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Acute Liver Failure – Causes and Symptoms

Acute liver failure denotes the loss of liver function that occurs unexpectedly — within days or weeks. It happens in a person who does not have any previous liver complications. A hepatitis virus or medications are the most common causes of acute liver failure. The disease is rarer in comparison to chronic liver failure, which takes longer to develop.

Many people in Mumbai suffer from liver complications. These complications can lead to acute liver failure. As a result, it is better to have the proper care in advance. Patients choose to get their liver treatment in India from overall the world due to the advance technology and infrastructure.

Acute liver failure is also called fulminant hepatic failure. It can be a life-threatening condition. It is a medical emergency that requires immediate admission to Liver ICU.

Acute liver failure may be treated and reversed, depending on the cause. However, in certain cases, there is no treatment available other than a liver transplant.

 

What are the symptoms of acute liver failure?

The following are some of the signs and symptoms of acute liver failure:

  • The patient’s skin and eyes will turn yellow. It is known as jaundice.
  • The patient will experience pain in the upper right abdomen
  • Swelling in the abdomen (ascites)
  • A feeling of nauseous and vomiting
  • A general feeling of being ill (malaise)
  • Sudden confusion or disorientation can happen
  • The patient may experience drowsiness

 

Acute liver failure is a life-threatening condition that can occur suddenly in healthy people. A person must visit a doctor if they experience any of the symptoms mentioned above.

 

What are the causes of acute liver failure?

Acute liver failure occurs due to damaged liver cells. The following are some of the possible causes:

 

Causes of Acute Liver Failure

 

1.Overdosage with acetaminophen: The most common cause of acute liver failure in the western world is taking too much acetaminophen. In our country, this condition is not that common. Acetaminophen is also known as paracetamol and is widely used in treating fever and pain. Acute liver failure can result from a single large acetaminophen dose.

One must seek immediate medical care if they or around them have taken excessive amounts of acetaminophen. Treatment may save the liver from failing if treated timely. Do not wait for symptoms of liver failure to show.

2. Medications:  Certain prescription medications like Antibiotics, Antitubercular medications, nonsteroidal anti-inflammatory drugs, and anticonvulsants may result in acute liver failure.

3. Viruses such as hepatitis and others: Acute liver failure can occur from Hepatitis A, B, and E. Epstein-Barr virus, cytomegalovirus, and herpes simplex virus are among the other viruses that can cause acute liver failure.

4. Supplements made from herbs: Acute liver failure has been linked to herbal medicines and supplements such as kava, ephedra, skullcap, and pennyroyal. Some of these things may contain heavy metals like lead, mercury which can damage the liver. These things are harmful to the liver and can cause severe damage over time.

5. Toxins: The poisonous wild mushroom Amanita phalloides, which is often mistaken as healthy to eat, contains toxins. It can cause acute liver failure after consumption. Another poison that can induce acute liver failure is carbon tetrachloride. It is an industrial chemical used in refrigerants and wax, varnish, and other materials solvents.

7. Metabolic disease: Certain rare metabolic disorders like acute fatty liver, and Wilson’s disease can lead to acute liver failure.

6. Autoimmune disease: It is a form of autoimmune hepatitis, a disorder in which the immune system attacks the liver cells, causing inflammation and damage. It can lead to acute liver failure.

8. Cancer: Liver failure can occur due to liver cancer as well

9. Infections: A severe infection (sepsis) or shock can significantly reduce blood flow to the liver, resulting in liver failure.

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Autoimmune Hepatitis Treatment in Mumbai

The human immune system typically makes large numbers of antibodies and lymphocytes. The antibodies and lymphocytes help fight off infections.

The immune system does not attack normal cells in the body. But in autoimmune disorders, the immune system produces antibodies and lymphocytes, referred to as autoantibodies that target the body’s cells and tissues.

Autoimmune hepatitis is a chronic condition in which the immune system targets the liver. It results in inflammation and damage to the organ. If left untreated, autoimmune hepatitis will deteriorate. It will lead to complications, including cirrhosis and liver failure.

Now, let’s know more about autoimmune hepatitis, its causes, symptoms, diagnosis, and autoimmune hepatitis treatment.

 

What is Autoimmune Hepatitis?

In autoimmune hepatitis, the body’s innate immune system destroys the liver’s cells. It causes inflammation and liver damage. It is a long-term illness. The autoimmune system will lead to cirrhosis and liver failure if left unchecked. Autoimmune hepatitis affects over a million people and leads to a Liver transplant in India. The majority of those affected are between the ages of 14 and 40.

  • Liver failure– happens when the liver stops functioning.
  • Cirrhosis– occurs as scar tissue replaces healthy liver tissue, obstructing natural blood flow.

 

Types of Autoimmune Hepatitis

Type 1 Autoimmune Hepatitis: 

It is the most common disease. Around half of those with autoimmune hepatitis may have rheumatoid arthritis, celiac disease, or ulcerative colitis.

 

Type 2 Autoimmune Hepatitis:

Adults are more likely to contract this form of hepatitis. However, it is most prevalent among infants and teenagers. Other autoimmune disorders can also accompany this form of illness. 

What are the symptoms of Autoimmune Hepatitis?

Symptoms differ from person to person. The following are some of the common symptoms:

Symptoms of Autoimmune Hepatitis
  • Excessive fatigue
  • Yellowing of the skin and eyes (jaundice)
  • Abdominal pain
  • Itching
  • Joint pain or swelling
  • Mild fever
  • Spiderlike blood vessels in the skin
  • Large abdomen due to enlarged liver and spleen

 

The symptoms of autoimmune hepatitis will mimic those of other illnesses. Therefore, always seek medical advice for a diagnosis.

Patients can suffer from problems such as permanent scarring of the liver tissue. Other conditions that could arise are:

  • Liver failure
  • Fluid collection in the abdomen
  • Enlargement of the veins of the esophagus
  • Liver cancer

What Causes Autoimmune Hepatitis?

The immune system attacking liver cells is the most common cause of autoimmune hepatitis. However, the reason for the body’s self-attack on the liver is unclear. Researchers believe it is due to a genetic interaction.

Following other risk factors can raise the risk of getting autoimmune hepatitis:

  • Gender – Females are more likely to have autoimmune hepatitis than males.
  • Infections – Infections such as influenza, herpes simplex, or the Epstein-Barr virus increase the risk of acquiring autoimmune hepatitis.
  • Heredity – People with a family history of autoimmune hepatitis are at a higher risk of contracting the disease.

How is Autoimmune Hepatitis Diagnosed?

A physician would diagnose the cause of autoimmune hepatitis by understanding the patient’s symptoms, performing a physical examination, blood tests, and liver biopsy.

  • Blood tests – It distinguishes autoimmune hepatitis from other liver disorders with similar symptoms, such as viral hepatitis.
  • Liver biopsy – A liver biopsy determines the degree and type of liver tissue damage. It involves inserting a needle across the skin to the liver, removing a small sample of liver tissue, and examining it under a microscope for the presence of any diseases.

Presentation Of Auto-Immune Hepatitis: Generally Autoimmune hepatitis presents as a slow or chronic disease. Sometimes it will present as Acute Liver Failure. If it presents as Acute Liver Failure, Liver Transplant remains the only Life-saving option.

Autoimmune Hepatitis Treatment 

The main goal of autoimmune hepatitis treatment is to suppress the overactive immune system. In most patients, the disease can be managed by following the standard treatment options.

  • Medications – They are the first preference of treatment. If the symptoms are mild or there are no symptoms, the doctor may not prescribe any medicines. Corticosteroids help reduce swelling and decrease the immune system’s activity. The main task is to find the lowest dose sufficient to treat the disease.
  • Immunity suppressors – These drugs reduce inflammation and block the immune cell’s activity.
  • Liver transplant – In most severe cases, such as cirrhosis or end-stage liver failure, a transplant is required. A healthy donor’s liver would then replace the liver.

How People Live with Autoimmune Hepatitis?

  • With treatment, most patients with autoimmune hepatitis can have an average life expectancy. The medication used for autoimmune hepatitis has improved the chances of survival tremendously. The patient should not stop the treatment without the doctor’s knowledge, as the condition may worsen.
  • Although the condition usually deteriorates at some point after stopping treatment, it can generally be treated again by quickly going back on medication.

Make an appointment with Dr. Gaurav Gupta to seek the most effective Autoimmune hepatitis treatment in Mumbai.

Frequently Asked Questions:

 1) What is the survival rate for Autoimmune Hepatitis Patients?

Generally, Auto-Immune Hepatitis patients will have a normal life. Sometimes it presents as Acute Liver Failure where urgent liver transplant may be required.

2) Is there a difference between Autoimmune Hepatitis and Viral Hepatitis?

Autoimmune hepatitis is an immune disease caused by genetic causes, while viral Hepatitis is a viral infectious disease. They can be Hepatitis A, B,C, E

3) Does Autoimmune Hepatitis impact fertility or conception? 

Autoimmune hepatitis does not affect pregnancy. Women of childbearing age with autoimmune hepatitis can conceive without any difficulty. However, for healthy childbirth, it is best to follow the doctor’s instructions.

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Do’s and don’ts in living with cirrhosis.

Cirrhosis is a late-stage liver condition in which good liver tissue is replaced by scar tissue, causing permanent damage to the liver. Scar tissue obstructs your liver’s ability to function normally. 

Healthy liver cells are injured by a variety of diseases and situations, resulting in cell death and inflammation. This is followed by cell repair and, as a result of the repair process, tissue scarring.

 

Risk factors for cirrhosis

Chronic hepatitis B or C, as well as excessive alcohol intake, are the most common causes of cirrhosis. Autoimmune liver disease, fatty liver, and rare hereditary illnesses such as hemochromatosis and Wilson’s disease are all examples of autoimmune liver disease.

 

Cirrhosis causes irreversible liver damage, yet a person with early cirrhosis can have a very active life for many years. However, they must seek treatment from a liver specialist in Mumbai. Cirrhosis of the liver, when advanced or a cirrhosis complication develops, necessitates a liver transplant.

 

liver with cirrhosis

What are the things you should follow if you have liver cirrhosis?

Do’s:

A proper plan for adequate treatment, detailed assessment of the liver is required to grade the disease.

In early cirrhosis, regular liver function testing and follow-up with the doctor are mandatory every 1-3 months. However, in advanced cirrhosis, the patient requires a regular liver function test and follow-ups every 1-4 weeks.

 

food for Liver Cirrhosis

A liver specialist will determine the precise time between check-ups based on the symptoms and disease incidence. In the case of chronic liver disease, a nutritious diet is critical for proper liver function. Except in extreme jaundice cases, digestion remains normal until it is extremely late stages of liver cirrhosis.

As a result, the misconception that all causes of liver disease necessitate total avoidance of fatty foods and proteins is wrong. In most cases, this is needless and dangerous, as it leads to malnutrition, weight loss, and faster deterioration of health.

Actually, Liver Cirrhosis patients’ needs high Protein and calorie food. On an average Cirrhotic patient will require 1-1.5 gm of protein/Kg of weight/day. Similarly, they will need 30-35 kcal/kg of weight/day.

If the HBV DNA test is positive in cirrhosis caused by Hepatitis B, a patient will require antiviral therapy in consultation with the Mumbai liver specialist.

If the patient suffers from an early stage of cirrhosis due to Hepatitis C, very good oral antiviral therapy is available to cure this disease.

 

Don’ts:

Liver Cirrhosis

In cirrhosis, one should avoid alcohol entirely at all costs. Patients will need to avoid a high salt diet; salt is restricted to just 2 gm/day. All high salt food like pickles, bakery items should be avoided. 

Self-medication is risky since the liver is not functioning properly. It can harm more to the already weakened liver.

Exercise: Another misconception for cirrhosis patients is they need to rest. Actually, keeping one active, doing physical activity and limb and lung exercise is very important. If a cirrhotic patient will not do exercises, he will start losing muscle mass very fast which will make him prone for infections.

Diet for cirrhosis patients: There are some ingredients and liquids that a patient should limit while they are on a cirrhosis diet. In contrast to other diets used to treat medical problems, they will have a greater range of nutritious and delicious ingredients to choose from. These ingredients include organic fruit, whole grains, and plant-based protein.

Fruits and vegetables: Choose fresh produce over frozen kinds, which are also high in salt and sugar. One can add fruit to cereal or oats for added protein, fibre, and natural sweetness. Apples are high in fibre. They are safe and suitable for your health.

Dairy:  Low-fat yogurt, small quantities of low-sodium hard cheese, and plant-based milk such as almond or soy milk are all popular options.

Grains: Instead of processed white flour, use brown rice, whole-grain bread, cereals, and pasta.

Protein: One should avoid red meat and any canned lunch meat or sausage, which is not allowed on a cirrhosis diet. Small portions of skinless lean meat, some fresh-caught fish varieties (like salmon), and egg whites can be appropriate. A high protein diet is very important for Cirrhosis patients.

Desserts: It is safer to skip packaged desserts like cake, cookies, brownies, etc. They are rich in sugar and salt. Pastries, doughnuts, and muffins all need to be avoided until they can make their own low-fat, low-sugar, and low-salt varieties.

Beverages: If a person has liver cirrhosis, they must not drink alcohol. However, plenty of other choices are available for them. Water is the most hydrating choice, so if the patient is on a low-sodium diet, read the labels on bottled water and see if it contains sodium. They can have pasteurized milk and juice also.

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All You Need To Know About: Liver Biopsy

What is a Liver Biopsy?

A liver biopsy is a surgical procedure that is used to diagnose liver problems. Tissue samples from your liver are removed and examined under a microscope for signs of disease or injury.

A liver biopsy will reveal whether your liver contains cancer cells or other abnormal cells. It can also show how well your liver is functioning.

Types of Liver Biopsies

1) Percutaneous Liver Biopsy

It is the most common method for diagnosing liver diseases. Your surgeon will administer a local anesthetic or may give you medicine through an IV to make you relax. The surgeon will put a small needle through the skin into your liver to remove a sample.

2) Laparoscopic Liver Biopsy

Your surgeon will give a general anesthetic. Further, the surgeon will put a thin, lighted tube (laparoscope) into your skin through a small cut. The tube has a small video camera that displays the stomach’s internal view on a computer screen. Observing the screen, the surgeon puts the needle through another tube to remove the sample.

3) Transjugular Liver Biopsy 

Liver specialists use this type of biopsy if you have blood-clotting problems or fluid in your stomach. Your Doctor will give a local anesthetic to make an incision into a vein in the neck. The doctor inserts a catheter through the vein down to the liver. Then, puts a contrast dye into the catheter and takes X-rays. The dye makes the vein visible on the X-rays. The needle passes through the catheter to your liver. Your doctor will remove the tissue samples through the catheter.

If your surgeon wants a sample from a specific part of your liver, the biopsy may be performed in the radiology unit. It will be conducted using an imaging test such as:

  • Ultrasound  – It implements high-frequency sound waves to produce images.
  • MRI – It uses a combination of large magnets, radio waves, and a computer to produce images.
  • CT scan – It utilizes both X-rays and computer technology to create images of organs and tissues of the body.

Why Might You Need A Liver Biopsy?

A liver biopsy is used to determine whether you have a liver disease that signs or lab tests cannot diagnose. If you have any of the following symptoms, a liver specialist can recommend a biopsy:

  • An enlarged liver
  • Abnormal lab tests that indicate liver disease
  • Yellowing of the skin and eyes (jaundice)

A liver biopsy may be used to investigate if you have a condition such as:

  • Auto-Immune Hepatitis – Inflammation of the liver
  • Liver tumour – An abnormal lump or mass of tissue
  • Wilson liver disease – Liver damage caused by copper accumulation
  • Fibrosis of the liver – The growth of scar tissue due to infection, inflammation, or injury.
  • Non-alcoholic liver disease – Liver disease is caused by the accumulation of fat in the liver

Steps To Take Before Undergoing Liver Biopsy 

  1. Your doctor may instruct you to avoid specific medication or supplements.
  2. Your doctor will need a blood test to check if you have blood-clotting problems.
  3. In any such situation, your doctor will prescribe medicine to avoid excessive bleeding.
  4. Your doctor might ask you to avoid meals for 6 to 8 hours before the procedure starts.

 

How is Liver Biopsy Done?

  • It is a simple procedure that involves removing the liver tissue using a biopsy needle.
  • Your doctor will perform the biopsy in the OPD for 10 to 15 minutes.
  • The doctor will ask you to lie down on the treatment couch and conduct an ultrasound scan to evaluate the exact area of your liver.
  • Your doctor will perform a biopsy after giving local anesthesia.

What Happens After Liver Biopsy?

  • You are likely to feel some pain at the biopsy site and slight pain in the shoulder or back.
  • You will be observed in the recovery room for the next few hours.
  • You will be prescribed painkillers and advised to avoid any physical exertion for the next few days.

The Risks Involved in the Liver Biopsy are:

  • Bleeding and mild discomfort.
  • Pneumothorax or a punctured lung.
  • Accidental injury to the adjacent parts such as gallbladder, intestines, or kidney.
  • Infection.

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Hepatitis Awareness and Information

Firstly hepatitis doesn’t mean only viral or infective hepatitis. Hepatitis is inflammation or swelling of liver cells (Hepatocytes). They can be viral or non viral. Some of the non-viral causes of Hepatitis are Alcohol, Fatty Liver, Certain drugs, Auto Immune and many others. Common Viral Hepatitis are Hepatitis A,B,C,D and E. Mostly signs of symptoms of any hepatitis can very and non specific. But patients can complain of tiredness, fever, and pain in right upper abdomen, jaundice and so on.

Viral Hepatitis A and E are generally transmitted through infective food and water. Avoiding such food and water can help in preventing against these type of hepatitis. Hepatitis B and C spread through contaminated blood or through mother to child. So avoiding single syringe for multiple people, blood transfusion from designated blood banks can help in preventing spread of these types of hepatitis. Very effective vaccination is available against hepatitis A and B, which can protect us against these types of disease.

Non-viral hepatitis is actually getting more and more common. We are seeing pandemic of NASH, which is Non-alcoholic Steatohepatitis. This disease starts from fatty liver and progress to liver inflammation and may lead to cirrhosis and end stage liver disease. Diabetes, Hypertension, Obesity, Hypercholesterolemia, Hypothyroidism are some of the risk factor associated with NASH. Sedentary lifestyle with increased consumption of processed food has increased the incidence of all these lifestyle disorder. Fortunately or unfortunately control of NASH is in our hands only. Healthy lifestyle, which includes our diet and good exercise, helps in control of fatty liver. Tight control of diabetes, Blood pressure and cholesterol helps in slowing down the progression of NASH.

Other common non-viral causes of hepatitis like alcoholic hepatitis is also preventable. Avoid drinking excess alcohol protects our liver. Some of the drugs prescribed by quacks in name of alternate style of medicine contain heavy metal like lead and mercury, these can damage the liver causing hepatitis and in some rare cases even Acute Liver failure. So it is essential to see only qualified doctors (Allopathy, Ayurveda or Homeopathy).

But sometimes despite all precautions we may still get hepatitis. If you see yellowish eye and skin with or without fever, tiredness and pain in stomach, it is best to see Liver specialist. Lot of these hepatitis if correctly and timely diagnosed can be cured. On World Hepatitis Day, we all should pledge to take care of our liver.

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