Liver failure

Growing up, I always wanted to be a doctor even though I didn’t know where I was going to specialize in. I had my career-defining moment at the point of losing my father to liver disease.

You see after seeing him suffer and lose his life to it, I realized that I had to help others fight it and maybe I could save lives and make a difference.

I already knew the basis around liver disease/failure due to my father living with the disease for over 12 years.

The causes included a reaction to medications that needed the liver for metabolism like paracetamol.

Infection with hepatitis has been recorded to be notorious for causing liver failure.

Hepatitis B was the most notorious of the viruses that caused liver issues.

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My father loved alcohol so much and was happy to abuse it every time. This was the cause of my father's death when I look at how he ended up with liver failure.

Other causes include advanced fatty liver and even eating a wild berry or mushroom could cause liver failure. Eating groundnuts that are almost spoilt could cause a liver to shut down.

By My Upchar, CC BY-SA 4.0, Wikimedia

Although, these later causes are rare.

As a hepatologist, I had diagnosed, treated, and dealt with so many cases associated with the gallbladder, pancreas, and liver but Jerry’s case was the rarest and Most complicated I had seen, maybe it was because I let my guard down in his particular case.

I could remember when he came to the hospital for a diagnosis, he had a few symptoms such as nausea, loss of appetite, fatigue, abdominal discomfort, uncontrollable weight loss, and after taking some medicine he had been prescribed by his local pharmacy and trying to shake it off, and it continued occurring.

He said at that point he began asking a lot of questions and all signs pointed him to his liver.

From what he said, his grandmother had suffered from a liver failure and it immediately clicked in him and he decided to find a doctor who specialized in livers which he was right to.

Most people don't realize that having a liver disease is one of the most common inherited diseases.
Up to one in every 200 people have liver disease aged between 45-54 in the United States.

Interestingly, it was said that when one family member has this disorder, siblings, parents, and children are also at risk.

I began by signing him up for a blood test to see how his liver was working and an imaging test to see what’s going on in his liver and figure out what’s causing the problem.

I silently hoped and prayed that his liver wasn’t failing and something could be done but in my profession, I had come to know that anything could happen.

It only took a few days before his test came out and it had shown that indeed his liver was gradually failing.

There are two types of liver failure.

Acute liver failure in which the liver just fails without having any background disease or pathology.

It is usually sudden in onset and the complications could last for days to weeks to even a lifetime.

Chronic liver failure has a longer time frame to it. There is almost always an underlying condition and this eventually builds and finally, the liver ends up being damaged.

In our meeting after the test, I asked him if there were habits he had such as smoking, drug usage, etc., that triggered his failing liver and he replied by saying he didn’t drink or smoke.

At that point, I realized that I had let myself down by not performing other tests like a test for hepatitis which after further probing was the cause of his grandmother's death.

I simply decided to move on because I thought it was one of those hereditary liver diseases and that was the worst thing to do as a doctor.

There are some rare liver diseases that could be inherited.

The Alagille syndrome (ALGS) and the Alpha-1 Antitrypsin Deficiency that was hardly spoken about or heard of are a few of them.

Jerry looked pretty healthy and there were visible signs of both these diseases.
I figured out that there were over 100 different liver diseases that lead to liver failure if they had gotten critical and I had to find out which he had which was a bit complicated since I couldn’t figure what was causing his problem.

I gave him some ursodiol which was a medication that would help slow down the damage happening to his liver while I was trying to pinpoint what partially was happening to him.

Liver failure occurs in 4 stages namely, inflammation which was the early stage and it meant the liver was enlarged or inflamed, the second stage was fibrosis which was when the scared tissues begin replacing the healthy tissues in the inflamed liver, thirdly cirrhosis which meant there were multiple scarring in the liver making it harder for the liver to function and lastly end-stage liver disease which was when the liver had deteriorated to the point where the damage couldn’t be reversed except with a liver transplant, luckily we were still at the first stage.

After days of trying to figure out what was wrong, I decided to ask the head of my facilities, and immediately the first question he had asked was if I had done a test for hepatitis and at that moment it clicked in me that his symptoms resembled autoimmune hepatitis and I never performed a test for viral hepatitis.
Autoimmune hepatitis was a rare disorder in which the body’s immune system attacked the liver and caused it to become inflamed, this disease could be chromic and could gradually lead to liver failure if untreated.

It occurred in females 4 times as often as males. It felt like I had finally detected what was wrong and immediately I felt relieved because being able to detect the problem was the first step to fixing it.

I proceeded to redo a blood test for hepatitis and it came out positive which meant that indeed I was correct.

Next was to prescribe some antiviral drugs, prednisone which was a steroid that helps with easing inflammation, and after a few weeks, I had lowered its dosage and added azathioprine which even though it had some side effects like lowering your white blood cells, etc, it was our best bet in helping him get better.

He consistently had to see me for and through that time I had prescribed some diet and lifestyle changes for him such as eating a balanced diet, eating fruits and vegetables, staying away from alcohol, and never taking drugs or supplements that I hadn’t approve.

At this point, his condition was under control.

Before I end this, I would like to say that even though his case was kept under control, over 35,000 deaths result from liver failure yearly, and some prevention methods like getting a hepatitis vaccine, eating a proper diet, maintaining a healthy weight, drinking alcohol in moderation, practising proper hygiene, not mixing alcohol with medication, and being careful with sharp objects among others, could help prevent the risk of getting cirrhosis or hepatitis which could lead to liver failure.
Like I would always say early detection saves lives and you could be saving yours by visiting a hospital if you have any of those symptoms today.

REFERENCES

• WebMD

• Cleveland clinic

• Health line

• Liver foundation

• Medicine net

• NIDDK