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Acute Liver Failure

Causes of Acute Liver Failure
This is a rare but devastating condition affecting the liver in an individual who was previously healthy with no liver disease. A variety of causes can cause acute liver failure. These include acute infections with Hepatitis A, hepatitis E and hepatitis B viruses. Certain drugs such as paracetamol can cause acute liver failure when taken in large doses with suicidal intent. Similarly rat killer poison consumption can also cause ALF. Occasionally, patients develop acute liver failure within a few weeks after starting treatment with anti-tuberculosis medications Hence liver function tests should be carefully monitored for at least the first couple of months when treatment for tuberculosis is initiated. Other causes of acute liver failure include herbal medications, Wilson’s disease. A definite cause for the liver failure may not be identified in a significant proportion of patients.

Symptoms of Acute Liver Failure
Jaundice, altered sensorium, inability for the blood to clot, kidney failure are the common presentations. These symptoms usually develop after a short period of general ill-health. Irrespective of the cause of ALF, these patients become very ill very quickly, sometimes over a matter of days. Damage to other organs such as the kidneys, lungs, heart and brain can develop increasing the risk of serious complications and death.

Treatment of Acute Liver Failure
Patients with acute liver failure should be urgently transferred and managed in a specialist liver centre. A team approach involving intensivist, hepatologist, transplant surgeon and support staff is the best way to manage these patients. ICU care is primarily aimed at protecting the brain from irreversible damage, supportive care for other organs such as the kidney, lungs and heart, nutrition and antibiotics to prevent infection. Specific treatments such as steroids for autoimmune hepatitis and pencillamine for Wilson’s disease will benefit appropriate patients.

A significant proportion of these patients will improve with aggressive medical treatment and recover completely. Some patients will continue to deteriorate and in these patients, liver transplantation is a true life-saver. Since the availability of this surgery, survival of patients with acute liver failure has improved from less than 20% to over 80%