Definition
Liver insufficiency is a limitation of the metabolic functions of the liver. Liver insufficiency is thus virtually the result or condition of many diseases or organ damage that can impair the metabolic function of the liver. From this perspective, it is difficult to strictly separate liver failure from liver failure. Liver failure represents the maximum manifestation and thus the most severe condition of liver failure. Liver failure very often occurs in the context of chronic liver diseases such as alcoholic liver cirrhosis or chronic viral hepatitis, but it can also be the expression of acute or toxic damage to the liver.
Causes
Structural damage to the hepatocytes (cells of the liver) or disturbed blood circulation in the liver leads to liver failure. The causes can be quite different. The most common cause of chronic liver damage in Germany is alcohol abuse.
Chronic alcohol consumption leads to alcoholic cirrhosis of the liver via various intermediate stages. At this stage, the damage to the liver is irreversible and results in liver failure that cannot be reversed. In addition to alcohol-toxic liver damage, liver damage caused by viral hepatitis must also be mentioned.
Mainly the hepatitis viruses B, C and D lead to chronic or acute viral hepatitis via various transmission routes, which can be accompanied by mild to severe liver failure. In the worst case, viral hepatitis can also lead to liver cirrhosis with irreversible liver failure. Other causes of liver failure are other inflammatory diseases such as PBC (primarily cheap cirrhosis), PSC (primarily sclerosing cirrhosis), autoimmune hepatitis and parasitic diseases (leishmaniasis, bilharzia, malaria).
Among the toxic causes, the non-alcoholic fatty liver diseases and various toxins, such as the poison of the tuber leaf fungus, but also drugs such as methotrexate, amiodarone and paracetamol should be mentioned. A number of different metabolic diseases can also be the cause of liver failure and are regularly associated with liver failure if left untreated, sometimes even treated. Last but not least, diseases of the vascular system such as Cirrhosis Cardiaque, Budd- Chiari Syndrome and Osler’s Disease can be mentioned as causes of liver failure.
- Wilson’s disease (copper storage disease)
- Hemochromatosis (iron storage disease)
- Alpha-1-antitrypsin deficiency
- Glycogen storage diseases and
- The cystic fibrosis. However, this clinical picture is very rare.
Liver failure leads to unspecific symptoms such as fatigue or upper abdominal pain. Diffuse itching and jaundice (skin and scleral icterus) may occur.
The cause of the itching has not yet been fully clarified. The deposition of metabolic products of bilirubin (a breakdown product of the blood) in the skin and sclerae causes yellowing. In underlying liver cirrhosis, the typical signs of hepatic skin such as palmar and plantar erythema (rashes on the palm or back of the hand), spider naevi (fine vascular drawings) or caput medusae (expansion of veins in the region of the navel) are evident.
However, these hepatic signs are not obligatory for liver failure. Liver insufficiency leads to a restriction of important metabolic functions of the liver. It leads to a coagulation disorder in the sense of an increased bleeding tendency, since fewer coagulation factors are produced in the liver.
In addition, there is an albumin deficiency, which leads to oedema and ascites. Furthermore, increased pressure (portal hypertension) in the hepatic vein (portal vein) can lead to the formation of esophageal varices (expansion of veins in the esophagus) and sometimes to life-threatening bleeding and even volume deficiency shock. Such portal hypertension results, for example, from cirrhosis of the liver that has existed for years.
Furthermore, liver insufficiency leads to a disproportion of testosterone to estrogen, so that in men, gynecomastia (feminization) and loss of secondary hair in the sense of a bald belly and chest can occur. These changes are due to a reduction in the hormone effects of testosterone. In women this imbalance leads to amenorrhea (absence of menstruation).
Both sexes are affected by a libido and potency disorder.In liver failure, the liver no longer performs important tasks, such as detoxifying ammonia, so that this metabolic product is increasingly deposited in the body. In the context of a hepatic encephalopathy, this can lead to disturbances of consciousness up to a hepatic coma. This leads to various limitations of consciousness, hand trembling (tremor) and in the worst case to coma. Another complication of liver failure is the hepatorenal syndrome, which leads to acute renal failure with a decrease in urine excretion. The mechanism responsible for its development is not yet fully understood.
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