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Liver Failure (Hepatic Failure): Types, Symptoms, Causes, and Diagnosis

HealthcareOnTime Team 2024-02-28 2024-02-29 3 Min Read
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  • Liver Failure (Hepatic Failure)

    Liver failure or hepatic failure occurs when the liver can no longer perform its functions like manufacturing bile and eliminating harmful toxins from the body effectively 1. Centred on various benign factors, it has been identified that these include liver diseases like hepatitis, Alcohol misuse, and genetic conditions.

    The condition can stem from infections like Hepatitis B and C, excessive drinking, or genetic factors, with diagnosis involving a liver kidney check-up, blood tests, liver panel test, and scans.

    A 2023 study shows that liver disease is said to cost two million deaths per year, of which is 4% of all deaths—to put more emphasis on it, one out of every 25 deaths in this world! 

    Also, the same study shows that about 66% of all deaths caused by liver disease afflict the male gender.

    Ignoring signs of liver cell failure can lead to dangerous complications. Hence, if you notice any liver failure symptoms, it's vital to see a doctor right away or get a liver test done to prevent the issue beforehand.

    Types of Liver Failure/Hepatic Failure

    Liver failure can take different forms, each with its own set of signs and symptoms. Here are the main types:


    Defined as: 

    Chronic Liver Disease (CLD)

    A slow deterioration of liver function over time, mostly more than 6 months. It can stem from a wide range of causes, including toxins, alcohol abuse, infections, and genetic factors, ultimately leading to cirrhosis, where liver structure is severely altered. 2

    At the cellular level, cirrhosis involves the activation of stellate cells and fibroblasts, which causes fibrosis, while regeneration is dependent on hepatic stem cells.3

    Acute Liver Failure

    Acute liver failure is considered the case of severe acute liver injury lasting less than twenty-six weeks due to impaired synthetic function of the liver (INR of 1.5 or higher) in a patient with liver cirrhosis or pre-existing liver disease 4. It occurs suddenly, often due to an overdose or poisoning, progressing swiftly and hard to detect 5.

    Stages of Liver Failure (Liver Disease Progression)

    Liver failure typically progresses through several stages, each with its own set of symptoms. Listed down are the key stages of liver failure:

    Stage 0: Healthy Liver

    • The liver functions normally, performing vital tasks like digestion, toxin removal, and energy storage 6.

    Stage 1: Beginning of Liver Damage

    • Inflammation or hepatitis marks the initial stage, often with no liver failure symptoms initially 7.

    Stage 2: Moderate Liver Damage

    • Fibrosis (scar tissue) happens; it's where the fibrous scars are made in the liver. The liver may not work effectively, but it may heal over time with the right treatment option spared 8.

    Stage 3: Prolonged Hepatic Damage

    • Significant damage occurs with more pronounced signs of liver cell failure, like low-grade fever, nausea, and jaundice. Untreated fibroids can progress to cirrhosis and liver cancer 9.

    Stage 4: Severe Liver Damage (Cirrhosis)

    • Liver cirrhosis is a process that entails scarring in the liver, and thus, the entire liver function is totally affected to a great extent. This type of liver failure symptoms are often manifested by severe weakness and abdominal pain, as well as fluid accumulation, not to mention internal bleeding and organ damage as far as complications are concerned 10.

    Stage 5: End-Stage Liver Failure

    • This is the advance­d stage where the­ liver can no longer work properly. At this stage­, liver failure symptoms may include disorie­ntation, extreme fatigue­, kidney problems, and yellowing of the­ skin and eyes.

    Who is at the Greatest Risk of Liver Failure?

    The greatest risk for liver failure is found in individuals with the following characteristics:

    • Drinking too much alcohol.
    • Excessive fat, sugar, and also cases of NAFLD (non-alcoholic fatty liver disease) can develop hepatic failure 11
    • Individuals with Hepatitis B (HBV) and Hepatitis C (HCV) 12
    • Genetic predisposition. 24
    • Long-term exposure to toxic materials (pesticides, chemicals, or aerosol sprays) 13.
    • Chronic or inappropriate consumption of some medications (e.g., acetaminophen 14) or dietary supplements may trigger liver damage.
    • Intravenous drug intake and the reuse of syringes can spread the virus to others, along with sharing needles.25
    • Patients with Coexisting Health Conditions like chronic kidney disease, heart failure, and diabetes, can exacerbate liver damage and increase the risk of liver failure

    Warning Symptoms of Liver Failure

    Liver failure progresses through several stages, each presenting distinct warning signs and symptoms. Recognizing these signs is crucial for early detection and intervention. Let's delve into the warning signs of liver failure:

    Type of Liver Failure

    Signs and Symptoms of Liver Failure

    Chronic Liver Failure

    • Jaundice 
    • Tiredness 
    • Confusion 
    • Nausea
    • Mental confusion, change in consciousness, or coma (hepatic encephalopathy 15)

    Acute Liver Failure

    • Diarrhea
    • Discomfort on the right side, just below the ribs
    • Fatigue
    • Loss of appetite
    • Nausea
    • Jaundice
    • Mental confusion
    • Blood clotting problems
    • (Hepatic encephalopathy) - Confusion
    • Drowsiness
    • Bruising or bleeding easily
    • (Variceal bleeding) - Vomiting blood
    • (Ascites) - Build-up of fluid inside the abdomen
    • Fluid retention and swelling (edema)
    • Coma
    • Itchy skin

    Main Causes of Liver Failure

    Causes of Acute Liver Failure

    The primary causes of acute hepatic failure include:

    • Overdosing on paracetamol like Acetaminophen 16.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, diclofenac, and naproxen, have been reported to induce drug-induced hepatitis 17.18
    • Kava, ephedrine, and pennyroyal supplements as part of herbal supplements 19.
    • Hepatitis A, hepatitis B, and hepatitis E
    • Epstein-Barr, herpes simplex, and cytomegalovirus.
    • Autoimmune Disease
    • Vascular diseases like Budd-Chiari syndrome (characterized by occlusion of the hepatic veins) 19.
    • Rare metabolic disorders like Wilson disease and acute fatty liver in pregnancy.
    • Cancerous tumor or hepatocellular carcinoma either originates in the liver or spreads in the liver. 20
    • Pathogen infestation, known as septic shock and cardiac arrest, leaves only a small percentage of blood flow to the liver 21.
    • Heat stroke in rare conditions, prolonged strenuous exercise in a hot environment, resulting in acute liver failure 22.

    Causes of Chronic Liver Failure

    Chronic hepatic failure results from several pathological conditions. Here are the main causes:

    • Cirrhosis
    • Fibrosis of the Liver 
    • Autoimmune Hepatitis
    • Metabolic Diseases (Wilson's disease and acute fatty liver in pregnancy (AFLP).
    • Liver Cancer

    Without treatment, chronic liver disease progresses to cirrhosis, ultimately resulting in liver failure. 

    That's why booking liver function tests allows a person to detect the disease in its initial stages and take the next step for liver failure treatment.

    Complications and Risks of Liver Failure

    Here are the key complications or risks associated with liver failure:

    • Bacterial and Fungal Infections: For example, pneumonia, either severe or common. 23
    • Ascites: Fluid depositing inside of the peritoneal cavity, which causes abdomen swelling 26.
    • Spontaneous Bacterial Peritonitis: Infections of the ascitic fluid would occur in the cavity of the abdomen 27.
    • Swelling of the Brain: A grave complicating factor of acute liver failure that may cause dizziness and other neurological symptoms.
    • Hepatic Encephalopathy: Central brain dysfunction that results from the liver's inability to metabolize toxins 28.
    • Portal Hypertension: Higher pressure of blood in the hepatic veins causing variceal bleeding 29.
    • Variceal Bleeding: Bleeding from dilated veins in the esophagus or stomach 30.
    • Hepatorenal Syndrome: Kidney function problems caused by end-stage liver disease.

    How to Overcome Liver Failure? 

    To deal with chronic or acute liver failure, a range of treatment techniques, personalized for the type and severity of the disease, can show a positive effect. Some of them are: 

    • Identify the Cause: Liver failure can be traced to viral infections such as hepatitis or alcohol-related lesions and other toxins 31. Proper diagnosis is important to tackle the condition carefully. 
    • Medical Treatment: Liver failure treatment will depend on the phase of the disease. It either involves having antiviral medications for viral hepatitis or immunosuppressants for immune hepatitis 32.
    • Liver Dialysis: In cases of end-stage liver failure (ESLD), when a donor is not found, liver dialysis may be needed as a temporary solution, aiming to remove the toxins present in blood from treatment by the liver. 33.
    • Liver Transplant: Cases of ESLD require a liver transplant as the only option. This procedure is quite complex, but it normally hinges on the existence of a suitable donor
    • Regular Monitoring: Diagnosed patients should be closely monitored in order to manage their disease well 34.
    • Lifestyle Changes: Implementation of a suitable diet (vitamins and minerals-rich food) along with no drug usage can help decrease the probability of hepatic failure 35.
    • Prompt Medical Intervention: Liver failure is life-threatening if not treated urgently. Consider booking a liver function test, especially in cases of acute liver failure, for successful treatment thereafter. 

    Liver Failure Diagnosis and Tests 

    If the liver has stopped working properly, some tests can be useful. Here are some key diagnostic tests:

    • Liver Function Tests (LFTs): A set of blood tests that can serve as a diagnosis for liver dysfunction. These tests measure the levels of different liver enzymes and proteins that are secreted into the blood. Examples include aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP), as well as bilirubin.
    • Complete Blood Count Test: A CBC test that reveals the number of red blood cells, white blood cells, and platelets in the blood.
    • Prothrombin Time (PT): A blood test that measures the amount of time it takes for blood to clot. The duration of PT is indicative of liver pathology and other coagulation factors disturbance 36.
    • Imaging Tests: Ultrasound imaging test that employs sound waves to generate live images or videos of the soft tissues within your body.
    • Liver Biopsy: A process through which a small sample of the liver tissues is removed for the microscope to be able to examine it.
    • Serologic Tests: Specific antibody or antigen detection tests done on blood, such as those for hepatitis viruses or autoimmune hepatitis.
    • Additional Tests: When there is a high level of clinical suspicion as reflected in a suspected diagnosis, additional tests like blood tests for serum ceruloplasmin and copper levels37 might be ordered to rule out Wilson's disease or testing for α1-antitrypsin (A1AT) deficiency 38 would be appropriate in those patients who have a chronic hepatic injury. 

    Management and Treatment Of Liver

    Conquering liver failure is a challenging task that requires a comprehensive strategy involving dietary moderation, medical treatment, and, in the worst-case scenario, a liver transplant.

    Here's a breakdown of the key strategies for tackling liver failure:

    Lifestyle Changes:

    • Alcohol Consumption: Reduction of or even complete elimination of alcohol from the diet is a key point to minimize further liver damage. If you're a regular drinker who is cautious about your liver, getting an alcohol impact check-up might be a good idea to gain clarity of your liver's state.
    • Diet: Adopting a healthy diet that is abundant in fruits, vegetables, whole grains, and healthy fats from fish and olive oil, as well as reducing sugar, fructose, and red meat consumption, is a must. Achieving the proper weight is one more aspect of a healthy lifestyle 38.

    Intensive Medical Care:

    • Quick Intervention: Prompt action is required and can be drug-based, such as acetylcysteine used for acetaminophen detoxification39 or to manage acute hepatic failure.
    • Controlling Complications: Timely and proper management of problems like cerebral edema, infections, and coagulopathy becomes critical for improving prognosis.

    Future Treatments:

    • Ongoing Research: The investigation of innovative treatments like hepatic support devices and hepatocyte transplantation brings nearer hope for the future. These experimental methods aim to cut down on the need for a liver transplant and increase the survival rate of the patients.

    Structured Approach to Treatment:

    • Intensive Care: The methodical approach to managing chronic or acute liver failure treatment is crucial. In this view, the initial assessment, observant complications monitoring, and even simple measures such as keeping a calm environment are expected to make treatment successful.

    Preventive Measures:

    • Avoiding Harmful Substances: Steering clear of substances known to harm the liver, including certain medications, is critical. 

    Remember, consulting healthcare providers before trying alternative medicines is advisable to safeguard liver health.

    Tips To Prevent Liver Failure/Hepatic Failure

    Preventive tips can be condensed into a few key factors for consideration, which are: 

    • Maintaining a healthy weight as obesity can lead to non-alcoholic fatty liver disease (NAFLD), which can cause liver damage and scarring 40.
    • A well-balanced diet, that is, consuming a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats, is necessary. Avoid foods high in saturated and trans fats, added sugars, and processed foods
    • Limit alcohol intake to no more than two drinks per day for men and one drink per day for women 41.
    • It is essential to take precautions when working with chemicals such as insecticides, aerosol products, and pesticides and to choose organic produce when possible
    • Drinking plenty of water is essential for maintaining liver health.
    • If you use drugs, avoid sharing needles to reduce the risk of contracting hepatitis and other viral infections.

    Ref Links: 


    Can Liver Failure be Prevented?

    Liver failure can often be prevented by maintaining a healthy weight, consuming a well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, and avoiding substances known to harm the liver, such as excessive alcohol, certain medications, and toxic chemicals. But it's important to note that you can prevent it only till the point where the damage is reversible.

    Are Liver Failure and Liver Cirrhosis the Same or Different?

    Liver failure and liver cirrhosis are related but different conditions. Cirrhosis is a common cause of chronic liver failure, involving the scarring of the liver due to long-lasting injury. However, liver failure occurs when the liver can't perform its essential functions adequately.

    Is Liver Failure Painful?

    Hepatic failure itself may not cause pain, but the severity of symptoms of liver failure increases as the condition progresses

    Can Liver failure be cured?

    Liver failure can be treated and prevented, but in cases where the damage is irreversible, a liver transplant may be necessary. However, medications like acetylcysteine are often used for acute liver failure treatment, especially when specific factors like acetaminophen overdose cause it.

    How important are hepatitis vaccines?

    Hepatitis vaccines are highly recommended by the CDC for various groups, including children, individuals with chronic liver disease, men who have sex with men, people who use illegal drugs, healthcare workers, travelers to high-risk areas, and more


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