Liver Failure

What is liver failure?

Your liver is one of your essential organs, one you can’t live without. It performs hundreds of important bodily functions. When your liver fails to keep up with its many jobs, your overall health will fail, too. This is liver failure. It means that your liver is no longer able to function adequately for your body’s needs.

Liver failure is a process, which may be fast or slow. Acute liver failure happens rapidly, within days or weeks. Chronic liver failure, the more common type, happens gradually, over months or years. As your liver begins to lose its functionality, you’ll notice more and more the symptoms of liver failure.

What is acute liver failure?

Acute liver failure happens suddenly, when something overwhelms your liver’s capacity to cope. It’s usually a large toxic load, like poisoning. Sometimes, it’s a severe viral infection. In acute liver failure, your liver rapidly begins to shut down, causing immediate symptoms. This is a medical emergency.

What is chronic liver failure?

Chronic liver failure is the end stage of chronic liver disease. It happens when something has been damaging your liver for a long time, and the damage has finally become irreversible. Chronic liver failure follows cirrhosis, severe scarring of your liver tissues. Scar tissue prevents your liver from functioning.

What are the stages of liver failure?

Most medical authorities define chronic liver failure as the end stage of chronic liver disease. Liver disease can progress through several stages. However, it’s important to remember that these stages aren’t discreet from each other. Someone with fibrosis (scarring) can still have inflammation (hepatitis):

1. Hepatitis. Hepatitis is inflammation in your liver. When chronic liver disease begins to cause chronic hepatitis, the process of long-term damage begins. Inflammation is meant to start the healing process in your liver tissues. But persistent inflammation leads to scarring (fibrosis).
2. Fibrosis. Fibrosis is a type of scarring in your tissues, a result of chronic inflammation. Fibrosis is progressive. Thin bands of fibrous tissue gradually stiffen your liver as they add up. It’s also reversible to an extent. Your liver cells can regenerate and recover if the inflammation stops.
3. Cirrhosis. Cirrhosis is when you have so much scarring in your liver that it’s no longer reversible. Your liver has powerful regenerative properties, but it needs a certain amount of healthy tissue to work with. Cirrhosis is permanent, but you can still slow or stop the process at this stage.
4. Liver failure. Chronic liver failure begins when cirrhosis has impaired your liver’s ability to carry out its necessary functions. As its functions begin to fail, complications develop throughout your body. Chronic liver failure isn’t rapid, but it’s eventually fatal without a liver transplant.

What are the signs and symptoms of liver failure?

You may notice different signs and symptoms of liver failure based on how advanced it is and which complications have begun to occur. The first symptoms of chronic or acute liver failure may include:

• Abdominal pain (especially in the upper right).
• Fatigue and malaise (feeling unwell).
• Nausea, vomiting and loss of appetite.

Symptoms more specific to liver disease may appear after these. The first warning signs of a damaged liver that’s starting to fail are signs of bile and other toxins building up in your blood. These may include:

• Jaundice (yellow tint to the whites of your eyes and skin).
• Hepatic encephalopathy (altered mental status).
• Pruritus (itchy skin, but with no visible rash).
• Dark-colored pee (urine) and/or light-colored poop (stool).

Chronic liver failure may also show up in subtler ways, like:

• Easy bleeding and bruising (coagulopathy).
• Visible blood vessels that look like spiders or like a rash of tiny dots.
• Small, yellow bumps of fat deposits on your skin or eyelids.
• Digestive difficulties, especially with fats.
• Weight loss and muscle loss.
• Musty-smelling breath.

Other serious signs of liver failure include:

• Ascites (abdominal swelling with fluid).
• Edema (swelling with fluid in your ankles, feet, hands or face).
• Vomiting blood or vomit that looks like coffee grounds.
• Motor dysfunction (twitching, tremors or lapses in muscle control).
• Low urine output.
• Shortness of breath.

Does liver failure cause different symptoms for a woman (AFAB) or a man (AMAB)?

Liver failure can affect your sex hormones, leading to an imbalance of estrogen and testosterone. This may cause different symptoms in a woman (assigned female at birth) or a man (assigned male at birth). Menstrual cycles may become irregular or stop. Testicles may shrink and breast tissue may enlarge in people assigned male at birth.

What does liver failure feel like?

Liver failure will cause toxins to flood your bloodstream, which feels pretty terrible. When your liver can’t filter toxins from your blood anymore, you’ll feel nauseous, tired and weak. Toxins may also infiltrate your brain, causing confusion, irritability, anxiety, drowsiness or motor dysfunction.

What causes liver failure?

Acute and chronic liver failure happen in different ways, but they’re both due to overwhelming stress on your liver. Some of the same toxins and diseases can stress your liver all at once or gradually over time, depending on how severe they are. Other causes of liver failure only happen suddenly or gradually.

Acute liver failure causes

Acute liver failure usually occurs in people with no prior history of liver disease. It happens when something overwhelmingly injures your liver. This might be an overwhelming toxic load that your liver encounters as it’s filtering your blood. It can also be an acute infection that attacks your liver directly.

Causes include:

• Viral infections, including viral hepatitis A, B, D and E. Less commonly, Epstein-Barr Virus, cytomegalovirus (CMV), varicella zoster virus or herpes simplex virus may cause it.
• Drug overdoses. Acetaminophen overdose is the most common cause of acute liver failure in the U.S. Other medications that may cause it in overdose include NSAIDs (nonsteroidal anti-inflammatory drugs) and certain antibiotics.
• Pregnancy complications. Rare but serious pregnancy complications can overwhelm your liver, including acute fatty liver of pregnancy, preeclampsia and HELLP syndrome.
• Genetic disorders. Certain inherited liver diseases may cause acute liver failure if they go untreated, including autoimmune hepatitis and Wilson disease.
• Miscellaneous causes. Mushroom poisoning, metastatic cancer, septic shock or heatstroke may trigger acute liver failure.

Chronic liver failure causes

Chronic liver failure is the result of cirrhosis. The scarring process prevents blood and oxygen from nourishing your liver tissues, causing cell death. As liver cells die, your liver functions less and less. Cirrhosis is the result of long-term hepatitis, which many chronic liver diseases can cause.

These include:

• Chronic infections. Viral hepatitis infections that become chronic can cause chronic hepatitis, including hepatitis B and hepatitis C.
• Chronic alcohol use. Heavy alcohol use can cause alcohol-induced hepatitis. If this becomes a chronic condition, it can cause cirrhosis and liver failure.
• Toxic hepatitis. Chronic overexposure to toxins such as industrial chemicals or drugs can cause chronic hepatitis.
• Metabolic dysfunction-associated steatohepatitis. In some people, metabolic dysfunction-associated steatotic liver disease leads to chronic hepatitis.
• Bile duct obstruction. Congenital (present at birth) conditions that obstruct your bile ducts can cause bile to build up and injure your liver, including biliary atresia and cystic fibrosis. Non-congenital causes include biliary stricture and gallstones.
• Autoimmune disease. Autoimmune hepatitis and autoimmune cholangitis (primary biliary cholangitis or primary sclerosing cholangitis) can lead to cirrhosis.
• Inherited metabolic disorders. Disorders such as glycogen storage disease, Wilson disease, hemochromatosis and Gaucher disease that cause toxic products to build up in your blood can cause chronic liver damage.
• Cardiovascular diseases. Conditions that affect blood flow to and from your liver, including Budd-Chiari syndrome, arterial diseases and right-sided heart failure can cause chronic liver damage.

What are the complications or effects of liver failure?

Your liver performs many important functions, supporting many different body systems. When these begin to fail, you’ll notice the effects throughout your body. For example, you might notice:

• General toxicity, feeling ill, tired, foggy or confused.
• Toxins interfering with your brain, nerves and motor functions.
• Digestive difficulties, malabsorption and malnutrition.
• Reduced blood clotting, easy bleeding and bruising.
• Reduced immunity and frequent infections.

In addition to these effects, many people with chronic liver failure already have complications from cirrhosis. Cirrhosis causes the side effect of portal hypertension, which in turn can cause:

• Fluid leakage, edema and ascites, a risk for peritonitis.
• Gastrointestinal varices and acute gastrointestinal bleeding.
• Enlarged and overactive spleen that removes too many blood cells.
• Low blood oxygen levels via hepatopulmonary syndrome.
• Chronic kidney failure via hepatorenal syndrome.

Complications of portal hypertension are the most frequent causes of hospitalization and death in people with chronic liver failure, and many of these can begin before chronic liver failure starts.

How is liver failure diagnosed?

If you have signs and symptoms of liver failure, a healthcare provider will run tests to confirm it. These may include:

• Blood tests. Liver function tests measure different liver products in your blood to determine how well your liver is functioning. Blood tests may also help identify the cause of your liver failure and some of its complications, like reduced blood clotting or anemia.
• Imaging tests. Imaging studies of your liver can show signs of liver disease, like swelling, scarring or fluid in your abdomen (ascites). An elastography is a type of imaging test that uses ultrasound or MRI (magnetic resonance imaging) to determine the degree of fibrosis or stiffness in your liver.
• Liver biopsy. A liver biopsy is a minor procedure to take a small tissue sample from your liver to test in a lab. A healthcare provider can usually take the sample through a hollow needle. A liver biopsy can confirm cirrhosis and help determine the cause of your liver disease.

What is the treatment for liver failure?

Treatment for liver failure involves:

• Managing its complications.
• Treating the cause, if possible.
• Liver transplantation, if necessary.

Supportive care to help stabilize your condition might include:

• IV fluids.
• IV nutrition.
• Blood glucose monitoring and supplementation.
• Antibiotics or antivirals.
• Plasma or blood transfusions.
• Oxygen therapy or mechanical ventilation.
• Vasopressor medications to increase blood flow.
• Medications or treatments to stop internal bleeding.
• Dialysis for kidney failure.

Treatments to address the causes of liver failure might include:

• Treatments for toxic overdose. Many toxins that cause acute liver failure have no direct antidote, but acetaminophen poisoning does. It’s called acetylcysteine. Other treatments for acute liver toxicity include laxatives, bowel irrigation, gastric lavage and activated charcoal.
• Medications for chronic diseases. If you have chronic liver failure due to a chronic disease, medications may help slow the damage. For example, corticosteroids and immunosuppressants can treat autoimmune diseases. Other diseases have other specific medications.

Your healthcare team will monitor your condition and manage complications as they arise. They’ll recommend you for a liver transplant if they judge that your prognosis (outlook) is worse without one. Providers have clinical scoring systems for judging your prognosis and whether to recommend a liver transplant.

There’s always some risk in having an organ transplant, especially when you’re not in good health for the procedure. But when the process of organ failure is near the end stage, that risk may save your life. If your healthcare team recommends you for a liver transplant, you’ll join a national waiting list.

How can I prevent liver failure?

Acute liver failure is rare, but it only takes one unfortunate event to trigger it. You can help to prevent this by following some common-sense safety guidelines:

• Protect yourself from toxic exposure. Wear gloves or a mask when interacting with toxic chemicals, such as insecticides and fungicides, cleaning products, paint and aerosol sprays.
• Protect yourself from blood exposure. Don’t share needles or personal items that might be exposed to blood, like razors or toothbrushes. Don’t touch someone else’s open wound.
• Practice food safety to prevent food poisoning. Don’t eat wild mushrooms that you can’t identify. Don’t eat raw foods when traveling abroad. Wash your hands before handling food.
• Get vaccinated for viral hepatitis. Vaccines can prevent hepatitis A and hepatitis B. If you’ve recently been exposed, you can still prevent the infection by getting the vaccine within 24 hours.
• Use medications only as directed. Don’t take more than the recommended dose, even if it’s only an over-the-counter (OTC) pain medication. Don’t combine medications with alcohol use.
• Stay in touch with a healthcare provider during pregnancy. Complications that can cause acute liver failure are rare. But if you’re having unusual symptoms, don’t hesitate to seek care.

Preventing chronic failure is more about general lifestyle choices. Chronic liver disease takes a long time to progress to liver failure. If you develop liver disease, you can slow, stop or even reverse the process by making changes earlier on. For example:

• Get your regular wellness checkups. Many people are unaware that they have liver disease until it’s advanced enough to cause symptoms. A checkup can help identify it sooner.
• Take care of your metabolic health. Metabolic factors like high blood sugar, high cholesterol and high BMI can stress your liver. A healthy diet and exercise can help.
• Don’t lean too hard on over-the-counter drugs. Too many painkillers, like NSAIDs or acetaminophen, can damage your liver. Consult a healthcare provider about chronic pain.
• Reduce or quit alcohol and tobacco. Alcohol and tobacco are both toxic to your liver. If you have liver disease, it’s best not to use them at all. A healthcare provider can help you quit.

Can a person recover from liver failure?

You can recover from acute liver failure, though this is difficult to predict. Chronic liver failure isn’t reversible, but it’s a gradual process, and sometimes you can slow it down. In general, your prognosis is better if there’s a specific treatment available for your condition and if you begin treatment sooner.

How long can a person live with liver failure?

Acute liver failure can be fatal in days, weeks or months. Chronic liver failure can last for months to years. How long the process takes depends on many factors, including:

• How severely the cause is affecting your liver.
• Whether treatment can slow or reverse it.
• The extent of the damage that’s already been done.
• Your overall health and resources for recovery.

Healthcare providers consider all these factors when placing you on the waiting list for a liver transplant. They use scoring systems to determine the urgency of your need and your place on the list.

How do I take care of myself while living with liver failure?

Acute liver failure is an emergency. If you think you might have it, you need to go straight to the hospital. Chronic liver failure isn’t an emergency, but it’s equally serious. If you’ve been diagnosed with chronic liver failure, you can help support your liver by maintaining a healthy diet and lifestyle.

• Minimize substance use. Avoid alcohol and tobacco, take medications only as prescribed and try to avoid using over-the-counter pain medications. Consult your healthcare provider about any herbs or supplements you want to take.
• Eat a healthy, balanced diet. Excess sugar and fats in your blood are stressful to your liver. You might want to consult a nutritionist to help you design a long-term plan, especially if you have nutritional deficiencies as a side effect of liver failure.
• Protect your immunity. Liver failure weakens your immune system, and common viral and bacterial infections may add stress to your liver. Take care to protect yourself during flu season. Ask your provider about recommended vaccines.

A note from Cleveland Clinic

Your liver is the largest organ in your body, a sign of the outsized role it plays in your life. When your liver begins to fail, you’ll feel it in all sorts of ways. Fortunately, your liver doesn’t fail all at once. Whether you have acute or chronic liver failure, earlier recognition and treatment can often make a difference in extending the life of your liver. At the end stage, a liver transplant could save your life.