, or other toxic chemicals. Ensure proper room ventilation
• Handle fluids that come into contact with your body, especially when using pesticides. Protect the skin with gloves, long-sleeved clothing, hats, and masks
• Maintain an ideal body weight, as obesity can lead to fat accumulation in the liver, contributing to chronic liver failure

When to see a doctor?

If a person experiences yellowing of the skin or eyes, upper right abdominal pain, or sudden onset of consciousness disorders such as sleepiness, confusion, or coma, they should seek immediate medical attention. If the person has a history of liver disease, obesity, excessive alcohol consumption, or regular use of illicit drugs, the suspicion of liver failure is increased.

Want to know more information about other diseases? Click here!