Liver Failure

Liver failure can be considered a very serious condition and some of its forms may be fatal despite maximal therapy. This is mainly due to the simple fact that liver is the chemical factory of our body. The liver tissue produces a variety of substances necessary for proper functioning of the organism and it also removes the pollutants and waste products from the body. Impaired liver function usually leads to disruption of the internal environment and disorders of blood coagulation.


Liver failure can be divided into acute and chronic. Chronic failure means gradual deterioration of liver functions and it is related to slow worsening of the patient's clinical condition. Acute liver failure occurs suddenly and it may either improve, or progress into the chronic failure. It is also necessary to keep in mind that the acute liver failure may occur in a previously completely healthy liver.


Acute or chronic liver failure is usually caused by factors that are related to liver cirrhosis (alcoholism, infectious hepatitis, industrial or organic toxins, medications, metabolic diseases such as Wilson's disease and hemochromatosis, autoimmune diseases such as autoimmune hepatitis, PBC and PSC, liver cancer, liver metastases, etc.)


The symptoms may be slightly different in acute and chronic liver failure.


Acute liver failure manifests by inability of the liver tissue to excrete the pollutants and harmful substances resulting in their accumulation in the body. These pollutants include ammonia and similar nitrogenous substances. Brain is the most sensitive organ to the waste products and the waste products cause hepatic encephalopathy. In acute liver failure, the encephalopathy develops rapidly and has severe manifestations including coma or even death.


Jaundice may appear due to failure of bilirubin processing (bilirubin is a pigment formed by degradation of hemoglobin).


Chronic liver failure reflects not only the impaired ability to metabolize the waste products, but also the failure of formation of substances needed for proper metabolism and homeostasis of the organism. The patients suffer from jaundice, chronic forms of hepatic encephalopathy (sleep inversion, changes of personality, dementia, hand tremor known as the flapping tremor, etc.) and bad breath (hepatic smell – “fetor hepaticus”). The damage of liver tissue disrupts blood clotting and the patient may suffer from increased bleeding. The skin usually contains small reddish marks known as the spider nevi that occur due to formation of dilated clusters of blood vessels. As the chronic liver failure is frequently accompanied with liver cirrhosis and portal hypertension, we may find its complications including the esophageal varices and ascites.


Very dangerous complication of liver failure is the so-called hepatorenal syndrome. The point is that the liver failure may disrupt the blood flow through the kidneys and cause their acute failure or progression of the chronic failure. The coincidence of both the liver and kidney failure is usually fatal.


The disease can be estimated from actual clinical symptoms and medical history, which usually includes clear risk factor of liver damage (usually chronic alcoholism). The blood test may show signs of disrupted blood clotting. The liver tissue may be examined by an ultrasound or computed tomography to find certain signs of liver cirrhosis. When the cause of liver failure is uncertain, it is advisable to perform a liver biopsy to examine a sample of liver tissue under the microscope.


Firstly, it is necessary to remove the cause of the liver failure, if possible. It is vital to avoid alcohol and any other substances toxic to liver. Comprehensive care is needed, the diet should be less rich on proteins, vitamin K may be supplemented to prevent bleeding disorders. Hepatic encephalopathy can be prevented by prevention of constipation by laxatives and administration of special antibiotics to kill the intestinal microflora (an important producer of harmful nitrogen waste products).


The most serious cases of liver failure are often admitted to ICU, but the prognosis is usually poor, especially when the hepatorenal syndrome occurs.


The ultimate option may be the liver transplantation. However, this applies only if the patient is indicated for transplantation – the patient must completely avoid alcohol and one’s health state must be able to handle the complex operation.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources