liver failure

Liver failure: description

In liver failure, various functions of the liver gradually decrease. This is dangerous because the liver performs many vital functions in the body: it is the most important organ of metabolism and, with an average weight of 1.5 kilograms, it is the largest gland in the human body.

The liver is in the right upper abdomen. Every day it produces about 700 milliliters of bile, builds up various proteins and plays an important role in the body’s hormonal balance and defense system. Especially important is their metabolic function: Almost all nutrients that the intestine absorbs – especially proteins, carbohydrates and fats – are then converted in the liver, degraded, stored or reused. The removal of drugs, alcohol and pollutants (“detoxification”) is the job of the liver.

Various illnesses, a lot of alcohol and a high-sugar diet can permanently stress and change the liver, leading to fatty liver and / or liver cirrhosis. However, this organ can largely maintain its functions for a long time even with a significantly reduced number of functional cells. If it comes to a liver failure, the liver is already severely damaged – this can either develop chronically (chronic liver failure) or very quickly, for example due to infection or poisoning (acute liver failure). In any case, a liver failure is a dangerous condition that needs immediate attention.

Liver failure: symptoms

While many liver diseases go unnoticed at an early stage, symptoms of liver failure are quite characteristic. The following signs are considered as leading symptoms in liver failure:

• The white in the eyes (sclera) and the mucous membranes turn yellow; in the further course the skin also assumes a yellowish color. This is what doctors call jaundice (jaundice).
• The affected person can concentrate only badly, his facial expressions change, he often gets tired, and his eyelids flutter. The liver failure triggers disorders in the brain, which is also summarized as hepatic encephalopathy.
• In addition, blood coagulation disorders occur, which can show, for example, in increased bleeding under the skin. This is called as hemorrhagic diathesis.

In addition, in case of liver failure, signs such as a typical breath smell of raw liver (foetor hepaticus) may occur. In the advanced stage, blood pressure often falls and breathing accelerates. After becoming more and more tired and almost asleep, the patient falls into a so-called hepatic coma in the course of hepatic encephalopathy.

Hepatic encephalopathy

A liver failure can also lead to a disorder of brain function. Read all about it in the article Hepatic encephalopathy.

Liver failure: causes and risk factors

In principle, quite different causes are possible for a liver failure. Often liver failure is preceded by liver disease, which has been around for months or years. Ultimately, the various functions of the liver collapse because the body no longer manages to compensate for the damage. In that case one speaks of one chronic liver failure, in a sudden severe deterioration of one Acute-to-chronic liver failure.

Chronic hepatic insufficiency can arise, for example, when, due to years of alcohol abuse, more and more liver cells are destroyed and the tissue is scarred (liver cirrhosis). A liver failure in cancer is also possible if the liver cells degenerate or “spreads” a malignant tumor from another organ. In some cases, a chronic viral infection such as hepatitis C takes a severe course and ultimately leads to liver failure.

One acute liver failure means that the liver function breaks down without a long-term previous illness. This is much less common; About 200 to 500 people develop acute liver failure annually in Germany. There can be several reasons if a liver failure suddenly develops within a short time:

• Viral hepatitis: Hepatitis A, B, D or E are viral infections that are usually associated with acute hepatitis. Rarely, cytomegalovirus and other herpes viruses can lead to such hepatitis. In some people, this is so severe that it leads to acute liver failure in a short time. However, this is rather rare in all forms of viral hepatitis.
• poisoning: In many industrialized countries, the proportion of toxic liver damage increases as the trigger of acute liver failure. Mostly behind it is an overdose of drugs such as acetaminophen, more rarely tuberculosis drugs and certain herbal remedies in far too high doses. Also, poisoning with mushrooms (such as tuberous mushroom), drugs (such as ecstasy) and chemicals can trigger acute liver failure.

Rarer causes of acute liver failure include autoimmune hepatitis, Wilson’s disease and pregnancy complications – acute pregnancy obesity or HELLP syndrome. In up to 20 percent of cases, the trigger of hepatitis remains unclear, which ultimately leads to liver failure. Doctors then speak of one cryptogenic hepatitis.

Liver failure: examinations and diagnosis

Many people with a liver failure are already over a long period of time with certain pre-existing medical conditions and a burden on the liver is known (chronic liver failure). This facilitates the diagnosis. An acute liver failure without pre-existing conditions is rarer – the doctor first asks the medical history (History) and inquires about drug and alcohol consumption, other toxic substances, stays abroad and possible sources of infection for a viral infection. Sometimes, liver failure has progressed so far that the person is confused or unconscious – in which case relatives are interviewed if possible.

The clinical symptoms such as jaundice and eye flutter quickly make the doctor think that the liver is not working properly. At a physical examination he feels the upper abdomen, where he can feel if the liver is enlarged or reduced. For the diagnosis of liver failure, he also takes blood – various laboratory values ​​in the blood count (such as coagulation parameters, bilirubin, ammonia) support the suspicion of chronic or acute liver failure.

Further investigations are based on the suspected cause, the symptoms and the course of the liver insufficiency. Sometimes the doctor takes a sample of liver tissue (liver biopsy) for laboratory examination; Also helpful are imaging procedures such as a special ultrasound scan (duplex sonography) or an X-ray of the chest. Sometimes the blood pressure in certain vessels is measured with a catheter. If suspected fluid accumulation in the brain (brain edema), the doctors can measure the intracranial pressure with a probe via a small hole in the skull.

Liver failure: treatment

Acute or acute-to-chronic liver failure requires immediate therapy in an intensive care unit. The treatment depends mainly on the cause of the liver damage – therefore an accurate diagnosis is very important. For example, patients with liver failure due to intoxication immediately receive gastric lavage and, if possible, an antidote. For certain viral infections, such as hepatitis B, antiviral therapy may be useful.

In addition, in case of liver failure symptoms such as the derailed blood values ​​are treated as well as possible, for example by infusions with glucose, electrolytes (blood salts) or blood plasma with coagulation factors. The ammonia concentration in the intestine is usually lowered by the doctors with special enemas. With increased intracranial pressure, various medications are also used to reduce intracranial pressure.

Liver failure: Therapy through a transplant

In some cases, especially with a previously damaged liver, there is little chance that the organ will recover and resume its functions. In that case, patients are immediately transferred to a transplant center, where they get a new liver as soon as possible. It may also be sufficient to replace only the left lobe of the liver (Auxiliary Partial Orthotopic Liver Transplantation, APOLT).

So-called extracorporeal liver replacement procedures such as special liver dialysis are in medical trials and not yet a standard therapy.

Liver failure: prevention

In order to prevent liver failure, it is important to reduce the risk factors for various liver diseases and intoxications. The following measures are useful for this:

• Pay attention to moderate alcohol consumption.
• Avoid excessive sugar and fat in your diet.
• Always treat and discontinue chronic illnesses (such as diabetes).
• Refrain from drugs; If necessary, pay attention to the use of sterile needles.
• Protect yourself with condoms during sexual intercourse, if you have no certainty about possible infections of the sexual partner.
• Make sure you have sufficient vaccine protection (eg against hepatitis A and B) before traveling abroad.
• Maintain the rules for food and drinking water hygiene, especially on trips abroad.
• Adhere strictly to the recommended dosages when taking medications. Keep them out of the reach of children.
• Avoid the consumption of mushrooms and plants, whose nature and origin you do not know for sure. A poisoning can be an acute liver failure trigger.

Liver failure: disease course and prognosis

A liver failure is a serious condition that needs immediate attention. The various liver functions are vital for the body – if the treatment comes too late, the prognosis is poor. The younger the person affected and the lower the severity of the underlying diseases, the higher the chances of recovery. Acute liver failure can usually be treated more successfully than an acute-to-chronic one. Even mild symptoms of hepatic encephalopathy are usually associated with a better prognosis.