Acute Liver Failure

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This week I saw a young lady who was severe ill with jaundice and concern of acute liver failure. She reminded me about this potentially life-threatening condition.

Acute liver failure is a rare but potentially life-threatening condition that is characterized by acute onset of liver impairment. It occurs in individuals with no preexisting liver disease. The hallmarks of this condition are abnormal liver function tests, abnormal clotting profile and alteration in attention, cognition or consciousness.

The liver is the biggest internal organ in the body with multiple functions. Some of the functions of the liver include production of while which is necessary for breakdown of fats, production of proteins and cholesterol. The liver is also involved in glucose metabolism and storage of glycogen. It also plays a pivotal role in storage of micronutrients such as copper, zinc, iron and certain vitamins.

Last but not least the liver also plays an important role in breaking down and filtering certain substances in the body like alcohol, ammonia, drugs and any other toxins. When there is liver failure the liver is unable to effectively carry out these functions.

They are several causes of acute liver failure. The commonest cause in our setting is viral hepatitis. The viruses that can cause this are Hepatitis A, Hepatitis B and Hepatitis E.  Hepatitis A is often associated with poor hygiene and is transmitted via fecal oral route, while hepatitis B can be transmitted through blood products, and is common amongst IV drug users who share needles.

Hepatitis B can also be transmitted sexually and more commonly from mother to child. Hepatitis E can also be transmitted through the fecal oral route and is more common in pregnant women.

The other common cause of acute liver failure is certain medications, the commonest being paracetamol overdose. Liver failure can occur usually when large doses of paracetamol, more than 10g are taken often to commit suicide. Other drugs that can cause liver failure include TB drugs and ARVs. It is worth emphasising that these occurrences are very rare, and clinicians do monitor for these complications. Herbal medications are also a very common causes of acute liver failure.

Less common causes include autoimmune hepatitis, mushroom poisoning, ischaemic liver injury, pregnancy related, obstruction of blood vessels going to the liver and cancer infiltration.

Symptoms that may suggest acute liver failure include yellowness of the eyes, confusion, drowsiness, coma, bruising and any bleeding. When suspected it is important to seek medical help as soon as possible as this condition is associated with a high death rate. It is often best managed in higher centers which can provide tertiary care. The treatment is specific those the cause of the acute liver failure and include supportive treatment to manage the bleeding tendencies, confusion and any other complications. In very advanced cases liver transplantation may be the only viable therapy.

In the subsequent weeks; I will discuss in detail the individual conditions that can cause acute liver failure.

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