Acute Liver Faliure Treatment Hospital in Mumbai, India

Acute Liver Failure Unit is a dedicated unit offering comprehensive care to patients suffering from acute liver failure which is the development of sudden, severe hepatic dysfunction from an acute insult to the liver, associated with the onset of hepatic encephalopathy and coagulation abnormalities.

Our multidisciplinary team of highly qualified transplant surgeons, hepatologist, gastroenterologist, anaesthesiologist and other supporting staff works together to ensure quality care and successful recovery.

In certain situations, the diagnosis of ALF may be delayed if a patient is experiencing minimal jaundice with altered mental status and absence of other features of ALF. Therefore, in such cases, it is necessary to have a high index of suspicion as early intervention. This is important to decrease morbidity and mortality.

The management of ALF must include:

  • Early identification of the aetiology of ALF and initiation of specific treatment is a must.
  • Symptomatic and supportive management of ALF (with an early transfer to the intensive care unit).
  • Discussion with liver transplant specialists must be held at the earliest and if required a patient must be immediately transferred to the liver transplant unit.

Since ALF is associated with significant morbidity and mortality. Therefore, we at the unit promote aggressive management of ALF and its complications. It has been observed that liver transplantation is the only life-saving modality in many patients with ALF. However, for patients, who are ineligible for transplants we offer plasma exchange therapy to improve their survival outcomes.

Our unit offers cutting edge technology that helps in the early identification of ALF, as it is very important to decrease mortality.

Definition of Acute Liver Failure

Acute Liver Failure (ALF) is a rare disease caused due to loss of functioning of the liver associated with a high risk of mortality. It is usually common in people without pre-existing liver disease and causes rapid deterioration of liver function within days. Severe liver dysfunction caused due to acute liver failure (ALF) can result in multi-organ failure and even death. Patients suffering from ALF are managed at the advanced intensive care unit. Our team of expert doctors recognise the early signs of ALF and employ appropriate lifesaving interventions like liver transplantation.

The most widely accepted definition for the study of liver diseases is evidence of coagulation abnormality usually,

  • International Normalized Ratio (INR) ≥ 1.5
  • Neurological dysfunction with any degree of hepatic encephalopathy (mental alteration)
  • No prior evidence of liver diseases
  • Diseases course ≤ 26 Weeks

Types of Acute Liver Failure

Based on the interval between the development of jaundice and the onset of encephalopathy, acute liver failure (ALF) is classified into 3 categories

  • Hyperacute Liver Failure: After the development of jaundice, the onset of encephalopathy is less than 7 days.
  • Acute Liver Failure: After the development of jaundice, the onset of encephalopathy is 8 to 28 days.

Sub-Acute Liver Failure: After the development of jaundice, the onset of encephalopathy is more than 5 weeks but less than 12 weeks

Stages of Acute Liver Failure

The primary stages linked with acute liver failure include:

- Inflammation: The liver inflammation is the first stage associated with acute liver failure.

- Fibrosis: If the patient does not undergo treatment, scarring occurs on the inflamed liver.

- Cirrhosis: In this stage, the patient experiences symptoms related to cirrhosis.

- End-stage liver disease (ESLD): In this stage, the patient’s condition is severe.

Signs and Symptoms of Acute Liver Failure

Based on the aetiology of ALF, the timing and indications of the clinical features of ALF may vary. The major indications of ALF range from simple symptoms to severe ones. These include

Simple Symptoms

  • Abdominal pain
  • Fatigue
  • Malaise
  • Nausea
  • Vomiting

 Severe Symptoms

  • Hypotension
  • Sepsis
  • Hepatic encephalopathy (drowsiness, confusion, cognitive impairment, slowed mentation, and euphoria to deep coma)

With these symptoms, patients may also develop coagulation abnormalities (Prolonged PT/INR). This increases the risk of bleeding. However, due to further testing the chances to diagnose ALF may be delayed or even missed and the opportunity to provide definitive therapy is also lost. Therefore to make an early diagnosis of ALF, it is important to have a high index of suspicion.

Causes of Acute Liver Failure

The most common causes of acute liver failure include:

- Chronic infections such as Hepatitis A, B and E viruses, Herpes Simplex virus

- Autoimmune hepatitis

- Metabolic diseases

- Drugs such as Rifampicin and Sodium valproate

- Liver cancer

- Budd-Chiari syndrome (vascular disease)

Possible Complication of Acute Liver Failure

- Infections related to blood, urinary tract and respiratory system

- Bleeding disorders

- Excessive fluid in the brain

- Kidney failure

Treatment of Acute Liver Failure

Liver Transplant

With proper diagnosis and evaluation, our team of doctors make an early decision of whether or not a patient is a candidate for liver transplantation (LT). If a patient requires a liver transplant then early transfer to our state-of-the-art transplant unit is recommended to initiate simultaneous liver transplant evaluation and ALF management. Liver transplant has shown remarkable improvement in the condition of patients suffering from ALF.

We at the unit perform liver transplants from both deceased (a person who is declared brain dead) donors and living (a relative or a living person who is a perfect match) donors with great success. We also perform auxiliary liver transplantation in which a patient’s own healthy part of the liver is left in place and the diseased part is replaced with a partial left or right lobe from the donor. Thereby, providing hepatic function until the native liver of the patient regenerates.

Precautions for Acute Liver Failure

- Consult a doctor and information regarding current medication regime

- Avoid contact with other individuals blood or body fluids

- Maintain a healthy weight

- Get vaccinated for hepatitis A and B.

Risks of Acute Liver Failure

The most common risk factors of acute liver failure include obesity, heavy alcohol use, and type 2 diabetes.

Prognosis

Patients with acute liver failure need to take good care of their health as the mortality rates recorded among the patients diagnosed with mortality percentage ranging from 65% to 85%.

Diagnosis for Acute Liver Failure

The doctor diagnoses the condition with the help of blood tests, imaging tests, and liver tissue examination.

Pathophysiology

Here there is a loss of synthetic function associated with jaundice and coagulopathy. Hepatic encephalopathy development is also associated with it.

Our Medical Experts

If you are facing any similar signs or symptoms please contact the Nanavati Max team to schedule an appointment at : +91 22 6836 0000

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