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Liver Failure

By

Danielle Tholey

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Feb 2021| Content last modified Feb 2021
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Liver failure is severe deterioration in liver function.

Causes

Complications

Many effects occur because the liver malfunctions:

Symptoms of Liver Failure

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 Low Blood Pressure and Shock read more .

In acute liver failure, people may go from being healthy to near death within a few days. Acute liver failure is a medical emergency and if possible people should be evaluated at a liver transplant center. 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 Overview of Liver Tumors Liver tumors may be noncancerous (benign) or cancerous (malignant). Cancerous liver tumors are classified as primary (originating in the liver) or metastatic (spreading from elsewhere in the... read more .

Diagnosis of Liver Failure

  • A doctor's evaluation

  • Blood tests

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 Kidney Failure read more , and infections. Depending on the person's symptoms, tests may be repeated frequently.

Treatment of Liver Failure

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.

Dietary restriction

People should also limit their consumption of sodium (in salt and many foods) to less than 2,000 mg a day to prevent fluid from accumulating within the abdomen. Alcohol is completely avoided because it can worsen liver damage.

Acute liver failure

Acute liver failure is a medical emergency. If possible, people should be evaluated at a liver transplant center and managed in an intensive care unit. Treatment may include

  • For low blood pressure: Fluids given intravenously and drugs to increase low blood pressure

  • For hepatic encephalopathy: Possibly treatments, such as lactulose (a laxative) and antibiotics

  • For infections: Antibiotics or antifungal drugs

  • For low blood sugar: Glucose (a sugar) given intravenously

  • For bleeding: Transfusions of fresh frozen plasma (the fluid part of the blood, which contains proteins that help blood clot, called blood clotting factors) and, when necessary, whole blood

Liver transplantation

Liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more , 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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