Liver failure

[JOEYZ]

Liver Failure
Liver failure is a severe deterioration in liver function.

Liver failure can result from any type of liver disorder, including viral hepatitis, cirrhosis, and liver damage from alcohol or drugs such as acetaminophen. A large portion of the liver must be damaged before liver failure occurs. Liver failure may develop rapidly over days or weeks (acute liver failure) or gradually over months or years (chronic liver failure).

Symptoms and Diagnosis
A person with liver failure usually has jaundice, a tendency to bruise or bleed, ascites, liver encephalopathy, and generally failing health. Other common symptoms include fatigue, weakness, nausea, and a loss of appetite. In acute liver failure, a person may go from being healthy to near death within a few days. In chronic liver failure, the deterioration in health may be very gradual until a dramatic event, such as bleeding varices (large, tortuous veins), occurs.

The clinical manifestations alone provide strong evidence of liver failure. Blood tests usually show severely deteriorated liver function.

Prognosis and Treatment
Treatment depends on the cause and on the specific clinical manifestations. The urgency of treatment depends on whether the liver failure is acute or chronic, but the principles of treatment are the same. The person is usually placed on a restricted diet. Protein consumption is carefully controlled: Too much protein can cause brain dysfunction; too little can cause weight loss. Sodium consumption is kept low to help keep ascitic fluid from accumulating in the abdomen. Alcohol is completely avoided because it can worsen the liver damage.

Ultimately, liver failure is fatal if it is not treated or if the liver disease is progressive. Even after treatment, liver failure may be irreversible. In terminal cases, the person may die of kidney failure (hepatorenal syndrome), because liver failure can eventually lead to kidney failure. Liver transplantation (see Section 16, Chapter 187), if performed soon enough, can restore a person to normal health, but it is suitable for only a small number of people with liver failure.
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Liver failure results in impairment of many functions we take for granted. Liver failure mostly arises slowly, over many years, but its progression is usually unnoticed. It can happen from infections, cancer, alcohol or other toxic substances, and genetic causes. Often, when symptoms first appear, already very little liver function is left. Much of the treatment of liver failure is focused upon salvaging whatever liver function is left and avoiding overtaxing the liver. Some few with liver failure will qualify for, and successfully get, liver transplantation. Most, though, will eventually die from the progression of the liver disease, though some, with careful attention to avoiding further stress on the liver, may live for years.

The liver has a multitude of functions: it helps digest food, filters and eliminates certain toxic chemicals in the blood, makes essential proteins, and maintains the level of energy-making compounds in the bloodstream. People with advanced liver failure are jaundiced because bilirubin accumulates in the skin, turning it yellow. The whites of the eyes become bright yellow-orange. Jaundice itself is not painful, but the abnormalities can cause quite troubling itching of the skin. Since certain compounds are not being put into the gut by the liver, bowel movements change from brown to chalky yellow-white. These brown compounds showing up in the urine make it appear quite dark.

With liver failure you may:

Feel weak, slow, and lethargic
Experience muscle tremors and twitches, and, in some cases, seizures
Feel quite itchy
Become confused, sleepy, or lapse into a coma
Have trouble with bleeding
Get a swollen belly and swollen legs
Often, you can delay the onset of confusion by keeping the bowel motion very rapid; for example, with a laxative called lactulose. Sometimes the itching of the skin responds to drugs that bind up some of the toxic chemicals. Nausea and vomiting, when they occur, usually can be suppressed with anti-emetic drugs.

Many people with liver failure get a very swollen abdomen because fluids that usually pass through the liver cannot do so. Fluid in the belly (called "ascites") can stretch the skin tight enough to be uncomfortable or can press against the lungs, making it necessary to remove part of the fluid with a needle. Because the liver is not making the proteins needed in the blood, fluid often seeps out of the bloodstream into the tissues, causing generalized swelling (edema). This swelling affects the belly, legs and arms, and sometimes the face. Elevation of the legs, diuretic medications, and fluid and salt restriction may help these symptoms.

Bleeding is fairly common, because the failed liver is no longer able to make essential clotting substances. For example, there may be oozing from the gums when teeth are brushed and large bruises may appear on the skin. In some cases, bleeding becomes the life-threatening event, usually with bleeding into the stomach. Treatments for this kind of severe bleeding may include interventions to block the blood vessels and transfusions of clotting proteins and of blood.

Unlike some illnesses where there is a particular treatment to consider stopping, such as a ventilator or dialysis, most liver failure patients will not have a single clear issue for decision. Nevertheless, you can decide to forgo any further transfusions if bleeding occurs, and to stop any other aggressive treatment that might sustain your life when complications arise. You should decide about resuscitation and hospitalization. Mostly, living with liver failure is the challenge. Dying from liver failure usually includes the fairly rapid onset of confusion and coma, and thus is a merciful end. Having plans in place in advance for medical treatment decisions and for saying good-bye to friends and family is important to do.

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Anatomy of the liver:
The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm, and on top of the stomach, right kidney, and intestines. Shaped like a cone, the liver is a dark reddish-brown organ that weighs about 3 pounds.

There are two distinct sources that supply blood to the liver, including the following:

oxygenated blood flows in from the hepatic artery
nutrient-rich blood flows in from the hepatic portal vein
The liver holds about one pint (13 percent) of the body's blood supply at any given moment. The liver consists of two main lobes, both of which are made up of thousands of lobules. These lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct. The hepatic duct transports the bile produced by the liver cells to the gallbladder and duodenum (the first part of the small intestine).

Did you know?
The liver can lose three-quarters of its cells before it stops functioning.

In addition, the liver is the only organ in the body that can regenerate itself.

Functions of the liver:
The liver regulates most chemical levels in the blood and excretes a product called bile, which helps carry away waste products from the liver. All the blood leaving the stomach and intestines passes through the liver. The liver processes this blood and breaks down the nutrients and drugs into forms that are easier to use for the rest of the body. More than 500 vital functions have been identified with the liver. Some of the more well-known functions include the following:
production of bile, which helps carry away waste and break down fats in the small intestine during digestion
production of certain proteins for blood plasma
production of cholesterol and special proteins to help carry fats through the body


conversion of excess glucose into glycogen for storage (glycogen can later be converted back to glucose for energy)
regulation of blood levels of amino acids, which form the building blocks of proteins
processing of hemoglobin for use of its iron content (the liver stores iron)
conversion of poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine)
clearing the blood of drugs and other poisonous substances
regulating blood clotting
resisting infections by producing immune factors and removing bacteria from the bloodstream
When the liver has broken down harmful substances, its by-products are excreted into the bile or blood. Bile by-products enter the intestine and ultimately leave the body in the form of feces. Blood by-products are filtered out by the kidneys, and leave the body in the form of urine.

	protein

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[Naughty Nurse]

Very good read!

[strongarm]

ill think ill stay on liver protection for the rest of my life.

[wangright]

great read