Liver failure Liver failure is a liver damage caused by various factors such as viral infections, alcohol, drugs, hepatotoxic substances, etc., leading to severe impairment or decompensation of the liver's synthetic, excretory, and metabolic functions. This results in a complex set of clinical symptoms primarily characterized by coagulation dysfunction, jaundice, hepatorenal syndrome, hepatic encephalopathy, and ascites. Liver failure often has a high mortality rate, is difficult to treat, and has a poor prognosis.

Liver failure is liver damage caused by various factors such as viral infections, alcohol, drugs, hepatotoxic substances, leading to severe impairment or decompensation of the liver's synthesis, excretion, and biotransformation functions. It presents a complex set of clinical symptoms primarily including coagulation dysfunction, jaundice, hepatorenal syndrome, hepatic encephalopathy, ascites, and others. Liver failure often has a poor prognosis, high treatment difficulty, and high mortality rate.

The early symptoms of liver failure are nonspecific, including fatigue, nausea, loss of appetite, and diarrhea. As liver failure progresses, gastrointestinal symptoms worsen, and typical symptoms gradually appear.

Jaundice symptoms such as yellowing of the skin, yellowing of the eyes, and dark urine;

Coagulation dysfunction symptoms including skin and mucous membrane bruising, petechiae, bleeding, and nosebleeds;

Hepatorenal syndrome symptoms such as decreased or absent urine output;

Hepatic encephalopathy symptoms including confusion, lethargy, stupor, and even coma;

Ascites symptoms such as abdominal distension, pain, and audible "splashing" sounds, indicating the presence of ascites.

Liver transplantation is one of the most effective methods for treating advanced liver failure caused by various reasons. It is more suitable for patients who have undergone active comprehensive medical treatment and/or artificial liver therapy with unsatisfactory treatment outcomes.

Contraindications

Failure of four or more organ systems (liver, kidney, lung, circulatory, brain);

Cerebral edema with brain herniation;

Circulatory failure requiring maintenance with two or more vasopressors, with no significant response to increased vasopressor doses;

Pulmonary arterial hypertension, with mean pulmonary arterial pressure >50mmHg;

Severe respiratory failure requiring maximal ventilatory support or extracorporeal membrane oxygenation support;

Persistent severe infections, sepsis caused by bacteria or fungi, infectious shock, severe bacterial or fungal peritonitis, invasive fungal infections, active pulmonary tuberculosis;

Persistent severe pancreatitis or necrotizing pancreatitis;

Careful evaluation of liver transplantation in cases of severe weakness due to malnutrition and muscle atrophy.

Cerebral edema

Patients may experience headaches, vomiting, restlessness, drowsiness, and even coma. Seizures, paralysis, and even motor aphasia may occur. Treatment may involve the use of mannitol or hypertonic saline for dehydration, administration of human serum albumin to reduce intracranial pressure, and, in cases of uncontrolled intracranial hypertension, mild hypothermia therapy and, if necessary, use of the Li artificial liver support system.

Hepatic encephalopathy

The underlying causes (such as severe infections, bleeding, and electrolyte disturbances) should be addressed first. Adjusting protein intake and nutritional support is also important. It is recommended to consume smaller, more frequent meals during the day and add extra meals at night.

Infection

Prophylactic use of anti-infective agents is not recommended except for patients before and after liver transplantation. If symptoms of infection occur, routine pathogen testing of body fluids (mainly ascites) and blood will be arranged, and medications will be chosen based on pathogen testing and antimicrobial susceptibility testing results. When using broad-spectrum anti-infective agents, a combination of multiple anti-infective agents and corticosteroids may be used to prevent secondary fungal infections.

Hyponatremia and refractory ascites

These are interrelated with complications such as acute kidney injury and can be treated with diuretics, albumin infusion, and paracentesis.

Acute kidney injury and hepatorenal syndrome

Upon admission, measures to correct hypovolemia, control infections, and avoid nephrotoxic drugs are generally arranged to prevent these complications. If they occur, vasopressors or albumin therapy may be used to improve kidney function.

Gastrointestinal bleeding

Upon admission, doctors generally use H2 receptor antagonists or proton pump inhibitors for prevention, while improving coagulation function and reducing portal pressure are also effective treatment measures for preventing bleeding.

Hepatopulmonary syndrome

If this complication occurs, oxygen therapy is initially provided through nasal cannula, pressure mask, or endotracheal intubation.

Patients should strictly rest in bed and reduce physical exertion. Family members should provide the patient with a diet high in carbohydrates, low in fat, rich in fiber, and with a moderate amount of protein (25g per day) for easy digestion, and suggest changing the eating pattern to small, frequent meals.

It is important for liver failure patients to maintain regular bowel movements. Family members should keep a record of the patient's bowel movements and inform medical staff promptly.

For patients with ascites, they should follow the medical arrangements and limit sodium intake. Patients with hepatic encephalopathy who cannot cooperate with eating will be given nasogastric feeding by medical staff. For patients with gastrointestinal bleeding, family members should strictly follow the fasting and water restriction arrangements provided by medical staff and record changes in urine output over 24 hours.

Maintain a healthy lifestyle;

Quit smoking, drink alcohol in moderation, and for patients with existing liver disease, abstain from alcohol;

Receive timely hepatitis vaccination;

Avoid sharing needles, razor blades, or toothbrushes, use condoms during sexual activity, and avoid viral hepatitis infection;

Seek early intervention when exposed to viral hepatitis;

Follow medication instructions and adhere to doctor's prescriptions;

When seeking medical treatment for a specific illness, inform the doctor of the medications, supplements, herbs, etc., being taken;

Do not consume wild mushrooms, and avoid eating wild animals raw.

When in contact with chemical toxins, ensure proper ventilation in the room, or wear gloves, long sleeves, a hat, and a mask to reduce respiratory and skin absorption of toxins.