What Is Acute Liver Failure?

Acute liver failure (also called fulminant hepatic failure, or fulminant hepatitis in the most serious forms) is a rapidly developing medical emergency caused by cells of the liver being injured so quickly that the liver cannot repair itself fast enough. Such an event can cause the liver to stop working altogether, resulting in problems in other areas of the body. Acute liver failure is different from acute hepatitis in that parts of the liver begin to die or no longer work.

Because the liver is such a vital part of the body, when it is damaged, other organs are affected, too. The brain is one of the more important organs affected during liver failure and injury to it results in a condition called encephalopathy.

Symptoms

Before a physician can diagnose fulminant hepatitis, the patient must show signs of encephalopathy, a disease of the brain. Key symptoms are confusion, change in behavior, change in alertness, and difficulty in working through mental processes. These symptoms can lead to coma and even death if liver failure does not reverse.

Causes

Acute liver failure is one of the most serious complications of viral hepatitis infection. In fact, every physician has this concern in their mind when treating patients with acute viral hepatitis. Acute liver failure is very rare, but is most common in hepatitis A infection and hepatitis B infection. Even then, fewer than 1% of people with hepatitis B infection, and an even smaller percentage of people with hepatitis A will develop fulminant hepatitis.

Another significant cause, especially in the United States, is acetaminophen toxicity. Acetaminophen, commonly known as Tylenol, is a pain-relieving drug similar to aspirin and can be purchased without a prescription. Too much of this drug will harm the liver and could lead to liver failure. People who frequently drink heavy amounts of alcohol and take too much acetaminophen might be at increased risk for acute liver failure.

Treatment

Treatment for liver failure is in a hospital critical care service because patients often are treated for multiple problems requiring specialized intensive care. The objective is to keep the patient alive long enough to allow the body's liver time to repair itself or until the patient can have a liver transplant. Unfortunately, liver transplants are not medically advisable for everyone and sometimes there are no livers available to transplant.

_Source:

Robert J. Fontana. Acute Liver Failure. In: M Feldman, LS Friedman, LJ Brandt, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006. Pages 1993-2002.

Jules L. Dienstag. Acute Viral Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo, eds. Harrison's Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008. Pages 1944-1945.