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Liver Failure

Severe impairment of liver function, occurring either suddenly or at the final stages of chronic liver disease

  • Excessive alcohol consumption is a risk factor
  • Age as a risk factor depends on the cause
  • Gender and genetics are not significant factors

The liver performs many vital functions, such as the breakdown of toxins in the blood. Liver failure allows toxin levels to rise, affecting the brain and other organs. In acute liver failure, the liver may fail suddenly. In chronic liver failure, it may fail over months or years.

Acute liver failure may be due to a disorder such as acute viral hepatitis (see Acute hepatitis) or damage from drugs, such as an overdose of paracetamol. Chronic liver failure is usually due to an underlying disorder such as alcohol-related liver disease or chronic hepatitis.

What are the symptoms?

The symptoms of acute liver failure can develop over several hours or days and are caused by the effect of toxins on the brain. Symptoms of acute liver failure may include:

  • Poor memory.

  • Confusion and agitation.

  • Drowsiness.

As acute liver failure progresses, other major organs, including the kidneys and the lungs, may gradually begin to fail. The condition may eventually lead to coma and death.

Chronic liver failure may produce no symptoms for several months or even years. When the symptoms do begin to appear, they usually develop gradually and may include:

  • Yellowing of the skin and whites of the eyes (see Jaundice).

  • Itching.

  • Yellowing of the skin and whites of the eyes (see Jaundice).

  • Swollen abdomen.

  • Abnormally shaped fingernails.

  • Numerous small, spider-like blood vessels in the skin, called spider naevi.

  • Redness of the palms of the hands.

  • Thickened tissue in the palms of the hands (see Dupuytren’s contracture).

  • In men, enlargement of the breasts and shrunken testes.

Bleeding into the digestive tract may occur from enlarged blood vessels that form in the wall of the oesophagus (see Portal hypertension and varices). Sometimes, chronic liver failure deteriorates suddenly and causes the symptoms of acute liver failure.

Spider naevi

In people with liver failure, numerous spider-like blood vessels known as spider naevi may appear on the skin, particularly in the chest area.

What might be done?

Liver failure that has deteriorated suddenly requires immediate hospital care, often in an intensive therapy unit. Antibiotics may be given to reduce the numbers of intestinal bacteria. These bacteria produce toxins that accumulate in the blood and adversely affect the brain and other organs.

If you have chronic liver failure, your doctor will arrange for blood tests to determine the extent of damage to the liver. You may need to follow a diet that is low in protein to reduce the work of the liver and minimize the build-up of potentially damaging toxins. Your doctor may also advise you to reduce the salt in your diet and may prescribe diuretic drugs to reduce swelling of the abdomen. You should stop drinking alcohol immediately and permanently. There is no treatment that can repair the damage that has already occurred to the liver.

What is the prognosis?

Most people who have severe liver failure need a liver transplant to survive. Fewer than 1 in 10 people survive acute liver failure without a transplant. In those who do survive, the liver often recovers completely, provided that it was previously undamaged. In chronic liver failure, the outlook largely depends on the underlying cause. Many people with chronic liver failure lead normal lives for many years.

Treatment: Liver Transplant

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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