Liver failure occurs with signs of hepatic encephalopathy due to severe acute or chronic liver disease. Acute liver failure, often caused by hepatitis or paracetamol toxicity, is marked by rapid decline in liver function, while chronic liver failure, commonly from cirrhosis, leads to persistent physiological impairment. Treatment typically involves liver transplantation, and complications can include renal failure and multi-organ failure.

1. LIVER FAILURE
DR MASUDI

2. INTRODUCTION
Hepatic failure is defined as the occurrence of signs or symptoms of
hepatic encephalopathy in a person with severe acute or chronic liver
disease.
 Acute liver failure is an uncommon syndrome in which hepatic
encephalopathy, characterized by mental changes progressing from
confusion to stupor and coma, results from a sudden severe
impairment of hepatic function.
Chronic liver failure develops when the functional capacity of the
liver can no longer maintain normal physiological conditions
The term 'hepatic decompensation' or 'decompensated liver disease'
is often used when chronic liver failure occurs

3. CAUSES OF LIVER FAILURE
Acute Liver Failure
Any cause of liver damage can produce acute liver failure, provided it
is sufficiently severe, hepatitis is the most common cause world-wide.
 Paracetamol toxicity

4. CAUSES OF LIVER FAILURE
Chronic Liver Failure
The most common cause is cirrhosis
Alcoholic hepatitis

5. Clinical Features of Liver Failure
The first signs of hepatic encephalopathy can be subtle and
nonspecific change in sleep patterns, change in personality, irritability,
and mental dullness.
 Thereafter, confusion, disorientation, stupor, and eventually coma
supervene.
Physical findings include asterixis and flapping tremors of the body
and tongue.
Fetor hepaticus refers to the slightly sweet, ammoniacal odor that is
common in patients with liver failure, particularly if there is portal-
venous shunting of blood around the liver.

6. Features of Chronic Liver Failure
Prolonged prothrombin time
 Low albumin
Jaundice
Portal hypertension
 Variceal bleeding
Hepatic encephalopathy
Ascites
Spontaneous bacterial peritonitis
Hepatorenal failure

7. Differential Diagnosis
Hypoglycaemia
Delirium tremens
Drug or alcohol intoxication
Wernicke's encephalopathy
Primary psychiatric disorders

8. Investigations
Laboratory
Serum elevations of alkaline phosphatase and alfa fetoprotein (AFP)
are common.
LFT
 AFP levels >500 ug/L are found in about 70 to 80% of patients with
hepatocellular carcinoma.
Imaging Procedures
Ultrasound
CT -Abdomen scanning
MRI

9. Treatment
Liver transplantation is the definitive management

10. Complications of Acute Liver Failure
Hypoglycaemia
 Metabolic acidosis
Infection (bacterial, fungal)
Renal failure
Multi-organ failure (hypotension and respiratory failure)

11. quiz
• What are the causes of liver cirrhosis?
• What are the complications of Liver cirrhosis?
• What are the factors which predispose to hepatoma?
• What are the differential diagnoses of hepatoma?
• What are the liver diseases which can lead to liver failure?
• What are the clinical features of liver failure?