Liver failure is a life-threatening condition that demands urgent medical care. Most often, liver failure happens gradually, over many years. It’s the final stage of many liver diseases. But a rarer condition known as acute liver failure happens rapidly (in as little as 48 hours) and can be difficult to detect at first.
Liver failure happens when large parts of the liver become damaged beyond repair and the liver can’t work anymore.
There are two types of live failure:
- Acute: This is when your liver stops working within a matter of days or weeks. Most people who get this don’t have any type liver disease or problem before this event.
- Chronic: Damage to your liver builds up over time and causes it to stop working.
Symptoms of Liver Disease and Liver Failure
The early symptoms of liver failure are often similar to those of liver diseases and other conditions. Because of this, liver failure may be tough to diagnose at first. Early symptoms include:
But as liver failure progresses, the symptoms become more serious, needing care right away. These symptoms include:
- Bleeding easily
- Swollen belly
- Mental confusion (known as hepatic encephalopathy)
Causes of Acute Liver Failure
The causes of acute liver failure, when the liver fails rapidly, include:
- Acetaminophen overdose: Large doses can damage your liver or lead to failure.
- Viruses including hepatitis A, B, and E, the Epstein-Barr virus, cytomegalovirus, and herpes simplex virus: They lead to liver damage or cirrhosis.
- Reactions to certain prescription and herbal medications: Some kill cells in your liver. Others damage the duct system that moves bile through it.
- Eating poisonous wild mushrooms: A kind called Amanita phalloides, also known as death cap, contains toxins that damage liver cells and lead to liver failure within a couple of days.
- Autoimmune hepatitis: As with viral hepatitis, this disease, in which your body attacks your liver, can lead to acute liver failure.
- Wilson’s disease: This genetic disease prevents your body from removing copper. It builds up in, and damages, your liver.
- Acute fatty liver of pregnancy: In this rare condition, excess fat gathers on your liver and damages it.
- Septic shock: This overwhelming infection in your body can damage your liver or cause it to stop working.
- Budd Chiari syndrome: This rare disease narrows and blocks the blood vessels in your liver.
- Industrial toxins: Many chemicals, including carbon tetrachloride, a cleaner and degreaser, can damage your liver.
Causes of Chronic Liver Failure
The most common causes of chronic liver failure include:
- Hepatitis B: It makes your liver swell and stops it from working the way it should.
- Hepatitis C: If you have it long-term, it can lead to cirrhosis.
- Long-term alcohol consumption: It also leads to cirrhosis.
- Hemochromatosis: This inherited disorder causes your body to absorb and store too much iron. It can build up in your liver and cause cirrhosis.
Other conditions that can lead to liver failure include:
- Hepatitis A: Contact with food or water contaminated with the hepatitis A virus, or with a person who’s infected with virus, can cause liver inflammation. This type usually goes away on its own.
- Autoimmune hepatitis: In this type, your body’s immune system, not a virus, attacks your liver and causes inflammation.
- Cirrhosis: Things like drinking alcohol for many years or having hepatitis scar your liver can make it hard or impossible for your liver to work.
- Primary sclerosing cholangitis: This disease slowly damages your bile ducts. It mostly affects young men.
- Oxalosis: This is when your kidneys can’t get rid of calcium oxalate crystals through your urine.
- Wilson's disease: People with this rare inherited disease store too much copper in their brain and liver.
- Alpha-1 antitrypsin deficiency: This genetic condition can lead to lung or liver disease.
- Liver cancer: People with long-term hepatitis B or hepatitis C often get this.
- Liver adenoma: This is when benign liver tumors are on an otherwise healthy liver. This often affects women between ages 20 and 44.
- Fatty liver disease: Extra fat cells can build up on your liver. Nonalcoholic fatty liver disease often affects people who are overweight, obese, or have high cholesterol. Alcohol-related fatty liver disease affects heavy drinkers.
- Alcoholic hepatitis: Liver inflammation that results from heavy or long-term drinking.
- Alagille syndrome: A genetic disorder that results in fewer bile ducts than normal in the liver.
- Primary biliary cholangitis (PBC): Over time, this disease destroys your small bile ducts. You might still hear it called by its former name, primary biliary cirrhosis.
- Galactosemia: People with this condition can’t process galactose, a sugar found in many foods. It can cause liver damage.
- Lysosomal acid lipase deficiency (LAL-D): With this genetic condition, you can’t produce an enzyme called lysosomal acid lipase (LAL), which helps your body break down fats and cholesterol in your cells. As a result, fats stay in your liver and cause damage.
Liver Disease Progression
- Stage 1: Inflammation. In the early stages, your liver will be inflamed and could be tender. Or it may not bother you at all.
- Stage 2: Fibrosis/scarring. If you don’t treat the inflammation, it will cause scarring. As scar tissue builds up in your liver, it stops blood flow, which keeps the healthy parts from doing their job and makes them work harder.
- Stage 3: Cirrhosis. The scar tissue takes over, and with less and less healthy tissue to do its job, your liver won’t work well, or it won’t work at all.
- Stage 4: End-stage liver failure/disease. This is an umbrella term for several conditions, including swollen liver, internal bleeding, loss of kidney function, fluid in your belly, and lung problems. Only a liver transplant can cure it.
Liver Disease Diagnosis and Tests
Tests and procedures used to diagnose liver failure and liver disease include:
- Blood tests. These let your doctor know how well your liver is working. You might get a prothrombin time test, which measures how long it takes your blood to clot. With acute liver failure, blood doesn't clot as quickly as it should.
Imaging tests. These take pictures that let your doctor see what’s going on in your liver and figure out what’s causing the problem. He may recommend
- Abdominal computerized tomography (CT) scanning
- Magnetic resonance imaging (MRI)
- Biopsy. The doctor will use a needle to remove a small piece of liver tissue and look at it in the lab. A transjugular liver biopsy is a special procedure that lets the doctor put the needle into a vein in your neck.
How Is Liver Failure Treated?
Medication. Acetylcysteine can reverse acute liver failure caused by an acetaminophen overdose. But you have to take it quickly. There are also medications that can reverse the effects of mushrooms or other poisons.
Supportive care. If a virus causes liver failure, a hospital can treat your symptoms until the virus runs its course. In these cases, the liver will sometimes recover on its own.
Liver transplant. If your liver failure results from long-term damage, the first step may be to try to save whatever part of your liver still works. If that fails, you’ll need a liver transplant. Fortunately, this procedure is often successful.
Complications of Liver Failure
Doctors will work to prevent complications, which include:
- Cerebral edema. Fluid buildup is a problem with liver failure. In addition to your belly, it can also pool in your brain and lead to high blood pressure there.
- Blood clotting problems. Your liver plays a big role in helping your blood clot. When it can’t do that job, you’re at risk of bleeding too freely.
- Infections, like pneumonia and UTIs. End-stage liver disease can make you more likely to get infections.
- Kidney failure. Liver failure can change the way your kidneys work and lead to failure.
How Can Liver Failure Be Prevented?
The best way to prevent liver failure is to limit your risk of getting cirrhosis or hepatitis. Here are some tips to help prevent these conditions:
- Get a hepatitis vaccine or an immunoglobulin shot to prevent hepatitis A and B.
- Eat a proper diet from all of the food groups.
- Maintain a heathy weight.
- Do not drink alcohol in excess. Avoid alcohol when you are taking acetaminophen.
- Practice proper hygiene. Since germs are commonly spread by hands, be sure to wash your hands thoroughly after you use the bathroom. Also, wash your hands before you touch any food.
- Don't share any personal toiletry items, including toothbrushes and razors.
- If you get a tattoo or a body piercing, make sure the conditions are sanitary and all equipment is aseptic (free of disease-causing germs).
- Be sure to use barrier protection (condoms) when having sex.
- If you use illegal intravenous drugs, don't share needles with anyone.