What is liver failure?
The liver performs many important functions, including:
- Making blood proteins that aid in clotting, transporting oxygen and supporting the immune system
- Manufacturing bile, a substance needed to help digest food
- Helping the body store sugar (glucose) in the form of glycogen
- Ridding the body of harmful substances in the bloodstream, including drugs and alcohol
- Breaking down saturated fat and producing cholesterol
Liver failure occurs when your liver isn’t working well enough to perform these tasks. Liver failure can be a life-threatening emergency that requires immediate medical attention.
How common is liver disease overall?
In the U.S., approximately 30 million people have some form of liver disease. More than 8,000 people in the U.S. received liver transplants in 2017, and more than 17,000 people are on the waiting list for a liver transplant.
Symptoms and Causes
What causes liver failure?
In many cases, chronic liver failure results from cirrhosis. Cirrhosis is the scarring of the liver from repeated or long-lasting injury, such as from drinking alcohol excessively over a long period of time or chronic hepatitis infection. As scar tissue replaces healthy liver tissue, the liver loses its ability to function.
Acute liver failure is most often caused by:
- Viral infections, such as Hepatitis B.
- The overuse of certain drugs or toxins, like acetaminophen (Tylenol®), and the use of other medications (including certain antibiotics, antidepressants, anti-seizure medications, man-made hormones and antifungal drugs) and herbs (green tea extract and kava).
- Metabolic (biologic) or vascular (vessels that carry fluids, such as arteries) disorders, such as Wilson disease and autoimmune hepatitis.
What are the symptoms of liver failure?
Liver failure can take years to develop. The symptoms of liver failure often look like symptoms of other medical conditions, which can make it hard to diagnose in its early stages. Symptoms get worse as your failing liver continues to get weaker.
Chronic liver failure, or liver failure that occurs over many years, may cause:
As liver failure advances, symptoms become more severe. In later stages, symptoms of liver failure may include:
- Jaundice (yellowing of the skin and eyes)
- Extreme tiredness
- Disorientation (confusion and uncertainty)
- Fluid buildup in the abdomen and extremities (arms and legs)
Sometimes, the liver fails suddenly, which is known as acute liver failure. People with acute liver failure may have the following symptoms:
- Changes in mental status
- Musty or sweet breath odor
- Movement problems
- Loss of appetite
- General feeling of being unwell
Diagnosis and Tests
How is liver failure diagnosed?
The doctor diagnoses liver failure based on your symptoms, your medical history and the results of tests (blood tests, urine tests, abdominal imaging).
Management and Treatment
How is liver failure treated?
Liver disease and liver failure are usually treated by specialists called hepatologists.
Treatment of liver failure depends on whether it is acute or chronic. For chronic liver failure, treatment includes changes to the diet and lifestyle, including:
- Avoiding alcohol or medications that can harm the liver
- Eating less of certain foods, including red meat, cheese and eggs
- Weight loss and control of metabolic risk factors, including high blood pressure and diabetes
- Cutting down on salt in the diet (including not adding salt to food)
For acute (sudden) liver failure, treatment includes:
- Intravenous (IV) fluids to maintain blood pressure;
- Medications such as laxatives or enemas to help flush toxins (poisons) out;
- Blood glucose (sugar) monitoring; glucose is given to the patient if blood sugar drops.
You may also receive a blood transfusion if you are bleeding excessively, or a breathing tube to help you breathe.
In both acute and chronic liver failure, the doctor may recommend a liver transplant. Before transplantation, doctors thoroughly screen transplant candidates to make sure a new organ might help them before placing them on organ waiting lists.
During the transplantation surgery, a healthy liver from a living or deceased donor replaces a damaged or diseased liver. Some transplant centers are able to replace a damaged liver with a portion of a healthy liver because the liver can regenerate, or grow back.
What complications are associated with liver failure?
Liver failure can affect many of your body’s organs. Acute liver failure can cause such complications as infection, electrolyte deficiencies and bleeding. Without treatment, both acute and chronic liver failure may eventually result in death.
Can liver failure be prevented?
You can reduce your chances of developing liver failure by:
- Being vaccinated for hepatitis B
- Cutting down on alcohol
- Maintaining a healthy weight and active lifestyle
- Following directions when using medications like acetaminophen (Tylenol®)
- Having a physical examination every year (at least) with a primary care provider, with screening for obesity, high cholesterol, high blood pressure and diabetes
Who is at the greatest risk for liver failure?
People most at risk for liver failure include those who:
- Have the chronic (long-term) liver infections Hepatitis B or C;
- Drink or have drunk alcohol excessively;
- Have preexisting or acquired medical conditions that make liver failure more likely, such as hemochromatosis (the body absorbs too much iron from food), non-alcoholic fatty liver disease (a large amount of fat in the liver; related to the metabolic syndrome), autoimmune disease (the body's own immune system attacks the liver) and Wilson disease (the body cannot remove extra copper).
Outlook / Prognosis
What is the outlook for patients after treatment for liver failure?
Many people recover from liver failure with treatment. If a transplant is necessary, most patients go back to their daily activities within 6 months. People who have received a transplant need lifelong medical care, including medications to prevent their body from rejecting the new organ.
When should I call my doctor about possible liver failure?
Contact your doctor or go to the emergency department immediately if you develop any symptoms of liver failure.