Acute Liver Failure

Acute liver failure (ALF) is a rapid deterioration of liver function, typically in individuals without pre-existing liver disease. Characterized by jaundice, coagulopathy, and encephalopathy, it demands urgent medical attention. Common causes include drug-induced liver injury (notably acetaminophen overdose), viral hepatitis, and ingestion of toxic substances. Diagnosis involves liver function tests and imaging, while treatment is intensive and multifaceted, focusing on managing complications and underlying causes. In severe cases, liver transplantation is necessary. The prognosis varies, depending on the cause and severity of liver damage. ALF is a medical emergency requiring immediate and specialized care for optimal outcomes.

Common Conditions Treated By The Department

  • Drug-Induced Liver Injury: This is one of the most common causes of ALF, especially overdoses of medications like acetaminophen (Tylenol).
  • Viral Hepatitis: Hepatitis A, B, and E can lead to acute liver failure, especially in cases where they rapidly progress.
  • Autoimmune Hepatitis: This is where the body's immune system attacks liver cells, leading to inflammation and potential failure.
  • Toxic Substance Ingestion: Ingestion of toxic substances, including certain mushrooms (like Amanita phalloides) and chemicals, can cause severe liver damage.
  • Metabolic Diseases: Rare metabolic diseases, like Wilson's disease (a disorder of copper metabolism), can precipitate acute liver failure.
  • Ischemic Hepatitis: Also known as shock liver, caused by a lack of blood flow and oxygen to the liver, often in the context of cardiac failure or sepsis.
  • Malignancy: Rapid infiltration of the liver by malignant cells, such as in cases of acute leukaemia or metastatic cancer, can lead to liver failure.
  • Budd-Chiari Syndrome: A rare condition characterized by blood clots that block the veins draining the liver, leading to liver damage.
  • Pregnancy-Related Liver Disorders: Conditions such as acute fatty liver of pregnancy and HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets).

Key Procedure & Diagnostic Techniques

  • Diagnostic Testing: This includes comprehensive blood tests (liver function tests, coagulation profile, blood count, metabolic panel), imaging studies (ultrasound, CT scan), and sometimes liver biopsy to determine the cause and extent of liver damage.
  • Management of Encephalopathy: This involves monitoring and treating increased intracranial pressure, using medications like lactulose and rifaximin, and providing supportive care to prevent complications associated with altered mental status.
  • Hemodynamic Monitoring: Patients with ALF often require careful monitoring of their blood pressure, heart rate, and oxygenation levels, often necessitating the use of invasive monitoring techniques.
  • Fluid and Electrolyte Management: Balancing fluids, electrolytes, and acid-base status is crucial, especially in patients with renal dysfunction or those developing ascites (fluid accumulation in the abdomen).
  • Blood Product Administration: Given the coagulopathy (clotting disorder) associated with ALF, transfusion of blood products like fresh frozen plasma, platelets, or vitamin K may be necessary.
  • Infection Control: Due to a high risk of infection, patients are closely monitored and treated with antibiotics or antifungal medications as necessary.
  • Nutritional Support: Ensuring adequate nutrition, often through enteral feeding if the patient is unable to eat, is an important aspect of care.
  • Liver Transplantation Evaluation and Surgery: For patients whose liver function does not improve, evaluation for an urgent liver transplant is a key procedure. This involves a multidisciplinary team including hepatologists, transplant surgeons, and other specialists.
  • Renal Support Therapy: In cases where renal failure occurs, renal replacement therapy like dialysis might be required.

Advantages Of The Department

  • Expertise and Specialization: Such departments are staffed by healthcare professionals who are experts in liver diseases, including hepatologists, transplant surgeons, critical care specialists, and specialized nurses. This expertise ensures patients receive the most current and effective treatments.
  • Comprehensive and Coordinated Care: ALF departments provide a multidisciplinary approach, coordinating various specialists required for managing complex cases of liver failure. This includes not just treatment of the liver failure itself, but also management of associated complications and comorbid conditions.
  • Advanced Diagnostic and Treatment Facilities: These departments are equipped with state-of-the-art diagnostic tools for accurate and rapid diagnosis, which is crucial in ALF due to its rapid progression. They also have access to advanced treatment options, including the latest medications and technologies.
  • Liver Transplantation Capability: ALF often requires liver transplantation as a life-saving measure. Specialized departments are typically linked with transplant programs, facilitating quicker and more efficient transplant evaluations and surgeries.
  • Improved Outcomes: Specialized care in ALF departments is associated with better patient outcomes, including higher survival rates, particularly in severe cases where timely, expert care is crucial.
  • Psychosocial Support: They often have resources for psychosocial support, helping patients and families cope with the stress and emotional burden of acute liver failure.

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Meet Our Doctors

Dr. Monika Jain

Chief of Gastroenterology & Hepatology

Interventional Gastroenterology, Hepatology, Medical Gastroenterology, Liver Cirrhosis, Acute Liver Failure, Institute of Gastrosciences

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Dr. Monika Jain

Chief of Gastroenterology & Hepatology

Dr. G.S. Lamba

Chief of Gastroenterology & Hepatology

Interventional Gastroenterology, Hepatology, Medical Gastroenterology, Liver Cirrhosis, Acute Liver Failure, Institute of Gastrosciences

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Dr. G.S. Lamba

Chief of Gastroenterology & Hepatology

Dr. Sawan Bopanna

Senior Consultant – Gastroenterology and Hepatology

Interventional Gastroenterology, Hepatology, Medical Gastroenterology, Liver Cirrhosis, Acute Liver Failure, Institute of Gastrosciences

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Dr. Sawan Bopanna

Senior Consultant – Gastroenterology and Hepatology

Dr. Rafiq

Associate Consultant

Interventional Gastroenterology, Hepatology, Medical Gastroenterology, Liver Cirrhosis, Acute Liver Failure, Institute of Gastrosciences

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Dr. Rafiq

Associate Consultant

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