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Liver Failure

by Steven K. Herrine, MD

Liver failure is severe deterioration in liver function.

  • Liver failure is caused by a disorder or substance that damages the liver.

  • Most people have jaundice, feel tired and weak, and lose their appetite.

  • Other symptoms include accumulation of fluid within the abdomen (ascites) and a tendency to bruise and bleed easily.

  • Doctors can usually diagnose liver failure based on symptoms and results of a physical examination and blood tests.

  • Treatment usually involves controlling protein consumption, limiting sodium in the diet, completely avoiding alcohol, and treating the cause, but sometimes liver transplantation is required.

Liver failure can result from any type of liver disorder, including viral hepatitis, 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:

  • The liver can no longer adequately process bilirubin (a waste product formed when old red blood cells are broken down) so that it can be eliminated from the body. Bilirubin then builds up in the blood and is deposited in the skin. The result is jaundice.

  • The liver can no longer synthesize enough of the proteins that help blood clot. The result is a tendency to bruise and bleed (coagulopathy).

  • Blood pressure in the veins that bring blood from the intestine to the liver is often abnormally high (called portal hypertension—see Portal Hypertension).

  • Fluid may accumulate within the abdomen (ascites).

  • Brain function may deteriorate because the liver cannot remove toxic substances as it normally does. These substances build up in the blood and cause brain function to deteriorate. This disorder is called hepatic encephalopathy.

  • New veins (called collateral vessels) that bypass the liver may form. They often form in the esophagus and the stomach. There, the veins enlarge and become twisted. These veins—called varicose veins of the esophagus (esophageal varices) or stomach (gastric varices)—are fragile and prone to bleeding.

Symptoms

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. 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.

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.

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 (hepatorenal syndrome) because liver failure can eventually lead to kidney failure. Some people develop liver cancer.

Diagnosis

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.

Treatment

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 (see Hepatic Encephalopathy). 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.

Liver transplantation (see 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.

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