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Pronunciations acetaminophen ascites bilirubin cholestasis cirrhosis coagulopathy encephalopathy hepatic encephalopathy hepatitis

Liver failure is severe deterioration in liver function.

Liver failure can result from any type of liver disorder, including viral hepatitis, cirrhosis, and liver damage from alcohol or drugs such as acetaminophen Some Trade Names
TYLENOL
. A large portion of the liver must be damaged before liver failure occurs. Liver failure may develop rapidly over days or weeks (acute) or gradually over months or years (chronic).

Many effects occur because the liver malfunctions:

• The liver can no longer adequately process bilirubin (a waste product formed when old red blood cells are broken down) to be excreted. The result is jaundice.
• The liver can no longer synthesize enough of the proteins that help blood clot. The result is a tendency to bruise and bleed (coagulopathy).
• Portal hypertension often occurs. It can result in fluid in the abdominal cavity (ascites), hepatic (liver) encephalopathy, or both.

Symptoms and Diagnosis

A person with liver failure usually has jaundice, ascites, hepatic encephalopathy, and generally failing health. Other common symptoms include fatigue, weakness, nausea, and loss of appetite. In acute liver failure, a person may go from being healthy to near death within a few days. In chronic liver failure, the deterioration in health may be very gradual until a dramatic event, such as bleeding varices (large, tortuous veins), occurs. The person may tend to bruise and bleed easily. Bleeding that would be slight in other people (for example, bleeding from a small cut or a nosebleed) may not stop on its own and may even be difficult for doctors to control.

Doctors can usually diagnose liver failure based on symptoms and the results of a physical examination. Blood tests are done to evaluate liver function, which is usually severely impaired.

Prognosis and Treatment

Treatment depends on the cause and on the specific symptoms. The urgency of treatment depends on whether liver failure is acute or chronic, but the principles of treatment are the same. The person is usually placed on a restricted diet. Protein consumption is carefully controlled: Too much protein can cause brain dysfunction, and too little can cause weight loss. Salt (sodium) consumption is kept low to help prevent ascitic fluid from accumulating in the abdomen. Alcohol is completely avoided because it can worsen liver damage.

Ultimately, liver failure is fatal if it is not treated or if the liver disorder is progressive. Even after treatment, liver failure may be irreversible. Some people die of kidney failure (hepatorenal syndrome), because liver failure can eventually lead to kidney failure. Liver transplantation (see Transplantation: Liver Transplantation), if performed soon enough, can restore liver function, sometimes enabling people to live as long as they would have if they did not have a liver disorder. However, liver transplantation is suitable for only a small number of people with liver failure.

Last full review/revision August 2006 by Sidney Cohen, MD