Acute Liver Failure

Virginia Mason's Liver Center of Excellence in the Digestive Disease Institute is dedicated to progressive and innovative management of liver disorders, including advanced liver disease such as cirrhosis and liver cancer.

To schedule an appointment with Virginia Mason's Liver Center specialists, call (206) 223-2319.

Acute liver failure is loss of liver function that occurs quickly, usually in just days or weeks. It is typically a medical emergency that requires hospitalization due to mental confusion, multi-organ failure, bleeding, infection and increased pressure in the brain. Acute liver failure often occurs in a person with no known pre-existing liver disease. Depending on the cause, it may be reversible with aggressive medical care or may require a liver transplant.

Symptoms

Onset of symptoms is rapid; it is important to seek medical treatment at the first signs of:

  • Abdominal swelling
  • Disorientation or confusion
  • Fatigue or sleepiness
  • Jaundice − yellowing of the skin or eyes
  • Malaise − a general sense of feeling unwell
  • Nausea and vomiting
  • Pain in upper right abdomen, just below ribs
  • Weakness

Causes

Acute liver failure occurs when liver cells are damaged significantly and are no longer able to function. Potential causes include:

  • Acetaminophen overdose: Too much acetaminophen (such as Tylenol, Midol, Nyquil and Sudafed) is the most common cause of acute liver failure and can occur after one very large dose of acetaminophen, or after higher than recommended daily doses over several days. If you or someone you know has taken an overdose of acetaminophen, seek medical attention as quickly as possible.
  • Autoimmune disease: Liver failure can be caused by autoimmune hepatitis, a disease where the immune system attacks liver cells, causing inflammation and injury.
  • Cancer: Whether it begins in or spreads to your liver, cancer can cause your liver to fail.
  • Hepatitis and other viruses: Hepatitis A, hepatitis B and hepatitis E can cause acute liver failure, as can other viruses such as Epstein-Barr virus, cytomegalovirus and herpes simplex virus, especially in patients who are immunosuppressed (such as patients with HIV, patients receiving chemotherapy or organ transplant recipients).
  • Herbal supplements: Kava, ephedra, skullcap and pennyroyal have all been linked to acute liver failure.
  • Metabolic disease: Wilson's disease (copper overload) and acute fatty liver of pregnancy are uncommon causes of acute liver failure.
  • Prescription medications: Although quite rare, some prescription medications have been linked to cases of acute liver failure. The most common drug classes are antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants.
  • Toxins: Poisonous wild mushroom Amanita phalloides, sometimes mistaken for an edible mushroom, and carbon tetrachloride, an industrial chemical found in refrigerants and solvents, can cause acute liver failure.
  • Shock: Overpowering infection (sepsis) and shock can severely impair blood flow to the liver, triggering it to fail.

Unfortunately, there are many cases of acute liver failure that have no apparent cause.

Complications

Often acute liver failure is accompanied by complications, including:

  • Bleeding
  • Cerebral edema − excessive fluid and swelling in the brain
  • Infections
  • Kidney failure
  • Mental confusion

Diagnosis

Tests and procedures used to identify acute liver failure include:

  • Blood tests: To understand liver function, doctors run a variety of tests including liver function and blood-clotting tests. Tests for specific causes of liver failure can also be run.
  • Imaging tests: An ultrasound, abdominal computerized tomography (CT) or magnetic resonance imaging (MRI) scan to look at the liver and blood vessels may be ordered.
  • Examination of liver tissue: Removing a small piece of liver tissue through a tiny incision on the abdomen or neck, a procedure called a liver biopsy, can help your physician understand the cause of liver failure.

Treatment

People with acute liver failure are often treated in the critical care unit. Treatment involves controlling complications and giving your liver time to heal, and may include:

  • Medications to reverse poisoning: Acetylcysteine or other drugs can reverse the effects of the toxin and may reduce liver damage.
  • Preventing severe bleeding: Medications can reduce the risk of bleeding. If you lose a lot of blood, your doctor may perform tests to find the source of the blood loss. You may require a blood transfusion.
  • Screening for infections: Samples of your blood and urine will be tested for infection. If you have an infection, medications to treat it will be prescribed.
  • Relieving excess fluid in the brain: Cerebral edema can increase pressure on the brain; medications will reduce the fluid buildup.
  • Liver transplant: When acute liver failure cannot be reversed, the sole treatment is liver transplant, where your injured liver is removed and replaced with a healthy liver from a donor.

Prevention

Decrease your risk of acute liver failure by taking these precautions:

  • Medications: If you take acetaminophen or other medications, do not take more than the recommended dosage. Talk to your doctor before taking acetaminophen, over-the-counter medications or herbal medicines.
  • Moderate alcohol use: Limit the amount of alcohol you drink. The recommended amount is one drink a day for women and two drinks a day for men.
  • Vaccinations: If you have chronic liver disease, a history of any type of hepatitis infection or an increased risk of hepatitis, ask your physician about getting the hepatitis A and/or B vaccine.
  • Aerosol sprays and toxic chemicals: When you use an aerosol cleaner, make sure the room is ventilated or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint and other toxic chemicals. Cigarettes contain toxic chemicals and smoking them is harmful.
  • Blood and body fluids: Accidental needle sticks or improper cleanup of blood or body fluids can spread hepatitis viruses. Having sex without condoms, sharing razor blades and toothbrushes can spread infection.
  • Clean needles: It is dangerous to use illicit intravenous drugs, but if you do, do NOT share needles. If you get tattoos or body piercings, make sure the place of business is clean and safe.

To schedule an appointment with Virginia Mason's Liver Center specialists, call (206) 223-2319.