What is Liver Failure?
What is Liver Failure?Liver failure is a life-threatening condition that occurs when the liver stops working. A healthy liver performs many important bodily functions, so immediate emergency care is necessary when it stops working.
An estimated 10% of the population in the United States, or 30 million people, have some form of liver disease. In 2022, over 9,500 people received liver transplants and over 10,000 people were on the waiting list.
Types of Liver Failure
TypesTwo types of liver failure occur. The first type is gradual and is the final stage of many liver diseases. The second is quick when liver failure results from a virus or substance overuse.
- Chronic liver failure. Chronic liver failure is caused by damage to the liver from recurring or long-lasting injury from diseases such as cirrhosis due to any cause.
- Acute liver failure. Also known as fulminant hepatic failure, acute liver failure occurs very quickly and typically happens in people that are not being treated for a known liver disease. It is usually caused by the overuse of drugs or a viral infection, and requires emergency hospitalization due to other complications.
Stages of Liver Disease and Liver Failure
StagesFour stages of liver failure define the progression of the disease:
- Stage 1: Inflammation. Patients may not have any symptoms at this stage, but some people may have tenderness on the right side of their abdomen. Elevated liver enzymes can be a sign of liver inflammation.
- Stage 2: Fibrosis/scarring. Liver scars can form as a result of longstanding inflammation. The scarring can worsen over time if the cause of liver damage is not treated.
- Stage 3: Cirrhosis. In cirrhosis, scarring in the liver has become more extensive. Liver function may be normal at this stage, but close monitoring for complications such as liver failure and liver cancer are needed. Liver transplant evaluation may be discussed at this stage.
- Stage 4: End-stage liver failure. At this stage, the body is suffering from multiple conditions, including fluid in the abdomen, internal bleeding, impaired kidney function, and confusion due to the liver not effectively filtering the blood. Liver transplant evaluation should be performed at this stage.
Signs & Symptoms of Liver Failure
SymptomsThe symptoms of liver failure are often similar to those of other conditions, making it difficult to diagnose. The symptoms can also be different depending on the type of liver failure.
The liver specialists at NewYork-Presbyterian are experts in treating the symptoms of all types and stages of liver failure.
Chronic liver failure symptoms
The initial stages of chronic liver failure typically take place over many years and can cause:
- Blood in the stool
- Diarrhea
- Fatigue
- Loss of appetite
- Nausea
- Vomiting blood
As the disease progresses, the symptoms worsen and may include:
- Jaundice (yellow skin and eyes)
- Bruises occur easily
- Disorientation and confusion
- Extreme fatigue
- Fluid retention in the legs, stomach, and/or lungs
Acute liver failure symptoms
When the liver fails quickly, the symptoms can be more severe. They include:
- Abdominal pain and swelling
- Bad breath
- Confusion and sleepiness
- Jaundice (yellow skin and eyes)
- Loss of appetite
- Malaise (overall sense of not feeling well)
- Mental confusion and uncertainty
- Movement problems or tremors in the hands and legs
What Causes Liver Failure?
CausesSome many different conditions and diseases can cause liver failure. The most common causes of liver failure can typically be a virus, the overuse of drugs or alcohol, or other conditions like Alagille syndrome.
Causes of chronic liver failure
- Alcohol-associated hepatitis involves 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
- Autoimmune hepatitis, in which the body’s immune system attacks the liver and causes inflammation
- Cirrhosis. Drinking alcohol for many years, or having chronic hepatitis B or C infection, can create scarring on your liver, making it difficult for your liver to work.
- Fatty liver disease. Alcohol-related fatty liver disease affects heavy alcoholic drinkers.
- Galactosemia, a condition where the body can’t process galactose (a sugar found in many foods), can cause liver damage.
- Lysosomal acid lipase deficiency (LAL-D). LAL-D is a genetic condition in which liver enzymes called lysosomal acid lipase (LAL) can’t be produced. LAL help breaks down fats and cholesterol in the cells. Without LAL, those lipids and cholesterol stay in your liver and can cause damage.
- Nonalcoholic fatty liver disease (NAFLD) is characterized by fat cell deposits in the liver. NAFLD typically affects people who have diabetes, high cholesterol, high blood pressure, and/or weight problems
- Oxalosis occurs when the kidneys can’t get rid of calcium oxalate crystals through the urine.
- Primary biliary cholangitis (PBC), is a disease that destroys your small bile ducts over time (formerly referred to as primary biliary cirrhosis)
Acute liver failure causes
- Acute fatty liver during pregnancy. Excess fat builds up on the liver, causing damage.
- Autoimmune disease, which is typically caused by autoimmune hepatitis
- Acetaminophen overdose. A common cause of acute liver failure is taking too much acetaminophen (otherwise known as Tylenol and other over-the-counter brands).
- Cancer. A broad range of cancers that either begin or spread to the liver can cause liver failure.
- Diseases of the veins in the liver. Vascular disease in the veins of the liver can lead to acute liver failure.
- Heat stroke. Exposure to extreme heat and physical activity can cause acute liver failure.
- Hepatitis A. Contact with a person, or food and water, contaminated with the hepatitis A virus can cause liver inflammation. This type usually goes away on its own.
- Herbal supplements. Certain supplements such as ephedra, kava, pennyroyal, and skullcap have been linked to acute liver failure.
- Hepatitis and other viruses. Hepatitis A, hepatitis B, and hepatitis E as well as other viruses such as Epstein-Barr, cytomegalovirus, and herpes simplex virus can all cause acute liver failure.
- Prescription medications. Overuse of some prescription medications such as antibiotics, acetaminophen, and anticonvulsants can cause acute liver failure.
- Septic shock. An overwhelming infection such as sepsis can reduce blood flow to the liver.
- Toxins. Some toxins including poisonous wild mushrooms (Amanita phalloides), and carbon tetrachloride (an industrial chemical found in refrigerants and solvents) have been known to cause acute liver failure.
- Wilson’s disease, a genetic disease that is a result of excess copper in the body
Risk Factors
Risk FactorsPatients with the highest risk for liver failure typically have preexisting or acquired medical conditions that can cause the liver to fail. The most common risk factors include:
- Chronic or long-term infections, such as hepatitis B or C
- Obesity
- Family history of liver disease
- Preexisting conditions like autoimmune disease, Type 2 diabetes, hemochromatosis (absorbing too much iron from food), non-alcohol related fatty liver disease, and Wilson disease
- Engaging in risky behaviors like heavy alcohol consumption, injecting drugs with shared needles, exposure to other people’s body fluids, unprotected sex, tattoos or body piercings, or smoking and exposure to toxins
Complications
ComplicationsAcute liver failure can make patients very sick. The most serious complications patients with acute liver failure experience are:
- Cerebral edema, or swelling of the brain. If this problem develops and progresses, it can lead to death.
- Infections. Liver failure can impair the body’s ability to fight infections such as bloodstream infections or urinary tract infections.
- Kidney failure. Liver failure can break down the blood supply to your kidneys, leading to kidney failure.
Prevention
PreventionThere are many ways to help prevent liver disease and reduce the risk of liver failure, including:
- Avoiding risky behaviors
- Don’t share needles
- Practice safe sex and use condoms
- Choose clean, safe facilities for tattoos and piercings
- When you use aerosol sprays, spray insecticides, fungicides, paint, or other toxic chemicals, make sure the room is ventilated or wear a mask
- When using insecticides or other tox chemicals, cover your skin with gloves, long sleeves, a hat, and a mask
- Avoiding contact with other people’s blood and body fluids
- Don’t share razor blades or toothbrushes
- Clean up body fluids to avoid spreading hepatitis viruses
- Avoid accidental needle sticks
- Avoid wild mushrooms. It can be difficult to tell which ones are safe to eat.
- Drink alcohol in moderation. If you choose to drink, do it safely (healthy adult women should drink up to one drink per day; for men, two drinks a day).
- Follow medication instructions. If you take over-the-counter medications, take the recommended dosage.
- Get vaccinations. If you have any liver disease or other health conditions or risk factors, you should get the hepatitis A and B vaccines.
- Maintain a healthy weight. Patients with weight problems are at risk for developing nonalcoholic fatty liver disease, which can progress to cirrhosis and liver cancer.
- Tell your physician about your medications. Discuss all over-the-counter and herbal supplements with your physicians so they can identify anything that will interfere with any prescriptions drugs you are taking.