Brief overview
- Symptoms: Eyes and skin turn yellow; impaired brain function (encephalopathy) leading to impaired concentration and consciousness; blood clotting disorders; failure of other organs possible in severely advanced disease.
- Course of disease and prognosis: Usually a consequence of other chronic liver diseases; acute form without preceding chronic liver disease is much rarer
- Treatment: Depends on cause and course of liver failure, e.g. detoxification measures for toxins
- Cause and risk factors: chronic liver damage, e.g., due to alcohol or drug consumption; infections with certain viruses (e.g., multiple hepatitis viruses); poisoning
- Diagnosis: Medical history, physical examination, blood tests, X-ray or ultrasound of the liver
- Prevention: moderate alcohol consumption, balanced diet, vaccinations against relevant viral infections, treatment of chronic pre-existing conditions
What is liver failure?
In liver failure (hepatic insufficiency), various functions of the liver gradually fail. This is dangerous because the liver performs many vital functions in the body: It is the most important organ of metabolism and, weighing an average of 1.5 kilograms, the largest gland in the human body.
The liver is also responsible for the breakdown of drugs, alcohol and pollutants (“detoxification”). Various diseases, a lot of alcohol and a diet high in sugar and fat put a strain on the liver in the long term and sometimes lead to the development of fatty liver and/or cirrhosis. However, the liver is capable of performing a large part of its tasks for a long time, even with significantly fewer functioning cells.
If liver failure occurs, the liver is already severely damaged. Liver failure develops either chronically (chronic liver failure) or very quickly, for example due to infection or poisoning (acute liver failure). In either case, it is a dangerous condition that must be treated immediately.
What are the symptoms?
While many liver diseases go unnoticed in the early stages, liver failure presents symptoms that are quite characteristic. The following signs are considered leading symptoms of liver failure:
- The whites of the eyes (sclera) and mucous membranes turn yellow; as the disease progresses, the skin also takes on a yellowish color. This is what doctors call jaundice.
- In addition, disorders of blood coagulation occur, which is manifested, for example, in frequent bleeding under the skin. This is called hemorrhagic diathesis.
In addition, liver failure sometimes results in a typical respiratory odor of raw liver (foetor hepaticus) and sometimes in painful discomfort in the upper abdomen. In advanced stages, blood pressure often drops and breathing accelerates. After the affected person becomes increasingly tired and sleeps almost exclusively, he falls into a so-called hepatic coma in the course of hepatic encephalopathy.
Hepatic encephalopathy
Liver failure often leads to brain dysfunction. Read all about it in the article Hepatic encephalopathy.
How is liver failure treated?
Acute or acute-on-chronic liver failure requires immediate therapy in an intensive care unit. Treatment depends primarily on the trigger of the liver injury – so accurate diagnosis is very important. Patients in whom liver failure is due to poisoning, for example, receive immediate gastric lavage and, if possible, an antidote. In the case of certain viral infections such as hepatitis B, antiviral therapy is often useful.
Liver failure: therapy through transplantation
In some cases – especially with a pre-damaged liver – the likelihood of the organ recovering and resuming its functions is low. In this case, patients are immediately transferred to a transplant center, where they receive a new liver as quickly as possible. If necessary, it may be sufficient to replace only the left lobe of the liver (auxiliary partial orthotopic liver transplantation, APOLT). In acute liver failure, about half of patients need a liver transplant.
Out-of-body (extracorporeal) liver replacement procedures such as specialized liver dialysis are under medical investigation and are not yet standard therapy.
Course of disease and prognosis
Liver failure is a serious condition that requires immediate treatment. The various liver functions are vital to the body’s survival – if treatment comes too late, the prognosis is poor. The younger the affected person and the less severe the underlying disease, the higher the chances of recovery.
Liver failure: causes and risk factors
In principle, liver failure can have very different causes. Liver failure is often preceded by a disease of the liver that has been present for months or years. Eventually, the various functions of the liver break down because the body is no longer able to compensate for the damage that has occurred. In that case, it is called chronic liver failure, and in the case of a sudden severe deterioration, it is also called acute-on-chronic liver failure.
Chronic liver failure often develops, for example, when years of alcohol abuse destroy more and more liver cells and the tissue becomes scarred (cirrhosis). Liver failure due to cancer is also possible if the liver cells degenerate or a malignant tumor “spreads” from another organ. In some cases, a chronic viral infection such as hepatitis C also takes a severe course and ultimately causes liver failure.
Acute liver failure means that the liver function collapses without any long-term previous disease. This occurs much less frequently. Possible reasons for liver failure to develop suddenly within a short period of time include:
- Poisoning: In most cases, toxic liver damage is caused by an overdose of medications such as paracetamol, or, less frequently, tuberculosis drugs and certain herbal remedies in far too high doses. Poisoning with mushrooms (e.g., tuber leaf fungus), drugs (e.g., ecstasy), and chemicals also sometimes trigger acute liver failure.
Less common causes of acute liver failure include autoimmune hepatitis, the inherited disease Wilson’s disease, and complications during pregnancy – acute fatty liver of pregnancy or HELLP syndrome. In up to 20 percent of cases, the trigger of the liver inflammation remains unclear. Doctors then speak of cryptogenic hepatitis.
Examinations and diagnosis
Many people with liver failure have already been under medical treatment for a long period of time with certain previous illnesses and a strain on the liver is known (chronic liver insufficiency). This makes diagnosis easier. Acute liver failure without preexisting conditions is less common.
Clinical symptoms such as jaundice and fluttering eyes quickly lead the doctor to think that the liver is not working properly. During a physical examination, he palpates the upper abdomen to feel whether the liver is enlarged or reduced in size. He also draws blood to diagnose liver failure. Various laboratory values in the blood count substantiate the suspicion of chronic or acute liver failure. These include, for example, altered coagulation values, transaminases, bilirubin or ammonia.
Further examinations depend on the suspected cause, the symptoms and the course of the liver failure. Sometimes the doctor takes a sample of liver tissue (liver biopsy) for laboratory testing. Imaging procedures such as a special ultrasound examination (duplex sonography) or a chest X-ray are also sometimes performed.
In one particular examination, “invasive blood pressure measurement,” a catheter is sometimes used to measure blood pressure in specific blood vessels. If fluid buildup in the brain (cerebral edema) is suspected, doctors use a probe to measure intracranial pressure through a small hole in the skull.
Liver failure: prevention
- Be sure to consume alcohol in moderation.
- Refrain from excessive sugar and fat in your diet.
- Always have chronic diseases (such as diabetes) properly treated and adjusted.
- Refrain from drugs; be sure to use sterile needles when appropriate.
- Protect yourself with condoms during sexual intercourse if you are not sure about possible infections of your sexual partner.
- Before traveling abroad, make sure you have sufficient vaccinations (e.g. against hepatitis A and B).
- Follow the rules for food and drinking water hygiene, especially when traveling abroad.
- If you are taking medication, follow the recommended dosages exactly. Keep them out of the reach of children.
- Refrain from eating mushrooms and plants whose species and origin you are not sure of. Poisoning is a common cause of acute liver failure.
