Liver Failure: Causes, Symptoms, Treatment and Cost

Liver failure, also termed as hepatic failure, is a disease in which the liver's capacity to function is impaired.

• Acute Liver Failure: Acute Liver Failure is characterised by a sudden loss of liver function that generally occurs within days or weeks. It can be caused by numerous conditions including drug-induced liver injury, viral hepatitis, acute fatty liver of pregnancy and fulminant Wilson’s disease.
• Chronic Liver Failure: Chronic liver failure refers to a condition in which liver function deteriorates over time.
• Alcoholic Liver Disease: Alcoholic liver disease is liver damage brought on by heavy alcohol intake over a long period of time.

• Heavy alcohol use: Long-term, heavy alcohol consumption can lead to cirrhosis and liver failure.
• Viral infections: Hepatitis B and C viruses may cause the liver to be chronically inflamed, which can result in cirrhosis or cancer.
• Toxins: Long-term exposure to certain chemicals such as industrial solvents, pesticides, and other pollutants can damage the liver and cause failure.
• Autoimmune diseases: Autoimmune hepatitis is an inflammatory condition in which your own immune system attacks the liver cells, leading to cirrhosis or death of the cells if untreated.
• Medication side effects: Some medications such as acetaminophen (Tylenol) at high doses may injure the liver cells leading to serious illness or death if not rapidly treated with supportive care.

Jaundice (yellowing of eyes and skin, dark urine).

• Abdominal pain and swelling
• Itching
• Nausea and vomiting
• Fatigue and weak muscles.
• Reduced appetite
• Weight loss
• Confusion, drowsiness, mental changes.

• Avoid excessive alcohol consumption.
• Watch your weight, eat healthy and exercise regularly.
• A doctor's advice should always be sought before taking medicine.
• Defend yourself against hepatitis B and C.
• Get vaccinated against hepatitis A and B.
• Get regular tests to monitor your liver health.

• Liver function tests: LFTs are blood tests used to identify and monitor liver disease or injury. They evaluate the concentrations of certain enzymes and proteins in the blood, which might indicate liver inflammation or damage.
• Kidney Function Tests: To assess for renal involvement in the form of pre-renal azotaemia or acute kidney injury.
• Liver biopsy: A liver biopsy is a procedure used to find out what's wrong with a person's liver and make a diagnosis. During the process, a small piece of tissue from the organ is obtained to look for signs of disease under a microscope.
• Urinalysis: To check for proteinuria, red blood cells in urine along with glucose levels which would indicate kidney dysfunction due to liver failure.
• Imaging Tests: Ultrasound scan or CT scan may be done to examine the size and anatomy of the liver/spleen along with measurement of ascites.

• Ascites: Fluid accumulation in the abdomen brought on by liver damage.
• Edema: Swelling due to build-up of fluid in tissues.
• Jaundice: Skin and eye yellowing brought on by an overabundance of the pigment bilirubin.
• Itching: Chronic itching caused by liver damage.
• Bleeding problems: Blood clotting problems due to decrease in production of clotting factors.
• Confusion & fatigue: Mental confusion and exhaustion due to liver damage.
• Kidney failure: Damage caused renal impairment due to waste accumulation.

• Consume amla or Indian gooseberry on an empty stomach daily, chopped up with a little water and honey to aid in the functioning of the liver.
• Include turmeric in your diet, as it is known to contain powerful antioxidants that can help to protect the liver from damage.
• Drink fresh carrot juice and fresh beetroot juice on an empty stomach every morning for improved liver activation levels.
• Consider consuming milk thistle, which has been found to protect the liver from damage due to alcohol consumption, drug abuse or fatty build-up in the body and is considered a very effective herbal remedy for treating liver failure naturally at home.

• An individual with liver failure should focus on eating a balanced diet that is low in sodium, fat and cholesterol.
• Foods to include in the diet are lean proteins such as fish, poultry, beans and nuts; complex carbohydrates such as whole grains, fruits and vegetables; and healthy fats such as olive oil and avocados.
• Increase intake of folate-rich foods such as leafy green vegetables, legumes and oranges to help reduce the risk of liver disease progression.
• Ensure you get enough fluids.

• Processed foods and fast foods: High amounts of sodium, sugar and unhealthy fats from processed food can be hard on liver.
• Dairy products: Limit the portions of whole milk, cream, cheese, butter or ice cream as these are high in saturated fat and difficult for impaired liver to metabolize.
• Fried foods: Fried fatty items can cause inflammation in the body as well as promote a fatty liver condition.
• Alcoholic Beverages: Completely avoid alcohol during a period of liver impairment as it is toxic to the organ and contributes to further damage.
• Sugary Beverages: High calorie energy drinks, soda or fruit juices should be avoided due to high sugar content which impedes liver function and promotes fatty build up in the organ tissue.
• Red Meat: Eat only lean cuts of beef or pork as aged sofaty meats can worsen inflammation in the body due to high cholesterol/saturated fat content.

• Liver transplantation: A potentially life saving procedure that replaces a failing liver with a healthy donor organ from another person.
• Hepatorenal bypass: This procedure involves connecting the liver to the kidney via a device that shunts part of the blood flow, thus improving the chances of recovery of diseased liver functions.
• Portacaval shunting: This surgery involves connecting two major blood vessels in order to reroute the blood and reduce pressure inside the liver.
• Machine perfusion technology: This procedure helps improve circulation and oxygen delivery to the liver cells by using an extracorporeal circuit, or a machine-containing circuit, to increase oxygen supply and regenerate damaged cells.
• Cryosurgery: Involves freezing cancerous tumors in order to reduce their size or eliminate them entirely without causing additional damage to healthy tissue around it.

A liver failure diagnosis is serious and should be evaluated by a gastroenterologist, who specializes in diseases of the digestive system, specifically the liver.Other medical experts may also be contacted, depending on what caused the liver failure.

These may include:

• A hepatologist (liver specialist).
• A hematologist oncologist if a blood disorder or cancer is suspected.
• A nephrologist if kidney failure develops as a result of liver failure.

• Corticosteroids: These drugs, such as prednisone and budesonide, help reduce inflammation in the liver and can help treat some cases of liver failure.
• Diuretics: These medications, sometimes referred to as 'water pills,' aid in the removal of extra water from the body and may be used to manage liver failure brought on by cirrhosis. Examples include furosemide and spironolactone.
• Antiviral drugs: These medications can be used to treat viral hepatitis, a common cause of liver failure. Examples include interferon and ribavirin.
• Immunosuppressants: These drugs, such as azathioprine and mycophenolate mofetil, block the immune system from attacking the liver cells in autoimmune hepatitis, a form of liver failure.
• Antioxidants: Antioxidants can help protect against damage to the liver caused by certain toxins or medications that could lead to liver failure. Examples include N-acetylcysteine and silymarin (milk thistle).
• Ursodeoxycholic acid (UDCA): This medication helps reduce the amount of bile acids in the blood, which can be beneficial for some types of liver disease that can lead to liver failure.

Generally, it takes several weeks to months of hospitalization or recovery at home, as well as medical treatments and lifestyle changes before the recovery process is complete.

Depending on its severity, underlying cause, and treatment, liver failure treatment outcomes may be very variable.

In mild liver failure, lifestyle changes and appropriate medications can help improve liver health and restore functioning.

In more severe cases, a transplant may be necessary to replace damaged or decaying tissue with healthy new organs.

• Monitor vital indicators and ensure proper nourishment.
• Follow-up appointments with physicians for the prescription of medications, examination of wounds, and physical therapy.
• Observe for signs of infection, swelling, and discomfort.
• Take prescription drugs exactly as advised.
• Avoid vigorous activity and heavy lifting.

Generally, the overall cost can range from Rs. 1 lakh to upwards of Rs. 5 lakh or even more, depending on the number of tests, consultations and medications required for treatment.

Additionally, if a liver transplant is necessary then the total expense may escalate to a few crore rupees as it is an expensive procedure.

The most common side effects of liver failure treatments include:

• Fatigue
• Nausea
• Diarrhea
• Abdominal pain
• Loss of appetite
• Itching
• Rash
• Headache
• Weight gain or loss
• Joint pain and swelling
• Confusion
• Memory problems.
• Other side effects can include:
• Anemia
• Electrolyte imbalances (such as low potassium).
• Elevated liver enzymes (which can indicate inflammation or damage to the liver).
• Changes in blood pressure.

Liver failure is a medical emergency that needs immediate attention from a qualified medical professional since it may lead to serious problems such as 'ascites, jaundice, kidney failure, etc.' and may require months or even years of treatment.