As opposed to chronic liver failure, which occurs gradually over time due to the presence of a chronic liver disease, such as hepatitis B or C, cirrhosis, or drug-induced liver damage, acute liver failure occurs much more rapidly. In fact, a patient can go from being healthy to near-death in just a few days. Due to this speed in the patients' deterioration, acute liver failure requires immediate medical intention and careful monitoring in an intensive care setting. Acute liver failure has a number of underlying causes, including:
The liver has a number of vital functions that are affected when acute liver failure occurs, including:
Early signs of acute liver failure tend to be vague, but typically include fatigue, nausea, weakness and loss of appetite. Worsening symptoms appear as the condition progresses, including jaundice (yellow skin), a tendency to bruise or bleed, ascites (abnormal fluid accumulation in the abdomen), and liver encephalopathy (brain dysfunction resulting from liver damage that prevents the metabolization of toxins in the blood). Liver encephalopathy is marked by confusion, disorientation, irritability, sluggishness, drowsiness, insomnia and/or coma. In addition, acute liver failure may be accompanied by a serious condition known as cerebral edema (brain swelling), which is often fatal due to the difficulty associated with controlling increased pressure within the closed, fixed area of the skull. A large portion of the liver must be damaged before acute liver failure can occur, but, in light of the severity of associated symptoms and the liver's critical functions, a patient's prognosis is essentially unpredictable when liver deterioration occurs so quickly. Medical management, which focuses on treating complications related to acute liver failure–including infections, impaired kidney function, low blood pressure, low blood sugars and difficulty breathing–carries with it a survival rate of only 20 to 30 percent; a poor outcome. The option of liver transplant, however, carries with it a much higher success rate–up to 90 percent–for patients who are appropriate candidates.