Liver Failure

Oral and Gastrointestinal

Liver failure is a rare condition that occurs when the liver loses its ability to function with no other liver disease present. The main functions of the liver are to rid the body of toxins and generate substances like carbohydrates, fats, bile, and proteins. The liver also plays a role in the production of vitamins. Failure can occur abruptly (acute) or over the course of many years (chronic). Acute liver failure can occur due to a health condition, such as hepatitis or an autoimmune disease, or from medication.  Acetaminophen is particularly hard on the liver and ingesting too much can cause the liver to fail. Acute liver failure (ALF) is a life-threatening condition that can progress rapidly and lead to multi-organ failure and death. While the incidence of ALF is rare with only 2000 cases in the United States a year, it is a serious condition that needs to be treated in a medical center as soon as possible.

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Symptoms

Liver failure can cause swelling all over the body, especially around the abdomen, bleeding, and engorgement of blood vessels on the skin. Men can complain of a decreased libido, breast enlargement, and shrinking of the testes. Other symptoms of liver failure are:

  • Jaundice or yellowing of the skin and eyeballs
  • Pain in the upper right abdomen
  • Ascites or swelling of the abdomen
  • Confusion
  • Nausea
  • Vomiting
  • Feeling unwell
  • Sleepiness
  • Tremors
  • Musty or sweet odor in the breath

If you are concerned you are in liver failure, especially when experiencing any of the above symptoms, seek medical attention immediately.

Types

Liver failure is traditionally classified into two types, acute (ALF) and chronic liver failure (CLF). Recently, a new classification has emerged known as an acute-on-chronic liver failure (ACLF).

Acute liver failure (ALF). Occurs when liver tissues become necrotic or die. This type of liver failure progresses rapidly and there is no underlying liver disease that causes the necrosis.

Chronic liver failure (CLF). This typically occurs over time with chronic progressive damage to the tissues of the liver. Alcohol-related liver failure is further classified as follows:

Alcoholic fatty liver disease. When fat cells deposit in the liver it causes alcoholic fatty liver disease. Obesity and drinking alcohol excessively are risk factors for this type of chronic liver failure.

Alcoholic hepatitis. Characterized by scarring, inflammation, and fat cell deposits in the liver.

Alcoholic cirrhosis. The most advanced stage of alcoholic liver disease is caused by heavy drinking. The toxic chemicals in alcohol cause inflammation and swelling and lead to permanent damage to liver tissues.

Acute-on-chronic liver failure (ACLF).  Occurs when a person with a chronic liver condition experiences an acute worsening of liver function that may lead to multiorgan system failure.

Risk Factors

  • Excessive alcohol use
  • Intravenous illicit drug use
  • Chronic liver disease
  • History of hepatitis (any type)
  • Eating wild mushrooms
  • Excessive prescription drug use
  • Unventilated exposure to chemical toxins
  • Obesity (may lead to nonalcoholic fatty liver disease)
  • Exposure to blood and body fluids (sharing needles, razor blades, etc.)

Diagnosis

When your doctor is diagnosing if you have a liver failure you must be open about your alcohol usage or any types of medications you are taking. The first step in diagnosis is taking a thorough medical history. Your doctor may ask if you have been exposed to any environmental toxins or ingested substances. Some tests that may be ordered are:

Blood tests. These tests help determine how well your liver is functioning. In acute liver failure, your blood will not clot as quickly as in a healthy body. A prothrombin test may be ordered to time how long it takes your blood to clot.

Biopsy. In a liver biopsy, a small piece of your liver tissue is removed and examined by a pathologist to determine why the liver is failing. In some cases, the patient is at high risk for bleeding and a transjugular liver biopsy is performed. This biopsy is done by making a small incision in the right side of the patient’s neck and a small tube (catheter) is inserted into a vein.  The catheter is then passed through the heart and into a vein that extends into the liver. The surgeon then inserts a very small needle into the tube and takes a sample of liver tissue.

Imaging tests. An ultrasound may be ordered by your healthcare provider to examine the liver. Ultrasound imaging can reveal liver damage without invasive surgery. Other imaging tests that may be ordered are CT (computerized tomography) or MRI (magnetic resonance imaging) to closely look at blood vessels and the liver. These imaging tests can identify possible tumors in the liver tissue or other causes of acute liver failure.

Treatments

Liver failure is a medical emergency that requires immediate admission to an intensive care unit. When in the hospital, a patient with liver failure is treated by a team of specialists that predict, prevent, and treat any complications that arise while supporting the patient’s liver in regeneration and repair. If the reason for your liver damage is an acetaminophen overdose, you will be prescribed an antidote known as N-acetylcysteine (NAC) that can reverse the damaging effects.  You may also be prescribed a medicine for internal bleeding. If the liver is damaged beyond a critical point, transplantation may be needed.

Alternative Treatments and Home Remedies

Liver failure is a serious medical condition. In this case, it is best to consult with your medical practitioner about proper treatment methods and avoid taking supplements (herbal and vitamin) and home remedies until the condition is resolved. There are herbal and vitamin supplements that may contain hepatoprotective (prevents damage to the liver) substances. You may consider taking these to help protect your liver from damage. However, the best course of action is to avoid alcohol, toxins, and any substances that may harm your liver. Consult your healthcare provider about any herbal, vitamin, or home remedy supplementation you are planning to take to ensure the supplement is safe.

Milk thistle. In Europe, the milk thistle plant has been used to treat liver disorders for the past 2000 years. In Germany, the German equivalent of the FDA has recommended the use of milk thistle to treat liver damage caused by toxins and cirrhosis. The German Commission E further supports the use of milk thistle to treat chronic diseases of the liver. The active chemical responsible for this activity is known as silymarin. Milk thistle is considered safe with few reported adverse side effects.

Holy basil. Also known as Tulsi, this herb has been used in traditional and folk medicine as a hepatoprotective plant. It is a flavorful herb used in Thai cuisine. Phytochemicals (chemicals in a plant) provide analgesic, anti-inflammatory, antistress, and hepatoprotective properties to the plant. There are no side effects reported with use and is considered non-toxic. Herbal tea with holy basil is a relaxing and enjoyable routine to ingest this herbal medicine.

Natural foods. Fruits, like apples and citrus, are full of antioxidants and have been shown in studies to protect against damage to liver cells. Green leafy vegetables are another excellent source of nutrition and phytochemicals that protect the body against inflammation and liver disease.

 

Prevention

  • Drink alcohol in moderation
  • Read labels of medications closely and follow instructions carefully
  • Be open with your doctor about all medications you are taking
  • Get vaccinated against hepatitis B if you have a history of chronic liver disease
  • Never share needles and seek help if you use intravenous drugs
  • If you get a tattoo or piercing, find a shop that is safe and sanitary
  • Avoid contact with blood or bodily fluids
  • Avoid eating wild mushrooms
  • Wear proper protective gear when exposed to toxins or chemicals

Lifestyle Changes

Many cases of acute liver failure may be for an unknown cause. However, you can reduce your chances of harming your liver by choosing a healthy substance-free lifestyle. Avoid drinking alcohol in excess. Choose positive coping mechanisms. Meditation, exercise, and positive social experiences are wonderful outlets for relieving the stresses that may tempt us to turn to alcohol to cope. Practice care when in an environment that may expose you to hazardous toxins.

References

Bomford, A. & Sherwood, R. A. Acute and chronic liver disease. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK499902/

Mayo Clinic Staff. (2020, October 21). Acute liver failure. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/acute-liver-failure/symptoms-causes/syc-20352863#:~:text=Acute%20liver%20failure%20is%20loss,failure%2C%20which%20develops%20more%20slowly.

Shah, N. J., Mousa, O. Y., Syed, K. & Savio, J. (2020, October 12). Acute on chronic liver failure. Retrieved from StatPearls: https://www.ncbi.nlm.nih.gov/books/NBK499902/

UCSF Department of Surgery. (2021). Acute liver failure (ALF). Retrieved from: https://surgery.ucsf.edu/conditions–procedures/acute-liver-failure-(alf).aspx

Xing, T-J. (2017,  June 01). Clinical classification of liver failure: Consensus, contradictions, and new recommendations. Journal of Clinical Gastroenterology and Hepatology, 2(2). Retrieved from: https://www.imedpub.com/articles/clinical-classification-of-liver-failure-consensus-contradictions-and-new-recommendations.pdf

Xiong, F. & Guan, Y-S. (2017, May 21). Cautiously using natural medicine to treat liver problems. World Journal of Gastroenterology, 23(19). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442075/

 

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