Liver Failure is a disease in which the liver does not work properly. The liver will not perform its functions, leading to further complications or even death.
Several possible causes can lead to liver failure. It also can be divided into two types of failure, acute and chronic. This is a very serious disease that requires immediate medical attention and hospitalization. Over 30 million people in the United States have some form of liver disease.
Within this article, you will find answers to some of the most common questions on this topic, including questions like what causes liver failure, who is at risk, and the complications of this disease. But before reaching that point, there will be brief explanations on basic concepts of the disease.
By reading this article, you will obtain key insights about Liver Failure, its causes, its symptoms, how it is diagnosed, and many more. Therefore, please continue reading to get pearls on this specific topic by the hand of a Doctor.
What are the types of Liver Failure?
First, it is important to understand what liver or hepatic failure is. The liver is an organ that receives a huge part of the blood flow and has a very important role within the human body. These are some of the functions that the liver performs:
- Making blood proteins that aid in clotting, transporting oxygen, and supporting the immune system.
- Making bile, a substance that helps with food digestion, specifically, fatty acids digestion.
- Helps the body to store sugar or glucose. It uses the form of glycogen to this end.
- The liver helps the body process substances that can be found in the bloodstream. It can also help the body to get rid of them. This includes medications, alcohol, and drugs.
- It helps to break down saturated fats and to produce cholesterol.
There are two principal types of liver disease; these are acute liver disease and chronic liver disease. However, to be more specific, acute liver failure also has more subdivisions. Among the subdivisions are the following:
- Hyperacute Liver Failure: It happens within 7 days.
- Acute Liver Failure: It occurs between 1 to 4 weeks.
- Subacute Liver Failure: It happens between 5 to 12 weeks.
Although these classifications exist and have a clinical significance on the development of the disease, doctors usually refer to it as acute liver failure or chronic liver failure.
Acute Liver Failure
Acute liver failure is a very complex clinical syndrome with a wide spectrum of symptoms. Among the problems that acute liver failure can cause are elevations of the liver biochemistry, coagulopathy, and overt hepatic encephalopathy. The most interesting thing about acute liver failure is that it happens without the presence of underlying chronic liver disease.
The most common cause for acute liver failure is a drug-induced liver injury in developed countries. In countries that are still developing, the most common cause is viral hepatitis. It is a condition that is more common among young people, and that greatly affects developing countries. Annually less than 10 million cases are detected throughout the world. While in the United States of America, there are approximately 2800 cases per year.
Chronic Liver Failure
It is a long-term disease that also receives the name of liver cirrhosis. The healthy liver tissue gets replaced by scar tissue little by little through time, making the liver stop working normally. This also makes the liver shrink in size and reduces the overall blood flow of the liver. In very severe cases, the liver may receive so much damage through time that it may stop working. Many causes promote the progression of cirrhosis like the following:
- Hepatitis and other viruses like cytomegalovirus
- Alcoholic liver disease
- Nonalcoholic liver disease
- Blocked or damaged bile ducts
- Autoimmune diseases
It is a disease that causes over 35.000 deaths in the United States per year. According to data, it is also the 14th most common cause of death in the United States, while in Europe, it is the 4th most common cause.
There are estimates that over 25% of the world population suffers from nonalcoholic fatty liver disease, meaning that 1 in 4 people are at risk of suffering a chronic liver disease.
What causes acute liver failure?
There are many causes for fulminant hepatic failure to develop. The most common cases directly correlate to acetaminophen overdose/acetaminophen toxicity and idiosyncratic drug reactions. However, for over 15% of the patients, the fulminant hepatic failure’s cause remains indeterminate.
Viral hepatitis may also lead to liver failure. Among them, Hepatitis A and Hepatitis B account for the most common causes. Hepatitis B tends to be more common in the developing world as a major cause of acute liver failure. On the other hand, Hepatitis C is a disease that rarely causes acute liver failure, which is why it becomes important to determine which type of hepatitis the patient has. Also, Hepatitis D as a co-infection with Hepatitis B may lead to acute liver failure. Other viral causes are atypical as well on the next list:
- Herpes simplex virus
- Epstein-Barr Virus
- Dengue Virus
- Hemorrhagic fever virus
All of these viruses will cause acute hepatitis. However, other causes may lead to hepatic failure. Among them are some like Autoimmune Hepatitis. For educational purposes, there will be a brief explanation of every cause.
Many drugs with and without prescription may be the cause of liver injury. As a matter of fact, drug-induced liver injury is a medical term and a leading cause of liver transplantation. The most common cause for this hepatotoxicity has a direct correlation with acetaminophen.
Solely in the United States, unintentional use of acetaminophen accounted for 48% of the cases, while intentional use cases were 44%. Some studies link antibiotics like fluoroquinolones with mild alteration in the liver function tests. The following list includes some of the medications that may cause acute liver failure or idiosyncratic hypersensitivity:
- Antibiotics like ciprofloxacin, doxycycline, and isoniazid, among others.
- Antidepressants like amitriptyline or nortriptyline
- Anesthetic agents
- Lipid-lowering medications like atorvastatin
- Nonsteroidal anti-inflammatory drugs (NSAID’s)
- Illicit drugs like Ecstasy and Cocaine
- Herbal medicines like Ginseng, Pennyroyal oil, chaparral or germander tea, and kawakawa.
There are also vascular causes that may lead to acute hepatic failure like the following:
- Ischemic hepatitis
- Hepatic vein thrombosis
- Hepatic venous-occlusive disease
- Portal vein thrombosis
- Hepatic artery thrombosis
This is a shortlist as the malignancies that may cause hepatic failure are just two.
- Primary liver tumor, among them the main cause, is usually hepatocellular carcinoma or rarely cholangiocarcinoma.
- Secondary tumor, in which there are extensive hepatic metastases with a primary in places like breast or lung.
What are the stages of liver failure?
Liver failure will always go through a series of steps in which the result will always be the same. Liver disorders like Fatty Liver, nonalcoholic fatty liver disease, viral hepatitis, among others, will affect the liver in similar ways. Of course, it is always important to be aware of this and visit a doctor periodically to keep track of these conditions as many of them cannot be felt until it is very late. The stages of liver failure are the following:
- Inflammation: In the early stages of liver injury or disease, there will always be a process that leads to liver inflammation. The liver tends to enlarge and become tender. Nonetheless, this may not cause any pain or discomfort as people generally do not feel it. Suppose this process continues over time, and the source of inflammation does not get treated. In that case, it can hurt the liver permanently, leading to liver fibrosis. The cells tend to enlarge as well, and a process may also damage them, but they can recover from it.
- Fibrosis: If the inflammation continues, the liver cells will start to scar. As the inflammation process grows and spread over time, the scar will replace the healthy liver tissue. However, although it seems obvious, the scar tissue cannot do the healthy tissue’s work. This will lead to a rearrange of the blood flow within the liver as well.
- Cirrhosis: In this stage, the liver’s scarring is so big that the scar tissue replaces healthy tissue on a big scale. It will lead to complications, including liver cancer if it does not receive proper treatment and on time. By this point, the therapeutical options focus on stopping the damage and protecting the left’s healthy liver tissue.
Who is at risk for liver failure?
Certain risk factors are key for doctors to keep an eye on patients who may develop liver failure. As a matter of fact, most of them can go unnoticed as a risk factor for the liver disease until it is too late. On the other hand, a couple can be very obvious, and it is popular culture that it is a risk factor for the liver. Here is a list of some of the risk factors.
- Exposure to toxins: The liver is the organ in the body responsible for removing or cleaning the toxins from the blood. This includes medications, alcohol, illicit drugs, or any harmful toxin that cannot be found naturally within the body. Be sure to wash fruits and vegetables before consuming them to ensure that you are not consuming pesticides.
- Harmful supplements: Just because a supplement carries a label that describes it as natural does not mean that it can be good for the body. Many of these natural supplements can cause liver failure, especially in children.
- Alcohol Abuse: As everybody knows, alcohol intake or abuse may lead to liver failure. Alcohol is a toxin that harms the liver cells and induces an inflammation process that may lead to cirrhosis.
- Obesity: Having excessive overweight has a direct correlation with developing high cholesterol levels and diabetes. These are conditions that may lead to developing diseases like nonalcoholic fatty liver disease, which, if left untreated, may lead to cirrhosis or even liver cancer.
- History of Liver disease: If the patient or anyone within the family has experienced a disease like hepatitis B or C, they are more vulnerable to developing further liver diseases. Of course, this also includes genetic diseases like hemochromatosis and Wilson’s disease.
What are the symptoms?
Liver failure has a wide variety of signs and symptoms that can be easily seen on the patient. However, it requires the evaluation of a doctor to determine what the cause of the symptoms is. Several diseases may cause similar symptoms. It is important to diagnose this disease early, as liver failure has a high mortality. These are some of the most common symptoms that liver failure presents:
- Loss of Appetite
- Weight loss
- Itchy skin
- The yellowish coloration of the skin and eyes (Jaundice)
- Easily bleeding or bruising
- Confusion, drowsiness, and slurred speech
- Spiderlike blood vessels on the skin
- Redness of palms of the hands
- General sense of feeling unwell
- Pain in the upper right abdomen
- Abdominal swelling (Ascites)
- Swelling of legs, ankles, or feet
There is a long list of signs and symptoms of this disease, as anyone can see. That is why when patients feel any of these symptoms should visit a doctor immediately. This is in order to prevent further complications and properly assess the patient.
What are the complications of liver failure?
Liver failure has a long list of possible complications as it is one of the body’s principal organs. It can affect many organs and systems, starting from the blood and going all the way to the brain. Liver failure can even help to develop liver cancer. These are some of the most common complications:
- Portal Hypertension: As cirrhosis affects the liver’s normal blood flow, the blood pressure on the veins that supply the liver from the intestines and spleen increases.
- Edema and Ascites: As the portal vein’s pressure increases, the fluid can accumulate in the legs and abdomen. Also, It is a direct result of the inability of the liver to produce blood proteins like albumin.
- Splenomegaly: Portal hypertension can also cause enlargement of the spleen, trapping white blood cells and platelets. A decrease of both of these blood cells can be the first sign of cirrhosis.
- Bleeding: Portal hypertension can also cause redirection of the blood to smaller blood vessels. This causes enlargement of these vessels and makes them easy to bleed. This is the case of varices in the legs, esophageal varices in the esophagus, and the gastric varices in the stomach. Esophageal and gastric varices can lead to a life-threatening condition if they start bleeding.
- Infections: With cirrhosis, the body might have difficulty fighting infections. Also, ascites can lead to bacterial peritonitis.
- Excessive fluid in the brain: Also receives the name of cerebral edema. Fluid buildup within the body can lead to an increase in the pressure within the brain. This process also receives the name of intracranial hypertension. Intracranial hypertension can lead to severe symptoms like seizures.
- Increased risk of Liver Cancer: Many of the patients who develop liver cancer have a history of previous cirrhosis.
How is it diagnosed?
It is very hard to detect cirrhosis as it is a disease that does not run with symptoms in its early stages. Doctors can begin to suspect cirrhosis when performing a routine blood test. However, doctors should perform a complete physical examination to search for signs and symptoms of liver failure.
After this, doctors will ask about your complete familiar history and habits like alcoholism, smoking, diet, and many more. Then the doctor will ask for a series of laboratory tests to rule out any type of liver disorder as liver failure comes after them. The key is to catch the disease before it reaches the failure stage. The laboratory tests are the following:
- Blood tests: Your doctor will ask for complete blood testing. This will allow him to check for signs of liver malfunction. Among these studies is bilirubin; doctors can search within these tests if there is a presence of an excess of bilirubin. They will also look for elevations of certain enzymes specific to the liver, which indicate liver damage. Within these blood tests will search for the presence of hepatitis viruses to rule out an infection. The ability of the blood to clot will be tested as well.
- Imaging tests: Doctors can also perform tests that enable them to see the condition of the liver. They can ask for Magnetic resonance elastography, which is an exam that detects the hardening or stiffening of the liver. Also, they can ask for other imaging tests like MRI, CT scan, and ultrasound.
- Liver Biopsy: Doctors will also ask for a tissue sample that is very useful for determining the severity, extent, and liver failure damage. Moreover, it can also help to determine the cause.
How is acute liver failure treated?
The treatment for Liver Failure will depend on the extent of the damage to the liver. Doctors will try to slow the disease’s progression, the extent of the scar tissue and treat the possible complications. If the damage to the liver is severe, the patient may require hospitalization. The treatment can be divided into three types which are the following.
Treating the underlying cause of Liver Failure
It is a treatment that can be optimal for patients who are still in early or medium stages to decrease the damage and stop the progression. The treatments are:
- Treating alcohol dependency: Many patients with cirrhosis have a history of alcohol abuse. That is why your doctor will recommend stopping alcohol drinking. Suppose this results to be a challenging task. In that case, he or she will suggest the patient appoint to a program for alcohol addiction.
- Weight loss: If the patient does not have a history of alcohol abuse, this might be a case of nonalcoholic fatty liver disease. For these cases, the doctor will recommend full changes in the patient’s lifestyle, including diet and doing exercise to reduce the fat deposits within the liver.
- Medications to control hepatitis and limit the virus’s damage, whether it is A, B, C, or D.
- Medications to control other causes or symptoms of liver failure like primary biliary cirrhosis.
Treatment for Complications
The primary complications that the doctor will try to assess are the following:
- Portal hypertension: Doctors will try to control complications like Esophageal Varices, which can be life-threatening. He or she will prescribe medications to control portal hypertension; certain blood pressure medications might help. Also, your doctor will try to prevent the risk of bleeding through medication. To know the overall status of these varices, the doctor will periodically perform an upper endoscopy.
- Excess of fluids: Most of the time, lifestyle changes like a low sodium diet may help. However, doctors will use medications to reduce and prevent the fluid buildup within the body if this is not enough.
- Hepatic encephalopathy: Doctors will also recommend treatment to prevent toxins accumulation within the body that may affect the brain.
This type of treatment is the last resource; it is used only if it is a severe liver failure case. Basically, it is the option when the liver ceases to work properly. Patients can receive a dead donor’s liver or a part of the liver from a living donor. However, these patients require extensive testing as doctors need to determine if these patients can have a good outcome after this surgery.
Doctors’ asides from testing have a policy that patients who suffer from alcoholic cirrhosis are not candidates for a liver transplant. This may seem a little bit harsh, but there is the possibility or the risk that these patients can return to harmful drinking after receiving a new liver.
Do you have symptoms of this disease?
This tool is a Liver Failure Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell anybody who uses it the likelihood of having a higher risk or symptoms of liver failure. Using the tool is free and would only take a few minutes.