Health

What Causes of Liver Failure at a Young Age

April 12, 2022

Overview

Liver failure is a critical medical condition. It occurs when a significant part of the liver is damaged and unable to perform vital functions. Most liver disease is preventable. Only about 5% of deaths are attributable to autoimmune and genetic disorders. Over 90% are due to three main risk factors: alcohol, viral hepatitis, and obesity.

What is Liver Failure?

The liver is a vital organ that performs several essential including:

Making blood proteins that aid in clotting, transporting oxygen, and supporting the immune system.
Manufacturing bile, a substance needed to help digest food.
The liver helps the body store sugar (glucose) in the form of glycogen.
Cleansing the body of harmful substances in the bloodstream, including drugs and alcohol.
Breaking down saturated fat and producing cholesterol.

When liver failure occurs, the liver does not perform these vital functions. Liver failure is a life-threatening condition that produces chronic complications and requires immediate medical attention. There are two types of liver failure based on liver damage:

Acute: Acute liver failure is a medical condition when the liver stops working within days or weeks. It occurs in a person who has no preexisting liver disease. The common cause of acute liver failure is hepatitis or drugs, such as acetaminophen. Acute liver failure is less common than chronic liver failure, which develops more slowly.

Chronic: Chronic liver failure occurs when damage to the liver builds up over time and causes it to stop working. The primary cause of chronic liver failure is long-term alcohol use.

Causes of Acute Liver Failure:

Acute liver failure occurs when liver cells are damaged rapidly within days or weeks and unable to perform vital functions. Acute liver failure happens suddenly, often in response to an overdose or poisoning. The potential causes include:

Acetaminophen overdose: Acetaminophen is commonly known as paracetamol. The overdose of acetaminophen is the most common cause of acute liver failure. Acute liver failure can occur after taking one higher dose of acetaminophen. Or after higher than recommended doses every day for several days. If someone has taken an acetaminophen overdose must seek medical attention as quickly as possible. The person should not wait for the signs of liver failure. Treatment may prevent liver failure.

Prescription medications: Some prescription medications may also cause acute liver failure. These medications include antibiotics, nonsteroidal anti-inflammatory drugs, and anticonvulsants.

Herbal supplements: Herbal drugs and supplements may cause acute liver failure. The consumption of kava, ephedra, skullcap, and pennyroyal, have been linked to acute liver failure.

Hepatitis and other viruses: Hepatitis A, hepatitis B, and hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include the Epstein-Barr virus, cytomegalovirus, and herpes simplex virus.

Toxins: Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides. Carbon tetrachloride is another toxin that can cause acute liver failure. It is an industrial chemical found in refrigerants and solvents for waxes, varnishes, and other materials.

Autoimmune disease: Autoimmune hepatitis is another cause of liver failure. It is a disease in which your immune system attacks liver cells, causing inflammation and injury.

Diseases of the veins in the liver: Vascular diseases can cause acute liver failure. Such as Budd-Chiari syndrome can cause blockages in the veins of the liver and lead to acute liver failure.

Metabolic disease: Rare metabolic diseases, such as Wilson's disease and acute fatty liver of pregnancy, infrequently cause acute liver failure.

Cancer: Whether it is liver cancer or spreads to the liver can cause acute liver failure.

Shock: Overwhelming infection (sepsis) and shock can severely impair blood flow to the liver, causing liver failure.

Heatstroke: Extreme physical activity in a hot environment can trigger acute liver failure.

In some cases of acute liver failure, the person has no apparent cause.

Causes of Chronic Liver Failure:

Chronic liver disease occurs due to liver cirrhosis and lasts over six months. It consists of inflammation (chronic hepatitis), liver cirrhosis, and hepatocellular carcinoma. The most common causes of chronic liver failure include:

Hepatitis B: The disease makes the liver swell and makes it unable to perform vital functions.

Hepatitis C: Long-term hepatitis C causes chronic liver failure.

Long-term alcohol consumption: It is the primary cause of chronic liver failure.

Hemochromatosis: This inherited disorder causes the body to absorb and store too much iron. It can build up in the liver and cause cirrhosis.

Hepatitis A: Hepatitis A is another cause of chronic liver failure. It occurs when a person comes in contact with contaminated food, water, or the infected person.

Autoimmune hepatitis: Autoimmune hepatitis is liver inflammation. It occurs when your body's immune system turns against liver cells.

Cirrhosis: Long-term alcohol drinking can cause cirrhosis. In this condition, scar tissue replaces healthy liver tissue and prevents your liver from working.

Primary sclerosing cholangitis: This disease slowly damages your bile ducts. Young men are at high risk of this disease.

Oxalosis: A condition in which kidneys fail to remove calcium oxalate crystals through the urine. They accumulate in the blood, eyes, bones, skin, muscles, blood vessels, heart, and other organs like the liver.

Wilson's disease: People with this rare inherited disease store too much copper in their brains and liver.

Alpha-1 antitrypsin deficiency: This genetic condition can lead to lung or liver disease.

Liver cancer: People with long-term hepatitis B or hepatitis C may develop cancer.

Liver adenoma: It is an uncommon, benign liver tumor. It happens in women between the ages of 20 and 44.

Fatty liver disease: The extra fat cells can build up in the liver. Nonalcoholic fatty liver disease often affects people with overweight or have high cholesterol. Alcohol-related fatty liver disease affects heavy drinkers.

Alcoholic hepatitis: Liver inflammation that results from bulky or long-term drinking.

Alagille syndrome: A genetic disorder results in fewer bile ducts than normal in the liver.

Primary biliary cholangitis (PBC): This disease destroys the small bile ducts in the long term. Also known by its former name is primary biliary cirrhosis.

Galactosemia: People with this condition cannot process galactose, a sugar found in many foods. It can cause liver damage.

Lysosomal acid lipase deficiency (LAL-D): It is a genetic condition. The person cannot produce an enzyme called lysosomal acid lipase (LAL). It helps the body to break down fats and cholesterol in the cells. As a result, fats stay in your liver and cause damage.

Symptoms of Acute Liver Failure:

Acute liver failure often occurs in people who don't have a preexisting liver condition. It is a medical emergency, and people experiencing symptoms consistent with acute liver failure should seek medical attention immediately.

The symptoms of acute liver failure can include:

Feeling unwell (malaise)
Feeling tired or sleepy
Nausea or vomiting
Abdominal pain or swelling
Yellowing of the skin and eyes (jaundice)
Feeling confused or disoriented

Symptoms of Chronic Liver Failure:

Chronic liver failure is a severe disease with critical complications and symptoms. The symptoms can be divided into two types early and advanced. The early symptoms may include:

Feeling tired or fatigued
Loss of appetite
Nausea or vomiting
Mild abdominal discomfort or pain

As the disease progress, the individual experience some advanced symptoms. The advance stage symptoms include:

Yellowing of the skin and eyes (jaundice)
Easy bruising or bleeding
Feeling confused or disoriented
The buildup of fluid in your abdomen, arms, or legs
Darkening of your urine
Severe skin itching

Complications of Acute Liver Failure:

Acute liver failure often causes complications, including:

Excessive fluid in the brain (cerebral edema): It is a life-threatening condition that causes fluid to develop in the brain. This fluid increases the pressure to build up in your brain. It can lead to disorientation, severe mental confusion, and seizures.

Bleeding and bleeding disorders: A failing liver cannot make enough clotting factors, which help the blood clot. Also, bleeding in the gastrointestinal tract happens in this condition. It may be difficult to control.

Infections. People with acute liver failure are more likely to develop infections, particularly in the blood, respiratory and urinary tracts.

Kidney failure. Kidney failure often occurs after liver failure, particularly in a person with an acetaminophen overdose that damages both your liver and your kidneys.

Complications of Chronic Liver Failure:

Signs and symptoms of chronic liver disease can be nonspecific, such as fatigue, anorexia, weight loss, or depend upon the complication the patient has developed. The following complications may occur in chronic liver disease:

Portal Hypertension (esophageal varices, ascites)
Hepatocellular Insufficiency (e.g., jaundice, hepatic encephalopathy)
Spontaneous Bacterial Peritonitis (SBP)
Hyperestrogenism
Hepatorenal Syndrome
Coagulopathy

1. Portal Hypertension:

Portal hypertension is a term used to describe elevated pressures in the portal venous system. Cirrhosis and hepatic schistosomiasis remain the most common cause of portal hypertension. The following are the consequences of long-standing portal hypertension.

Esophageal varices: a condition characterized by cirrhosis of the liver. It leads to raised portal pressure, which can cause esophageal or gastric varices. Esophageal variceal bleeding is the most common life-threatening complication of CLD.
Caput medusae
Rectal hemorrhoids
Ascites: It is an accumulation of fluid in the peritoneal cavity. In most people, ascites develop later. Clinical findings in such patients are abdominal distension, shifting dullness, and a fluid wave. Tense ascites can lead to shortness of breath or early satiety.

2. Hepatocellular Insufficiency:

It comprises jaundice and hepatic encephalopathy.

Hepatic Encephalopathy: It is a neuropsychiatric syndrome caused by hepatic dysfunction. Detoxification of harmful products of metabolism, e.g., ammonia, occurs in the liver. In chronic liver failure, ammonia detoxification is impaired, leading to an increased ammonia level. Almost 50% of patients can develop hepatic encephalopathy. Depending upon the severity of the disease, there are different grades of hepatic encephalopathy.
- Grade 0/Minimal: Subclinical, normal mental status with minimal changes in memory, coordination, intellectual function, and concentration.
- Grade 1: Trivial lack of awareness, euphoria or anxiety, shortened attention span, impairment of addition or subtraction, altered sleep rhythm.
- Grade 2: Lethargy or apathy, disorientation to time, personality change, inappropriate behavior, dyspraxia, asterixis.
- Grade 3: Somnolence to semi-stupor, responsive to stimuli, confused, gross disorientation, bizarre behavior.
- Grade 4: Coma

The patient may experience any of these symptoms.

Jaundice: Jaundice is a medical condition characterized by yellowish discoloration of the eyes, skin, and mucous membrane. It is because of overproduction or under clearance of bilirubin. Metabolism of hemoglobin or myoglobin produces bilirubin in the spleen. Bilirubin then circulates in the body, bound to albumin. The liver dissociates this complex and converts unconjugated bilirubin into conjugated bilirubin. Jaundice is clinically visible when total bilirubin is greater than 2 mg/dl. In chronic liver disease, the liver does not conjugate bilirubin, which deposits in various body tissues.

3. Spontaneous Bacterial Peritonitis (SBP):

It is one of the acute and painful complications of chronic liver disease. Bacteria (E. coli, Klebsiella, Streptococcus pneumonia) leak into the gastrointestinal tract and infect the ascitic fluid. The infection travels through the ascitic fluid to the peritoneal membrane, causing inflammation. SBP presents with fever, generalized abdominal pain, tenderness, and absent bowel sounds.

4. Hyperestrinism:

In chronic liver disease, the catabolism of estrogen becomes impaired, resulting in excess estrogen in the body. It manifests as palmar erythema, spider angiomas, gynecomastia (enlarged tender subareolar tissue), and testicular atrophy.

5. Hepatorenal Syndrome (HRS):

A hepatorenal syndrome is a form of impaired kidney function that occurs in individuals with advanced liver disease. Individuals with the hepatorenal syndrome have no identifiable cause of kidney dysfunction, and the kidneys are not structurally damaged.

6. Coagulopathy:

The liver produces clotting factors, so the patients with chronic liver disease have coagulopathies and manifest or contribute to easy bruising and bleeding in gastrointestinal tracts.

Stages of Liver Failure:

Liver failure progresses with time and causes complications and damage. Damage from liver disease can accrue in several stages, which increasingly affect liver function.

Inflammation: In this early stage, the liver becomes enlarged or inflamed. Many people with liver inflammation do not experience any symptoms. If the inflammation continues, it can lead to permanent damage.

Fibrosis: Fibrosis happens when an inflamed liver begins to scar. The scar tissue replaces the healthy liver tissue. And the scarred tissue cannot perform the same functions. It can start to affect your liver's ability to function optimally. Fibrosis can be hard to detect because symptoms are not present at this stage.

Cirrhosis: In the cirrhosis stage, severe scarring has built upon the liver. Because there is even less healthy liver tissue, it becomes difficult for the liver to perform proper vital functions. While symptoms may not have been present before, the person begins to experience symptoms of liver disease.

End-stage liver disease (ESLD): People with ESLD have cirrhosis in which liver function has deteriorated dramatically. ESLD is associated with complications such as ascites and hepatic encephalopathy. The condition is irreversible even with treatments and needs a liver transplant.

Liver Disease Diagnosis and Tests:

After experiencing the symptoms, the person must see the doctor. To diagnose the liver failure, your doctor will start by taking your medical history and performing a physical examination. They may then perform a variety of additional tests, including:

Liver blood tests: Liver blood tests assess the levels of various proteins and enzymes in the blood that show the complete picture of liver functions.
Other blood tests: Your doctor may also perform a total blood count (CBC) or test for viral hepatitis or genetic conditions that can cause liver damage.
Imaging tests: An imaging test can take pictures that let your doctor see what is happening in the liver and figure out what is causing the problem. They may recommend Ultrasound, Abdominal computerized tomography (CT) scanning, or Magnetic resonance imaging (MRI)

The doctor will use a needle to remove a small liver tissue piece and look at it in the lab. Since people with acute liver failure are at risk of bleeding during the biopsy, the doctor may perform a transjugular liver biopsy. The doctor makes a tiny incision on the right side of your neck and then passes a thin tube (catheter) into a neck vein, through your heart, and into a vein exiting your liver. Your doctor then inserts a needle through the catheter and retrieves a sample of liver tissue.

Treatment of Liver Failure:

A person with liver disease and liver failure may seek help from specialists called hepatologists. Treatment of liver failure depends on whether it is acute or chronic.

For chronic liver failure, treatment includes changes to the diet and lifestyle, including:

avoiding alcohol or medications that can harm the liver
eating less of certain foods, including red meat, cheese, and eggs
weight loss and control of metabolic risk factors, including high blood pressure and diabetes
cutting down on salt in the diet (including not adding salt to food)

For acute liver failure, treatment includes:

intravenous (IV) fluids to maintain blood pressure
medications such as laxatives or enemas to help flush toxins (poisons) out
blood glucose (sugar) monitoring glucose is given to the patient if blood sugar drops
receive a blood transfusion in case of excess bleeding

Liver transplant: The doctor may recommend a liver transplant for acute and chronic liver failure. Before transplantation, doctors thoroughly screen transplant candidates to ensure that a new organ might help them before placing them on organ waiting lists. During a liver transplant, a surgeon removes the damaged liver and replaces it with a healthy liver from a donor. Some transplant centers can replace a damaged liver with a portion of a healthy liver because the liver can regenerate or grow back.

Medication: Acetylcysteine can reverse acute liver failure caused by an acetaminophen overdose. Mushroom and other poisonings also may be treated with drugs. It can reverse the effects of the toxin and may reduce liver damage.

Supportive care: Your medical team will take your blood and urine samples to test for infection. If your doctor suspects you have an infection, you will receive medications to treat the infection. A hospital can treat your symptoms until the virus runs its course. In these cases, the liver will sometimes recover on its own.

Relieving pressure caused by excess fluid in the brain: Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.

Supply nutritional support: Somehow, you are unconscious and unable to eat. The doctor recommends supplements to treat deficiencies.

Risk Factors of Liver Failure:

Certain things can make you more likely to develop certain liver diseases. One of the most well-known risk factors is heavy drinking. Like, 8 alcoholic drinks per week for women and more than 15 drinks per week for men. Other risk factors include:

sharing needles
getting a tattoo or body piercing with nonsterile needles
having a job where you have exposure to blood and other bodily fluids
having sex without using protection against sexually transmitted infections
living with diabetes or high cholesterol
having a family history of liver disease
living with extra weight
being exposed to toxins or pesticides
taking certain supplements or herbs, especially in large amounts
mixing certain medications with alcohol
taking more than the recommended dose of certain medications

Prevention of Liver Failure:

Reduce your risk of acute liver failure by taking care of your liver. You may follow the steps include:

Follow instructions on medications: If you take acetaminophen. Read the package insert for the recommended dosage, and do not take more than that. If you already have liver disease, ask your doctor if it is safe to take any amount of acetaminophen.

Tell your doctor about all your medicines: Consult your doctor about all your medications. Even over-the-counter and herbal medicines can interfere with the prescription drugs you are taking.

Drink alcohol in moderation, if at all: If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men.

Avoid risky behavior: Get help if you use illicit intravenous drugs. Do not share needles. Always use condoms during sex. If you get tattoos or body piercings, make sure the shop you choose is clean and safe. Avoiding smoking makes things worse.

Get vaccinated: If you have chronic liver disease, a history of hepatitis infection, or an increased risk of hepatitis, talk to your doctor about getting the hepatitis B vaccine. A vaccine also is available for hepatitis A.

Avoid contact with other people's blood and body fluids: Accidental needle sticks or improper cleanup of blood or bodily fluids can spread hepatitis. Sharing razor blades or toothbrushes also can spread infection.

Do not eat wild mushrooms: It is hard to tell the difference between a poisonous mushroom and a safe to eat. It is better to shop for a mushroom from a reliable store.

Take care with aerosol sprays: Use an aerosol cleaner in an open room or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint, and other toxic chemicals. Follow product instructions carefully.

Watch what gets on your skin: When using insecticides and other harmful chemicals, cover your skin with gloves, long sleeves, a hat, and a mask.

Maintain a healthy weight: Obesity can cause many problems, and one condition is called nonalcoholic fatty liver disease. It may include fatty liver, hepatitis, and cirrhosis.