Acute

Hepatic
Failure

Definition
Acute

liver failure occurs when your liver

rapidly loses its ability to function. More
commonly, liver failure develops slowly over
the course of years. But in acute liver failure,
liver failure develops in a matter of days.
Acute liver failure can cause many
complications, including excessive bleeding
and increasing pressure in the brain. Another
term for acute liver failure is fulminant hepatic
failure.
Acute liver failure is a medical emergency that
requires hospitalization. Some causes of acute
liver failure can be reversed with treatment.
But in other situations, a liver transplant may
be the only cure for acute liver failure.

S&S
A

yellowing of your skin and eyeballs

(jaundice)
Pain in the upper right area of your
abdomen
Nausea
Vomiting
A general sense of not feeling well
Difficulty concentrating
Disorientation or confusion
Sleepiness

causes
Acetaminophen overdose.Taking too much acetaminophen
(Tylenol, others) is the most common cause of acute liver failure
in the United States. Acute liver failure can occur if you take a
very large dose of acetaminophen all at once, or it can occur if
you take higher-than-recommended doses every day for several
days, especially in people with chronic liver disease.
Prescription medications.Some prescription medications,
including antibiotics, nonsteroidal anti-inflammatory drugs and
anticonvulsants, can cause acute liver failure.
Herbal supplements.Herbal drugs and supplements, including
kava, ephedra, skullcap and pennyroyal, have been linked to
acute liver failure.
Hepatitis and other viruses.Hepatitis A, hepatitis B and
hepatitis E can cause acute liver failure. Other viruses that can
cause acute liver failure include Epstein-Barr virus,
cytomegalovirus and herpes simplex virus.

causes
Toxins.Toxins that can cause acute liver failure include
the poisonous wild mushroom Amanita phalloides, which
is sometimes mistaken for edible species.
Autoimmune disease.Liver failure can be caused by
autoimmune hepatitis a disease in which your
immune system attacks liver cells, causing inflammation
and injury.
Diseases of the veins in the liver.Vascular diseases,
such as Budd-Chiari syndrome, can cause blockages to
form in the veins of the liver and lead to acute liver
failure.
Metabolic disease.Rare metabolic diseases, such as
Wilson's disease and acute fatty liver of pregnancy,
infrequently cause acute liver failure.
Cancer.Cancer that begins in your liver or cancer that
spreads to your liver from other places in your body can
cause your liver to fail.

Complications
Excessive

fluid in the brain (cerebral

edema).Excessive fluid causes pressure to build in your
brain, which can displace brain tissue outside of the space
it normally occupies (herniation). Cerebral edema can also
deprive your brain of oxygen.
Bleeding disorders.A failing liver isn't able to produce
sufficient amounts of clotting factors, which help blood to
clot. Bleeding from ulcers in the gastrointestinal tract or
other locations is difficult to control because blood doesn't
clot quickly.
Infections.People with acute liver failure are at an
increased risk of developing a variety of infections,
particularly in the blood and in the respiratory and urinary
tracts.
Kidney failure.Kidney failure often occurs following liver
failure, especially in cases of acetaminophen overdose,
which damages both your liver and your kidneys.

Tests and diagnosis

Blood tests.Blood tests to determine how well your liver is
functioning may include the prothrombin time test, which
measures how long it takes for your blood to clot. If you have
acute liver failure, your blood doesn't clot as quickly as it should.
Imaging tests.Your doctor may recommend imaging tests,
such as ultrasound, to evaluate your liver. Imaging tests may
show liver damage and may help your doctor determine the
cause of your liver problems.
Examination of liver tissue.Your doctor may recommend a
procedure to remove a small piece of liver tissue (liver biopsy).
Tests of the liver tissue may help your doctor understand why
your liver is failing. For people with a risk of bleeding during
biopsy, such as those with acute liver failure, the doctor may
perform a transjugular liver biopsy. To do this, a tiny incision is
made on the right side of your neck and a thin tube (catheter) is
passed into a large vein in your neck, through your heart and
down into a vein exiting your liver. Your doctor then inserts a
needle down through the catheter and retrieves a sample of liver
tissue.

Treatments and drugs

Treatments for acute liver failure
Medications to reverse poisoning.Acute liver
failure caused by acetaminophen overdose or
mushroom poisoning is treated with drugs that
can reverse the effects of the toxin.
Liver transplant.Acute liver failure can't be
reversed in many cases. In these situations, the
only treatment may be a liver transplant. During
a liver transplant, a surgeon removes your
damaged liver and replaces it with a healthy liver
from a donor.

Treatments for
complications

Relieving excess fluid in the brain.Cerebral

edema caused by acute liver failure can increase
pressure on your brain. Medications can help reduce
the fluid buildup in your brain.
Screening for infections.Your medical team will
take periodic samples of your blood and urine to be
tested for signs of infection. If your doctor suspects
that you have an infection, you'll receive medications
to treat the infection.
Preventing severe bleeding.People with acute
liver failure often develop bleeding ulcers in the
gastrointestinal tract. Your doctor can give you
medications to reduce the risk of bleeding. If you lose
a lot of blood, you may require blood transfusions.

Prevention
Follow

instructions on medications.
Tell your doctor about all your
medicines.
Drink alcohol in moderation, if at
all.
Avoid risky behavior.

Prevention
Get

vaccinated.
Avoid contact with other people's
blood and body fluids.
Don't eat wild mushrooms.
Take care with aerosol sprays.

Prevention
Watch

what gets on your skin.

Choose a healthy diet.
Maintain a healthy weight.