Liver Failure - Symptoms, Causes Stages and Treatment

By Dr. Abhideep Chaudhary in Liver Transplant

May 31 , 2023 | 7 min read

Liver failure, also known as hepatic failure, occurs when the liver loses its ability to perform vital functions.In the initial stages,symptoms of liver failuremay not be apparent. The liver plays a crucial role in various metabolic processes, including converting food into energy, eliminating waste products, synthesising albumin, forming coagulation factors, producing bile, filtering toxins from the blood, and storing excess glucose. Liver failure can manifest as either acute or chronic. Acute liver failure can be caused by viral infections like hepatitis B or drug overdose. Chronic liver failure is most commonly associated with cirrhosis or scarring of the liver. Both forms of liver failure carry a high morbidity and mortality rate.

Liver Disease Worldwide

Globally, more than a billion people have chronic liver disease. In developing countries, acute liver failure affects mostly younger people due to the higher incidence of infectious hepatitis in these regions. About 100 million people are affected by some form of liver disease in the U.S. Annually, the country performs thousands of liver transplants, with a corresponding number of individuals waiting to receive one.

Signs and Symptoms of Liver Failure

In the early stages, liver damage does not show any signs or symptoms. Chronic liver failure develops over several years. Even if liver failure symptoms do show up, they may resemble other medical conditions. By the time definitive symptoms show up, the liver is already damaged. However, as the condition progresses, various symptoms of liver failure may emerge, including:

Here are Signs and Symptoms of Liver Failure:

  • Fatigue and Weakness
  • Abdominal Swelling and Pain
  • Bleeding and Bruising
  • Itchy Skin

Fatigue and Weakness

The liver's vital functions include metabolism and energy generation. Fatigue is an early symptom of liver failure where scar tissue restricts blood flow, altering chemical levels between the liver and brain. Low oxygen levels and toxin buildup may contribute to severe exhaustion.

Abdominal Swelling and Pain

Abdominal swelling and pain are typical signs of liver failure. Liver failure can cause ascites, in which fluid collects in the space between the abdominal lining and abdominal organs. Albumin prevents fluid leakage from blood vessels into tissues and its level is lowered in case of chronic liver disesse. Ascites can lead to increased abdominal pain and bloating.

Bleeding and Bruising

These are frequent signs of liver failure. Bruises occur due to the rupture of a blood vessel. Liver damage can lead to excessive bleeding (from the nose and gums) and bruising because a damaged liver cannot produce enough clotting factors. The function and number of platelets are also severely affected in case of chronic liver disease.

Itchy Skin

Itching or pruritus is one of the symptoms of chronic liver disease, especially cirrhosis. When itching becomes severe, it can lead to loss of sleep, infections, and other health problems. High levels of bile salt accumulate beneath the skin leading to an increased urge to itch.

Causes of Liver Failure

Understanding the causes and risk factors of liver failure is vital for the prevention and effective management of this condition. Various factors and underlying conditions can contribute to both acute and chronic liver failure.

Here are Causes of Liver Failure:

  • Heat Stroke
  • Prescription Medications
  • Overdose of Acetaminophen
  • Metabolic Diseases

Heat Stroke

Liver failure can result from a heat stroke or extreme physical activity in hot conditions, but it is reversible and manageable with appropriate treatment.

Prescription Medications

Certain routine prescription drugs, including antibiotics, non-steroidal anti-inflammatory drugs, and certain epilepsy medications, can cause acute liver failure. Since the liver is primarily responsible for metabolising drugs in the circulatory system, drug-induced liver injury can manifest as either acute or chronic.

Overdose of Acetaminophen

One of the most common causes of acute liver failure in the U.S. is an overdose of acetaminophen (paracetamol). It can occur after a single large intake or while taking more than the recommended daily dose for several days.

Metabolic Diseases

Metabolic diseases that can cause acute liver failure include:
Wilson Disease: A genetic disorder in which excess copper in the body reaches the liver.
Acute Fatty Liver During Pregnancy: A potentially fatal condition that can occur in the third trimester, with fever, jaundice (yellowish discolouration of skin and eyes), fatigue, and abdominal pain.

Know about the Worst And Best Foods For Jaundice Patients

Stages of Liver Disease

Liver disease can stem from various causes, but its progression often follows a similar pattern. Initially, during the early stages of liver cirrhosis, the liver has the potential to regenerate and heal itself. However, without appropriate preventive measures, the condition can worsen over time, eventually becoming irreversible. Liver disease has five distinct stages.

Here are Stages of Liver Failure:

  • Stage 1: Inflammation
  • Stage 2: Scarring or Fibrosis
  • Stage 3: Cirrhosis
  • Stage 4: End-stage Liver Disease (ESLD) or Liver Failure
  • Stage 5: Liver Cancer

Stage 1: Inflammation

Any injury to the liver due to alcohol or infection can affect its ability to eliminate toxins from the body. This can cause inflammation and swelling of the liver with tenderness. This stage is important because the liver can heal itself in this situation with prompt management.

Stage 2: Scarring or Fibrosis

Untreated inflammation of the liver can lead to scarring of the tissues. The cells are not able to function normally and masses of tissues turn necrotic without adequate blood supply. The restricted blood flow through the liver also leads to a build-up of toxins.

Stage 3: Cirrhosis

Cirrhosis refers to severe and irreversible scarring of the tissues of the liver. Often, it takes several years for the condition to progress from the second stage to cirrhosis. Affected people experience symptoms like fatigue, loss of appetite, abdominal swelling and pain and signs like jaundice. Cirrhosis could lead to complications like liver cancer.

Stage 4: End-stage Liver Disease (ESLD) or Liver Failure

When the liver stops functioning it is referred to as liver failure. It is accompanied by diarrhoea, weight loss, and loss of mental abilities. The liver is unable to heal itself and medications do not help.It can be acute or chronic. Chronic liver failure progresses through the above four stages and requires a liver transplant.

Stage 5: Liver Cancer

When normal cells are transformed into abnormal cells that grow in an uncontrolled manner and lose their ability to function normally, it is referred to as cancer. The most common liver cancer in adults is hepatocellular carcinoma and it is the third leading cause of cancer deaths worldwide.

Diagnosis of Liver Failure

To diagnose liver failure, a comprehensive medical history and symptom analysis are essential. Determining the underlying cause and assessing the extent of liver damage is crucial in formulating an appropriate treatment plan. The following steps are typically involved in the diagnostic process:

Physical Exam and Medical History

A comprehensive physical examination and detailed medical history are essential in diagnosing liver failure. The physical exam evaluates overall health. The medical history provides valuable information about risk factors, previous liver diseases, medication use and lifestyle habits.

Laboratory Tests and Imaging

Laboratory tests and imaging play a crucial role in the diagnosis and evaluation of liver diseases, providing valuable insights into the liver's overall health. It includes:

  • Blood Tests
    • Complete Blood Count
    • Coagulation Panel - To determine bleeding and clotting times
    • Alpha-FetoProtein tumour marker test
    • Liver function tests
  • Biopsy
  • Imaging
    • Computed Tomography (CT) scan
    • Magnetic Resonance Imaging (MRI)
    • Ultrasound exam

Treatment Regimen

Treatment options depend on the underlying cause and severity of the condition. They may include medication, lifestyle changes, liver transplantation, and supportive care to manage symptoms and improve liver function. Effective treatment depends on early diagnosis and includes:

  • Intravenous fluids to maintain blood pressure.
  • Drug overdose can be managed with oral or intravenous N-acetylcysteine and laxatives to flush out toxins.
  • Viral hepatitis requires antiviral medicines.
  • Autoimmune hepatitis (a chronic condition where the body’s immune system attacks its liver cells) is managed with steroids.

Medications and Lifestyle Changes

In the treatment of liver failure, medications may be prescribed to manage symptoms, control underlying causes, or improve liver function. Additionally, lifestyle changes such as alcohol cessation, healthy diet, weight management, and regular exercise can play a significant role in liver health.

Liver Transplant

Liver transplantation is considered a life-saving option for individuals with end-stage liver failure, where the damaged liver is replaced with a healthy liver from a donor, restoring normal liver function.

Summing Up

With very few classic symptoms, liver failure is a cause for concern, and medical attention should be sought if any of the following are observed:

  • Fever, Shivering
  • Difficulty In Breathing
  • Vomiting Of Blood
  • Dark Or Black Faeces
  • Prolonged Periods Of Confusion, Personality Changes

Frequently Asked Questions:

What Is The Outlook For Patients After Treatment For Liver Failure?

In most instances, people with liver failure recover with treatment. When a transplant has been done, an otherwise healthy person can return to a routine life and work after six months. They will require medications for the rest of their life to ensure that their body doesn’t reject the new organ.

How Can Liver Failure be Prevented?

Liver failure can be prevented by:

Getting Hepatitis BVaccination

Reducing Alcohol Consumption

Staying Physically Active And Keeping A Healthy Weight

Using Medications As Indicated

Having Routine Annual Physical Exams With Screening For Specific Conditions Like Diabetes, Hypertension, And Cholesterol Levels

What are The Complications of Liver Failure?

Liver failure can lead to complications involving many of the body’s organs. Among the most frequent complications are:

Recurrent Infections

Electrolyte Imbalances

Frequent Bleeding

Cirrhosis Can Sometimes Lead To Encephalopathy (Degenerative Brain Injury) Because Of Inadequate Elimination Of Toxins.

Liver Cancer

Death, Without Treatment

How Do I Know if My Liver Function is Worsening?

Liver function can be determined through blood tests to determine a person’s MELD (Model for End-stage Liver Disease) score, which checks four parameters:

Bilirubin levels

Creatinine levels

INR (International Normalised Ratio) or prothrombin time

Sodium - An important electrolyte that is depleted during liver disease.

The MELD score can range from 6 to 40, with higher scores indicating poor liver function.

Can a Damaged Liver Heal By Itself?

As long as a liver has not undergone cirrhosis, it can regenerate itself. If proper treatment protocols are followed, an affected person’s liver will regain normal function. These recommendations include adopting a healthy lifestyle, cutting down on alcohol, and keeping obesity away.