Acute Liver Impairment
Definition: Acute liver impairment, or acute liver failure, is a rapid deterioration of liver function that occurs within days to weeks. It is characterised by jaundice, coagulopathy, and encephalopathy in individuals without preexisting liver disease.
Causes:
- Drug-Induced: Paracetamol (acetaminophen) overdose is the most common cause in many countries. Other drugs include certain antibiotics and anti-seizure medications.
- Viral Hepatitis: Hepatitis A, B, and E.
- Toxins: Ingestion of poisonous substances such as certain mushrooms (Amanita phalloides).
- Ischemia: Reduced blood flow to the liver due to conditions like heart failure or shock.
- Autoimmune Hepatitis: Immune system attacks the liver cells.
- Metabolic Diseases: Conditions such as Wilson’s disease. Wilson’s disease is a rare genetic disorder that causes the body to accumulate too much copper. This copper buildup can damage organs, especially the liver and brain, if left untreated.
Symptoms:
- Jaundice: Yellowing of the skin and eyes.
- Confusion and Disorientation: Due to hepatic encephalopathy.
- Nausea and Vomiting
- Abdominal Pain: Particularly in the upper right quadrant.
- Bleeding Tendencies: Due to impaired synthesis of clotting factors.
Diagnosis:
- Blood Tests: Liver function tests (ALT, AST, bilirubin), coagulation profile (INR), and ammonia levels.
- The ALT test measures the level of this enzyme in the blood. Elevated levels of ALT typically indicate liver damage, as the enzyme is released into the bloodstream when liver cells are injured.
- The normal range for ALT is approximately 7 to 55 units per litre of blood.
- The ALP test measures the level of this enzyme in the blood. Elevated ALP levels can indicate liver disease, bile duct obstruction, or bone disorders.
- The normal range for ALP is approximately 30 to 130 units per litre of blood.
- Imaging: Ultrasound, CT scan, or MRI to assess liver structure and blood flow.
- Liver Biopsy: Sometimes needed to determine the cause and extent of liver damage.
Treatment:
- Supportive Care: Intensive monitoring and supportive measures in an ICU.
- Antidotes: N-acetylcysteine for paracetamol overdose.
- Treat Underlying Cause: Antiviral therapy for hepatitis, immune suppressants for autoimmune hepatitis.
- Liver Transplant: In cases of fulminant liver failure.
Acute Biliary Impairment
Definition: Acute biliary impairment involves the sudden onset of conditions that obstruct the bile flow from the liver to the intestines. This can result in jaundice, cholangitis, or acute pancreatitis.
Causes:
- Gallstones: Most common cause, blocking the bile ducts.
- Bile Duct Strictures: Narrowing of the bile ducts due to injury or inflammation.
- Tumors: Can obstruct bile flow if located in or near the bile ducts.
- Infections: Bacterial infections such as cholangitis.
Symptoms:
- Jaundice: Yellowing of the skin and eyes due to the buildup of bilirubin.
- Right Upper Quadrant Pain: Severe pain often radiating to the back or shoulder.
- Fever and Chills: Indicative of infection like cholangitis.
- Dark Urine and Pale Stools: Due to obstructed bile flow.
Diagnosis:
- Blood Tests: Elevated liver enzymes (ALT, AST, ALP, GGT), bilirubin levels.
- Imaging: Ultrasound, MRCP (Magnetic Resonance Cholangiopancreatography), ERCP (Endoscopic Retrograde Cholangiopancreatography), and CT scan.
- Endoscopic Procedures: ERCP for direct visualisation and intervention.
Treatment:
- ERCP: To remove gallstones, place stents, or perform sphincterotomy.
- Surgery: Cholecystectomy (removal of the gallbladder) if gallstones are the cause.
- Antibiotics: For bacterial infections causing cholangitis.
- Percutaneous Transhepatic Cholangiography (PTC): For drainage and stenting when ERCP is not possible.