Description
Liver failure can result from various causes, including chronic liver diseases like cirrhosis, viral hepatitis, or acute conditions such as drug toxicity, and is characterized by a significant decline in liver function. Diagnosis involves clinical evaluation, liver function tests, imaging, and sometimes biopsy, while management focuses on addressing the underlying cause, supportive care, and, in severe cases, liver transplantation.
Summary Listen
- Liver failure is defined as the liver's inability to perform its multitude of functions sufficiently to sustain an individual's survival. It is categorized into acute, subacute, chronic, and acute-on-chronic forms, each with varying prognoses. Acute liver failure is characterized by the development of encephalopathy within 26 weeks in a person without prior liver disease, while chronic liver failure develops gradually due to long-term conditions.
- Risk factors for acute liver failure commonly include viral hepatitis (A and E) in India, and drug-induced liver injury (DILI) or herbal-induced liver injury (HILI). Chronic liver failure risk factors often include alcohol consumption, fatty liver disease, hepatitis B and C, autoimmune diseases, vascular diseases, and metabolic conditions like Wilson's disease.
- Coagulopathy in liver failure involves an imbalance in both procoagulant and anticoagulant factors, leading to either hypercoaguable or hypocoaguable states. Monitoring involves prothrombin time/INR, but thromboelastography (TEG) offers a more comprehensive assessment of clotting ability.
- Key complications of liver failure include delayed identification, especially in acute cases where jaundice might be dismissed as a minor ailment. Timely monitoring of prothrombin time/INR and referral to a transplant center upon encephalopathy onset are crucial to prevent cerebral herniation.
- Liver transplantation is considered in acute liver failure based on King's College criteria. In chronic liver disease, transplantation is an option when portal hypertension complications are unmanageable. Patients with cirrhosis should be informed of the potential need for transplantation in the future.
- Hepatic encephalopathy's severity is classified using the West Haven criteria, ranging from subtle behavioral changes (grade 1) to coma (grade 4). Minimal hepatic encephalopathy is detected through neuropsychiatric testing.
- Spontaneous bacterial peritonitis (SBP) is a complication arising from bacterial translocation due to gut edema in portal hypertension. Diagnosis involves paracentesis and ascitic fluid analysis, with cell counts and culture sent to rule out spontaneous infection.
- Cirrhosis leading to liver failure can stem from various etiological factors, including fatty liver disease, hepatitis B and C, drug-induced liver injury, autoimmune diseases, vascular diseases, and metabolic disorders.
- Spontaneous hepatic regeneration occurs, but in acute liver failure, widespread hepatocyte destruction can hinder this process. The injured tissue may activate steatohetic cells or fibrotic response, hindering cell regeneration, eventually leading to liver cirrhosis.
- Liver failure impairs drug metabolism, leading to prolonged drug half-lives and potential toxicity. Dosage adjustments and careful consideration of drug contraindications are necessary.
- Liver failure management involves treating the underlying cause and complications, such as portal hypertension. Artificial liver support systems remain debatable. Continuous renal replacement therapy (CRRT) can aid in ammonia removal. Therapeutic plasma exchange (PLEX) shows potential in toxin removal.
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About the Speakers
Dr. Pathik Parikh
Founder & COO - Reporgo; Lead, Department of Hepatology, Apollo Hospitals, Ahmedabad
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