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Acute liver failure


Disease: Acute liver failure Acute liver failure
Category: Liver Diseases
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Disease Definition:

Liver failure often develops slowly over the course of years, usually due to long term alcohol use or infection with the hepatitis virus, but acute liver failure can develop in a matter of days. It occurs when the liver rapidly loses its ability to function. This is a medical emergency that usually follows a acetaminophen overdose. An acute liver failure less commonly results from a viral infection, poisoning or an underlying condition affecting blood flow in the liver.

In the treatment of an acute liver failure, the problems caused by the failing liver should be managed, such as the buildup of toxins in the bloodstream, then, the liver may be able to heal on its own, or a liver transplant may be needed.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


The signs and symptoms of liver disease could be experienced before the liver fails, such as:


  • Tenderness in the upper right area of the abdomen
  • A yellowing of the eyeballs and the skin (jaundice)
  • Encephalopathy: it may develop as the condition worsens. This condition is the damage of the nervous system and brain resulting from the inability of the liver to metabolize toxins into harmless substances, allowing their buildup in the body and causing signs and symptoms such as changes in the mental state, behavior and personality.


Some of the signs and symptoms of encephalopathy may be:


  • Muscle tremors and stiffness
  • Mood changes or agitation
  • Forgetfulness, confusion, delirium and disorientation
  • Dysfunctional or uncontrollable movement, such as difficulty with handwriting
  • Decreased responsiveness or sleepiness
  • In severe cases of acute liver failure, people lose consciousness and become comatose.


Because a failing liver can't produce sufficient amounts of substances that help the blood to clot, people suffering from acute liver failure have bleeding problems to an extent that even minor cuts on the skin can cause severe bleeding.


Located on the right-hand side of the abdomen, the liver is a large multi-lobed organ. The common functions of the liver include:


  • Producing clotting factors that help the blood clot, including proteins and many other substances, as well as bile that breaks down fats.
  • Filtering bacteria, toxins and waste products from the blood.
  • Storing vitamins, sugar, cholesterol and iron.


The body’s ability to perform any of these functions is hindered when the liver fails. Many reasons could cause an acute liver failure, including:

  • The use of ecstasy, cocaine or other recreational drugs.
  • Acetaminophen overdose is the most common cause of acute liver failure. Lots of other medications as well as herbal supplements can cause drug reactions that lead to liver failure, such as kava extract. However, these types of reactions are rare.
  • Toxins: Amanita phalloides, which is a wild mushroom and is sometimes mistaken for other edible species, is poisonous and causes acute liver failure. Toxins from industrial chemicals and bacteria can damage the liver including carbon tetrachloride.
  • Viruses: In countries where the virus is widespread, hepatitis E is a more common cause of liver failure, especially among pregnant women.
  • Some of the other viruses that are linked with acute liver failure include herpes simplex virus, hemorrhagic fever viruses, cytomegalovirus, Epstein-Barr virus and paramyxovirus.
  • Vascular disease: Acute liver failure can be caused by conditions that cause blockages to form in the veins of the liver, such as veno-occlusive disease, portal vein thrombosis and Budd-Chiari syndrome.
  • Metabolic disease: Reye's syndrome, acute fatty liver of pregnancy and Wilson's disease are rare metabolic diseases that can cause acute liver failure.
  • Autoimmune diseases: When the liver cells are attacked by the immune system causing inflammation and injury, it is called autoimmune hepatitis.
  • Cancer: Cancer that spreads to the liver from another organ or malignant tumors that grow in the liver can cause failure of the liver.


However, there's no identifiable cause in about 15 percent of cases of acute liver failure.



There are many common complications associated with acute liver failure, such as:


Kidney failure:
It usually occurs following liver failure, specifically in the case of acetaminophen overdose that damages both the kidneys and the liver.


The risk of developing a variety of infections is increased in people suffering from acute liver failure, especially infections in the blood and the respiratory and urinary tracts.


Cerebral edema:
In this condition, an excessive amount of fluid is collected in the brain, causing pressure to build in the brain, which in turn causes brain tissue to be displaced outside of the compartment it normally occupies (herniation). This complication can also deprive the brain of oxygen, but exactly why acute liver failure causes cerebral edema is still not known.


Bleeding disorders:
Blood clots, because the failing liver isn't able to produce sufficient amounts of clotting factors and because it doesn't clot quickly. Bleeding from ulcers in the gastrointestinal tract or other locations is difficult to control.


Pulmonary edema:
Breathing difficulties can be caused by a buildup of fluid in the lungs.
Quickly identifying and treating complications is quite essential because an acute liver failure can be fatal.


Usually, people suffering from an acute liver failure are admitted to an intensive care unit in a hospital for continual monitoring. Depending on the signs and symptoms as well as the cause of acute liver failure, treatments may include:

Screening for infections:
When suspecting an infection, the patient will receive antibiotics or antifungal medications. It is important to screen their blood, urine and sputum for signs of infections because they are especially vulnerable to developing infections.

Relieving cerebral edema:
Acute liver failure can lead to cerebral edema (brain swelling), which increases pressure on the brain. In case of having severe cerebral edema, the patient will be given medications through a vein in the arm to help reduce the fluid buildup in the brain.

Preventing severe bleeding:
Bleeding ulcers in the gastrointestinal tract is usually developed in people with acute liver failure. The patient will be given medications to help abate the bleeding and will need blood transfusions if they’re losing a lot of blood.

Reversing poisoning with an antidote:
If acute liver failure is caused by acetaminophen overdose or mushroom poisoning, the patient will be given drugs that can reverse the effects of the toxin.
Fluid, electrolyte and glucose supplements can be included as additional treatments.

If a part of your the is removed or damaged, it can grow back to approximately its original size because the liver is one of the few organs in the body that has the ability of regeneration. However, sometimes, if the damage is so severe, it won’t be able to regenerate. In such cases, liver transplantation is necessary.

During a liver transplantation, a whole liver or part of a liver is placed surgically from a deceased donor into a recipient. Another type of transplant is the living-donor transplant, where a part of a living donor's liver is given, in which case both partial livers regenerate after being transplanted.

However, because it is a lengthy surgery, complications are possible, such as bleeding, infection and death. And in some cases, the body may reject the new liver.


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