Liver failure is a severe decline in liver function.
What does the Liver do?
The liver is the second largest organ in the body, sitting under the diaphragm and lungs. There are two lobes or sections of the liver, the right and the left lobe. The right lobe is six times larger than the left. The liver is made up of many liver cells called hepatocytes. The liver is an important organ in the body and is responsible for a number of essential functions.
- Filters the blood and breaks down toxins such as drugs and alcohol.
- Processes old blood cells and stores iron.
- Helps to maintain normal blood sugar level.
- Produces the majority of clotting factors.
- Produces and maintains normal levels of protein in the blood.
- Assists in resisting infections by producing immune factors and removing bacteria from the blood.
- Plays a central role in fat and protein metabolism.
There are many causes of liver failure such as hepatitis A, B or C, alcoholism, autoimmune diseases, metabolic disorders, toxins, drugs, fatty liver disease, and chronic biliary obstructions. Sometimes the liver fails for no apparent reason. If the disease is longstanding, liver tissue can sometimes be gradually replaced by extensive scar tissue, leaving small areas of liver cells (“nodules”) that regenerate and attempt to carry out the normal liver functions. This is called cirrhosis of the liver.
The symptoms and signs of liver failure include tiredness, loss of appetite, nausea, bruising and excessive bleeding, confusion, abdominal pain and swelling, and a yellow tinge to the whites of the eyeballs and skin (jaundice). Over time, if the condition becomes worse and the liver continues to fail, other symptoms may develop such as muscle wasting, marked fluid retention, and increased confusion that may progress to a coma. The build up of toxins in the body, contributes to increased confusion and swelling of the brain tissue. This is a sign of end stage liver disease.
What Happens in Intensive Care?
Often people with liver failure can be treated in hospital without coming to an Intensive Care environment. However if the symptoms of reduced level of consciousness and or bleeding become worse they will be admitted to the Intensive Care Unit (ICU) for close monitoring and organ support.
When the patient arrives in ICU they will be placed on a bedside monitor to closely observe their vital signs and supplemental oxygen may be given via an oxygen mask. If the patient is deeply comatose they will require intubation (insertion of a breathing tube) and mechanical ventilation. A urinary catheter and nasogastric tube will also be required. Medications such as n-acetylcysteine may be given intravenously to assist the liver. Blood tests will be done frequently to assess the severity of liver failure. The liver enzymes and clotting factors are monitored as well other essential blood factors. The patient may be given extra blood products to help control bleeding.
Liver failure may also lead to kidney failure (renal failure) and the heart and lungs may also require support. The patient’s neurological state and conscious levels are closely monitored to gauge how bad the brain swelling is. Supportive therapy includes the use of drugs to support blood pressure, and a dialysis machine to support and do the work of the kidneys. The liver has a capacity to regenerate itself and the plan of care is often to support the patient until this can occur.
Sometimes the supportive therapy will be unsuccessful and the patient will be assessed for liver transplantation. The Intensive Care Specialist will approach the Royal Prince Alfred Hospital (RPAH) for advice on this. . The appropriateness and suitability for liver transplantation are assessed, and if appropriate the patient will be transferred to RPAH. If a liver is unavailable for transplantation or the patient is not suitable for transplantation then it is possible that the patient may not recover.
How long will the patient remain in Intensive Care?
The time spent in Intensive Care will differ from patient to patient and can vary from a few days to a few months.
- Page Author: Suzy Dimovski, Acting CNC RPA
- Page Editor : CWPWP
- Page webpublished : April 13, 2006