Liver failure happens when your liver starts to shut down. This is usually because it's become damaged and can't be repaired. It's a life-threatening condition that demands urgent medical care. Most often, liver failure happens gradually, over many years, and is called chronic liver failure. It’s the final stage of many liver diseases. But a rarer condition, known as acute liver failure, happens rapidly -- in as little as 48 hours.
Chronic liver disease/cirrhosis (a disease where your liver is permanently scarred) is the 10th leading cause of death in the U.S., according to 2022 government statistics. It causes nearly 55,000 deaths per year. Worldwide, 2 million people die from liver disease every year.
Your liver has many functions, such as:
- Making bile to help you digest food
- Making blood proteins that help your blood clot and transport oxygen
- Supporting your immune system
- Getting out substances such as drugs and alcohol from your body
- Breaking down saturated fat and making cholesterol
When your liver can no longer do these things, then liver failure sets in.
Types of Liver Failure
There are two types of liver failure:
Acute: Your liver stops working within a matter of days. Most people who get this don’t have any type of liver disease or problem before this event. It's usually caused by a hepatitis virus or overuse of acetaminophen (Tylenol) or some other medications. These events severely harm liver cells.
Chronic: Damage to your liver builds up over time and causes it to stop working. It happens alongside cirrhosis and can be due to hepatitis, long-term alcohol abuse, fatty liver disease, and other illnesses. You often don't realize you have liver damage until several years have passed. Each time the liver has to repair itself because of injury from one of these conditions, it forms scar tissue. As more scar tissue forms, it's harder for the liver to function properly.
Liver Failure Symptoms
Early signs of liver damage
The early symptoms of liver failure are often similar to those of other conditions. Because of this, liver failure may be tough to diagnose at first. Early symptoms include:
Signs of advanced liver failure
As liver failure progresses, the symptoms become more serious, needing care right away. These symptoms include:
- Jaundice (yellowing of eyes and skin)
- Bleeding easily
- Swollen belly
- Mental confusion (known as hepatic encephalopathy)
- Sleepiness
These symptoms will appear in both chronic and acute liver failure.
What are the signs of liver failure on the face?
You may see:
- Yellowing of the eyes
- Yellowing of the skin (more noticeable in white people than in black and brown people)
What Causes Liver Failure?
Acute liver failure causes
The causes of acute liver failure, when the liver fails rapidly, include:
- Acetaminophen overdose: Large doses can damage your liver or lead to failure.
- Viruses including hepatitis A, B, and E, Epstein-Barr virus, cytomegalovirus, and herpes simplex virus: They lead to liver damage or cirrhosis.
- Reactions to certain prescription and herbal medications: Some kill cells in your liver. Others damage the duct system that moves bile through it.
- Eating poisonous wild mushrooms: A kind called Amanita phalloides, also known as the death cap, contains toxins that damage liver cells and lead to liver failure within a couple of days.
- Autoimmune hepatitis: As with viral hepatitis, this disease, in which your body attacks your liver, can lead to acute liver failure.
- Wilson’s disease: This genetic disease prevents your body from removing copper. It builds up in your liver and damages it.
- Acute fatty liver of pregnancy: In this rare condition, excess fat gathers on your liver and damages it.
- Septic shock: This overwhelming infection in your body can damage your liver or cause it to stop working.
- Budd Chiari syndrome: This rare disease narrows and blocks the blood vessels in your liver.
- Industrial toxins: Many chemicals, including carbon tetrachloride, a cleaner and degreaser, can damage your liver.
Chronic liver failure causes
The most common causes of chronic liver failure include:
- Hepatitis A, B, and C: These viruses can infect the liver, making it inflamed and unable to work properly.
- Long-term alcohol consumption: Heavy drinking can lead to cirrhosis.
- Nonalcoholic fatty liver disease (NAFLD): It often affects people who are overweight, obese, or have high cholesterol. In 2023, NAFLD was renamed metabolic dysfunction-associated steatotic liver disease (MASLD). Alcohol-related fatty liver disease affects heavy drinkers. In both diseases, extra fat cells build up on your liver, leading to an enlarged liver.
Other causes of liver failure
Less common reasons for chronic liver failure include:
- Autoimmune hepatitis: In this type, your body’s immune system, not a virus, attacks your liver and causes inflammation.
- Primary sclerosing cholangitis: This disease slowly damages your bile ducts. It mostly affects young men.
- Oxalosis: This is when your kidneys can’t get rid of calcium oxalate crystals through urine, leading to their buildup in other parts of your body.
- Hemochromatosis: This inherited disorder causes your body to absorb and store too much iron. It can build up in your liver and cause cirrhosis.
- Wilson's disease: People with this rare inherited disease store too much copper in their brain and liver.
- Alpha-1 antitrypsin deficiency: This genetic condition can lead to lung or liver disease.
- Liver adenoma: This is when benign tumors appear on an otherwise healthy liver. This often affects women between the ages of 20 and 44.
- Alagille syndrome: A genetic disorder that results in fewer bile ducts than normal in the liver.
- Primary biliary cholangitis (PBC): Over time, this disease destroys your small bile ducts. You might still hear it called by its former name, primary biliary cirrhosis.
- Galactosemia: People with this condition can’t process galactose, a sugar found in many foods. It can cause liver damage.
- Lysosomal acid lipase deficiency (LAL-D): With this genetic condition, you can’t produce an enzyme called lysosomal acid lipase, which helps your body break down fats and cholesterol in your cells. As a result, fats stay in your liver and cause damage.
Liver Disease Stages
Stage I: Inflammation. In the early stages, your liver will be inflamed and could be tender. Or it may not bother you at all.
Stage II: Fibrosis/scarring. If you don’t treat the inflammation, it will cause scarring. As scar tissue builds up in your liver, it stops blood flow, which keeps the healthy parts from doing their job, making them work harder.
Stage III: Cirrhosis. The scar tissue takes over, and with less and less healthy tissue to do its job, your liver won’t work well, or it won’t work at all.
Stage IV: End-stage liver failure/disease. This is an umbrella term for several conditions, including swollen liver, internal bleeding, loss of kidney function, fluid in your belly, and lung problems. Only a liver transplant can cure it.
Liver Disease and Liver Failure Diagnosis
Tests and procedures used to diagnose liver failure and liver disease include:
Blood tests. These let your doctor know how well your liver is working. You might get a prothrombin time test, which measures how long it takes your blood to clot. With acute liver failure, blood doesn't clot as quickly as it should.
Imaging tests. These take pictures that let your doctor see what’s going on in your liver and figure out what’s causing the problem. They may recommend:
- Ultrasound
- Abdominal CT scanning
- MRI
Biopsy. The doctor uses a needle to remove a small piece of liver tissue and looks at it in the lab. A transjugular liver biopsy is a special procedure that lets the doctor put the needle into a vein in your neck.
Liver Failure Treatment
Medication. Acetylcysteine can reverse acute liver failure caused by an acetaminophen overdose. But you have to take it quickly. There are also medications that can reverse the effects of mushrooms or other poisons.
Supportive care. If a virus causes liver failure, a hospital can treat your symptoms until the virus runs its course. In these cases, the liver will sometimes recover on its own.
Liver transplant. This could mean receiving a liver from a deceased donor or a part of a liver from a live donor. A part of a healthy liver will grow to its normal size after transplant. The number of Americans waiting for a liver transplant far exceeds the number of livers available from deceased donors.
Surgery. This involves removing the diseased part of your liver, a procedure called a liver resection, or hepatectomy. The healthy part of your liver will regrow.
How to treat liver failure in people with alcohol addiction
Alcohol-related liver disease (also called alcoholic liver disease) is liver damage related to drinking too much alcohol. It normally takes years of alcohol abuse before symptoms show up. Symptoms are the same as for chronic liver disease:
- Weight loss
- Jaundice
- Swelling in the stomach and ankles
- Confusion and fatigue
- Passing blood in your poop or vomiting blood
A few liver cells die every time the liver filters alcohol. Although some will come back, too much alcohol can damage the liver permanently.
The main treatment is to stop drinking. This, of course, is difficult if you're addicted to alcohol. You may be given a drug called benzodiazepine (Valium) or offered psychological counseling to help you through withdrawal. Many people go to rehab centers to help them kick alcoholism. Others find a lot of help with support groups such as Alcoholics Anonymous.
Other treatments, such as getting a liver transplant, are only available to you once you stop drinking. You'll also want to eat a proper diet because many people with alcohol-related liver disease don't eat healthily. Avoid salty foods to bring down swelling in your body.
Complications of Liver Failure
Doctors will work to prevent complications, which include:
Cerebral edema. Fluid buildup is a problem with liver failure. In addition to your belly, it can also pool in your brain and lead to high blood pressure there.
Blood clotting problems. Your liver plays a big role in helping your blood clot. When it can’t do that job, you’re at risk of bleeding too freely.
Infections, such as pneumonia and urinary tract infections (UTIs). End-stage liver disease can make you more likely to get infections.
Kidney failure. Liver failure can change the way your kidneys work and lead to failure.
How Can Liver Failure Be Prevented?
The best way to prevent liver failure is to limit your risk of getting cirrhosis or hepatitis. Here are some tips to help prevent these conditions:
Have a healthy lifestyle
- Eat a proper diet from all of the food groups. Go easy on sodium.
- Keep a healthy weight.
- Don't drink alcohol in excess.
Avoid risky behaviors
- Be sure to use barrier protection (condoms) when having sex.
- If you use illegal intravenous drugs, don't share needles with anyone.
- Don't share any personal toiletry items, including toothbrushes and razors.
- If you get a tattoo or a body piercing, make sure the conditions are sanitary and all equipment is aseptic (free of disease-causing germs).
Check on your medications and vaccinations
- Get a hepatitis vaccine or an immunoglobulin shot to prevent hepatitis A and B.
- Follow instructions on drug labels. Don't take more acetaminophen in a day than is recommended. If you already have liver disease, ask your doctor whether you should take it at all.
- Avoid alcohol when you're taking acetaminophen.
- Some prescription drugs and herbal supplements have been linked to liver failure, so let your doctor know about everything you're taking.
Screen for liver diseases
Blood tests can check liver function and any signs of disease. Even without any symptoms of liver disease, you may need screening if you've been exposed to hepatitis and haven't been vaccinated against it, have a family history of liver disease, are obese, have diabetes, or are addicted to alcohol.
Many liver function tests are part of a routine blood test called the comprehensive metabolic panel (CMP). You'll probably need to fast before the test.
Takeaways
Liver failure can be acute (sudden) or chronic (ongoing). Signs of liver failure include yellowing of the skin and eyes (jaundice), swelling of the ankles and stomach, itchy skin, constant tiredness, and loss of appetite. You can have chronic liver failure for years with no symptoms. Treatment includes medication (for acute liver failure), and a change in diet and alcohol use (for chronic liver failure). If you have either type, you may end up having to have surgery to remove part of your liver or get a liver transplant.
Liver Failure FAQs
How long can a person live with liver failure?
If you have end-stage liver disease, your lifespan will be about 2 years, unless you get a liver transplant. Once your liver starts to shut down (liver failure), you can only live for a day or two.
What can stop liver failure?
If you have acute liver failure, medications that address the cause of the problem and a liver transplant can stop it. For chronic liver failure, a change in diet, stopping drinking, and a liver transplant are needed.
What is the best drink to repair your liver?
Some say it's coffee. Research has shown that drinking more than two cups of coffee per day slowed down the progress of liver disease and cirrhosis in some people. It's not clear yet which of the many chemicals in coffee is responsible for the benefits. Not everyone who drinks coffee is protected from liver disease. If your doctor has told you to watch your diet, try not to add sugar and cream to your coffee, as these aren't good for your liver.
