ACUTE AND CHRONIC LIVER INSUFFICIENCY / ACUTE LIVER FAILURE & CHRONIC LIVER FAILURE
Liver insufficiency refers to the diminished ability of the liver to perform its normal metabolic and synthetic functions.
Types of liver insufficiency:
- Acute liver insufficiency: develops rapidly, often due to viral hepatitis, drug-induced liver injury, or other acute causes.
- Chronic liver insufficiency: develops slowly over months or years, often due to chronic hepatitis, cirrhosis, or other long-standing liver diseases.
Definition
- Acute Liver Failure: Sudden loss of liver function in a person with no pre-existing liver disease.
- Chronic Liver Failure: Gradual loss of liver function over time, often due to underlying liver disease.
Types of Acute Liver Failure
- Hepatocellular: Most common type, caused by viral hepatitis, toxins, or other factors.
- Fatty Liver: Caused by excessive fat accumulation in liver cells.
- Vascular: Caused by obstruction of hepatic artery or portal vein.
- Biliary: Caused by obstruction of bile ducts.
Causes of Acute Liver Failure
- Viral hepatitis (A, B, C, D, E)
- Toxins (medications, alcohol, heavy metals)
- Metabolic disorders (Wilson's disease, hemochromatosis)
- Autoimmune disorders (primary biliary cholangitis)
- Cancer (liver cancer or cancer spreading to liver)
- Pregnancy-related liver damage
Clinical Features of Acute Liver Failure
- Jaundice
- Enlarged liver
- Abdominal pain
- Nausea and vomiting
- Fatigue
- Confusion or altered mental status
Investigations for Acute Liver Failure
- Liver function tests (LFTs)
- Complete blood count (CBC)
- Coagulation studies (prothrombin time, INR)
- Imaging studies (ultrasound, CT scan)
- Liver biopsy (if necessary)
Complications of Acute Liver Failure
- Hepatic encephalopathy
- Coagulopathy
- Infection (sepsis)
- Kidney dysfunction
- Cardiac complications
Management of Acute Liver Failure
- Supportive care (fluid management, nutrition)
- Medications to manage symptoms and complications (lactulose, rifaximin)
- Liver transplantation (if necessary)
Chronic Liver Failure
Causes of Chronic Liver Failure
- Hepatitis B and C
- Non-alcoholic fatty liver disease (NAFLD)
- Alcoholic liver disease
- Primary biliary cholangitis
- Primary sclerosing cholangitis
- Hemochromatosis
- Wilson's disease
Clinical Features of Chronic Liver Failure
- Fatigue
- Weight loss
- Abdominal swelling
- Jaundice
- Spider nevi
- Palmar erythema
Investigations for Chronic Liver Failure
- Liver function tests (LFTs)
- Complete blood count (CBC)
- Coagulation studies (prothrombin time, INR)
- Imaging studies (ultrasound, CT scan)
- Liver biopsy (if necessary)
Complications of Chronic Liver Failure
- Hepatic encephalopathy
- Coagulopathy
- Infection (sepsis)
- Kidney dysfunction
- Cardiac complications
- Portal hypertension
- Portal varices
Management of Chronic Liver Failure
- Supportive care (fluid management, nutrition)
- Medications to manage symptoms and complications (lactulose, rifaximin)
- Liver transplantation (if necessary)
Homoeopathic Therapeutic Medicines for Liver Failure
- Phosphorus: For liver congestion, jaundice, and fatty liver.
- Natrum muriaticum: For liver cirrhosis, ascites, and edema.
- Arsenicum album: For liver inflammation, jaundice, and skin lesions.
- Lycopodium: For liver enlargement, jaundice, and abdominal pain.
- Chelidonium: For liver congestion, jaundice, and gallstones.
Important Points
- Liver transplantation is the only definitive treatment for end-stage liver disease.
- Liver failure can occur in anyone, regardless of age or health status.
- Early detection and treatment of liver disease can prevent liver failure.
- Liver failure is a medical emergency requiring prompt attention.
- Liver transplantation should be considered for patients with severe liver disease.
Pathophysiology:
- Liver damage or loss of liver cells leads to decreased production of proteins, clotting factors, and other essential substances.
- Reduced liver function leads to the accumulation of toxins, waste products, and metabolites.
- Impaired liver function can cause a range of complications, including coagulopathy, encephalopathy, and ascites.
Diagnostic tests:
- Liver function tests (LFTs): measure liver enzyme levels, such as ALT and AST, and assess liver synthetic function, including albumin and bilirubin levels.
- Coagulation profile: evaluates liver function by assessing clotting factor levels, including prothrombin time (PT) and partial thromboplastin time (PTT).
- Imaging studies: include ultrasound, CT, and MRI to assess liver morphology, detect focal lesions, and evaluate for signs of cirrhosis or liver cancer.
Complications:
- Hepatic encephalopathy: a brain disorder caused by liver dysfunction, characterized by confusion, altered mental status, and coma.
- Variceal bleeding: bleeding from enlarged, fragile veins in the esophagus or stomach, often due to portal hypertension.
- Hepatorenal syndrome: a type of kidney failure caused by liver disease, characterized by decreased kidney function and fluid overload.
Management:
- Medical management: focuses on treating the underlying cause of liver insufficiency, managing complications, and supporting liver function with medications and nutritional supplements.
- Transplantation: considered for patients with end-stage liver disease, acute liver failure, or severe complications.
Homoeopathic therapeutics:
- Arnica: for liver and spleen congestion
- Calcarea carbonica: for liver and gallbladder issues
- Chelidonium: for liver and bile duct inflammation
- Lycopodium: for liver and pancreatic issues
- Natrum muriaticum: for liver and gallbladder issues
- Phosphorus: for liver and pancreatic issues
- Sulfur: for liver and skin issues
- Thuja occidentalis: for liver and gallbladder issues## Acute Liver Insufficiency / Acute Liver Failure & Chronic Liver Failure