Acute liver failure

Diagnosis

The following tests and procedures are used to identify acute liver failure:

• Blood tests: To ascertain how efficiently the liver functions, blood tests are performed. How long it takes for blood to clot is determined by a prothrombin time test. Blood clotting is slower than it should be when there is acute liver failure.
• Imaging tests: To examine the liver, a healthcare provider could suggest an ultrasound. These tests may reveal liver damage and assist in identifying the cause of the problem. To examine the liver and blood vessels, the healthcare provider may also advise abdominal computed tomography (CT) or magnetic resonance imaging (MRI) screening. These examinations may be used to detect malignancies or the Budd-Chiari syndrome, two potential causes of sudden liver failure. They might be applied if an ultrasound test comes back negative, but the healthcare provider suspects a problem.
• Liver biopsy: A small bit of liver tissue may be removed (liver biopsy) by the healthcare provider. By doing this, the healthcare provider could be able to comprehend why the liver is failing.

A transjugular liver biopsy may be carried out since patients with acute liver failure are at risk of bleeding during the procedure. On the right side of the neck, a small incision is made in order to do this procedure. The next step is the insertion of a tiny tube (catheter) into a vein in the neck, through the heart, and into a vein leaving the liver. A sample of liver tissue is then taken by inserting a needle into the catheter.

Treatment

Intensive care units in hospitals that have the capability of doing liver transplants are frequently used to treat patients with acute liver failure. The healthcare provider may attempt to treat the liver injury directly, but in many situations, treatment involves handling complications while allowing the liver an opportunity to heal.

• Medications to reverse poisoning: Acetylcysteine is a drug used to treat acute liver failure brought on by acetaminophen overdose. Other acute liver failure reasons may be treated with the aid of the medication. Drugs that can reverse the toxin’s effects and possibly lessen liver damage may also be used to treat poisonings from mushrooms and other sources.
• Liver transplant: A liver transplant may be the only option for treatment when acute liver failure cannot be reversed. A surgeon replaces the diseased liver with a healthy liver from a donor during a liver transplant.

The healthcare provider will also aim to prevent complications associated with acute liver failure and manage its symptoms.
Treatments for acute liver failure may include:

• Excess fluid in the brain causing pressure: Pressure on the brain might rise as a result of cerebral edema brought on by acute liver failure. Medications may assist in order to lessen the accumulation of fluid in the brain.
• Infection: Every now and then, a healthcare provider will draw blood and urine samples to screen for infections. Infection-treating drugs will be given to the patient if the healthcare provider detects they have an infection.
• Severe bleeding prevention: In order to lower the risk of bleeding, the healthcare provider may prescribe medication. Tests may be run to determine the cause of the blood loss if they lose a lot of blood. Blood transfusions can be required.
• Nutritional support: They could require supplements to treat nutritional deficits if they are unable to eat.
• Future treatments: Researchers are still looking into new acute liver failure treatments, particularly those that can lower or postpone the requirement for a liver transplant. While a number of potential future treatments are being investigated, it’s crucial to keep in mind that they are still in the experimental stage and might not yet be accessible.
• Some of the subjects under investigation include:
  • Artificial hepatic assist devices: The liver would be replaced by a machine, much to how dialysis helps when the kidneys fail. Devices of many different types are being researched. Some technologies, but not all, may boost survival, according to research. An extracorporeal liver support system was found to enable some patients with acute liver failure survive without a transplant in a well-controlled multicenter experiment. High-volume plasma exchange is another name for the procedure. More research is, however, required for this therapy.
  • Hepatocyte transplantation: The requirement for a liver transplant may be momentarily put off by merely transplanting the liver’s cells and not the full organ. It might in some circumstances result in a full recovery. The application of this therapy has been constrained by a lack of high-caliber liver donors.
  • Auxiliary liver transplantation: In this treatment, a little section of the liver is removed, and it is then replaced with a graft of a comparable size. As a result, the liver can regenerate on its own without the use of immunosuppressant medications. As of right now, auxiliary liver transplantation is a challenging process that requires more time to be assessed.
  • Xenotransplantation: In this procedure, an animal or other nonhuman source liver is used to replace the patient’s own liver. Several decades ago, a healthcare provider tried experimental liver transplants using pig livers, but the outcomes weren’t great. However, developments in immunological and transplant therapy have led scientists to reevaluate this approach. It might support those who are in need of a human liver transplant.