What is the Difference Between Acute and Chronic Liver Failure

Acute and chronic liver failure are two types of liver failures. Liver failure is a potentially life-threatening condition where the liver is no longer able to service the body’s needs. This condition can be categorized into two as: acute and chronic liver failure.

The key difference between acute and chronic liver failure is their progress. Acute liver failure is the rapid loss of liver function that happens quickly in days or weeks, while chronic liver failure is the slow decline of liver function that happens when something has been damaging the liver for a very long period of time.

CONTENTS

1. Overview and Key Difference
2. What is Acute Liver Failure
3. What is Chronic Liver Failure
4. Similarities – Acute and Chronic Liver Failure
5. Acute vs Chronic Liver Failure in Tabular Form
6. Summary – Acute vs Chronic Liver Failure
7. FAQ: Acute and Chronic Liver Failure

What is Acute Liver Failure?

Acute liver failure develops rapidly, typically over days to a few weeks.  This type of liver failure is rare. It often happens to those who have never had previous liver problems or diseases. The causes of acute liver failure include taking too much acetaminophen, hepatitis, ingesting toxins, unexpected liver toxicity from medications, and certain diseases such as Budd-Chiari syndrome and Wilson’s disease. Moreover, the signs and symptoms of acute liver failure include jaundice, pain in the upper right abdomen, ascites, nausea, vomiting, malaise, confusion, sleepiness, musty of sweet order breath, and tremor.

Acute liver failure can be diagnosed through physical examination, blood test, CT scan, MRI, and liver biopsy. Furthermore, acute liver failure treatments may include medications to reverse poisoning (acetylcysteine for acetaminophen overdose) and liver transplant.

What is Chronic Liver Failure?

Chronic liver failure is a slow decline in liver function or loss of liver function that happens alongside cirrhosis or severe scarring of the liver. This is the most common type of liver failure. Choric liver failure can occur due to alcohol consumption, viral infections like hepatitis, metabolic dysfunction associated with steatotic liver disease (MASLD), genetic diseases, and autoimmune diseases. Moreover, the signs and symptoms of chronic liver failure include feeling weak and tired all the time, loss of appetite, loss of sex drive, jaundice, itchy skin, flu-like symptoms, cognitive changes such as memory problems, coordination changes, changes in intellectual function, poor concentration, euphoria, bizarre behaviour, and disorientation.

Chronic liver failure can be diagnosed through medical history, physical examination, blood test, urine test, ultrasound, CT scan, transient elastography, upper gastrointestinal endoscopy, and liver biopsy. Furthermore, treatment options for chronic liver failure are regular exercise to retain muscle mass, taking lactulose and rifaximin for hepatic encephalopathy, stopping the usage of drugs damaging the liver, liver transplant, taking antiviral medications, avoiding alcohol, losing weight for MASLD, taking corticosteroids and immunosuppressants for autoimmune diseases, taking iron chelators or blood removal for hereditary hemochromatosis, and copper chelators for Wilson disease.

Similarities Between Acute and Chronic Liver Failure

1. Acute and chronic are two types of liver failures.
2. Both types can be caused by viral infections and the overdose of medications.
3. These types can be diagnosed through physical examination, imaging tests, and biopsy.
4. Both types can be treated through specific medications and liver transplants.

Difference Between Acute and Chronic Liver Failure

Definition

1. Acute liver failure is the rapid deterioration of the liver function that occurs quickly in days or weeks.
2. Chronic liver failure is the slow deterioration of liver function that occurs when something has been damaging the liver for a very long period of time.

Commonness

1. Acute liver failure is comparatively less common.
2. Chronic liver failure is comparatively more common.

Time Taken to Complete

1. Acute liver failure happens in days or weeks.
2. Chronic liver failure happens in months or years.

Caused by

1. Acute liver failure can be caused by an overdose of acetaminophen, hepatitis (A, B or autoimmune), ingesting poisonous mushrooms, unexpected liver toxicity from medications, Budd-Chiari syndrome, and Wilson’s disease.
2. Chronic liver failure can be caused by excess alcohol intake, hepatitis, fatty liver disease, bile duct diseases, and various hereditary conditions.

Signs and  Symptoms

1. Signs and  symptoms of acute liver failure include diarrhea, discomfort, fatigue, loss of appetite, nausea, bruising early, vomiting blood, and build-up of fluid in the abdomen.
2. Signs and  symptoms of chronic liver failure include ascites, vomiting blood, gallstones, itching, yellowing of the skin and eyes, kidney failure, muscle loss, loss of appetite, easy bruising, spider-like veins in the skin, fatigue, weight loss, and confusion as toxins build up in the blood.

Diagnosis

1. Acute liver failure can be diagnosed by physical examination, tests for mental alertness, blood test, CT scan, MRI, and liver biopsy.
2. Chronic liver failure can be diagnosed by medical history, physical examination, blood test, urine test, ultrasound, CT scan, transient elastography, upper gastrointestinal endoscopy, and liver biopsy.

Treatment

1. Acute liver failure can be treated with charcoal or N-acetylcysteine for acetaminophen overdose and liver transplant.
2. Chronic liver failure can be treated by stopping alcohol consumption, controlling excessive iron or copper levels, or using immune suppressing medicines, recommended vaccines for viruses and liver transplants.

The following table summarizes the difference between acute and chronic liver failure.

Summary – Acute vs Chronic Liver Failure

The two forms of liver failure are acute and chronic liver failure. Acute liver failure is the rapid loss of liver function within days or weeks due to an overdose of certain drugs like acetaminophen or viral hepatitis, while chronic liver failure is the gradual loss of liver function due to progressive scarring of the liver by alcohol abuse, hepatitis, and other viruses. This is the summary of the difference between acute and chronic liver failure.

FAQ: Acute and Chronic Liver Failure

1. What are the first symptoms of liver failure?

• The acute symptoms of liver failure are fatigue, nausea, loss of appetite, discomfort on the right side just below the ribs, and diarrhea. As it gets worse, the skin may turn yellow, and people may become confused or comatose.

2. What is the most common cause of acute liver failure?

• Acute liver failure happens when the liver suddenly starts to not work. An overdose of acetaminophen can be the most common. Viral hepatitis can also cause acute liver failure.

3. Can you survive acute liver failure?

• Medicine may be able to reverse it if given early enough. The treatments include charcoal or N-acetylcysteine for acetaminiophen overdose and liver transplant. Metabolic diseases can often be treated with medication or changes in diet if no permanent damage has been done. Early treatment can help manage the condition and sometimes even reverse it.

4. What happens in chronic liver disease?

• Chronic liver disease involves the progressive deterioration of liver functions over more than six months. This includes the synthesis of clotting factors and other proteins, detoxification of harmful metabolic products, and excretion of bile. It often occurs alongside cirrhosis and is primarily caused by alcohol abuse.

5. Can you live with chronic liver disease?

• Yes, it is possible to live with chronic liver disease. In the early stages of compensated cirrhosis, life expectancy can exceed 15 years. However, once portal hypertension develops, life expectancy may decrease due to the risk of internal bleeding. In cases of decompensated cirrhosis, the average life expectancy is around seven years.

 Reference:

1. Shah, Niraj J. “Acute Liver Failure.” StatPearls. U.S. National Library of Medicine.

2. “Chronic Liver Disease – An Overview.” ScienceDirect.

Image Courtesy:

1. “Fimmu-09-02948-g001” By Evangelos Triantafyllou, Kevin J. Woollard, Mark J. W. McPhail, Charalambos G. Antoniades and Lucia A. Possamai – The Role of Monocytes and Macrophages in Acute and Acute-on-Chronic Liver Failure (CC BY 4.0) via Commons Wikimedia

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