Therapy

Liver failure is an urgent indication for therapy. Liver failure can sometimes lead to serious and in the worst case to fatal complications, since the liver fulfils vital metabolic functions that cannot be compensated by other organs. A distinction is made between symptomatic and causal therapy of liver failure.

In symptomatic therapy, the aim is to replace all important functions and metabolic products of the liver as far as possible and to stabilize the circulation. First of all, intensive medical monitoring is necessary, as this is an acutely life-threatening situation. The circulation is stabilized.

A control of blood sugar and a good adjustment of its value, as well as the substitution of important electrolytes are also essential for a stable circulation. Drugs that are toxic to the liver should be avoided. The intake is immediately stopped or changed to another medication.

An alcohol leave is also absolutely necessary. A sufficient fluid intake and a balanced, sufficiently caloric diet is aimed for. Contrary to the old doctrine, a protein restriction in the diet is no longer recommended today.

Furthermore, the following therapeutic indications result from the respective symptoms:

Tendency to bleed: Here the substitution of coagulation factors and vitamin K takes place.
Portal vein hypertension: When there is high blood pressure in the liver vessels, blood pressure is lowered with drugs such as propanolol to prevent bleeding when so-called esophageal varices (esophageal varices bleed) burst open, which is often present in liver failure due to liver cirrhosis.
Albumin deficiency: Albumin deficiency can lead to oedema and abdominal fluid. Albumin is substituted and in the case of abdominal fluid, a puncture or drug treatment with spironolactone can be performed.
Cerebral edema: This is where mannitol is administered and blood pressure is adjusted
Hepatorenal Syndrome: Here, treatment with terlipressin and and albumin as well as intensive medical care is provided. Healing can only be achieved by a liver transplant.
Hepatic encephalopathy: In the mild stage (up to stage 2) only outpatient treatment is necessary.
Lactulose is administered, which ultimately results in less ammonia (the cause of hepatic encephalopathy). Should the therapy with lactulose fail, the active ingredient ornithine aspartate is used. In advanced stages, in-patient care is necessary.

Besides the general measures for liver failure, laxative measures and the administration of broad-spectrum antibiotics are the main focus here.

The causal therapy of liver failure depends on the underlying disease responsible for it: Ultimately, however, in about 50% of patients with liver failure or liver insufficiency, a liver transplantation is eventually necessary as a curative therapy. Some underlying diseases such as PBC (primary cheap cirrhosis) or PSC (primary sclerosing cholagitis) can only be cured by this alone. The time until liver transplantation can be bridged with liver dialysis.

For cancer patients, therapy depends on the stage of their cancer and the degree of metastasis and residual liver function. Both surgical and conservative procedures are possible. Liver transplantation can only be performed here in the case of cancer without metastasis or vascular invasion.

Viral hepatitis: Antiviral therapy is being sought here.
Poisoning with drugs or poisons: Here it is important to remove the toxins. This is attempted with measures such as gastric lavage, plasmapheresis or forced diuresis as well as with specific antidotes and drugs.In case of poisoning with Paracetamol®, acetylcysteine is administered. Poisoning with the tuber leaf fungus is treated with penicillin and silibinin.
Hemochromatosis: Here bloodletting is the therapy of choice.
Wilson’s disease: This is treated with chelating agents and zinc salts.