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Acute Liver Failure

DEFINITION

Acute liver failure is when the liver rapidly stops functioning properly. The liver normally works to helps process nutrients, create proteins including those that help blood clot, and remove drugs and toxins from the body. Some liver diseases happen over time leading to liver failure. In contrast, acute liver failure happens over the course of only a few days and is extremely serious. Without the liver, many of the functions of the body cannot be performed normally. The blood loses its ability to clot; many medications and toxins cannot be removed from the body; and some proteins the body needs cannot be produced. There are many causes of acute liver failure including acetaminophen (Tylenol) overdose, some prescriptions medications, some herbal supplements, hepatitis (especially Hepatitis A, B, E and some viruses), toxins (like toxic wild mushroom), autoimmune diseases (called autoimmune hepatitis where the body attacks itself), vascular diseases of the liver (problems with the veins in the liver that cause blood to back up like clots or other obstruction), metabolic diseases (like Wilson’s Disease), or cancer (either from the liver itself or from other places in the body that comes to the liver). In some cases, the liver fails without any known cause. If acute liver failure is not treated, many complications can occur. The brain can swell, a condition called cerebral edema. The brain sits in the skull, a solid bone with a small hole slightly larger than a half dollar where the spinal cord exits. When the brain swells enough, it can be partly pushed through this hole (called brainstem herniation), resulting in serious and irreversible damage and death. Additionally, a person with hepatic failure may not be able to clot their own blood, leading to problems with bleeding both outside and inside of the body. People who are in hepatic failure are also less able to fight off infection and more likely to have their kidneys fail. Sometimes the cause of acute liver failure can be found and reversed leading to better liver function. Other times, however, the only cure for acute liver failure is liver transplant.

SYMPTOMS
Jaundice (yellow color of the eyes and skin), nausea and vomiting, abdominal pain (especially on the right side of the abdomen just below the ribs), problems concentrating, confusion, somnolence (feeling sleepy), muscle aches and tremors

DIAGNOSIS
The diagnosis of acute hepatic failure is made with laboratory tests after a full history and physical exam by your doctor. Usually, this diagnosis is made in the emergency room or hospital. Blood tests will be done to look at the function of your liver (liver function tests), the ability of your blood to clot properly (prothrombin time and partial thromboplastin time), and probably additional tests like those for hepatitis and acetaminophen level. Sometimes a biopsy, or small piece of tissue, is taken with a needle from the liver to look at under a microscope to help determine the cause of the liver failure. Additional imaging may be done with CT scans or MRIs to get a better look at the liver, including any cancer or blood clots that may be present.

TREATMENT
People with acute liver failure need to be treated in the Intensive Care Unit (ICU) to try and prevent further complications. If a medicine or poison is the cause of the acute hepatic failure, medications or treatments to reverse those medications may be necessary. If acetaminophen (Tylenol) is the cause, a medication called n-acetylcysteine may be used or the doctor may use dialysis (removal of the acetaminophen by filtering the blood). While in the ICU, the patient will be closely monitored for bleeding and infection. If bleeding is a problem, the patient may be given blood products like fresh frozen plasma to help the blood clot. If infections become a problem, antibiotics will likely be given. Other medications can also be given to prevent swelling of the brain. Ultimately, if the liver does not begin to function on its own, the only treatment option is transplant. A liver transplant can be difficult to get, but those who need transplants urgently usually get livers first. If you suspect that you or someone you know may have symptoms of acute hepatic failure, your need to go to the emergency room immediately. Acute hepatic failure is an extremely serious situation that can rapidly end in death.

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