Understanding Liver Failure: Causes, Symptoms and Treatments

The liver is a key organ in the human body, performing vital functions like filtering toxins, producing bile, and regulating metabolism. When the liver fails, it can have life-threatening consequences. According to the CDC, liver disease is the ninth leading cause of death in the United States, affecting millions of people worldwide.

Liver failure can develop rapidly (acute) or gradually (chronic), depending on its cause. This article explores the causes, symptoms, diagnosis, treatment options for liver failure, and prevention strategies to maintain liver health.

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What is Liver Failure?

Liver failure can happen suddenly or over time, depending on the underlying cause.

Types of Liver Failure

Understanding the different types of liver failure helps determine the right treatment and prognosis.

Acute Liver Failure

Acute liver failure develops suddenly, often within days or weeks, in individuals with no prior liver disease. It is typically caused by toxins, viral infections, or drug overdoses (e.g., excessive acetaminophen use). This condition is life-threatening and requires immediate medical attention.

Chronic Liver Failure

Chronic liver failure, also known as end-stage liver disease, occurs gradually over months or years due to long-term liver damage. It is often the result of alcohol abuse, hepatitis, or fatty liver disease. If untreated, chronic liver failure can progress to cirrhosis, where scar tissue replaces healthy liver cells.

Liver Function

It is important to know how the liver functions and what happens when it starts to fail to understand liver failure.

Key liver functions are:

Detoxification
Bile Production
Metabolism Regulation
Blood Clotting

How Liver Failure Disrupts These Functions

When the liver fails, toxins accumulate in the blood, digestion becomes impaired, and vital proteins are not produced. This can lead to serious health complications, including brain dysfunction, excessive bleeding, and organ failure.

Causes of Liver Failure

Long-term damage, infections, or toxic exposure can cause liver failure. Identifying the cause is essential for proper treatment.

Common Causes

Certain conditions are more frequently responsible for liver failure.

Chronic Alcohol Abuse: Excessive alcohol consumption over time damages liver cells, leading to alcoholic liver disease and cirrhosis.
Viral Hepatitis (A, B, C): Hepatitis viruses can infect and damage liver cells. Chronic hepatitis B and C can cause cirrhosis or liver cancer.
Non-Alcoholic Fatty Liver Disease (NAFLD): NAFLD occurs when fat accumulates in the liver, leading to inflammation and scarring. It is commonly linked to obesity, diabetes, and high cholesterol.

Rare Causes

Some less common conditions can also trigger liver failure.

Genetic Disorders: Some genetic disorders such as Wilson’s Disease causes copper buildup in the liver, leading to toxic damage.
Autoimmune Hepatitis: In this condition, the immune system mistakenly attacks the liver, causing chronic inflammation.
Toxins and Medications: Certain toxins, drugs, and herbal supplements (e.g., acetaminophen overdose, poisonous mushrooms, or industrial chemicals) can lead to acute liver failure.

Risk Factors

Certain lifestyle choices and medical conditions increase the likelihood of liver failure.

Lifestyle Choices

Excessive alcohol consumption
Poor diet high in sugar and processed foods
Lack of physical activity

Pre-existing Health Conditions

Obesity
Diabetes
Hepatitis infections
Cirrhosis

Symptoms and Diagnosis

Liver failure presents a wide range of symptoms, often worsening as the condition progresses.

Early Symptoms of Liver Failure

The early signs may be subtle but should not be ignored.

Fatigue and Weakness: Individuals often experience unexplained exhaustion, low energy, and weakness.
Jaundice and Skin Changes: A yellowing of the skin and eyes (jaundice) occurs when the liver fails to process bilirubin, a yellow pigment in the blood.

Advanced Symptoms

As liver failure progresses, more severe symptoms appear.

Confusion and Cognitive Impairment: A buildup of toxins in the brain can lead to hepatic encephalopathy, causing confusion, memory loss, and mood changes.
Bleeding and Bruising Easily: Since the liver produces clotting factors, liver failure increases the risk of uncontrolled bleeding and bruising.

Diagnostic Methods

Diagnosing liver failure requires a comprehensive evaluation using medical history, physical exams, and specialized tests. Since liver failure can be caused by various conditions, early and accurate diagnosis is essential for determining the best treatment plan.

Blood Tests and Liver Function Tests

Blood tests help assess liver function and detect abnormalities that indicate liver failure. These tests measure:

Liver Enzymes: Elevated liver enzymes suggest liver inflammation or damage.
Bilirubin: A buildup of bilirubin in the blood causes jaundice and indicates impaired liver function.
Prothrombin time (PT/INR): Assess blood clotting ability, which is often impaired in liver function.
Albumin and Total Protein: Low albumin levels suggest reduced liver function.
Hepatitis Panel: Identifies infections like hepatitis A, B, and C, common causes of liver failure.

Blood tests provide valuable insight into liver health, but additional imaging studies are often needed for further evaluation.

Imaging Studies

Medical imaging provides information about the liver's size, shape, and structure to detect abnormalities like scarring, tumors, or fluid buildup. Commonly used imaging tests include:

Ultrasound: A non-invasive test that provides real-time images of the liver.
Computed tomography (CT) Scan: Offers detailed cross-sectional images of the liver, allowing doctors to assess blood flow, tumors, and structural damage.
Magnetic Resonance Imaging (MRI): Provides high-resolution images to evaluate liver tissues, bile ducts, and vascular abnormalities. MRI is particularly useful in detecting liver cancer and fibrosis.

A liver biopsy may be necessary when imaging results are inconclusive.

Liver Biopsy

A liver biopsy is a diagnostic tool that involves collecting a small tissue sample for microscopic examination. This test helps determine the extent of liver damage, inflammation, and scarring.

Additional Diagnostic Tests

In some cases, doctors may order specialized tests to further assess liver function and detect complications:

Elastography (FibroScan): A non-invasive ultrasound technique that measures liver stiffness, helping detect fibrosis and cirrhosis without the need for a biopsy.
Genetic and Autoimmune Tests: Used to diagnose hereditary liver disorders and autoimmune conditions like autoimmune hepatitis.

Treatment Options for Liver Failure

Treatment for liver failure depends on the underlying cause, severity, and progression of the disease.

Medical Treatments

Medications help manage symptoms and slow disease progression.

Medications

When liver function declines, toxins, fluids, and imbalances build up in the body. Medications can help manage these complications:

Diuretics: Help reduce fluid retention and swelling caused by cirrhosis and liver failure. Common diuretics include spironolactone and furosemide, which help manage ascites (fluid in the abdomen) and edema (leg swelling).
Lactulose: Lactulose helps the body expel ammonia, a toxin that builds up in the blood due to liver failure. This prevents or reduces hepatic encephalopathy.
Beta-blockers: Used to manage portal hypertension, which occurs when liver damage increases blood pressure in the portal vein, leading to serious complications like esophageal varices (swollen veins in the esophagus that can rupture and bleed).

Antiviral Therapies for Hepatitis

If viral hepatitis (such as hepatitis B or C) is the cause of liver failure, antiviral medications may help slow or prevent further damage:

Hepatitis B treatments: Tenofovir or entecavir can help suppress viral replication and protect liver cells.
Hepatitis C treatments: Direct-acting antivirals (DAAs) like sofosbuvir and ledipasvir can eliminate the hepatitis C virus and reduce liver inflammation.

Surgical Interventions

For individuals with advanced liver failure, surgery may be necessary to manage complications or replace the liver entirely in severe cases.

Liver Transplantation

A liver transplant is the only curative treatment for end-stage liver failure. This procedure involves replacing the diseased liver with a healthy donor liver, which can come from either:

A deceased donor (most common)
A living donor, where a portion of the liver is transplanted (since the liver can regenerate)

Supportive Surgeries

Some surgical procedures are used to relieve symptoms and manage complications in liver failure patients who are not immediate candidates for transplant:

Transjugular Intrahepatic Portosystemic Shunt (TIPS): A procedure that places a shunt in the liver to reduce pressure in the portal vein and prevent internal bleeding from varices.
Paracentesis: A procedure that drains excess fluid from the abdomen (ascites) to relieve discomfort and breathing difficulties.
Biliary Drainage Procedures: If bile flow is obstructed due to liver disease, stents or drainage tubes may be placed to improve bile flow and prevent jaundice.

Integrative and Functional Approaches

Alongside conventional treatments, diet, lifestyle changes, and certain alternative therapies may help support liver function and improve overall health. However, these should only be used under medical supervision, as some supplements can be harmful to the liver.

Nutritional Support and Diet

A balanced, liver-friendly diet can help reduce inflammation and improve overall health. Recommendations include:

High-protein foods (lean meats, eggs, legumes) support muscle strength and prevent malnutrition.
Low-sodium intake to prevent fluid retention and swelling.
Healthy fats (olive oil, nuts, avocados) instead of processed fats that may contribute to fatty liver disease.
Limiting refined sugars and carbohydrates to reduce the risk of fatty liver disease and insulin resistance.

Herbal Supplements and Alternative Therapies

While some herbal supplements claim to support liver function, many are unregulated and can cause harm. Always consult a healthcare provider before taking any supplements.

Milk thistle (Silymarin): A commonly used herbal remedy thought to support liver health and reduce inflammation. However, evidence is mixed, and it should not replace medical treatments.
Turmeric (Curcumin): May have anti-inflammatory properties, but high doses can interfere with liver enzymes.

Note: These supplements are not FDA-approved treatments for liver failure. Always consult a healthcare provider before using any alternative therapies.

Living with Liver Failure

Managing liver failure requires lifestyle changes and support systems.

Lifestyle Modifications

Diet and Nutrition: Eating a liver-friendly diet can help manage symptoms.
Avoiding Alcohol and Toxins

Support Systems

Having a strong support system helps patients cope with the disease. Support groups and counseling offer emotional and financial support.

Prevention of Liver Failure

Preventing liver failure starts with healthy lifestyle choices and regular screenings.

Maintaining a Healthy Liver

Balanced Diet and Regular Exercise: A healthy diet and exercise can prevent obesity and fatty liver disease.
Limiting Alcohol Consumption: Drinking in moderation or avoiding alcohol altogether protects the liver.

Vaccinations and Regular Screenings

Hepatitis Vaccinations: Getting vaccinated against hepatitis A and B reduces infection risk.
Routine Liver Function Tests: Regular blood tests can help detect problems early.

Awareness of Medications and Toxins

Many cases of liver failure are caused or worsened by exposure to medications, toxins, and environmental chemicals.

Safe Use of Over-the-Counter Drugs

Many over-the-counter (OTC) medications are widely available and commonly used, but some can be harmful to the liver if taken incorrectly or in large amounts. The most well-known OTC drug associated with liver damage is acetaminophen (Tylenol®).

Acetaminophen toxicity is a leading cause of acute liver failure in the U.S. and worldwide.
Taking more than the recommended dose (4,000 mg per day for adults) can cause severe liver damage.
The risk increases if acetaminophen is taken with alcohol or combined with other medications that contain acetaminophen (such as cold and flu medicines).

Other medications that may harm the liver if overused or misused include:

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can increase the risk of liver injury in people with liver disease or heavy alcohol use.

Avoiding Environmental Toxins

Toxic substances from the environment, workplace, or even household products can contribute to liver damage over time. Reducing exposure to these harmful chemicals can help protect liver function.

Industrial and Workplace Toxins

Workplace chemicals that are harmful to the liver include:

Solvents and industrial chemicals (e.g., benzene, carbon tetrachloride, and vinyl chloride)
Pesticides and herbicides

Harmful Herbal Supplements and Natural Toxins

While some herbal supplements are marketed as liver detoxifiers, not all are safe—many can cause liver damage or worsen existing liver disease.

Herbs and natural substances that may be toxic to the liver include:

Kava
Comfrey: Contains toxic alkaloids that cause liver scarring (fibrosis).
Green tea extract (high doses): While green tea is safe in moderation, concentrated supplements have been associated with acute liver injury.
Aflatoxins: Toxins produced by mold in improperly stored grains, nuts, and legumes can cause liver damage.

Always contact your healthcare provider before starting any supplements or herbs.

This article is for informational purposes only and should not replace professional medical advice. Always consult a licensed healthcare provider before making decisions about your health or treatment options.