Acute Liver Failure – Diagnosis and Treatment
Diagnosis
Doctors use several tests and exams to figure out the cause and how severe acute liver failure is.
Blood tests are often one of the first steps. Doctors use these to measure how well the liver is working and if there are signs of problems like hepatitis, autoimmune hepatitis, or Wilson disease.
Common tests look for prothrombin time (to see how quickly blood clots), bilirubin levels, and liver enzymes. Slow blood clotting and high bilirubin can point to serious liver trouble, including acute liver failure, cirrhosis, or drug-induced liver injury.
Imaging tests show if the liver is swollen or damaged. An ultrasound can check for issues such as tumors, Budd-Chiari syndrome, or signs of chronic liver disease.
If ultrasound does not give clear answers, CT scans or MRIs help spot problems like hepatic masses, portal hypertension, or vascular blockages. Imaging also helps rule out liver cancer like hepatocellular carcinoma or problems with the bile ducts.
In some situations, doctors examine a small sample of liver tissue, known as a liver biopsy, to find the cause of liver failure, such as viral hepatitis (like hepatitis A, B, or C), autoimmune problems, or cancer.
Since patients with acute liver failure often bleed easily (coagulopathy or thrombocytopenia), doctors may use a special kind of biopsy called a transjugular liver biopsy.
This method gets a tissue sample using a thin tube placed through a vein in the neck rather than directly in the liver.
Here is a summary table of key diagnostic tools:
| Test/Procedure | What It Checks For |
|---|---|
| Blood tests | Liver function, hepatitis, clotting, bilirubin, injury |
| Ultrasound | Tumors, hepatitis, ascites, cirrhosis, blockages |
| CT/MRI | Vascular problems, cancer, liver structure |
| Liver biopsy | Disease cause, infections, autoimmune, cancer |
Doctors look for signs like jaundice, hepatic encephalopathy, ascites, bleeding, infection, kidney failure, or hepatorenal syndrome. Checking these signs gives important clues about how much the liver is affected and what the treatment should be.
Treatment
Doctors focus treatment for acute liver failure on both addressing the cause and supporting the body while the liver heals or arranging for a transplant if needed. Hospitals with special resources usually provide this care.
Key components of care often include:
- Giving specific medicines if poisoning is the cause.
- Monitoring and limiting brain swelling.
- Preventing or treating infection.
- Protecting against dangerous bleeding.
- Providing nutrition support.
| Problem | Possible Treatment |
|---|---|
| Poisons/toxins | Acetylcysteine, antidotes |
| Brain swelling | Medicines to lower fluid/pressure |
| Infection | Frequent blood/urine tests, antibiotics |
| Bleeding risks | Drugs to protect blood, transfusions |
| Nutrition issues | Feeding supplements |
Medicines for Specific Causes
Doctors can reverse or limit damage from certain toxins with some drugs. For example, they give acetylcysteine when acetaminophen overdose is involved. It might also help with other poisons or unknown causes.
Doctors may use antidotes with other toxins, such as some mushrooms.
Organ Replacement Procedure
If the liver is too damaged to recover, doctors consider a liver transplant. In this surgery, surgeons remove the sick liver and replace it with a healthy donor organ.
Experienced centers perform these transplants due to their complexity.
Preventing and Treating Complications
The medical team works actively to avoid further issues:
- Managing Brain Pressure: Doctors use special medicines to help lower fluid that builds up in the brain (cerebral edema), which can be life-threatening.
- Fighting Infections: Staff test blood and urine samples often. If they find infection, they start treatment quickly.
- Minimizing Bleeding: Medicines and blood transfusions help lower the risk of major blood loss, which is a danger because the liver helps with blood clotting.
- Feeding the Patient: If someone can’t eat, staff provide nutrition through supplements or special feeding methods so the body gets enough energy and building blocks for healing.
Research Into New Care Options
Scientists are developing future therapies to treat acute liver failure, with the hope of reducing the need for full organ transplants. Research is ongoing in these areas:
Promising Experimental Treatments
Artificial Liver Support Machines
These devices act like artificial livers. One type is called extracorporeal liver support or high-volume plasma exchange. It helps filter harmful substances from the blood, much like kidney dialysis.
Studies have shown that some people recover without needing a transplant after using these machines, but more research is needed before this becomes standard care.
Transplanting Liver Cells Only
Instead of replacing the whole liver, doctors are testing whether just adding healthy liver cells—hepatocytes—can help. This method might buy time for patients, giving their own liver a chance to heal.
Because donor livers are hard to get, using only cells could help more people, but this is still an experimental technique.
Partial Liver Replacement for Regrowth
Another approach involves removing part of the damaged liver and placing a matched section from a donor (called auxiliary transplantation). This lets the person’s own liver regrow while providing some liver function.
Since it avoids long-term use of anti-rejection medicines, it could be safer, but the procedure is complex and not widely available.
Using Animal Livers
With improved technology and medicines that help prevent organ rejection, researchers are reconsidering transplanting animal livers (often from pigs) to humans.
While human-to-human transplants remain preferred, animal organs might one day support patients who are waiting for a human donor liver.
Getting Ready for Your Medical Visit
Steps You Can Take
Patients facing acute liver failure should prepare some questions before meeting their care team. This will help them understand the condition and feel more in control. Important questions to ask include:
- What might have triggered the liver problems?
- Is there a chance my liver can recover?
- What treatments are available for my situation?
- Is a liver transplant something I might need?
- Does this hospital work with transplants, or should I be moved somewhere else?
Patients may want to take notes during their visit or bring a family member for support. Organizing a list of all medications and supplements taken, both prescription and over-the-counter, can also be helpful.
Questions Your Medical Team May Ask
Doctors will ask for details to learn more about the person’s health and what led to their liver problems. Families should be ready to answer questions like:
| Question Topic | Example Questions |
|---|---|
| Symptom Onset | When did the symptoms start? |
| Medication History | What prescription or non-prescription drugs do you use? |
| Supplement and Drug Use | Do you take herbal supplements or use illegal drugs? |
| Medical and Family History | Have you had liver problems before? |
| Mental Health and Substance Use | Is there a history of depression or alcohol use? |
Giving honest and detailed answers helps the care team make the best decisions about treatment and possible next steps.
Daily Life with Severe Liver Failure
Conversations about Liver Replacement
People dealing with severe liver failure may need to think about liver transplantation.
Doctors often talk with patients and their families about this choice when the liver is not able to heal on its own. Transplants can offer a new chance at life for those whose livers are failing.
Support is important during these times. Many find comfort and learn more by joining online health communities and transplant support groups. These spaces can help connect people who are waiting for a transplant, or those who have already had one.
Deciding to Pursue a Transplant
Below is a list of factors that doctors and patients may talk about before deciding on liver transplantation:
- How badly the liver is damaged
- The person’s overall health
- If there are any illnesses that could affect surgery
- The chances of finding a healthy donor
- Support from friends or family after surgery
| Step | What Happens |
|---|---|
| Evaluation | Doctors run tests and review health history. |
| On the waitlist | A person may be placed on a transplant list. |
| Preparation | Learning about surgery and recovery. |
It is important for everyone involved to keep talking, ask questions, and find helpful information. Being part of a support group can make these decisions a little easier.
