Liver Failure

Key points

• Liver failure is when the liver can’t do its normal functions
• It may be life threatening
• Chronic liver failure is the end-stage of many long-term liver diseases
• Acute liver failure can also happen when the liver is suddenly severely injured by a poison, a virus or an illness
• Liver failure often has serious complications
• If you have liver failure, you may need to be admitted to an intensive care unit
• Some people with liver failure need a liver transplant

What causes liver failure?

Liver failure is a life-threatening condition. It is when the liver is so badly damaged it can’t do its normal functions.

There are two types of liver failure: acute liver failure and chronic liver failure.

Acute liver failure

Some people who have a completely normal liver can suddenly develop liver failure due to a medication, a toxin, a virus or another illness. This is called acute liver failure and can be immediately life-threatening.

Acute liver failure can happen in just 48 hours. When the liver fails very rapidly, it’s usually due to:

• Liver injury caused by a deliberate or accidental overdose of paracetamol
• Being poisoned by medicines, herbs or supplements or poisonous mushrooms
• Some viruses, including hepatitis A, B, and E, the Epstein-Barr virus, cytomegalovirus, and herpes simplex virus
• Autoimmune hepatitis
• Wilson’s disease
• Complications of pregnancy
• Very low blood pressure due to severe infection, bleeding or heart failure
• Budd Chiari syndrome (a rare condition due to clots blocking blood vessels that drain out of the liver).

Chronic liver failure

Chronic liver failure develops slowly, over time. It comes at the advanced stage of many different liver diseases. It’s also called advanced liver disease or end-stage liver disease.

There are different stages of chronic liver disease. First the liver may be inflamed (hepatitis). Then the liver starts to get stiff and scarred (fibrosis). Eventually, cirrhosis develops.

Chronic liver failure can develop from many different liver diseases, including:

• Hepatitis B that lasts a long time
• Hepatitis C if it’s not treated
• Autoimmune hepatitis
• Drinking too much alcohol long-term, which can lead to cirrhosis
• Fatty liver disease, which can eventually develop into cirrhosis
• Haemochromatosis, which causes too much iron to build up in the liver
• Primary sclerosing cholangitis
• Primary biliary cholangitis
• Wilson’s disease
• Alpha-1 antitrypsin deficiency

What are the symptoms of liver failure?

As the liver struggles to work, you might notice these symptoms:

• Very itchy skin
• Yellow skin and whites of the eyes (jaundice)
• Swollen belly due to build-up of fluid (ascites)
• Swollen legs, ankles and feet (oedema)
• Nausea and loss of appetite
• Vomiting blood
• Bleeding easily, or a lot of bruises
• Being confused and sleepy.

If you have liver failure, you might develop complications:

• Cerebral oedema: a build-up of fluid on your brain
• Blood clotting problems: because your liver isn’t working properly, you may find it difficult to stop any bleeding
• Infections: people with liver failure are more likely to develop pneumonia and urinary tract infections
• Kidney failure: if the liver isn’t working, the kidneys can’t work properly either. This can lead to kidney failure
• Hepatic encephalopathy: a complication of liver disease that may cause severe drowsiness or even unconsciousness (coma)

How is liver failure diagnosed?

Liver failure is diagnosed by a doctor based or results of physical examination, blood tests and scans.

If you are known to have liver disease, your doctor should be regularly monitoring you and might diagnose decompensated cirrhosis or chronic liver failure as your condition gets worse.

Some people are not known to have liver disease but suddenly become very unwell and have very abnormal blood test results that might show acute liver failure. This requires urgent hospital admission to find out why the liver has failed, and to start treatment to help you recover.

How is liver failure treated?

Many people with severe chronic or acute liver failure will need to spend some time in intensive care so that the medical team can treat all the complications at the same time and allow the liver to recover. In some circumstances, if your medical team think the liver won’t recover, they may recommend a liver transplant.

The medical team will treat any complications you might have. For example, there are treatments for fluid in the belly (ascites), bleeding, kidney problems and infections.

If you are really drowsy or unconscious because of liver failure, a tube may be placed into your windpipe to allow a machine to move air in and out of your lungs.

If the liver failure is caused by paracetamol poisoning, you will be given an antidote called N-acetylcysteine via a drip. This helps to clear the toxins out of your body. If you get this medicine early enough after a paracetamol overdose, liver failure may be prevented.

In other situations, specific treatments in hospital can treat the cause of liver failure and allow the liver to recover.

If your liver failure is caused by alcohol, it is really important to never drink again. Your doctors may recommend medicine or support to help you stop drinking. Your liver function may recover if you avoid alcohol.

What to do next

If you have had liver failure, it is important to avoid anything that can cause further damage to the liver. It is important you have regular checkups with your healthcare team.

Reviewed November 2022