Liver failure

A decline in liver function leading to coagulopathy, jaundice, and encephalopathy.

• Acute Liver Failure (ALF): Rapid deterioration within 8 weeks in a patient without pre-existing liver disease.
• Chronic Liver Failure: Gradual decline over months to years, often due to chronic liver diseases.
• Acute-on-Chronic Liver Failure (AoCLF): Acute deterioration in a patient with pre-existing chronic liver disease.

• Acute Liver Failure: Paracetamol overdose, viral hepatitis (A, B, E), drugs (e.g. amoxicillin-clavulanic acid), toxins.
• Chronic Liver Failure: Chronic alcohol consumption, viral hepatitis (B, C, D), non-alcoholic fatty liver disease (NAFLD), cirrhosis.

• Jaundice and scleral icterus.
• Ascites and peripheral oedema.
• Hepatic encephalopathy: Altered consciousness, asterixis (‘flapping tremor’).
• Coagulopathy: Easy bruising, prolonged bleeding.

• Liver function tests (LFTs): Elevated transaminases (ALT, AST), raised bilirubin, decreased albumin.
• INR: Prolonged.
• Viral hepatitis serology.
• Imaging: Ultrasound, CT, or MRI of the liver to detect structural abnormalities.

• Supportive care: Nutritional support, treat coagulopathy (vitamin K, fresh frozen plasma).
• Specific treatments: N-acetylcysteine for paracetamol overdose, antiviral therapy for viral hepatitis.
• Encephalopathy: Lactulose, rifaximin, avoidance of sedative drugs.
• Transplantation: Liver transplant may be needed for some patients.

• Depends on the cause and severity.
• Acute liver failure has a high mortality rate without prompt treatment.
• Chronic liver failure can progress to cirrhosis and hepatocellular carcinoma.

• Hepatorenal syndrome: Renal failure due to severe liver damage.
• Hepatic encephalopathy: Accumulation of toxins in the brain due to liver dysfunction.
• Variceal haemorrhage: Due to portal hypertension.