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Acute Liver Failure

  • What is liver failure?

    Liver failure is severe deterioration of liver function. Liver failure occurs when a large portion of the liver is damaged due to any type of liver disorder.

    What causes liver failure?

    A number of liver diseases, such as biliary atresia, metabolic liver disease and hepatitis, can lead to liver failure as they progress into late stages. Liver diseases that lead can lead to liver failure share the following characteristics:

    • Jaundice: is a yellow discoloration of the skin and whites of the eyes due to an abnormally high level of bilirubin (bile pigment) in the bloodstream, which is then excreted through the kidneys. High levels of bilirubin may be attributed to inflammation or other abnormalities of the liver cells, or blockage of the bile ducts. Sometimes jaundice is caused by the breakdown of a large number of red blood cells, which can occur in newborns. Jaundice is usually the first sign, and sometimes the only sign, of liver disease.

    • Cholestasis is reduced or stopped bile flow. "Chole" refers to bile and "stasis" means "keeping at the same level." Bile flow may be blocked inside the liver, outside the liver, or in both places. Cholestasis is caused by hepatitis, metabolic liver diseases, drug effects, a stone in the bile duct, bile duct narrowing, biliary atresia, or inflammation of the pancreas. Symptoms of cholestasis may include the following: jaundice, dark urine, pale stool, easy bleeding, itching, small, spider-like blood vessels visible in the skin, an enlarged spleen, fluid in the abdominal cavity, chills and abdominal pain.

    • Liver enlargement (hepatomegaly) is usually an indicator of liver disease. There are usually no symptoms associated with a slightly enlarged liver. Symptoms of a grossly enlarged liver include abdominal discomfort or "feeling full."

    • Portal hypertension is abnormally high blood pressure in the portal vein, which brings blood from the intestine to the liver. Portal hypertension may be due to increased blood pressure in the portal blood vessels or resistance to blood flow through the liver. Portal hypertension can lead to the growth of new blood vessels (called collaterals) that connect blood flow from the intestine to the general circulation, bypassing the liver. When this occurs, substances that are normally removed by the liver pass into the general circulation. Symptoms of portal hypertension may include: a distended abdominal cavity (ascites), prominence of abdominal wall veins, bleeding of the varicose veins at the lower end of the esophagus or the stomach lining.

    • Ascites - Ascites is fluid build-up in the abdominal cavity caused by fluid leaks from the vessels on the surface of the liver and intestine. Ascites due to liver disease usually accompanies other liver disease characteristics such as portal hypertension. Symptoms of ascites may include a distended abdomen, which causes discomfort and shortness of breath.

    • Liver encephalopathy - Liver encephalopathy is the deterioration of brain function due to toxic substances building up in the blood which are normally removed by the liver. Liver encephalopathy is also called portal-systemic encephalopathy, hepatic encephalopathy, or hepatic coma. Symptoms of liver encephalopathy may include: changes in logical thinking, personality, and behavior, mood changes impaired judgment, drowsiness, confusion, sluggish speech and movement, disorientation, loss of consciousness, coma

    What are the symptoms of liver failure?

    • jaundice
    • tendency to bruise or bleed easily
    • ascites
    • impaired brain function (encephalopathy)
    • poor weight gain and growth
    • fatigue
    • weakness
    • nausea
    • loss of appetite

    How is liver failure and diseases that lead to liver failure diagnosed?

    When diagnosing liver disease, the physician looks at the patient's symptoms and conducts a physical examination. In addition, the physician may request a combination of the following tests:

    Blood Tests:

    • Liver enzymes - Elevated levels of liver enzymes can alert physicians to liver damage or injury, since the enzymes leak from the liver into the bloodstream under these circumstances.

    • Bilirubin - Bilirubin is produced by the liver and is excreted in the bile. Elevated levels of bilirubin often indicate an obstruction of bile flow or a defect in the processing of bile by the liver.

    • Albumin, Total Protein, and Globulin - Below-normal levels of proteins made by the liver are associated with many chronic liver disorders.

    • Clotting Studies, such as Prothrombin Time (PT) and Partial Thromboplastin Time (PTT) - Tests that measure the time it takes for blood to clot are often used prior to liver transplantation. Blood clotting requires vitamin K and proteins made by the liver. Liver cell damage and bile obstruction can both interfere with proper blood clotting.

    Other diagnostic tests can include:

    • Abdominal Ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

    • Liver Biopsy - a sample of liver tissue is obtained with a special biopsy needle and examined under a microscope.

    • Computed Tomography Scan (Also called CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

    How is liver failure treated?

    In most cases, late stage liver disease, resulting in liver failure requires a liver transplantation. A liver transplant is an operation performed to replace a diseased liver with a healthy one from another person. For more information on liver transplants, see Liver Transplantation.

    Contact Us

    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 5
    Boston MA 02115

    617-355-5837
    fax: 617-730-0716




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