What is liver failure?

Liver failure is a severe decline in liver function and the inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology. Two forms are recognised, acute and chronic.

Acute Liver Failure is defined as “the rapid development of hepatocellular dysfunction, specifically coagulopathy and mental status changes (encephalopathy= disease or disorder of the brain) in a Patient without known prior liver disease”.The diagnosis of acute liver failure is based on physical exam, laboratory findings, Patient history, and past medical history to establish mental status changes, coagulopathy, rapidity of onset, and absence of known prior liver disease respectively.

Chronic liver failure usually occurs in the context of liver cirrhosis, itself potentially the result of many possible causes, such as excessive alcohol intake, hepatitis B or C, autoimmune, hereditary and metabolic causes (such as iron or copper overload, Steatohepatitis or non-alcoholic fatty liver disease).

The symptoms and signs of liver failure include tiredness, loss of appetite, nausea, bruising and excessive bleeding, confusion, abdominal pain and swelling, and a yellow tinge to the whites of the eyeballs and skin (jaundice). If the condition becomes worse and the liver continues to fail, other symptoms may develop such as muscle wasting, marked fluid retention(edema), and increased confusion that may progress to a coma. The build up of toxins in the body, contributes to increased confusion(encephalopathy) and swelling of the brain tissue. This is a sign of end stage liver disease.

• What does the Liver do?
• What Happens in Intensive Care?
• How long will your loved one remain in Intensive Care?
• Weblinks

 

What does the Liver do?

The liver is the second largest organ in the body, sitting under the diaphragm and lungs. There are two lobes or sections of the liver, the right and the left lobe. The right lobe is six times larger than the left. The liver is made up of many liver cells called hepatocytes. The liver is an important organ in the body and is responsible for a number of essential functions.

The liver

• Filters the blood and breaks down toxins such as drugs and alcohol.
• Processes old blood cells and stores iron.
• Helps to maintain normal blood sugar level.
• Produces the majority of clotting factors.
• Produces and maintains normal levels of protein in the blood.
• Assists in resisting infections by producing immune factors and removing bacteria from the blood.
• Plays a central role in fat and protein metabolism.

This image was found at Medicinenet

What Happens in Intensive Care?

Often people with liver failure can be treated in hospital without coming to an Intensive Care environment. However if the symptoms of reduced level of consciousness and or bleeding become worse they will be admitted to the Intensive Care Unit (ICU) for close monitoring and organ support.

If your loved one requires Intensive Care for Liver failure he or she

•  will require monitoring using a Bedside Monitors and an Arterial Catheter(Arterial Line)
• You can expect your loved one to have frequent Chest X-rays and blood tests(Blood& Pathology tests in Intensive Care) especially arterial blood gases (ABGs)
• Initially oxygen and respiratory support might be commenced via an oxygen mask or via Non- Invasive Ventilation(NIV) or BIPAP ventilation
• Full ventilation using a Ventilators(Breathing Machine) and a Breathing Tube (endotracheal tube) will usually be required to improve and maintain the oxygen delivery
• Sedation may be used if your loved one is in an induced coma
• Infusion pumps are administering drugs to support your loved ones blood pressure and haemodynamic system, as well as intravenous fluids may be administered via a central venous catheter/ CVC(Central Venous Lines)
• An NG Tube (Nasogastric Tubes) is usually inserted into your loved ones stomach, in order to commence nutrition or to remove fluids
• Urine Output is usually measured hourly, after insertion of a Urinary Catheter
• Liver failure may also lead to kidney failure (renal failure) and the heart and lungs may also require support. Your loved ones neurological state and conscious levels are closely monitored to gauge how bad the brain swelling is. Supportive therapy includes the use of drugs to support blood pressure, and a dialysis machine to support and do the work of the kidneys. The liver has a capacity to regenerate itself and the plan of care is often to support your loved one until this can occur.Sometimes the supportive therapy will be unsuccessful and your loved one will be assessed for liver transplantation. If a liver is unavailable for transplantation or if your loved one is not suitable for transplantation then it is possible that your loved one may not recover.

 

Treatment for liver failure

If detected early enough, acute liver failure caused by an overdose of acetaminophen can sometimes be treated and its effects reversed. Likewise, if a virus causes liver failure, supportive care can be given at a hospital to treat the symptoms until the virus runs its course. In these cases, the liver will sometimes recover on its own.

For liver failure that is the result of long-term deterioration, the initial treatment goal may be to save whatever part of the liver is still functioning. If this is not possible, then a Liver transplant is required. Fortunately, liver transplant is a common procedure that is often successful.

How long will your loved one remain in Intensive Care?

The time spent in Intensive Care differs from Patient to Patient and can vary from a few days to a few months.

Weblinks

• Liver Foundation USA http://www.liverfoundation.org/
• British Liver Trust http://www.britishlivertrust.org.uk/
• Liver Transplantation January 2002 NSW Government Action Plan for Health
• NSWHealth Fact Sheets: Infectious diseases
• Better Health Victoria – the Liver explained
• Health Insite – Liver diseases , Australian Government

Any Questions?

Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.

The information contained on this page is general in nature and therefore cannot reflect individual Patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual Patient. Please refer to the full disclaimer.

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