Hepatic insufficiency occurs when the liver is no longer able to function and the organ can no longer repair or regenerate.
Hepatic insufficiency is dangerous and requires immediate medical attention.
As a rule, liver damage occurs gradually over the course of years.
However, it can lead to acute hepatic insufficiency that develops rapidly (in less than 48 hours) and it can be difficult to detect it early.
Classification of hepatic insufficiency
- Acute or fulminant hepatic insufficiency means that the damage occurs within eight weeks of the onset of liver disease.
- Protracted hepatic insufficiency (also called subacute) occurs when 8 to 26 weeks have passed since the liver disease.
The difference may not be immediately obvious because the underlying condition may have existed for a long time but has not yet been diagnosed.
- Decompensated chronic hepatic insufficiency occurs when the latent period is over six months.
Type of hepatic insufficiency
- Mild: symptoms include poor digestion, bitter taste in the mouth, loss of appetite, itching and drowsiness;
- Moderate: manifested with fatigue, weight loss, portal hypertension, bleeding, jaundice and bloated abdomen;
- Severe: personality change, bleeding, tremor, portosystemic encephalopathy or hepatic encephalopathy (HE), and coma (terminal patient).
Causes of hepatic insufficiency
There are many causes of liver insufficiency, here are some listed:
- Chronic alcohol abuse.
- Overdose of paracetamol. For alcoholics, a lower dose of this drug is sufficient.
- Toxicity of pharmaceuticals, ciprofloxacin, doxycycline, erythromycin, isoniazid, nitrofurantoin, halothane, statins, cyclophosphamide, methotrexate, disulfiram, flutamide, propylthiouracil, anabolic steroids, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Note: The list is not exhaustive.
- Poisoning by various substances, including fungi or chemicals containing carbon tetrachloride, other organic solvents and phosphorus.
- Herbal remedies, including ginseng, mint oil and the aromatic plant teucrium.
- Illicit drugs such as ecstasy and cocaine.
- Reye’s syndrome.
The viral hepatitis, especially if it is a strain accompanied by co-infection with hepatitis B.
Hepatitis E is similar to hepatitis A in that it occurs in conjunction with contamination of food and water. It is common in India, Asia, Africa, the Middle East and Central America.
It can cause acute hepatitis, but is usually not severe. An exception is pregnancy, because an abortion can be triggered at any stage. If it occurs in the last trimester of pregnancy, it is fatal in 20% of cases.
The infections can also be caused by:
- Epstein-Barr virus,
- Viral hemorrhagic fever.
Hepatic insufficiency can be caused by hepatocellular or metastatic carcinoma.
- Wilson’s disease
- Alpha-1 antitrypsin deficiency
- Fructose intolerance
Diseases in pregnancy
Acute fatty liver during pregnancy – about half develop preeclampsia.
- Budd-Chiari syndrome
- Autoimmune hepatitis
- Possible complication after liver resection
- Unknown cause – 15%
Causes of hepatic insufficiency by type:
The most common causes of chronic hepatic insufficiency are:
- Hepatitis B
- Hepatitis C
- Hemochromatosis (a congenital disease that causes the absorption and retention of too much iron in the body)
Causes of acute hepatic insufficiency can be:
- Overdose of paracetamol (ben-u-ron)
- Virus such as hepatitis A, B and C (especially in children)
- Reactions to certain medications or herbal products prescribed by the doctor
- Consumption of toadstools
Hepatic insufficiency in children
For many reasons, liver function could be disrupted.
In children, the most common reason is biliary atresia.
This occurs when the bile ducts in the liver (ducts that carry bile from the liver) are missing or blocked. If the bile cannot escape from the liver, this causes liver damage or cirrhosis.
The causes of biliary atresia are unknown.
Some children are born with this condition, while others develop it later.
Other reasons why the liver stops functioning include:
- Alagille syndrome: a hereditary disease (genetic) that leads to abnormalities of the liver and other disorders;
- Alpha-1 antitrypsin deficiency: an inherited disease in which the body cannot produce alpha-1 antitrypsin protein, causing damage to the liver and lungs;
- Hepatitis: inflammation of the liver, which can have various causes;
- Wilson’s disease: an inherited disease that leads to the accumulation of copper in the body and can damage many organs.
The causes of acute hepatic insufficiency vary depending on the age of the child.
Infection or metabolic disease at birth are the most common causes of acute hepatic insufficiency in children under 2 years of age.
Older children are more likely to have hepatitis caused by a virus (such as hepatitis A or B) and hepatic insufficiency from medications, such as hepatotoxicity from acetaminophen.
What are the symptoms of hepatic insufficiency?
- Jaundice (caused by increased bilirubin)
- Propensity for bruising or rapid bleeding
- Changes in brain function (encephalopathy)
- Insufficient growth and weight gain
- Loss of appetite
Over time, as the disease worsens and the liver continues to fail to function, other symptoms such as muscle breakdown, fluid retention, and mental confusion may develop, which can progress to coma.
Toxin accumulations in the body lead to greater confusion and cerebral edema.
This is the sign of end-stage liver disease.
Complications of hepatic insufficiency
Acute hepatic insufficiency often causes complications, including:
Excessive fluid in the brain (cerebral edema)
Cerebral edema causes increased pressure in the brain. The consequence is the displacement of a part of the brain from an area where it should be.
Cerebral edema can also deprive the brain of oxygen.
A liver that is not working properly is not able to produce enough clotting factors that serve to clot the blood.
Bleeding from ulcers in the digestive tract or other places is difficult to control because the blood does not clot fast enough.
People with acute hepatic insufficiency have a greater risk of developing infections, especially in the blood, respiratory and urinary tract.
Renal insufficiency often occurs after hepatic insufficiency, especially with an overdose of paracetamol, which can damage both organs.
This is understood to mean a pathologically elevated ammonia content in the blood, it is a medical emergency.
Diagnosis and examinations of hepatic insufficiency
The examinations and analyses used to diagnose acute hepatic insufficiency are:
Blood tests. The blood tests help determine how the liver works.
Among the most important values is prothrombin time, which measures the time required for blood clotting. In acute hepatic insufficiency, the blood does not clot as quickly as it should.
Imaging techniques. The doctor may order imaging tests to evaluate the liver, such as echography.
These examinations reveal the damage to the liver and allow the doctor to arrive at a diagnosis.
Analysis of liver tissue. The doctor may recommend a procedure to remove a small piece of tissue from the liver (liver biopsy).
Liver biopsy can help figure out why the liver is failing.
In people who have an increased risk of bleeding during a biopsy, for example, in the case of acute hepatic insufficiency, the doctor may perform a transjugular liver biopsy.
To do this, a small incision is made on the right side of the neck and a thin tube (catheter) is inserted into a large jugular vein, which then passes through the heart to a vein that leads out of the liver.
The doctor inserts a needle through the catheter and takes a tissue sample from the liver.
The tissue samples are examined in the laboratory to determine the cause of the hepatic insufficiency.
Treatment of hepatic insufficiency
People with acute hepatic insufficiency are treated in the intensive care unit of a hospital, because if the liver stops working, you can die.
If possible, the doctor can treat acute hepatic insufficiency, but in many cases the treatment consists of controlling the complications to give the liver time to recover.
Treatment of acute hepatic insufficiency includes:
Medications for poisoning
The liver poisoned by an overdose of paracetamol or by fungi is treated with drugs that can reverse the effect of the toxin.
In many cases, acute hepatic insufficiency cannot be treated. In such cases, liver transplantation is the only possible treatment.
During liver transplantation, the surgeon removes the damaged liver and replaces it with a donor’s healthy liver.
Treatment of complications
The doctor will control the signs and symptoms and try to prevent complications that may occur due to acute hepatic insufficiency.
Treatment includes medications to reduce the accumulation of cerebrospinal fluid (cerebral edema).
The medical team regularly orders blood and urine checks to test for infections.
If the doctor suspects an infection in the patient, he can prescribe medication to treat the infection.
severe bleeding People with acute hepatic insufficiency often develop bleeding ulcers in the digestive tract.
The doctor may prescribe medications that reduce the risk of bleeding.
If you lose a lot of blood, a blood transfusion can be performed.
Natural remedies for hepatic insufficiency
There are no natural remedies that cure liver insufficiency, but after recovery, you can change your lifestyle to feel better and prevent recurrence.
For example, one should limit the use of medication and alcohol consumption as much as possible.
The diet should be low-fat, especially saturated fats and fried foods should be avoided.
Prognosis and survival rate of patients with hepatic insufficiency
In cases of severe hepatic insufficiency with marked ascites and stage III – IV encephalitis, life expectancy is 1-3 years, and the 1-year survival rate is less than 20%.
Patients who have neither encephalitis nor ascites have a life expectancy of 15-20 years and a 1-year survival rate of about 90%.