Liver failure is severe deterioration in liver function.
Liver failure can result from many types of liver disorder, including viral hepatitis (most commonly hepatitis B or C), cirrhosis, and liver damage from alcohol or drugs such as acetaminophen.
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).
Many effects occur because the liver malfunctions:
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.
In acute liver failure, people may go from being healthy to near death within a few days. 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.
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.
Other tests, such as urine tests, other blood tests, and often a chest x-ray, are done to check for problems that can develop, including deterioration of brain function, kidney failure, and infections. Depending on the person's symptoms, tests may be repeated frequently.
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 are usually placed on a restricted diet, limiting the amount of animal protein, particularly in red meat but also in fish, cheese, and eggs. Eating too much animal protein can contribute to brain dysfunction. To make sure people get enough protein, doctors advise them to eat more foods that contain vegetable protein (such as soy). People should also limit their consumption of sodium (in salt and many foods). Doing so can help prevent fluid from accumulating within the abdomen. Alcohol is completely avoided because it can worsen liver damage.
Acute liver failure is treated as soon as possible because problems (such as bleeding) can develop and worsen quickly. People with acute liver failure are treated in an intensive care unit (ICU) if possible. Treatment may include
If needed, a plastic breathing tube is inserted through the mouth into the windpipe and sometimes a mechanical ventilator is used to assist with breathing.
Liver transplantation, 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.