Liver failure is caused by a disorder or substance that damages the liver.
Most people have jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more (yellow skin and eyes), feel tired and weak, and lose their appetite.
Other symptoms include accumulation of fluid within the abdomen (ascites Ascites Ascites is the accumulation of protein-containing (ascitic) fluid within the abdomen. Many disorders can cause ascites, but the most common is high blood pressure in the veins that bring blood... read more ) and a tendency to bruise and bleed easily.
Doctors can usually diagnose liver failure based on symptoms and results of a physical examination and blood tests.
Treatment usually involves controlling protein consumption, limiting sodium in the diet, completely avoiding alcohol, and treating the cause, but sometimes liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more is required.
(See also Overview of Liver Disease Overview of Liver Disease Liver disease can manifest in many different ways. Characteristic manifestations include Jaundice (a yellowish discoloration of the skin and whites of the eyes) Cholestasis (reduction or stoppage... read more .)
Many effects occur because the liver malfunctions:
The liver can no longer adequately process bilirubin (a waste product formed when old red blood cells are broken down) so that it can be eliminated from the body. Bilirubin then builds up in the blood and is deposited in the skin. The result is jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more .
The liver can no longer synthesize enough of the proteins that help blood clot. The result is a tendency to bruise and bleed Bruising and Bleeding Bruising or bleeding after an injury is normal (see also How Blood Clots). However, some people have disorders that cause them to bruise or bleed too easily. Sometimes people bleed without any... read more (coagulopathy).
Blood pressure in the veins that bring blood from the intestine to the liver is often abnormally high (called portal hypertension Portal Hypertension Portal hypertension is abnormally high blood pressure in the portal vein (the large vein that brings blood from the intestine to the liver) and its branches. Cirrhosis (scarring that distorts... read more ).
Brain function may deteriorate because the liver cannot remove toxic substances as it normally does and these substances build up in the blood. This disorder is called hepatic encephalopathy Hepatic Encephalopathy Hepatic encephalopathy is deterioration of brain function that occurs in people with severe liver disease because toxic substances normally removed by the liver build up in the blood and reach... read more .
New veins (called collateral vessels) that bypass the liver may form. They often form in the esophagus and the stomach. There, the veins enlarge and become twisted. These veins—called varicose veins of the esophagus (esophageal varices) or stomach (gastric varices)—are fragile and prone to bleeding Gastrointestinal Bleeding Bleeding may occur anywhere along the digestive (gastrointestinal [GI]) tract, from the mouth to the anus. Blood may be easily seen by the naked eye (overt), or blood may be present in amounts... read more .
The kidneys malfunction in up to half of people with liver failure. Liver failure that leads to kidney failure Overview of Kidney Failure This chapter includes a new section on COVID-19 and acute kidney injury (AKI). Kidney failure is the inability of the kidneys to adequately filter metabolic waste products from the blood. Kidney... read more is called hepatorenal syndrome.
The immune system malfunctions, increasing the risk of infections
People may have metabolic abnormalities, such as a low potassium level in the blood (hypokalemia Hypokalemia (Low Level of Potassium in the Blood) In hypokalemia, the level of potassium in blood is too low. A low potassium level has many causes but usually results from vomiting, diarrhea, adrenal gland disorders, or use of diuretics. A... read more ) or a low blood sugar level (hypoglycemia Hypoglycemia Hypoglycemia is abnormally low levels of sugar (glucose) in the blood. Hypoglycemia is most often caused by medications taken to control diabetes. Much less common causes of hypoglycemia include... read more ).
Causes of Liver Failure
Liver failure can result from many types of liver disorder, including viral hepatitis Overview of Acute Viral Hepatitis Acute viral hepatitis is inflammation of the liver, generally meaning inflammation caused by infection with one of the five hepatitis viruses. In most people, the inflammation begins suddenly... read more (most commonly hepatitis B or C), cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more , and liver damage from alcohol Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more or drugs such as acetaminophen Acetaminophen Poisoning Acetaminophen, a common ingredient in many prescription and non-prescription drugs, is safe in normal doses, but severe overdose can cause liver failure and death. People sometimes ingest too... read more .
A large portion of the liver must be damaged before liver failure occurs. Liver failure may develop rapidly over days or weeks (acute) or gradually over months or years (chronic).
Symptoms of Liver Failure
People with liver failure usually have jaundice, ascites, hepatic encephalopathy, and generally failing health. Jaundice makes the skin and whites of the eyes look yellow. Ascites may cause the abdomen to swell. Hepatic encephalopathy may cause confusion or drowsiness. Most people also have general symptoms, such as fatigue, weakness, nausea, and loss of appetite.
The breath may have a musty sweet odor.
People may bruise and bleed easily. For example, bleeding that would be slight in other people (for example, bleeding from a small cut or a nosebleed) may not stop on its own and may even be difficult for doctors to control. Loss of blood can result in low blood pressure (hypotension) and shock Low Blood Pressure and Shock .
In acute liver failure, people may go from being healthy to near death within a few days. Acute liver failure is a medical emergency and if possible people should be evaluated at a liver transplant center. In chronic liver failure, the deterioration in health may be very gradual until a dramatic event, such as vomiting blood or having bloody stools, occurs. Blood in vomit or stool is usually caused by bleeding from varicose veins in the esophagus and stomach.
If kidney failure develops, less urine is produced and excreted from the body, resulting in the buildup of toxic substances in the blood.
Eventually, breathing becomes difficult.
Ultimately, liver failure is fatal if it is not treated or if the liver disorder is progressive. Even after treatment, liver failure may be irreversible. Some people die of kidney failure. Some people develop liver cancer Overview of Liver Tumors Liver tumors may be noncancerous (benign) or cancerous (malignant). Cancerous liver tumors are classified as primary (originating in the liver) or metastatic (spreading from elsewhere in the... read more .
Diagnosis of Liver Failure
A doctor's evaluation
Doctors can usually diagnose liver failure based on symptoms and the results of a physical examination. Blood tests are done to evaluate liver function, which is usually severely impaired.
To check for possible causes, doctors ask about all substances that people have taken, including prescription and over-the-counter drugs, herbal products, and nutritional supplements. Blood tests are also done to identify possible causes.
Treatment of Liver Failure
Treatment of the cause
For acute liver failure, immediate treatment
Treatment depends on the cause and the specific symptoms. The urgency of treatment depends on whether liver failure is acute or chronic, but the principles of treatment are the same.
People should also limit their consumption of sodium (in salt and many foods) to less than 2,000 mg a day to prevent fluid from accumulating within the abdomen. Alcohol is completely avoided because it can worsen liver damage.
Acute liver failure
Acute liver failure is a medical emergency. If possible, people should be evaluated at a liver transplant center and managed in an intensive care unit. Treatment may include
For low blood pressure: Fluids given intravenously and drugs to increase low blood pressure
For hepatic encephalopathy: Possibly treatments, such as lactulose (a laxative) and antibiotics
For infections: Antibiotics or antifungal drugs
For low blood sugar: Glucose (a sugar) given intravenously
For bleeding: Transfusions of fresh frozen plasma (the fluid part of the blood, which contains proteins that help blood clot, called blood clotting factors) and, when necessary, whole blood
If needed, a plastic breathing tube is inserted through the mouth into the windpipe and sometimes a mechanical ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more is used to assist with breathing.
Liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more , if done soon enough, can restore liver function, sometimes enabling people to live as long as they would have if they did not have a liver disorder. However, liver transplantation is not suitable for all people with liver failure.