Acute Liver Failure

Acute liver failure (ALF) is a rare but life-threatening medical condition that occurs when the liver suddenly loses its ability to function. This can happen within days or weeks, and it is often characterized by the rapid development of hepatic encephalopathy, coagulopathy, and jaundice.

Causes

The causes of acute liver failure can be divided into several categories:

• Drugs and Toxins: Certain medications such as acetaminophen (paracetamol), antibiotics, and anticonvulsants can cause ALF. Other toxins like mushrooms (Amanita phalloides) and industrial chemicals can also lead to liver failure.
• Viral Hepatitis: Viral infections such as hepatitis A, B, C, D, and E can cause ALF, especially in people with pre-existing liver disease.
• Metabolic Disorders: Certain metabolic disorders like Wilson's disease and Reye's syndrome can lead to ALF.
• Ischemic Hepatitis: Reduced blood flow to the liver can cause ischemic hepatitis, which can progress to ALF.
• Autoimmune Hepatitis: In some cases, autoimmune hepatitis can cause ALF.

Symptoms

The symptoms of acute liver failure may include:

• J jaundice (yellowing of the skin and eyes)
• Fatigue and weakness
• Nausea and vomiting
• Abdominal swelling
• Confusion, disorientation, and altered mental status (hepatic encephalopathy)
• Bleeding and bruising easily (coagulopathy)

Diagnosis

The diagnosis of acute liver failure is based on a combination of clinical presentation, laboratory tests, and imaging studies. The following tests may be used to diagnose ALF:

• Liver function tests (LFTs) such as alanine transaminase (ALT), aspartate transaminase (AST), and bilirubin
• Coagulation studies such as prothrombin time (PT) and international normalized ratio (INR)
• Imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) to evaluate liver morphology and rule out other causes of liver dysfunction
• Liver biopsy to assess liver histology and guide management

Treatment

The treatment of acute liver failure depends on the underlying cause and may include:

• Supportive care such as fluid resuscitation, nutritional support, and management of complications like hepatic encephalopathy and coagulopathy
• N-acetylcysteine (NAC) for acetaminophen overdose
• Antiviral medications for viral hepatitis
• Corticosteroids for autoimmune hepatitis
• Liver transplantation in severe cases where medical management is not effective

Prognosis

The prognosis of acute liver failure depends on the underlying cause, severity of liver dysfunction, and presence of complications. With prompt medical attention and supportive care, some patients with ALF can recover fully, while others may require liver transplantation or may succumb to their illness.