Liver Failure Treatment in Mumbai

Liver Failure: Early Warning Signs, Symptoms, Treatment Plan and When to Consider a Liver Transplant

Liver failure occurs when the liver becomes severely damaged and can no longer perform its essential functions effectively. It may develop suddenly, known as acute liver failure, or progress gradually over months or years due to chronic liver disease.

Recognising the early warning signs of liver failure are important to know because symptoms can be subtle at first but can lead to serious complications such as jaundice, fluid build-up, internal bleeding, confusion, kidney problems and multi-organ failure.

Not everyone with liver failure needs to be transplanted. Some causes can be improved with timely treatment. Patients with severe or irreversible liver damage may need evaluation for liver transplantation

For Liver Failure and Liver Transplant Evaluation In Mumbai, patients can consult Dr. Aditya J. Nanavati, Director – Multi-Organ Transplant & Hepatobiliary Surgery, Fortis Hospital, Mulund.  He Specializes in liver transplantation, complex hepatopancreatobiliary surgery and abdominal multi-organ transplantation with  Clinical experience across 800+ liver transplants.

If symptoms are progressing rapidly or signs of complications of advanced liver disease are starting to develop, early evaluation by a liver specialist is especially important.

What Is Liver Failure?

The liver carries out many important functions that are essential for our everyday health. These are: 
•    Removing toxins from the bloodstream
•    Processing nutrients and medicines
•    Producing proteins needed for blood clotting
•    Producing bile for digestion
•    Helping maintain fluid balance
•    Supporting immune function

Liver failure develops when extensive liver damage prevents the organ from carrying out these essential functions adequately.

Depending on the speed and background of the disease, liver failure can occur as follows: 
•    Acute liver failure
•    Chronic liver failure
•    Acute-on-chronic liver failure

The cause, severity and likelihood of recovery of the liver differ between these conditions.

What Are the Symptoms and Signs of Liver Failure?

The early symptoms of liver disease can sometimes be non-specific and may overlap with many other conditions.

Early signs of liver failure or deterioration of liver disease may include:

1. Persistent Fatigue and Weakness 

If the liver can’t work normally, you may feel unusually tired, have less stamina and continue to feel weak.

Fatigue alone is not enough to confirm liver failure, but ongoing symptoms, especially in a person with known liver disease, should not be ignored.

2. Reduced Appetite

A reduced desire to eat may occur in patients with worsening liver disease and can contribute to weight loss and poor nutrition.

3. Feeling sick and vomiting

Persistent nausea, vomiting or digestive upset may be associated with worsening liver function.

4. Unexplained Weight Loss
Progressive liver disease can cause poor appetite, reduced absorption of nutrients and loss of muscle.

If you have chronic liver disease and you have unintentional weight loss, you need to see a doctor.

5. Dark Urine

Dark urine may be caused by higher levels of bilirubin and may precede or accompany visible jaundice.

6. Mild Yellowing of the Eyes

Yellowing of the whites of the eyes may be an early sign of increasing bilirubin levels.

As liver dysfunction progresses, the yellowing of the skin may also become more noticeable.

7. Swelling in the Feet or Ankles

Fluid retention can cause swelling in the lower legs and ankles.

Persistent swelling may occur in advanced liver disease and should be considered with other symptoms.

What are the signs of advanced liver failure?

As liver disease progresses, symptoms may become more noticeable and potentially severe.

Important warning signs are:

• Jaundice 
  Jaundice is the yellowing of the skin and eyes due to an increased amount of bilirubin in the blood.

      Progressive jaundice may indicate worsening liver function.

• Ascites or Abdominal Swelling

In advanced liver disease , fluid can accumulate in the abdomen  ascites

Patients may observe:

•  Increasing abdominal size 
• Abdominal tightness
• Difficulty eating large meals
•  Breathlessness due to pressure from fluid
• Ascites is a major sign of decompensated liver disease.

• Vomiting Blood or Black Stools

  
  Cirrhosis can increase pressure within the portal venous system, leading to enlarged veins known as varices.
  If these veins bleed, patients may experience:

• Vomiting blood
• Passing black, tar-like stools
• Sudden weakness or dizziness

In fact, the transplant centers in Mumbai too point out vomiting of blood and black stools as major warning signs of advanced liver disease.

• Confusion or Excessive Sleepiness

When the liver fails to remove toxins from the blood stream, these compounds can affect the brain.

This is called hepatic encephalopathy.

• Symptoms can include: 
•  Forgetfulness
•  Difficulty concentrating
•  Changes in sleep pattern
•  Confusion
•   Unusual behaviour
•   Excessive drowsiness

•  Loss of consciousness in severe cases
  Confusion or unusual sleepiness in a patient with liver disease should prompt urgent evaluation.

   

• Decreased Urine Output or Kidney Failure

Severe liver disease may start to affect kidney function.

Patients may notice less urine output or more swelling. In advanced cases hepatorenal syndrome may develop.

• Recurrent infections

Immune responses may be affected by liver dysfunction, which may predispose patients with advanced liver failure to infections.

Recurrent fevers or infections can be an important sign of deterioration.

• Severe Muscle Loss and Weakness
  Severe chronic liver disease may lead to muscle wasting and severe physical weakness.

This is usually most obvious in the arms, legs and face.

When Are Liver Failure Symptoms an Emergency?

Get urgent medical attention if a patient with known or suspected liver disease develops:

•  Sudden confusion 
•  Extreme sleepiness 
• Unconsciousness 
•  Vommitting blood 
•  black ,Tarry stools 
•  Jaundice that gets worse quickly 
• Abdominal distension, pronounced 
• Trouble breathing 

•  Significantly reduced urine output 

  Acute liver failure in particular can progress rapidly. Specialist evaluation and early consideratinof transplantation may be required in severe cases.
   

What causes liver failure?

There are many different conditions that can lead to liver failure.

• Liver Cirrhosis
  Cirrhosis develops when healthy liver tissue is progressively replaced by scar tissue.
  As cirrhosis progresses the liver may not be able to perform its essential functions and eventually causes chronic liver failure.
• Fatty Liver Disease

In some patients, metabolic fatty liver disease can progress from fat accumulation to inflammation and fibrosis and cirrhosis.

As cirrhosis becomes advanced, patients may be at risk for liver failure.

• Alcohol-Related Liver Disease

Heavy drinking over a long time can damage the liver over and over. This can lead to scarring (fibrosis), cirrhosis and finally liver failure.

• Viral Hepatitis

Chronic hepatitis B and C can cause progressive liver damage.

Severe acute liver damage can also be caused by some viral infections.

• Autoimmune liver disease

Autoimmune hepatitis and other conditions can cause serious inflammation and damage to the liver.

• Drug- or toxin-induced liver injury

Certain medicines, herbal products, toxins or overdoses can severely injure the liver.

This can lead in some cases to acute liver failure.

• Genetic and Metabolic Disorders

Severe liver dysfunction can be caused by diseases such as Wilson’s disease and other inherited metabolic disorders.

What  is Acute  Liver Failure?

Acute liver failure (ALF) is the occurrence of severe liver dysfunction in a person without pre-existing advanced chronic liver disease over a short period of time.

And may be associated with:

• Liver injury caused by drugs 
• Infectious diseases 
•  Autoimmune disorder 
• Toxines  
• Wilson’s disease 
• Other acute liver injury

Patients may initially develop jaundice and then deteriorate rapidly with abnormal blood clotting and hepatic encephalopathy.

Acute liver failure requires urgent assessment as some patients may need emergency liver transplantation. Mumbai transplant programs have also specifically identified acute liver failure as a condition that needs urgent transplant evaluation when recovery is unlikely.

What Is Chronic Liver Disease?

Chronic liver failure develops slowly after prolonged damage to the liver.

It most commonly occurs in people with advanced cirrhosis.

In time patients may develop:

•    Jaundice
•    Hepatic encephalopathy
•    Variceal bleeding
•    Recurrent infections
•    Kidney dysfunction
•    Ascites

These complications developing are often referred to as decompensated liver disease and may result in evaluation for liver transplant.

What Is Acute-on-Chronic Liver Failure?

Acute-on-chronic liver failure, or ACLF, is when a person with pre-existing chronic liver disease experiences a sudden decline.

This can lead to failure of the liver as well as other organs such as the kidneys, brain or the circulatory system.

Symptoms may include: 
•    Ascites
•    Confusion
•    Gastrointestinal bleeding
•    Kidney dysfunction
•    Fever or infection
•    Severe weakness
•    Rapidly worsening jaundice

The current liver programs in Mumbai have found jaundice, ascites, encephalopathy, kidney failure and gastrointestinal bleeding as the major manifestations of ACLF.

Some patients with ACLF may need to be evaluated for a liver transplant.

Can Liver Failure Be Treated Without a Liver Transplant?

In some patients yes.

Treatment depends on:

•  Reason for liver failure 
• Extent of damage 
• If the condition is acute or chronic 
•  Complications present 
• Function of Other Organs

• Likelihood that the liver will recover

  Treatment may include: 

•   Stopping medicines or toxins causing liver injury
•  Antiviral or immune-directed treatment where appropriate
•  Managing infections
•   Treating ascites
•  Managing hepatic encephalopathy
•  Controlling gastrointestinal bleeding
•  Nutritional support
•  Supporting kidney function
•  Intensive-care treatment where required

Some acute liver injuries may recover.

However, established irreversible chronic liver disease usually has less capacity for a significant recovery and transplantation may be required.

When Does Liver Failure Require a Liver Transplant?

A liver transplant should be considered if liver failure is severe or irreversible, and medical therapy is unlikely to restore adequate liver function.

Situations that could lead to transplant evaluation include:

• Decompensated Cirrhosis

Patients with complications such as recurrent ascites, encephalopathy or variceal bleeding may require transplant evaluation.

• Progressive Liver Failure

If liver function continues to worsen despite treatment, transplantation may be an option.

• Acute Liver Failure

Urgent transplantation may be required in patients with severe acute liver failure who are unlikely to recover spontaneously.

• Acute on Chronic Liver Failure

In selected patients with a background of chronic liver disease there may be sudden severe deterioration when transplantation may be considered.

• Selected Liver Cancers

Liver transplantation may be an option for selected patients with hepatocellular carcinoma meeting accepted transplant criteria.

How do doctors determine if a liver transplant is necessary?

A liver transplant specialist looks at much more than one symptom or blood test.

Assessment can include: 
•    Cause of liver disease
•    MELD score
•    Frequency of hospitalisation
•    Presence of ascites
•    Hepatic encephalopathy
•    Variceal bleeding
•    Kidney function
•    Heart and lung health
•    Infection status
•    Nutritional condition
•    Presence of liver cancer
•    Overall fitness for major surgery
•    Severity of liver failure
•    
The goal is to see whether transplantation is better than continuing medical management.

What is the MELD Score?

The MELD score (or Model for End-Stage Liver Disease score) is a tool that doctors use to identify the severity of advanced chronic liver disease.

The higher the score the worse the disease generally .

But MELD is not the only thing that’s considered.

Some patients may have severe complications of advanced liver disease even if the score does not fully reflect their clinical status.

Thus, in the transplant evaluation, the MELD score, symptoms, complications and the general health of the patient are taken into account.

What Tests Are Done Before Liver Transplantation?
 

Patients being evaluated for liver transplant may need:
•    Kidney function tests
•    Blood clotting tests
•    Blood-group testing
•    Infection screening
•    Ultrasound
•    CT or MRI
•    Cardiac assessment
•    Lung evaluation
•    Nutritional assessment
•    Cancer screening where indicated
•    Assessment of overall surgical fitness
•    Liver function tests

Likewise, Mumbai’s transplant programs describe the process of transplant evaluation as multidisciplinary, involving blood tests, imaging and assessment of the heart, lungs, kidneys and other organ systems.

Liver Transplantation from a Living or Deceased Donor

Patients needing transplantation might be offered a liver through either pathway.

Living Donor Liver Transplantation

A healthy donor who is medically qualified donates a portion of their liver to the recipient.

Before the surgery, the donor and recipient are evaluated in detail.

Deceased Donor Liver Transplantation

After finding a suitable patient, a liver from a deceased organ donor is assigned to him according to the relevant organ allocation system.

The choice of option depends on medical urgency, donor availability, compatibility and the assessment made by the transplant team.

Why You Should Get Evaluated for a Liver Transplant Early

Patients shouldn’t wait until they are very far along in liver failure to talk about transplantation.

Early evaluation allows the team to:

•  Recognize potentially reversible causes 
•  Determine the stage of liver disease  
• Handle complications 
•  Improve nutrition 
•  Check heart, lungs and kidney 
• Assess potential living donors 
• Explain living and deceased donor transplant options 
• arrange transplantation as and when required

Timely referral is especially important in acute liver failure as the condition can deteriorate rapidly.

In chronic liver failure, evaluation prior to severe deterioration may enable better planning of suitable treatment.

Why Fortis Hospital, Mulund for Liver Failure and Liver Transplant Care?

Liver failure may require multi-disciplinary expertise across medical treatment, critical care, surgery and transplantation.

Fortis Hospital, Mulund, Mumbai is capable of assessing patients with liver failure, advanced liver disease for liver transplantation and complex hepatobiliary disorders.

Dr. Aditya J. Nanavati, Director – Multi-Organ Transplant & Hepatobiliary Surgery, is a specialist in liver transplantation, living and deceased donor liver transplantation, complex HPB surgery and abdominal multi-organ transplantation. His clinical practice includes more than 800+ liver transplants.

His academic work includes research in acute-on-chronic liver failure, living-donor liver transplantation, ABO-incompatible liver transplantation and robotic donor hepatectomy.

Patients looking for liver failure treatment in Mumbai, liver transplant evaluation in Mumbai or a liver transplant specialist in Mumbai can get their evaluation done on time to know whether the next step should be continued medical treatment or transplantation.

In Mumbai, you can consult Dr. Aditya J. Nanavati and the Liver Transplant team at Fortis Hospital, Mulund for liver failure and liver transplant evaluation.