Liver failure

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Liver failure or liver insufficiency is when the central metabolic organ - the liver - can no longer work properly. Sometimes this develops without a pre-existing liver disease (acute liver failure), in other cases it develops from long-term liver damage (chronic liver failure). Here you can read more about the causes, course and treatment options for liver failure.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. K74K76K70K71K72

Liver failure: description

In the event of liver failure, various functions of the liver gradually fail. This is dangerous because the liver fulfills many vital tasks in the body: It is the most important organ of metabolism and, with an average weight of 1.5 kilograms, it is the largest gland in the human body.

The liver is in the right upper abdomen. Every day it produces around 700 milliliters of bile, builds up various proteins and plays an important role in the hormonal balance and in the body's immune system. Their metabolic function is particularly important: Almost all nutrients that the intestine absorbs - especially proteins, carbohydrates and fats - are then converted, broken down, stored or used further in the liver. The liver is also responsible for breaking down drugs, alcohol and pollutants (“detoxification”).

Various illnesses, a lot of alcohol and a diet high in sugar and fat can strain and change the liver in the long term, so that fatty liver and / or liver cirrhosis can develop. However, this organ can largely maintain its functions for a long time even with a significantly reduced number of functional cells. If liver failure occurs, the liver is already severely damaged - this can either develop chronically (chronic liver failure) or very quickly, for example due to an infection or poisoning (acute liver failure). Either way, liver failure is a dangerous condition that needs to be treated immediately.

Liver failure: symptoms

While many liver diseases go unnoticed in the early stages, when the liver fails, symptoms appear that are quite characteristic. The following signs are considered to be the guiding symptoms of liver failure:

The white in the eyes (sclera) and the mucous membranes turn yellow; in the further course the skin also takes on a yellowish color. Doctors call this jaundice (jaundice).
The affected person can concentrate hard, his facial expressions change, he often gets tired and his eyelids flutter. Liver failure triggers disorders in the brain that are also summarized as hepatic encephalopathy.
Blood clotting disorders also occur, which can be seen, for example, in increased bleeding under the skin. This is called hemorrhagic diathesis.

In addition, signs of liver failure such as a typical breath odor of raw liver can occur (foetor hepaticus). In advanced stages, blood pressure often falls and breathing speeds up. After the person concerned becomes more and more tired and almost only sleeps, he falls into a so-called hepatic coma in the course of hepatic encephalopathy.

Hepatic encephalopathy

Liver failure can also lead to impaired brain function. Read everything about this in the article on Hepatic Encephalopathy.

Liver failure: causes and risk factors

Basically, there are very different causes for liver failure. Liver failure is often preceded by a disease of the liver that has existed for months or years. Ultimately, the various functions of the liver collapse because the body can no longer compensate for the damage that has been caused. In this case one speaks of a chronic liver failure, in the case of a sudden severe deterioration also of an acute-on-chronic liver failure.

Chronic liver insufficiency can develop, for example, when more and more liver cells are destroyed and the tissue scarred (liver cirrhosis) as a result of years of alcohol abuse. Liver failure in cancer is also possible if the liver cells degenerate or a malignant tumor "spreads" from another organ. In some cases, a chronic viral infection such as hepatitis C also takes a severe course and ultimately leads to liver failure.

Acute liver failure means that liver function breaks down without a long-term previous illness. This is much less common; Around 200 to 500 people in Germany develop acute liver failure every year. There can be various reasons for liver insufficiency suddenly developing within a short period of time:

Viral hepatitis: Hepatitis A, B, D or E are viral infections that are usually associated with acute inflammation of the liver. More rarely, the cytomegalovirus and other herpes viruses can also lead to such hepatitis. In some people, this is so severe that it quickly leads to acute liver failure. However, this is rather rare with all forms of viral hepatitis.
Poisoning: In many industrialized countries, the proportion of toxic liver damage as a trigger of acute liver failure is increasing. Mostly behind this is an overdose of drugs such as paracetamol, more rarely also tuberculosis drugs and certain herbal remedies in far too high dosages. Poisoning with mushrooms (such as death cap mushroom), drugs (such as ecstasy) and chemicals can also trigger acute liver failure.

Less common causes of acute liver failure are autoimmune hepatitis, the hereditary disease Wilson's disease and complications during pregnancy - acute gestational fat liver or HELLP syndrome. In up to 20 percent of cases, the trigger of the liver inflammation remains unclear, which ultimately leads to liver failure. Doctors then speak of cryptogenic hepatitis.

Liver failure: examinations and diagnosis

Many people with liver failure have been receiving medical treatment for a long period of time with certain pre-existing conditions and the liver is known to be stressful (chronic liver failure). This makes diagnosis easier. Acute liver failure without previous illnesses is less common - the doctor first asks about the medical history (anamnesis) and inquires about drug and alcohol consumption, other toxic substances, stays abroad and possible sources of infection for a viral infection. Sometimes liver failure is so advanced that the person is confused or unconscious - in which case relatives are asked if possible.

Clinical symptoms such as jaundice and fluttering eyes can quickly lead the doctor to think that the liver is not working properly. During a physical exam, he will feel the upper abdomen, and he will be able to feel whether the liver is enlarged or reduced. He also takes blood to diagnose liver failure - various laboratory values in the blood count (such as coagulation parameters, bilirubin, ammonia) confirm the suspicion of chronic or acute liver failure.

The further examinations depend on the suspected cause, the symptoms and the course of the liver insufficiency. Sometimes the doctor will take a sample of liver tissue for a laboratory test (liver biopsy); Imaging procedures such as a special ultrasound examination (duplex sonography) or a chest x-ray can also be helpful. Sometimes the blood pressure in certain vessels is measured with a catheter. If there is a suspicion of an accumulation of fluid in the brain (cerebral edema), the doctors can measure the intracranial pressure with a probe through a small hole in the skull.

Liver failure: treatment

Acute or acute-on-chronic liver failure requires immediate therapy in an intensive care unit. The treatment depends primarily on the trigger of the liver damage - therefore, an accurate diagnosis is very important. For example, patients in whom the liver failure is due to poisoning are given a gastric lavage immediately and, if possible, an antidote. Antiviral therapy can be useful for certain viral infections such as hepatitis B.

In addition, in the case of liver failure, symptoms such as derailed blood values are treated as well as possible, for example by infusions with glucose, electrolytes (blood salts) or blood plasma with coagulation factors. Doctors usually use special enemas to lower the ammonia concentration in the intestines. In the case of increased intracranial pressure, various medications are also used to lower intracranial pressure.

Liver failure: therapy through a transplant

In some cases - especially if the liver is damaged - there is little chance that the organ will recover and resume its functions. In that case, patients are immediately transferred to a transplant center, where they can get a new liver as soon as possible. If necessary, it is sufficient to replace only the left lobe of the liver (auxiliary partial orthotopic liver transplantation, APOLT).

So-called extracorporeal liver replacement procedures such as special liver dialyses are being tested in medical practice and are not yet a standard therapy.

Liver failure: prevention

To prevent liver failure, it is important to contain the risk factors for various liver diseases and poisoning. The following measures are useful for this:

Make sure you drink alcohol in moderation.
Avoid excessive sugar and fat in your diet.
Always have chronic diseases (such as diabetes) properly treated and adjusted.
Refrain from drugs; pay attention to the use of sterile needles if necessary.
Protect yourself with condoms during sexual intercourse if you are not certain about possible infections of the sexual partner.
Before traveling abroad, make sure that you have adequate vaccination protection (e.g. against hepatitis A and B).
Pay particular attention to the rules of food and drinking water hygiene when traveling abroad.
Strictly adhere to the recommended dosages when taking any medication. Keep them out of the reach of children.
Avoid eating mushrooms and plants whose species and origin you are unsure of. Poisoning can cause acute liver failure.

Liver failure: disease course and prognosis

Liver failure is a serious condition that needs to be treated immediately. The various functions of the liver are vital for the body to survive - if treatment is late, the prognosis is poor. The younger the person affected and the lower the severity of the underlying disease, the higher the chances of recovery. Acute liver failure can usually be treated more successfully than acute-on-chronic. Even milder symptoms of hepatic encephalopathy are usually associated with a better prognosis.

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