Liver Failure
What is the life expectancy in cases of liver failure? All the information about liver insufficiency and its possible prognosis.
Symptoms and Causes
Liver failure, fulminant hepatitis, fulminant liver failure, or liver insufficiency is a severe disorder of liver function due to significant damage to liver cells. The liver plays a fundamental role in the body, as it is responsible for synthesizing nutrients, eliminating toxins, aiding fat digestion, and modulating the immune response. Therefore, liver failure is a serious condition that can be life-threatening.
Based on progression and cause, three types of liver insufficiency are distinguished:
- Acute liver insufficiency: A sudden and fulminant failure that leads to the rapid loss of liver functions within days (hyperacute liver insufficiency) or weeks (subacute liver insufficiency), usually in people without preexisting liver disease. It constitutes a medical emergency that, depending on the cause, may be reversible.
- Chronic liver insufficiency: A progressive and permanent failure of liver function, developing over months or years. It is a more common condition, usually resulting from liver cirrhosis.
- Acute-on-chronic liver insufficiency: A sudden acute failure occurring in patients with controlled chronic insufficiency. It has a high mortality rate.
Symptoms
Symptoms of acute liver insufficiency may include:
- General malaise.
- Nausea and vomiting.
- Weakness.
- Jaundice: Yellowish discoloration of the skin and eyes due to the accumulation of bilirubin, which the liver cannot process.
- Pain in the upper right abdomen.
- Ascites: Swollen abdomen due to fluid accumulation in the abdominal cavity.
- Musty-smelling breath.
- Drowsiness, disorientation, and confusion.
- Frequent bruising and bleeding, as the liver fails to synthesize proteins involved in blood clotting.
- Portal hypertension, affecting the vein that transports blood from the intestines to the liver.
- Alterations in blood potassium and glucose levels.
Chronic liver insufficiency, on the other hand, is usually asymptomatic or presents with nonspecific initial symptoms:
- Fatigue and muscle weakness.
- Loss of appetite and weight loss.
- Loss of menstruation and libido.
- Enlarged liver.
- Itching or redness on the palms.
- Joint pain or swelling.
- Jaundice.
- Gastrointestinal bleeding.
- Portal hypertension.
Causes
The most common causes of acute liver insufficiency include:
- Ingestion of high doses of acetaminophen (paracetamol).
- Viral infections, such as hepatitis.
- Poisoning from mushrooms or chemical substances.
- Certain herbal supplements and medications.
- Autoimmune diseases.
- Cancer.
- Vascular diseases causing obstructions in hepatic veins.
- Pregnancy (eclampsia).
Chronic liver insufficiency is usually due to:
- Excessive and continuous alcohol consumption.
- Liver diseases (hepatitis or non-alcoholic fatty liver disease).
- Metabolic and biliary tract disorders.
Risk Factors
The following factors may predispose individuals to liver insufficiency:
- High-risk sexual behaviors.
- Contact with blood or bodily fluids from other people, such as sharing needles or razors.
- Family history of hereditary liver diseases.
- Alcoholism.
- Exposure to toxins.
- Drug overdose.
- Obesity.
Complications
Acute liver failure can have fatal consequences:
- Hepatic or portosystemic encephalopathy: Toxins that the liver cannot eliminate accumulate in the blood and reach the brain, severely impairing its functions. This can lead to coma.
- Cerebral edema caused by excess fluid pressure.
- Severe, difficult-to-control bleeding due to coagulation disorders caused by liver insufficiency.
- Kidney failure or hepatorenal syndrome, particularly in cases of acetaminophen overdose.
- Chronic liver insufficiency.
- Liver cancer.
- Sudden acute failure, with a high mortality rate.
Prevention
Liver dysfunction can be prevented by taking certain measures:
- Vaccination against hepatitis viruses.
- Taking only the prescribed dosage of medications.
- Avoiding alcohol consumption.
- Reducing risky behaviors, such as using protection during sexual intercourse and avoiding intravenous drug use.
- Maintaining a healthy diet and exercising regularly.
Which Doctor Treats Liver Failure?
Liver insufficiency and other liver diseases are diagnosed and treated by intensive care specialists or gastroenterologists.
Diagnosis
To confirm liver insufficiency, tests are performed to assess liver function:
- Blood tests to detect abnormal values indicating:
- Liver failure, such as altered protein levels or elevated bilirubin, bile salts, ammonia, and specific enzymes (transaminases).
- Prothrombin time, a protein involved in blood clotting.
- Iron and copper deposits in the blood, which, in excessive amounts, damage liver cells.
- Imaging tests, such as ultrasound, CT scan, or MRI, to analyze the liver and blood vessels, locate liver damage, and determine the cause of insufficiency.
- Liver biopsy: Analyzing a liver tissue sample to detect information not evident in other tests, such as inflammation, excess fat, or copper and iron accumulation.
Treatment
Acute liver insufficiency must be treated immediately in an intensive care unit:
- Intravenous fluid administration.
- Medications to increase blood pressure.
- Antibiotics and lactulose to reduce ammonia and toxin levels in cases of hepatic encephalopathy.
- Medication to counteract intoxication from acetaminophen, mushrooms, or other substances.
- Antibiotics, antifungals, or antivirals in cases of infection.
- Corticosteroids and immunosuppressants for autoimmune hepatitis.
- If the damage is irreversible, a liver transplant or hepatocyte transplant (liver cell transplant) is necessary.
For chronic liver insufficiency, in addition to treating the underlying cause:
- Vaccination against hepatitis.
- Dietary restrictions, including reduced sodium and carbohydrates and complete alcohol elimination.
- Avoiding harmful medications and central nervous system depressants.
- Liver or hepatocyte transplant when damage is irreversible.
