Liver Failure

What is liver failure?

Liver failure happens when your liver can no longer work well enough to perform its functions. A healthy liver normally:

• Filters toxins from your blood
• Helps you digest food
• Supports your immune system
• Makes proteins 
• Helps your blood clot correctly
• Stores and releases energy

The main types of liver failure are:

• Acute liver failure: Occurs suddenly over days or weeks in people who do not have prior liver disease.
• Chronic liver failure: Develops gradually after long-term liver damage from chronic liver disease, such as fatty liver disease, alcohol-associated liver disease or viral hepatitis.
• Acute-on-chronic liver failure: Develops in people that have a chronic liver disease or cirrhosis with an acute deterioration of liver function.

All forms are serious and need medical care but they have different causes and treatments. 

What causes liver failure?

Many different problems can damage your liver tissue and lead to liver failure. 

Causes of acute liver failure

Acute liver failure may be caused by: 

• Severe reactions to medicines, especially acetaminophen (Tylenol) overdose
• Viral infections, including some viral hepatitis infections
• Poisonous wild mushrooms
• Industrial toxins, including certain cleaning solvents and degreasers
• Serious infections and shock (sepsis)
• Heat stroke
• Rare blood vessel problems and metabolic or autoimmune conditions
• Some pregnancy-related liver problems

Causes of chronic liver failure

Chronic liver failure may be caused by these conditions, which can scar your liver tissue and reduce your liver function over a long period of time: 

• Fatty liver disease (MASLD/MASH)
• Alcohol-related liver disease
• Chronic viral hepatitis B or C
• Autoimmune liver diseases
• Long-term bile duct problems
• Genetic disorders
• Some metabolic conditions
• Rare heart and lung conditions

Who is at risk?

Your risk of developing acute liver failure may be higher if you:

• Take high doses of acetaminophen or other medicines that can harm the liver
• Use some herbal or dietary supplements in large amounts or those that have not been properly evaluated by regulatory agencies
• Work with industrial chemicals or solvents
• Are pregnant and develop a rare pregnancy-related liver condition

Your risk of developing chronic liver failure may be higher if you: 

• Already have chronic liver disease
• Drink heavily or use alcohol over many years
• Have obesity, diabetes or metabolic syndrome
• Have viral hepatitis or are exposed to someone else’s blood or body fluids with viral hepatitis
• Have a family history of liver disease or certain inherited conditions

Symptoms of liver failure

In the early stages of many types of liver disease, you may not notice symptoms. That’s why regular checkups and blood tests are important if you have liver risk factors.

Symptoms of liver failure can vary. They depend on how quickly liver failure gets worse and how severe the damage is. 

Common symptoms include: 

• Feeling extremely tired or weak
• Yellowing of the skin or eyes (jaundice)
• Swelling in your belly or legs
• Nausea or vomiting
• Loss of appetite
• Weight or muscle loss
• Easy bruising or bleeding
• Dark urine
• Pale or gray-colored stools
• Itchy skin
• Pain or tenderness in the upper right side of your abdomen
• A musty or sweet odor to your breath

Liver failure can also affect your brain. You may notice:

• Confusion or trouble concentrating
• Sleepiness or changes in your sleepwake cycle
• Mood or personality changes
• Irritability
• Anxiety
• Depression

Emergency warning signs

Go to the emergency room or call 911 if you have a diagnosis of chronic liver disease or liver failure and notice: 

• Sudden confusion or trouble staying awake
• Severe jaundice that starts quickly or gets worse rapidly
• Vomiting blood or passing black or bloody stools
• Heavy or sudden bleeding
• Many new bruises
• Severe shortness of breath
• Little or no urine output
• A rapidly swelling belly

These can be life-threatening complications of liver failure.

How is liver failure diagnosed

If your provider thinks you might have liver failure, they will ask about your symptoms, health history, medicines, alcohol use and possible toxin exposures. They will also do a physical exam to look for signs of liver disease, such as jaundice (yellowing of the skin) or swelling or tenderness in your abdomen. 

You may need several tests, including: 

• Blood tests: Liver function tests measure liver enzymes and bilirubin. Other blood tests show how well your liver makes clotting proteins.
• Imaging tests: Ultrasound, CT scan or MRI can show the size and shape of your liver and whether you have cirrhosis, tumors, blocked bile ducts or blood vessel problems.
• Liver biopsy: In some cases, providers need to remove a small sample of liver tissue so they can look at it under a microscope.

These tests help your care team find out what’s causing liver damage, decide whether you have acute or chronic liver failure and see how advanced the disease is. 

Treatment and care for liver failure

Treatment depends on the cause and type of liver failure and how severe it is.

Your care may include: 

• Treating the cause, if possible
• Medicines to manage symptoms and complications
• Nutrition support, including paying close attention to calories and protein
• Avoiding alcohol and substances that can damage the liver
• Lifestyle changes and regular follow-up to help keep your liver function from getting worse 
• Liver transplant, for advanced liver failure or end-stage liver disease 

If you have acute liver failure, you will probably need care in the hospital, possibly in an intensive care unit. That way, your care team can closely watch for complications.

Complications of liver failure

Without treatment, liver failure can lead to serious, life-threatening complications. These may include: 

• Internal bleeding
• Fluid buildup in the belly and legs
• High blood pressure in the veins that connect to the liver, called portal hypertension
• Bleeding veins in the esophagus or stomach
• Severe infections
• Kidney failure
• Brain changes that can cause confusion, personality changes, sleepiness or coma
• Swelling of the brain
• Life-threatening organ failure

When to see a liver specialist

Talk with your primary care provider if you have risk factors for liver disease or notice possible liver symptoms. Your provider may refer you to a gastroenterologist (digestive system specialist) or hepatologist (liver specialist) if: 

• Your liver blood tests stay abnormal
• Your symptoms do not improve or they get worse
• Your provider thinks you might have cirrhosis or advanced liver disease
• You need ongoing specialty monitoring or treatment
• You need evaluation for a liver transplant

Seeing specialists when your disease is still at an early stage can help slow liver damage and lower your risk of severe complications. 

Find care at Banner Health

At Banner Health, we offer comprehensive care for people with liver failure and complex liver conditions. Our liver specialists work closely with primary care providers, transplant surgeons, critical care doctors, dietitians, pharmacists and social workers to diagnose liver disease, manage symptoms, recommend treatment plans and support you and your family.

Schedule an appointment with a Banner Health liver specialist near you.