What Is Liver Failure?

Liver failure refers to the liver's inability to carry out its usual metabolic and synthetic functions as part of its normal physiological processes. This condition can be categorized into two types: acute and chronic, with the latter being commonly known as cirrhosis.

Since liver failure may occur in two ways, it is important you are aware of the symptoms and possible risk factors in order to prevent liver failure from happening. Read more about it just below. 

Overview

Liver failure is a condition where the liver is unable to perform its normal functions due to severe damage or disease. The liver is a vital organ that plays a crucial role in various bodily functions, including metabolism, detoxification, and regulation of blood clotting.

Liver failure can be acute or chronic.¹ Acute liver failure occurs rapidly, often within days or weeks, and can be life-threatening. Chronic liver failure, on the other hand, occurs gradually over months or years and can be caused by various conditions, including chronic hepatitis, alcohol abuse, or non-alcoholic fatty liver disease. 

Causes of liver failure

Liver failure occurs when the liver is unable to perform its essential functions, leading to impaired bodily processes.¹ As liver failure advances, an individual may exhibit a combination of symptoms, such as yellowing of the skin and eyes (jaundice), mental impairment or confusion, swelling in the arms, legs, or abdomen, extreme tiredness, and a heightened susceptibility to bleeding.¹

Liver failure can happen in two ways - acute or chronic. Chronic liver failure is a slow deterioration of liver function that can happen over months or years and is usually caused by cirrhosis, which is severe liver scarring due to excessive alcohol intake, hepatitis, or non-alcoholic fatty liver disease.¹ On the other hand, acute liver failure is a rare but severe condition that progresses rapidly over days or weeks and is often caused by taking too much acetaminophen, hepatitis, poisoning, or certain diseases. Acute liver failure is considered a medical emergency and requires intensive care.² Acute-on-chronic liver failure is when a stable chronic liver failure suddenly gets worse, and it could be caused by infections or medications.² Treatment options for liver failure depend on the cause and severity of the condition and may include medication, lifestyle changes, or a liver transplant^.

Signs and symptoms of liver failure

Symptoms of liver failure may include jaundice (yellowing of the skin and eyes), fatigue, weakness, nausea, vomiting, abdominal pain, confusion, and coma.³ Treatment options for liver failure depend on the underlying cause and severity of the condition and may include medications, lifestyle changes, and in severe cases, liver transplant.³

Management and treatment for liver failure

Acute-on-chronic liver failure can cause the liver to fail in a matter of weeks to months, which is faster than the typical progression of chronic liver failure that takes months to years.² Treating the underlying cause of liver failure is the primary focus before considering a liver transplant, similar to acute liver failure.⁴ 

Liver transplant is usually the only treatment option for liver failure, but in some cases, if the cause is acute or hereditary, it can be treated with medication.⁴ The treatment of acute liver failure varies depending on its underlying cause. 

For example, if liver failure is caused by an overdose of acetaminophen, medicine can be used to counteract its effects. If acetaminophen overdose is suspected, activated charcoal may be given to reduce the absorption of the medication in the gastrointestinal tract. Similarly, if liver failure is caused by a hereditary copper overload disease, medication can be used to remove copper from the body.^2,4 For acute liver failure caused by viral hepatitis, specific medications may be prescribed based on the type of hepatitis. Steroids can be used to treat autoimmune hepatitis. 

In cases where the cause of acute liver failure is unknown, a liver biopsy may be necessary to gather more information and determine the appropriate treatment.^2,4 

Chronic liver disease cannot be cured, however, it can be maintained. Antibacterial medications can also be used to treat infections that cause liver failure in patients with cirrhosis. 

These treatments aim to restore the liver's function to its previous state. Lifestyle changes also have to be made in order to prevent liver cirrhosis. These include quitting smoking, reducing alcohol consumption, and maintaining a healthy balanced diet. 

Diagnosis of liver failure

Tests and procedures used to diagnose acute liver failure involves several methods. 

Firstly, blood tests are conducted to assess the functioning of the liver. One such test is the prothrombin time test, which measures the time taken for blood to clot. In cases of acute liver failure, blood tends to clot slowly.⁴ 

Secondly, imaging tests such as an ultrasound, abdominal CT scan, or MRI, may be recommended to examine the liver and blood vessels. These tests can identify liver damage and help determine the underlying cause of liver problems. If ultrasound testing yields negative results, these imaging tests may be used to look for specific causes of acute liver failure such as Budd-Chiari syndrome or tumors.⁴ 

Lastly, the examination of liver tissue, known as a liver biopsy, may be recommended. This procedure involves removing a small piece of liver tissue to help identify the cause of liver failure. However, due to the risk of bleeding during the biopsy, a transjugular liver biopsy may be performed, which involves making a small incision on the right side of the neck and inserting a thin tube through a vein to retrieve a sample of liver tissue.⁴

Risk factors

include: 

• Having a long-term infection such as Hepatitis B or C
• High alcohol consumption
• Having preexisting medical conditions such as hemochromatosis (when the body absorbs excessive iron), non-alcohol related fatty liver disease, autoimmune disease and Wilson disease (your body cannot remove extra copper)¹

Complication

The failure of the liver can have a negative impact on multiple organs in your body. If it is acute, it can lead to various complications like infection, imbalances in electrolytes, and bleeding. If left untreated, both acute and chronic liver failure can ultimately lead to death.

FAQs

How can I prevent liver failure

Liver failure can be prevented by:

• Being vaccinated for hepatitis B
• Reducing alcohol consumption
• Maintaining a healthy lifestyle 
• Taking care when using medications like acetaminophen
• Having a physical examination yearly with screening for obesity, high cholesterol, and diabetes

How common is liver failure

Each year, liver disease is responsible for around 2 million fatalities globally. Out of those, roughly 1 million are linked to complications arising from cirrhosis, while the other million are caused by viral hepatitis and hepatocellular carcinoma.⁵

When should I see a doctor

In the early stages, liver damage may not display any noticeable symptoms. Typically, a failing liver is identified through blood tests. However, as time passes, symptoms such as jaundice and the other indications listed earlier may become apparent.

However, acute liver failure can occur rapidly in an individual without prior liver problems, and it can be a serious threat to life. If you or someone you know experiences sudden yellowing of the skin or eyes, tenderness in the upper abdomen, or any unusual alterations in mental state, personality, or behavior, it is crucial to seek immediate medical attention.

Summary

The key outtakes would be that acute liver failure is a condition where the liver suddenly stops working, often caused by an overdose of acetaminophen. Symptoms of liver failure include fatigue, nausea, loss of appetite, discomfort on the right side of the body, and diarrhea. It is a serious condition that requires immediate medical attention, and if conventional treatments are not effective, a liver transplant may be necessary. Therefore, if you experience any of these symptoms, make sure to contact your healthcare provider for further assessment.