Liver failure is when the liver stops functioning. In other words, it stops doing its job and starts shutting down. A healthy liver performs many essential functions in the human body, including:

Filtering toxins from blood
Removing old red blood cells
Producing blood clotting factors
Making bile, a greenish-yellow fluid that helps with digestion by breaking down fats from the food we eat
Metabolizing proteins, carbohydrates, and fats
Storing glycogen as a source of energy

Liver Failure Types: Acute Liver Failure vs Chronic Liver Failure

Acute liver failure, also called fulminant hepatic failure, develops quickly over a period of days to weeks. It usually occurs in people with no history of liver disease. An overwhelming infection, drug overdose, or exposure to toxins can cause acute liver failure. It is a life-threatening condition and requires emergency medical care in the hospital.

Chronic liver failure, also called end-stage chronic liver disease, develops gradually over a period of months to years. It is more likely to occur in people with liver disease. Chronic liver failure occurs due to long-lasting liver damage, for example, from cirrhosis (scar tissue) due to any cause.

Importance of Early Identification

Early identification of liver disease symptoms is important because it can allow for timely interventions. This can prevent progression to liver failure symptoms. In other words, if signs of liver damage are detected early, treatment can be started to prevent liver failure.

By learning about the symptoms of liver disease and the signs of liver failure, you can seek timely medical care. Lifestyle changes, medications, and other treatments can be used to manage liver damage symptoms.

Common Misconceptions about Liver Failure Symptoms

Myth: Liver failure is always caused by alcohol.

Fact: Alcohol-associated damage is one of the causes of liver disease and liver failure. But liver problems can also occur due to other causes, such as an immune system malfunction (autoimmune hepatitis), a medication overdose (drug-induced liver injury), or non-alcohol-related fatty liver disease (due to obesity, insulin resistance, genetic factors, high blood sugar, and high cholesterol).

Myth: Liver disease can always be reversed.

Fact: The human liver has the ability to repair itself, and many liver diseases are reversible. But if the liver damage is severe or prolonged, the liver can be permanently damaged and failing liver function may not be reversible. In this case, a liver transplant may be necessary.

Myth: Cirrhosis is solely caused by alcohol.

Fact: Most people associate the word cirrhosis with alcohol. However, alcohol-related liver disease is just one of the causes of liver cirrhosis. Cirrhosis refers to scarring or stiffening of the liver and it can occur due to many other causes besides alcohol-related liver damage.

Recognizing the Symptoms of Liver Failure: Acute vs Chronic

What Are The Symptoms of a Toxic Liver?

Symptoms of acute liver failure may include:

Abdominal pain, especially in the upper right part of the abdomen
Ascites (a swollen belly)
Sleepiness
Mental confusion
Musty or sweet odor to breath
Malaise (feeling unwell)
Loss of appetite
Jaundice (yellowing of the skin and whites of the eyes)
Problems with movement
Itching
Tremors

Early Symptoms of Chronic Liver Disease

Symptoms of liver disease in the early stages may include:

Indicators of Advanced Liver Damage

Signs of more severe liver damage (chronic liver disease or liver failure) typically develop over many months to years. Chronic liver disease symptoms may include:

What Happens When The Liver Shuts Down?

Edema (swelling in the legs, feet, hands, and face due to fluid retention)
Ascites (fluid buildup in the abdomen), which can cause abdominal pain, bloating, nausea, and vomiting
Hepatic hydrothorax (fluid in the lungs), which can cause shortness of breath, a persistent dry cough, chest pain, and fatigue

Underlying Causes and Risk Factors for Liver Diseases

Causes of Acute Liver Failure

Acute liver failure occurs due to a severe liver injury and is a medical emergency. Common causes that can trigger acute liver failure include:

Viral infections such as hepatitis virus A, B, D, or E. Less commonly, other viruses such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), or varicella-zoster virus (VZV).
Drug overdoses, most commonly an overdose of nonprescription pain medications. An acetaminophen overdose is the most common cause of acute liver failure in the US. Other medications that can cause acute liver injury and liver failure include nonsteroidal anti-inflammatory drugs (NSAIDs) and some antibiotics.
Complications of pregnancy such as HELLP syndrome and acute fatty liver of pregnancy. HELLP syndrome is the acronym describing the main symptoms of this complication: Hemolysis (H), Elevated liver enzymes (EL), Low platelet count (LP)
An inherited (genetic) disease such as autoimmune hepatitis, Wilson disease, or lysosomal acid lipase deficiency.
Other causes such as heatstroke, septic shock, metastatic cancer (cancer that has spread), mushroom poisoning, and exposure to insecticides and other toxic chemicals.

Causes of Chronic Liver Failure

Chronic liver failure occurs as a result of cirrhosis (scarring of liver tissue). This prevents blood and oxygen from reaching liver cells, causing them to die. As more and more of the liver tissue becomes scarred, liver function declines, leading to chronic liver failure. Common causes include:

Chronic hepatitis caused by viral infections by hepatitis viruses such as hepatitis B or hepatitis C.
Long-term alcohol abuse, which causes alcohol-induced hepatitis (liver inflammation), which causes cirrhosis and liver failure.
Toxic hepatitis from long-term exposure to chemicals and toxins.
Metabolic dysfunction-associated steatotic liver disease (MASLD) which occurs due to a buildup of fat in the liver due to metabolic risk factors. It was previously called nonalcoholic fatty liver disease (NAFLD).
Obstruction of the bile ducts, causing bile to build up and damage the liver. This can be present since birth (congenital), such as in biliary atresia or cystic fibrosis. It can also develop later due to gallstones or biliary stricture.
Autoimmune diseases. An autoimmune disease is a condition in which the immune system attacks healthy tissue. Examples include autoimmune hepatitis and autoimmune cholangitis (primary sclerosing cholangitis, primary biliary cholangitis, or primary biliary cirrhosis).
Inherited disorders such as glycogen storage diseases, Wilson’s disease, Gaucher disease, and hemochromatosis. These conditions cause toxins to build up in the blood and trigger liver damage.
Cardiovascular diseases that affect blood flow to the liver, such as Budd-Chiari syndrome, right-sided heart failure, and arterial diseases.

Risk Factors for Liver Disease and Liver Failure

Acute liver failure is rare but can occur due to a single damaging event. Risk factors for acute liver failure include:

Exposure to toxic chemicals such as cleaning products, insecticides, and aerosol sprays.
Shared needles, toothbrushes, and razors that can lead to the spread of viral infections through contact with other people’s blood and bodily fluids.
Food poisoning with wild mushrooms or contaminated food.
Indiscriminate use of over-the-counter pain medications or combined use of OTC painkillers and alcohol.
Lack of adequate healthcare during pregnancy.

Chronic liver disease and liver failure develop slowly over time. Risk factors include:

Metabolic syndrome (high blood sugar, high cholesterol, obesity).
Overuse of painkillers such as acetaminophen and NSAIDs.
Alcohol use.
Smoking.

The Stages of Liver Disease Progression

Overview of Liver Disease Stages

As noted above, chronic liver disease develops slowly over time. It goes through four main stages. Chronic liver failure is the last stage or end stage of chronic liver disease.

Hepatitis (inflammation of the liver) is the first stage of chronic liver disease when liver damage begins.
Fibrosis (scarring of liver tissue) occurs when inflammation lasts for a long time. The scarring is progressive and gradually causes the liver to stiffen up due to the formation of thin bands of fibrous tissue. Chronic liver disease is still reversible at this stage. Liver cells can repair and regenerate themselves if the inflammation and liver damage is controlled.
Cirrhosis is irreversible and severe scarring of liver tissue. At this stage, liver cells die, and cirrhosis is permanent, but there are ways to slow the process and prevent further liver damage.
Liver failure or end-stage liver disease occurs when cirrhosis is severe enough that the liver can no longer do its job. Chronic liver failure leads to complications throughout the body and is fatal without a liver transplant.

Note: The stages of chronic liver disease are not discrete (completely separate from each other). For instance, someone with fibrosis might still have hepatitis.

Symptom Progression Through The Stages of Chronic Liver Disease

In the early stages, liver disease causes nonspecific symptoms such as fatigue, loss of appetite, nausea, and diarrhea. Some people may have more severe symptoms, such as blood in stool or vomit.

As the liver damage gets worse, symptoms can include severe fatigue, jaundice, mental status changes, and weight loss.

When liver failure progresses, complications such as edema, ascites, and hepatic hydrothorax develop due to the buildup of fluid and toxins in the body. Chronic liver disease is also linked to an increased risk of liver cancer.

Cirrhosis Symptoms

People with cirrhosis may have liver disease symptoms such as fatigue, weakness, poor appetite, weight loss, skin itching, stomach pain, nausea, vomiting, spider-like blood vessels, jaundice, varices or internal bleeding in the gastrointestinal tract, swelling of the lower legs and feet, swelling in the abdomen, drowsiness, confusion, vomiting blood, dark colored urine, light-colored stool, and easy bruising and bleeding.

Diagnosis and Treatment Options

Your healthcare provider can diagnose liver disease and liver failure based on your symptoms, medical history, medication history, family history, physical exam, and test results. Diagnostic tests may include:

Blood tests (liver function tests) to check liver enzymes and assess liver function. Other blood tests may help to identify the cause of liver damage or its complications, such as anemia or blood clotting problems.
Imaging tests can help your healthcare team identify signs of liver disease, such as fluid in the abdomen or scarring in the liver. A test called elastography is a type of MRI (magnetic resonance imaging) that tells doctors how much fibrosis (scarring or stiffness) is present in the liver.
Liver biopsy involves obtaining a small sample of liver tissue for examination in the laboratory. This is a minor procedure done using a hollow needle. It helps your healthcare providers find out the cause of liver disease.

Treatment Approaches: How Do Doctors Treat Liver Failure?

Treatments for acute liver failure may include:

Antidotes for drugs and toxins, such as acetylcysteine for acetaminophen poisoning.
Other treatments to remove toxins from the body in people with acute liver injury, such as the use of laxatives, gastric lavage or bowel irrigation, and activated charcoal.

There is no cure for chronic liver failure. Treatment approaches consist of treating the underlying cause, managing complications, and a liver transplant if needed.

Supportive care for liver failure patients may include intravenous (IV) fluids and nutrition, antibiotics and antiviral drugs, blood transfusions, oxygen therapy, and dialysis for kidney failure.

In addition, patients with chronic liver failure receive medications to manage underlying chronic diseases. For example, corticosteroids or immunosuppressants for autoimmune disorders.

Liver Transplantation: The Last Resort

There is no cure for liver failure. Your healthcare team will recommend you for a liver transplant if they feel you cannot survive without a new liver. There are clinical scoring systems such as the Child-Turcotte-Pugh (CTP) system and the Model for End-Stage Liver Disease (MELD) system. Healthcare providers use them to forecast the likely prognosis (outcome). They base their recommendations for a liver transplant on these scoring systems. This determines your place on the liver transplant waiting list.

Experts estimate that 10% of the U.S. population, or 30 million people, are living with liver disease. About 9,500 people receive liver transplants each year, and there are over 10,000 people on the waiting list.

FAQs about Liver Health and Failure

What Is The Life Expectancy of a Person With Liver Failure?

People with early-stage cirrhosis (compensated cirrhosis) have a life expectancy of 15 years or more. Those with late-stage cirrhosis (decompensated cirrhosis) have an average life expectancy of 7 years. Health complications related to liver failure can further reduce life expectancy to two years or less.

Managing Life with Liver Disease

Living with liver disease can impact many aspects of your life. In addition to medical treatment for your liver disease and its complications, your healthcare team will work with you to address key aspects such as nutrition and diet, lifestyle changes, and psychosocial issues.

How to Prevent Liver Disease?

Here are some ways to lower your risk of developing liver disease and liver failure:

Protect yourself from exposure to toxins by wearing gloves or masks.
Take precautions to avoid contact with other people’s blood or body fluids.
Practice food safety and good hand hygiene.
Get vaccinated against viral hepatitis (there are vaccines available to protect against hepatitis A and hepatitis B).
Use over-the-counter medications only as directed. Check with a healthcare provider before taking any dietary or herbal supplements.
Drink alcohol in moderation (up to one drink for women and up to two drinks for men).
Maintain a healthy weight and get regular exercise.
Get regular health checkups and screenings for early detection and treatment of liver disease.

Check out our article: Is My Liver Healthy? Quiz Yourself