What Is Liver Failure?
Article Sources
- 1. Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
- 2. Mayo Clinic. Diseases and Conditions: Liver Disease. (2020) https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502
- 3. Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview
The liver is the largest solid organ in the abdominal cavity, and it plays an equally important role in maintaining health. Filtering toxins from the blood is its most famous job, but it also performs many other functions vital to life.2Mayo Clinic. Diseases and Conditions: Liver Disease. (2020) https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502 Thus, when the liver is not functioning correctly, multiple systems are affected.
Liver failure is an uncommon but serious condition that can have a sudden or gradual onset. Impaired thinking is the most serious symptom of liver failure, and death can occur if the condition is not treated promptly.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
1. Acute Liver Failure
When someone with a healthy liver develops symptoms of liver failure during a period of 26 weeks or less, doctors refer to the condition as acute liver failure.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview It is usually marked by coagulation problems like bleeding and easy bruising.
Acute liver failure encompasses conditions like Fulminant hepatic failure (FHF) and subfulminant hepatic failure. FHF is usually associated with cognition and mental status changes.
2. Chronic Liver Failure
Although the complete loss of liver function is a life-threatening event, a progressive liver disease called cirrhosis can lead to a gradual decline in the organ’s health and its ultimate failure. In the U.S., hepatitis C infection causes 26% and excessive alcohol consumption causes 21% of cirrhosis cases.3Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview
Other conditions like autoimmune disorders, certain drugs, and parasites are also associated with cirrhosis. This is a long-term condition and the damage to the liver accumulates over time.
3. Causes of Liver Failure
In the U.S., acetaminophen overdose is the leading cause of acute liver failure. 1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview Other causes include medications, illicit drugs, mushrooms, and medicinal herbs. Environmental chemicals, such as organic solvents and phosphorous also act as poisons that severely damage the liver.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
In the United States, alcoholism and hepatitis C infection are the primary causes of cirrhosis. Chronic heart disease and metabolic disorders also can lead to decreased liver function. 3Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview More rarely, a genetic disorder known as Wilson disease causes liver failure through the buildup of copper metal inside the liver and other body tissues.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
4. Brain Damage
When the liver is unable to perform its job, toxins that would normally be removed continue to circulate in the bloodstream. One effect of this condition, known as hepatic encephalopathy, is decreased mental ability as a result of liver failure. Symptoms include trouble thinking, confusion, poor judgment, and shaky hands.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
Because it is one of the most serious symptoms, the rapidity of the development of encephalopathy determines whether doctors consider liver failure fulminant or subfulminant.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview The degree to which encephalopathy has progressed before seeking treatment is a major determinant of whether a patient will recover.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
5. Excessive Bleeding and Blood Clots
One of the liver’s duties is to synthesize proteins involved in the body’s blood clotting response.2Mayo Clinic. Diseases and Conditions: Liver Disease. (2020) https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502 As the liver loses its functionality, the manufacturing of these necessary molecules is subsequently impaired. As a result, patients can experience either excessive blood clotting or an impaired ability to make clots.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
Symptoms of coagulopathy, a condition in which the blood cannot clot efficiently, include unexplained bleeding from the joints, nose, or gums. Internal bleeding also can occur, causing abdominal swelling. Excessive clotting is known as thrombosis and can lead to stroke or heart attack.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
6. Diagnosis
During an initial physical exam, a doctor will palpate the patient’s abdomen to determine whether there is a pain in the upper right side, and to estimate the size of the liver. A liver that is smaller than normal can indicate loss of tissue due to necrosis, while an enlarged liver may suggest heart failure or hepatitis.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
Doctors generally confirm their initial diagnosis with the results of blood and urine tests, which can offer clues about liver function and blood clotting abilities. Ultrasound, MRI, or CT scans provide an image of the liver and surrounding organs.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
7. Incidence
Each year, acute liver failure affects approximately 2,000 people in the U.S., with 74% of cases occurring in whites, 10% in Hispanics, 3% in African-Americans, and 3% in Asian-Americans.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview In developed countries worldwide, it occurs in 10 people per million.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
Chronic liver failure from cirrhosis and liver disease causes 1.2% of all deaths each year in the United States, making it the ninth leading cause of death. It is the 14th leading cause of death worldwide and the fourth in Europe.3Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview Liver damage from hepatitis E is more common in countries with large indigenous populations.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
8. Prognosis
Without treatment, acute liver failure has a high mortality, but it varies depending on the cause. For example, patients experiencing liver failure due to viral hepatitis have a worse prognosis than those who have overdosed on acetaminophen.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview Age also affects survival, with the lowest rates in those under 10 and over 40 years old.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
A liver transplant significantly improves the chance of survival. The mortality rate one year after transplant is only 10 to 15% and remains less than 30% after 5 years.3Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview These rates reflect drastic technological advancements since the 1980s when patient mortality was 30% one year and 85% five years post-transplant. 3Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview
9. Prevention
Because the overuse of pain medications is the primary cause of liver failure, using drugs only as prescribed is important. Other lifestyle choices that reduce the chance of suddenly damaging the liver are avoiding exposure to aerosols and other environmental toxins, getting vaccinated against hepatitis, and not participating in risky sexual behaviors.2Mayo Clinic. Diseases and Conditions: Liver Disease. (2020) https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502
Alcoholism is to blame for a large number of cases of liver failure that have occurred slowly over time. Thus, avoiding excessive alcohol consumption is the best way to keep the liver healthy.2Mayo Clinic. Diseases and Conditions: Liver Disease. (2020) https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502 Once cirrhosis has begun, a diet that avoids toxins and minimizes inflammation can prevent the conditioning from worsening.3Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview
10. Treatment
Acute liver failure is a life-threatening illness that requires treatment in a hospital’s intensive care unit.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview In the case of poisoning with acetaminophen or certain mushrooms, emergency room physicians administer an antidote that binds to the poison and removes it from the system. Liver transplantation is often warranted, with blood dialysis performed while waiting for a donor.1Gagan K et al. Acute liver failure. Medscape: Drugs and Diseases (2019) https://emedicine.medscape.com/article/177354-overview
The priority in the treatment of patients with chronic liver failure is to remove the cause, be it alcohol consumption or a virus. 3Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview Secondary treatment priorities include administering mediations to restore a healthy gut biome, improve circulation, and reduce inflammation and high blood pressure.3Wolf, David C. et al. Cirrhosis. Medscape: Drugs and Diseases (2018) https://emedicine.medscape.com/article/185856-overview
