Liver failure occurs when the liver rapidly loses its ability to function, resulting in mental status changes and coagulation abnormalities. It can be caused by viral hepatitis, drug toxicity, toxins, or other metabolic issues. Acute liver failure presents as a sudden onset of severe liver injury over days or weeks in someone without pre-existing liver disease. Treatment involves identifying and treating the underlying cause, medications to reduce intracranial pressure and manage complications, and liver transplantation may be required in severe cases.

1. Liver Failure/ Hepatic Failure
By,
Justin V Sebastian
Associate Professor

2. LIVER FAILURE
Liver failure is an uncommon condition
in which rapid deterioration of liver
function results in coagulopathy and
a l t e r a t i o n i n t h e m e n t a l
status( encephalopathy ).
Liver failure indicates that liver has
sustained injury.

3. TYPES OF LIVER FAILURE
FULMINANT
HEPATIC
FAILURE
• Encephalopathy
starts within 8
weeks
Non fulminant
hepatic failure
• Encephalopathy
starts between 8
to 26 weeks

4. ACUTE LIVER FAILURE
Acute liver failure (ALF)
is
a rare condition
characterised by the abrupt
onset of severe liver injury.

5. ALF
•
Acute liver failure is loss of liver function
that occurs rapidly — in days or weeks —
usually in a person who has no pre-
existing liver disease .
•
It's a medical emergency that requires
hospitalization .

6. INCIDENCE
•
In developed country incidence is 10
cases per million people per year.
• It accounts for 6% of all deaths due to
liver disease.
•
It is more common in women than in men,
and more common in white people than in
other races.

7. ETIOLOGY OFALF
•
VIRAL
HEPATITIS
DRUG
INDUCED
HEPATOTOX
ICITY
TOXIN
RELATED
HEPATOTOX
ICITY
VASCULAR
CAUSES
METABOLIC
CAUSES

8. VIRAL HEPATITIS
Virus hepatitis may lead to hepatic failure.
Hepatitis A and B Accounts for most of the
cases.
Atypical causes of viral hepatitis and
fulminant hepatic failure include the following:
Cytomegalovirus, Herpes simplex virus,
paramyxovirus, Epstein-Barr virus

9. DRUG INDUCED HEPATOTOXICITY
• Acetaminophen is the main drug for these type
of hepatotoxicity.
• Acetaminophen (also known as paracetamol )
may lead to liver failure as a result of intentional
or accidental overdose.
• Some kind of antibiotics, antidepressants,
anaesthetic agents, Salicylates are also
associated with hepatotoxicity.

10. TOXIN RELATED HEPATOTOXICITY
Amanita phalloides, mushroom toxin.
Cyanobacteria toxin .
Organic solvents (eg, carbon tetrachloride).
Yellow phosphorus.

11. AMNITAPHALLOIDES

13. METABOLIC CAUSES
Galactosemia (Decreased liver enzyme to break
down )
Reye syndrome. (fatty liver+ encephalopathy )
Wilson disease. (copper accumulation )

14. MALIGNANCIES
•
Primary
liver
tumour
(hepatocellular
carcinoma).
• Secondary
tumour
includes
hepatic
metastasis or breast, lung cancer .

15. Pathophysiology

16. C/M OFALF
▪ Hepatic
encephalopathy
(mental
confusion,
difficulty concentrating and disorientation)
▪ Sudden jaundice .
▪
Pain
and
tenderness
in
the upper
right
side
of
the stomach.
▪ Nausea.
▪ Vomiting.
▪ Melena.

17. • Ascites
(accumulation
of
fluid
in
the
stomach)
• Ankle Edema (accumulation of fluid in the
legs, ankles and feet)
• Feeling ill (Malaise).
• Drowsiness.

18. • Bleeding easily
• Cerebral oedema
• Coma
• Brain herniation.
• Hypotension.
• Tachycardia.
• Hematemesis.

19. DIAGNOSTIC EVALUATION
• History collection.
• Physical examination.
• CBC.
• Prothrombin time (PT) . (9.5-13.5 Seconds )
• Liver enzymes
• Serum bilirubin level, Serum ammonia level.
• ABG.
• Serum Creatinine level,
• Serum free copper

20. •
Blood
cultures:
suspected infection.
For
patients
with
immunoglobulin
M
• Viral
serology:
hepatitis
A
virus
(IgM),
hepatitis
B
surface antigen (HBsAg).
• Drug screening.
• Electroencephalography(EEG)
• Intracranial pressure monitoring.
• Percutaneous (contraindicated in
presence of coagulopathy) or transjugular
liver biopsy.

21. •
Autoimmune
markers
(for
diagnosis):
markers:
Autoimmune
autoimmune
hepatitis
A. Antinuclear antibody (ANA).
B. Anti-smooth muscle antibody (ASMA).

22. MANAGEMENT OFALF
Treatment of acute liver failure consists
of Drugs and liver transplantation.
Pharmacological management
includes certain antidotes to reverse
the effects of ALF and various
medications to reduce ICP.
Antidotes neutralise toxic agents or
counteract any form of poisoning.

23. PHARAMACOLOGICAL INTERVENTION
Penicillin G.
Activated charcoal.
N-Acetylcysteine.
Osmotic diuretics.
Barbiturate.
Benzodiazepine.
Anaesthetic agents.

24. PENICILLIN G
•
Intravenous Penicillin G is the drug of
choice for the treatment of Mushroom
Poisoning from Amanita Phalloides.

25. ACTIVATED CHARCOAL
•
Patients who have recently ingested A.
Phalloides activated charcoal may bind
the toxin and prevent absorption.

26. ACTIVATED CHARCOAL

27. N-Acectylcycteine
•
It is the drug of choice in acetaminophen
overdose.

28. OSMOTIC DIUERETICS
• Intracranial hypertension in acute liver
failure managed by osmotic diuretics such
as Mannitol.
• Mannitol decreases cerebral Edema.

29. BARBITURATE
• Pentobarbital are used when severe
intracranial hypertension does not respond
to any measures.

30. BENZODIAZEPENE
•
Midazolam
is
used
for
sedation
in
mechanically ventilated patients.

31. ANEASTHATICAGENTS
•
Propofol
is
a
sedative
hypnotic
used
to
reduce cerebral blood flow.

32. LIVER TRANSPLANTATION
When acute
liver failure
can't be
reversed, the
only treatment
may be a liver
transplant.
During a liver
transplant, a
surgeon
removes
patient’s
damaged liver
and replaces it
with a healthy
liver .
Liver
transplantation
is indicated for
many patients
with ALF.

33. COMPLICATIONS
Kidney
failure.
Cerebral
Edema.
Bleeding
disorders.
Infections.

34. OTHER INTERVENTIONS
For
coagulopathy/
GIT
bleeding
vitamin
K
can
be given to treat abnormal PT.
Hypotension should be treated with fluids.
Pulmonary
complications
mechanical
ventilation may be required.
Head
of
the
patient
should
be
elevated
to
30
degree .
Neurological
status
should
be
monitored
regularly.

35. NURSING DIAGNOSIS
• Increased risk of dehydration, electrolytes and
metabolic disturbances related to liver damage.
• Increased risk of secondary infections due to
impaired immune state, related to liver
dysfunction.
• Increased risk of haematological complications
related to liver dysfunction.

36. cont
•
Changes in neurological state (Encephalopathy)
due to liver insufficiency.
• Anxiety related to the symptoms of disease and
fear of the unknown.

37. NURSING INTERVENTIONS
•
Assess, report and record signs and symptoms
and reactions to the treatment.
• Monitor fluids input and output closely, observe
signs of dehydration, secondary infections,
neurological disturbances, Edema and jaundice.
• Provide adequate diet with carbohydrates and
vitamins.

38. Cont.
• Administer antibiotics, antiemetic, vitamins and other
medications as prescribed, monitor for side effects.
• Monitor for signs of possible bleeding.
• Provide prescribed diet, rest and comfort measures.
• Provide emotional support to client and his family,
explain all procedure to decrease anxiety and to obtain
cooperation.