Definition
Acute liver failure (ALF) is a rare but a life-threatening condition.
ALF causes severe injury and massive necrosis of hepatocytes
resulting in severe liver dysfunction that can lead to multi-organ
failure and death. It can occur in patients without preexisting liver
disease and cause rapid deterioration of liver function within
days. Patients with ALF are almost always managed in an intensive
care unit and in some cases need a liver transplantation to
prevent death. Therefore, all physicians need to recognize the
early signs of ALF and employ appropriate lifesaving
interventions.
Causes
Acute liver failure occurs when liver cells are damaged significantly
and are no longer able to function. Potential causes include:
 Acetaminophen overdose.
 Prescription medications.
 Herbal supplements.
 Hepatitis and other viruses.
 Toxins.
 Autoimmune disease.
 Diseases of the veins in the liver.
 Metabolic disease.
 Cancer.
 Shock.
 Heat stroke.
pathogenesis
The pathophysiology depends on the etiology of the ALF. Most
cases of ALF (except acute fatty liver of pregnancy and Reye
syndrome) will have massive hepatocyte necrosis and/or
apoptosis leading to liver failure. Hepatocyte necrosis occurs due
to ATP depletion causing cellular swelling and cell membrane
disruption.
Diagnosis
The doctor may then recommend the following:
 Blood tests. A group of blood tests called liver function tests may be
used to diagnose liver disease. Other blood tests may be done to
look for certain liver problems or genetic conditions.
 Imaging tests. Ultrasound, CT scan, and MRI scans can show liver
damage.
 Examine the tissue sample. A liver biopsy is often done using a long
needle inserted through the skin to extract a sample of tissue that is
sent to a laboratory for testing.
Treatment
Treatment for liver disease depends on the diagnosis.
 Some liver problems can be treated with lifestyle modifications,
such as stopping alcohol or losing weight, usually as part of a
medical program that includes careful monitoring of liver
function.
 Other liver problems can be treated with medication or may
require surgery.
Treatment of liver disease that causes or eventually leads to liver
failure may require a liver transplant.
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