What are the other Names for this Condition? (Also known as/Synonyms)

• Acute Liver Failure (ALF)
• Acute-On-Chronic Liver Failure (ACLF)
• Hepatic Failure

What is Liver Failure? (Definition/Background Information)

• Liver Failure is a very complicated condition that may be caused by various factors ranging from viral infection to acetaminophen overdose, or a genetic disorder
• Liver Failure can be broadly categorized into the following 2 types:
  • Acute-on-Chronic Liver Failure (ACLF): ACLF refers to an acute decline of liver function in individuals with pre-existing liver conditions such as liver cirrhosis
  • Acute-Liver Failure (ALF): ALF is also known as Fulminant Hepatic Failure and it refers to a sudden and rapid loss of liver function in individuals with no pre-existing liver disease
• The common signs and symptoms of Liver Failure include confusion, jaundice (yellowing of skin and eye), nausea, and abdominal pain. Certain serious complications may develop as a result of the condition, such as cerebral edema (accumulation of fluid in the brain), kidney failure, and internal bleeding. Hence, individuals with suspected Liver Failure should seek medical attention immediately
• Blood test and ultrasound scan are the most commonly used diagnostic tools for the diagnosis of Liver Failure. Liver biopsy may sometimes be performed to determine the cause of the condition
• The treatment of Liver Failure varies and depends on the underlying cause. If Liver Failure is caused by acetaminophen overdose or mushroom poisoning (due to consumption of wild mushrooms), antitoxin will be administered. However, if it occurs due to irreversible liver damage, such as due to cirrhosis, then liver transplantation may have to be performed. The prognosis of Liver Failure is generally poor
• Liver Failure may be prevented by availing hepatitis vaccine, maintaining a healthy body weight, avoiding binge drinking, and taking only prescribed medication dosage (thus avoiding an overdose)

Who gets Liver Failure? (Age and Sex Distribution)

• Liver Failure, particularly due to chronic liver disease, is more likely to occur in elderly individuals. However, individuals of any age may be affected
• Cases of Liver Failure have been reported throughout the world. There is no racial, ethnic or gender preference observed

What are the Risk Factors for Liver Failure? (Predisposing Factors)

The risk factors for Liver Failure may include the following:

• Overdose of the drug acetaminophen (Tylenol)
• Toxic effects of mushroom; the condition may be caused by eating wild mushrooms
• Wilson’s disease
• Illicit drug abuse; sharing contaminated needles
• Excessive alcohol consumption

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Liver Failure? (Etiology)

Liver Failure may be caused by a variety of conditions and these are explained below:

• Drugs and medication:
  • An overdose of acetaminophen/paracetamol (Tylenol) can result in Liver Failure. As acetaminophen is a very common painkiller that does not require prescription, the public has easy access to it. However, caution should be taken when one chooses to self-medicate as overdose of acetaminophen will result in liver injury
  • Other drugs, such as anti-tuberculosis medications, non-steroidal anti-inflammatory agents, and anticonvulsants, when taken in excess quantities, may also result in Liver Failure
• Hepatitis virus: Infection by hepatitis B, A, and E viruses is another cause of Liver Failure. In this infection, the hepatitis virus attacks the liver cells and as the infection progresses, the liver function is compromised. If the viral infection is left untreated, it may ultimately lead to Liver Failure. Hepatitis-induced Liver Failure tends to be more common in developing countries and the condition is rare in North America
• Toxin: Ingestion of toxins may also result in poisoning and Liver Failure. A common poisoning occurs from the ingestion of toxic mushrooms that are classified under the genus Amanita
• Autoimmune hepatitis: It is the inflammation of liver that occurs when the immune system of the body attacks the liver. As the inflammation persists, it causes damage to the liver and eventually leads to organ failure
• Vascular disease: Budd-Chiari syndrome, also known as hepatic vein thrombosis, occurs when the vein that drains blood away from the liver is occluded by a blood clot. This blockage prevents normal blood flow through the liver. As a result, the liver fails to receive sufficient supply of oxygen and nutrients. Also, at the same time, it is unable to get rid of body metabolic wastes. If this unfavorable condition persists, the liver can be damaged and lead to its subsequent failure
• Inherited metabolic disease: Wilson’s disease is an inherited disorder that causes one to lose the ability to remove excess copper from the body. As a result, copper builds up in multiple organs, including in the liver, resulting in liver damage. When too much copper accumulates within the liver, it becomes toxic to the liver and causes the organ to fail
• Cancer: Rapid metastasis of cancer from other organs or tissue to the liver may also cause Acute Liver Failure

What are the Signs and Symptoms of Liver Failure?

The signs and symptoms of Liver Failure may include:

• Jaundice
• Fatigue
• Nausea, vomiting
• Poor appetite
• Low sugar level
• Abdominal swelling; abdominal pain
• Confusion, altered mental status
• Internal bleeding
• Coma

How is Liver Failure Diagnosed?

A Liver Failure can be diagnosed by the following tests and examination:

• A thorough physical examination including mental status examination and evaluation of the individual’s medical history is essential towards establishing a diagnosis
• Liver function test may be conducted to test for the amount of liver enzymes, such as alanine aminotransferase (ALT), circulating in blood. When the liver is damaged, elevated amount of liver enzymes may be detected in blood
• Imaging tests, such as ultrasound scan or CT scan, may be performed to examine the liver structure and help detect the presence of any scarring
• A liver biopsy may also be performed to allow microscopic examination of the liver tissue. The biopsy will involve the extraction of a small piece of liver tissue from the individual under anesthesia

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Liver Failure?

The potential complications of Liver Failure include:

• Cerebral edema (or the accumulation of fluid in the brain)
• Coagulopathy (easy bleeding): Increased risk of bleeding due to lack of coagulation factors in the body
• Kidney dysfunction
• Encephalopathy ranging from confusion to coma

How is Liver Failure Treated?

Several treatment methods may be employed to treat Liver Failure and its underlying cause. However, if the condition is severe and irreversible has taken place, then a liver transplantation may be necessary. The treatment measures for Liver Failure may include:

• Fluid intake
• Treatment of bleeding disorders (underlying bleeding episode)
• Treating underlying infections
• Antidotes may be given to individuals with acetaminophen overdose, mushroom poisoning, or other drug-induced Liver Failure:
  • The commonly used antidote for acetaminophen overdose is N-acetylcysteine (NAC)
  • Silibinin is often used to treat mushroom poisoning
• In more severe or life-threatening cases of Liver Failure, a liver transplantation will be required to restore liver function

It should be noted that one will have to go through lifelong immunosuppression after transplantation to avoid graft rejection.

How can Liver Failure be Prevented?

The preventive measures for Liver Failure may include the following:

• Hepatitis vaccination
• Adhering strictly to instruction on medication label to prevent overdose
• Avoiding intravenous needle sharing
• Avoiding excessive alcohol consumption
• Avoiding the consumption of unknown type of mushrooms or wild mushrooms

What is the Prognosis of Liver Failure? (Outcomes/Resolutions)

• Since liver is a very important organ in the body, Liver Failure puts one in a life-threatening situation
• The prognosis of individuals with Liver Failure is generally poor, especially if complications, such as cerebral edema, coma, coagulopathy, or renal failure, have developed as a result of the failing liver

Additional and Relevant Useful Information for Liver Failure:

The various (non-specific) signs and symptoms of Liver Failure, such as fatigue, nausea, jaundice, and poor appetite, may often be overlooked and dismissed. However, one should seek medical attention as soon as one notices yellowing of the skin and eye (jaundice), as it is an early indicative sign of a liver disease. The early diagnosis of liver diseases or acute onset of Liver Failure will allow for early medical intervention and significantly improved prognosis.