What is liver failure? ============================== **The liver is the second largest organ in the body that processes everything you eat and drink and produces the energy and nutrients the body needs. It also cleans the blood from harmful substances and helps the body to fight infections, but if the person's body is exposed to harmful chemicals or viruses, the liver may be damaged.** **When the liver is damaged, a person may suffer from liver failure. As a result of liver failure, the proper functioning of the liver stops. This disease is a very serious disease that may become a chronic disease if it is not treated severely.** **Types of liver failure** **Generally, two types of liver failure occur in humans:** **1) Acute liver failure** **2) chronic liver failure** - **Acute liver failure** **Acute liver failure is the loss of liver function that occurs in a few days or weeks in a person who does not already have liver disease. This disease is mostly caused by the hepatitis virus or different drugs such as acetaminophen.** **Acute liver failure is also known as fulminant liver failure, which can cause complications such as excessive bleeding and increased pressure in the brain, in which case the patient must be hospitalized immediately.** ### **Causes of acute liver failure** **Acute liver failure is less common than chronic liver failure. Acute liver failure occurs suddenly without showing any specific symptoms. Some of the causes of acute liver failure are: - **Overuse of acetaminophen or the combination of acetaminophen with alcohol consumption** - **Excessive use of drugs such as certain antibiotics, antidepressants, anticonvulsants, artificial hormones and antifungal drugs and herbs (green tea extract and kava)** - **Metabolic (biological) or vascular disorders (vessels that carry fluids, such as arteries), such as Wilson's disease and autoimmune hepatitis (A, B and autoimmune)** - **cytomegalovirus, Epstein-Barr virus and herpes simplex virus diseases** - **Consumption of poisons, such as poisonous mushrooms** - **Unexpected hepatotoxicity caused by drugs** **In developing countries, viral hepatitis is usually considered the most common cause of liver failure. But in developed countries, toxins are usually considered the most common cause of this disease.** - **In general, the most common cause of liver failure in terms of virus is hepatitis B virus, which often coincides with hepatitis D infection. But hepatitis C is not a common cause of this disease.** **Other viral diseases that cause liver failure include: cytomegalovirus, Epstein-Barr virus, herpes simplex virus, human herpes virus 6, parvovirus B19, varicella zoster virus, hepatitis A virus (rarely), hepatitis E virus (especially if a person is infected during pregnancy) and viruses that cause disease such as arbovirus, arnavirus and filovirus.** - **The most common poison that causes liver failure is acetaminophen, and its toxicity depends on the dose. Predisposing factors for acetaminophen-induced liver failure include preexisting liver disease, chronic alcohol consumption, and the use of certain medications such as anticonvulsants.** **Other toxins include amoxicillin/clavulanate, halothane, iron compounds, isoniazid, non-steroidal anti-inflammatory drugs, some compounds found in herbal products, and the mushroom Amanita phalloides.**

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### **Causes of acute liver failure in infants** - **Infections: herpes simplex, echovirus, adenovirus, hepatitis B, parvovirus, etc.** - **Drugs/Poisons: Acetaminophen** - **Cardiovascular: oxygen delivery to the extracorporeal membrane, left heart hypoplastic syndrome, shock, suffocation, myocarditis** - **Metabolic: galactosemia, tyrosinemia, iron storage, mitochondrial status, HFI, fatty acid oxidation, and...** - **Immune: autoimmune hepatitis, immune dysregulation, immunodeficiency, hemophagocytic lymphohistocytosis** **In toddlers and older** - **Infections: hepatitis A, B and D, hepatitis NANB, Epstein-Barr virus, cytomegalovirus, herpes, leptospirosis and...** - **Drugs / poisons: valproic acid, isoniazid, halothane, acetaminophen, mushrooms, phosphorus, aspirin, etc.** - **Cardiovascular: myocarditis, heart surgery, cardiomyopathy, Budd-Chiari syndrome** - **Metabolic: oxidation of fatty acids, Reye's syndrome, leukemia, etc.** - **Immune: autoimmune hepatitis, immune dysregulation, immunodeficiency, hemophagocytic lymphohistocytosis** ### **symptoms of acute liver failure** **Symptoms of acute liver failure can be similar to those of a virus and include stomach upset, feeling constantly tired or vomiting, which can quickly turn into jaundice (yellowing of the skin), encephalopathy and coagulopathy (blood clotting problem).** **In encephalopathy, the brain does not work as it should and happens when the liver is unable to break down or get rid of toxic products. Babies up to 28 days may not have many symptoms of encephalopathy that are easily visible.** **Babies older than 28 days may be irritable. Older children may seem irritable, have trouble falling asleep, forget things, become confused, or feel sleepy.** **Generally, the following symptoms may be observed in acute liver failure:** - **discomfort on the right side, just below the ribs** - **Loss of appetite** - **nausea** - **diarrhea** - **fatigue** As the disease worsens, the person may become confused and drowsy. Other symptoms such as simple bruising or bleeding, vomiting blood, and fluid accumulation in the abdomen may also be observed.** **Stages of progression of liver failure** - **First stage: inflammation** **In the early stages of liver failure, the liver is inflamed and may be sensitive or the person may not feel any discomfort in his liver area.** - **Second stage: fibrosis or scar** **If liver inflammation is not treated, it may cause ulcers. Accumulation of scar tissue in the liver causes the blood flow to stop, and as a result, the healthy parts do not do their job and hardly function normally.** - **third stage: cirrhosis** ** Scar tissue grows and the amount of healthy liver tissue decreases. So with less healthy tissue to do its job, a person's liver doesn't work well or at all.** - **The fourth stage: the final stage of failure** **Liver failure is a term for several conditions such as swelling of the liver, internal bleeding, loss of kidney function, fluid accumulation in the abdomen, and lung problems. If the liver failure becomes chronic, the person will probably need a liver transplant.** - **Acute liver failure diagnosis method** **Liver failure is a serious disease that requires immediate medical attention. When visiting a doctor, the patient's history of drug use, exposure to toxins, and symptoms of hepatitis, which include jaundice, fatigue, and abdominal pain, are examined. Also, the level of mental alertness and blood tests are also performed, in which liver enzymes, bilirubin level and prothrombin time are checked.** **Therefore, the following methods are used to diagnose liver failure:** - **Do a blood test: The purpose of doing this test is to check how the person's liver is working. A prothrombin time test, which measures how long it takes for blood to clot, may be ordered. In acute liver failure, the blood does not clot at the required speed.** - **Imaging tests: The image also helps the doctor to check what is happening in the liver and find out what the problem is. The following methods may be recommended for liver imaging:** - **sonography** - **Abdominal CT scan** - **MRI imaging** - **Biopsy or sampling: In this method, using a needle, a small piece of liver tissue is removed and examined in the laboratory.**

### **Treatment of acute liver failure** **Treatment of acute liver failure depends on its main cause. If the hepatitis virus is the cause of acute liver failure, the doctor may prescribe a special drug depending on the type of hepatitis virus that caused the failure. If autoimmune hepatitis causes liver failure, the doctor may suggest the use of steroids.** **If the doctor cannot diagnose the cause of acute liver failure, a person may need a liver biopsy. Knowing more information helps to determine the person's treatment period. If the use of drugs leads to the desired result, the person may need a liver transplant.** ### **Complications of acute liver failure** ** Common symptoms of acute liver failure include bacterial and fungal infection and low blood sugar. Brain swelling is another complication of acute liver failure and is one of the most serious complications. Confusion, abdominal swelling and abnormal bleeding are also common.** ### **Is it possible to prevent acute liver failure?** **People can prevent some underlying causes of acute liver failure. For this purpose, excessive consumption of acetaminophen should be avoided. Also, avoiding contact with the blood or feces of an infected person reduces the risk of contracting viral hepatitis, which is one of the causes of acute liver failure. Using the vaccine to prevent hepatitis A and B is also effective in preventing acute liver failure.** **Key points about acute liver failure** - **Acute liver failure occurs when a person's liver suddenly begins to lose its ability to perform its functions.** - **Excessive use of acetaminophen is the most common cause of acute liver failure.** - **Acute liver failure causes fatigue, nausea, loss of appetite, discomfort on the right side, just below the ribs, and diarrhea.** - **Acute liver failure is a serious disease that requires immediate medical attention.** - **If medical treatments are not effective, a person may need a liver transplant.** - **Chronic liver failure** **Chronic liver failure develops more slowly than acute liver failure and may even last months or years, but no specific symptoms appear in a person. Chronic liver failure is the most common type of failure that occurs with cirrhosis or severe liver injury.** ** Cirrhosis itself is caused by hepatitis C, excessive alcohol consumption or non-alcoholic fatty liver disease. In chronic liver failure, a person's liver becomes inflamed, and this inflammation causes the formation of scar tissue over time, and the liver gradually loses its normal function.** **Causes of chronic liver disease** **suffering from hepatitis C infection** **Suffering from non-alcoholic fatty liver disease** - **metabolic syndrome** - **Obesity** - **type 2 diabetes** - **Genetic reasons** **Possible and less common causes of chronic liver failure** - **autoimmune hepatitis** - **bile duct diseases** - **Budd-Chiari syndrome, which causes blockage of the hepatic veins** - **cancer drugs such as chemotherapy** - **Chronic right heart failure** - **Drug-induced liver cirrhosis** - **Genetic types, such as alpha-1 antitrypsin deficiency** - **Hemochromatosis, which causes the accumulation of iron in the liver and other organs** Wilson's disease, which causes copper to accumulate in the liver and other body tissues. - **unknown causes** ** Ways to help maintain liver health** - **doing sports activities regularly** - **Paying attention to weight loss in obese people and maintaining a healthy weight** - **Subject to a balanced and healthy diet** - **Preventing the use of drugs, cigarettes and poisons** **Avoid taking illegal drugs, especially acetaminophen overdose** - **prevention of alcohol consumption** - **Not using contaminated and shared needles that may be carriers of hepatitis viruses.** - **In case of exposure to blood (such as in laboratories), medical attention should be observed.** **You can contact us for more information and advice.** Stay in touch with us