Liver failure or liver insufficiency is when the central metabolic organ – the liver – is no longer working properly. Rarely, this develops without a pre-existing liver disease (acute liver failure). Most often, the cause is long-term liver damage (chronic liver failure). Read more about symptoms of liver failure, course and treatment.
ICD codes for this disease: K74 | K76 | K70 | K71 | K72
- Symptoms of liver failure: eyes and skin turn yellow; impaired brain function (encephalopathy) leading to disturbances in concentration and awareness; blood clotting disorders; If the disease is very advanced, failure of other organs is possible.
- Course of the disease and prognosis: Usually the result of other chronic liver diseases; The acute form without preceding chronic liver disease occurs much more rarely.
- Treatment: Depending on the cause and course of the liver failure, e.g. B. Detoxification measures for toxins.
- Cause and risk factors: Chronic liver damage, for example through alcohol or drug consumption; Infections with certain viruses (e.g. several hepatitis viruses); poisoning.
- Diagnosis: medical history, physical examination, blood tests, X-ray or ultrasound of the liver.
- Prevention: moderate alcohol consumption, balanced diet, vaccinations against relevant viral infections, treatment of chronic pre-existing conditions.
What is liver failure?
In the case of liver failure (liver insufficiency), various functions of the liver gradually fail. This is dangerous, because the liver fulfills many vital tasks in the body: It is the most important organ of metabolism and with an average weight of 1.5 kilograms it is the largest gland in the human body.
The liver is located in the upper right abdomen. Every day it produces around 700 milliliters of bile, builds up various proteins and plays an important role in the hormone balance and in the body’s defense system. Their metabolic function is particularly important: Almost all nutrients that the intestine absorbs – above all proteins, carbohydrates and fats – are then converted, broken down, stored or processed in the liver.
The liver is also responsible for breaking down drugs, alcohol and harmful substances (“detoxification”). Various diseases, a lot of alcohol and a diet high in sugar and fat put a strain on the liver over the long term and sometimes lead to the development of fatty liver and/or cirrhosis of the liver. However, the liver is able to carry out most of its tasks for a long time even with significantly less functioning cells.
If liver failure occurs, the liver is already severely damaged. Liver failure develops either chronically (chronic liver failure) or very quickly, perhaps due to infection or poisoning (acute liver failure). Either way, it’s a dangerous condition that needs immediate attention.
What are the symptoms of liver failure?
While many liver diseases go unnoticed in their early stages, liver failure has symptoms that are quite distinctive. The following signs are considered to be the main symptoms of liver failure:
- The whites of the eyes (sclera) and mucous membranes turn yellow; as the disease progresses, the skin also takes on a yellowish color. Doctors refer to this as jaundice (icterus) .
- The sufferer has trouble concentrating, his facial expressions change, he often gets tired, and his eyelids flutter. Liver failure triggers various disorders in the brain, which are also summarized as hepatic encephalopathy.
- In addition, blood clotting disorders occur, which can be seen, for example, in frequent bleeding under the skin. This is known as hemorrhagic diathesis.
In addition, liver failure sometimes causes a typical smell of raw liver on the breath (foetor hepaticus) and sometimes painful symptoms in the upper abdomen. In the advanced stage, blood pressure often falls and breathing accelerates. After the affected person becomes more and more tired and almost only sleeps, he falls into a so-called hepatic coma in the course of the hepatic encephalopathy.
How is liver failure treated?
Acute or acute-on-chronic liver failure requires immediate therapy in an intensive care unit. The treatment mainly depends on the trigger of the liver damage – therefore an exact diagnosis is very important. Patients whose liver failure is due to poisoning, for example, are immediately given a gastric lavage and, if possible, an antidote. Antiviral therapy is often useful for certain viral infections such as hepatitis B.
In addition, in the case of liver failure, symptoms such as abnormal blood values are treated as well as possible, for example with infusions of glucose, electrolytes (blood salts) or blood plasma with coagulation factors. Doctors usually lower the ammonia concentration in the intestines with special enemas. In the case of increased intracranial pressure, various medications are also used to reduce intracranial pressure.
Liver failure: therapy by transplantation
In some cases – especially in the case of a previously damaged liver – the probability that the organ will recover and resume its functions is low. In this case, the patients are immediately transferred to a transplant center, where they receive a new liver as soon as possible. It may also be sufficient to replace just the left lobe of the liver (auxiliary partial orthotopic liver transplantation, APOLT). In acute liver failure, about half of patients require a liver transplant.
(Extracorporeal) liver replacement procedures that take place outside the body, such as special liver dialysis, are being tested medically and are not yet standard therapy.
Course of the disease and prognosis
Liver failure is a serious condition that needs immediate treatment. The various liver functions are essential for the body to survive – if treatment is delayed, the prognosis is poor. The younger the person affected and the lower the severity of the underlying disease, the higher the chances of recovery.
Acute liver failure is usually easier to treat than acute-to-chronic. Even milder symptoms of hepatic encephalopathy are usually associated with a better prognosis, while in the case of severely advanced encephalopathy, self-healing is often no longer possible and the only option left is a liver transplant. However, acute liver failure leads to multiple organ failure and even death in almost half of the cases.
Liver failure: causes and risk factors
Basically, there are many different causes for liver failure. Liver failure is often preceded by liver disease that has been present for months or years. Ultimately, the various functions of the liver break down because the body is no longer able to compensate for the damage that has been caused. In this case one speaks of chronic liver failure, in the case of a sudden severe deterioration also of acute-to-chronic liver failure.
Chronic liver failure, for example, often occurs when more and more liver cells are destroyed and the tissue scars (liver cirrhosis) as a result of years of alcohol abuse. Liver failure in cancer is also possible if the liver cells degenerate or a malignant tumor “spreads” from another organ. In some cases, a chronic viral infection such as hepatitis C also becomes severe and ultimately causes liver failure.
Acute liver failure means liver function collapses without a long-term underlying condition. This happens much less often. Some of the possible reasons that liver failure develops suddenly within a short period of time include:
- Viral hepatitis: Hepatitis A, B, D or E are viral infections that are usually associated with acute liver inflammation. Less commonly, the cytomegalovirus and other herpesviruses lead to such hepatitis. In some cases, this is so severe that it quickly leads to acute liver failure.
- Poisoning: In most cases, toxic liver damage is caused by an overdose of drugs such as paracetamol , more rarely also tuberculosis drugs and certain herbal remedies in doses that are far too high. Poisoning with mushrooms (e.g. death cap mushroom), drugs (e.g. ecstasy) and chemicals sometimes trigger acute liver failure.
Rarer causes of acute liver failure are autoimmune hepatitis, the hereditary disease Wilson’s disease and complications during pregnancy – acute pregnancy fatty liver or HELLP syndrome. In up to 20 percent of cases, the cause of the liver inflammation remains unclear. Doctors then speak of cryptogenic hepatitis.
Investigations and diagnosis
Many people with liver failure have been under medical treatment for a longer period of time with certain pre-existing conditions and the liver is known to be under stress (chronic liver failure). This makes the diagnosis easier. Acute liver failure without previous illnesses is rarer.
The doctor first asks about the medical history (anamnesis) and inquires about the consumption of medicines and alcohol, other toxic substances, stays abroad and possible sources of infection for a viral infection. Sometimes liver failure is so advanced that the person is confused or unconscious – in this case, family members are interviewed if possible.
The clinical symptoms such as jaundice and fluttering eyes quickly lead the doctor to believe that the liver is not working properly. During a physical exam, they palpate the upper abdomen to feel whether the liver is enlarged or reduced. He also draws blood to diagnose liver failure. Various laboratory values in the blood count reinforce the suspicion of chronic or acute liver failure. These include, for example, changed coagulation values, transaminases, bilirubin or ammonia.
The further examinations depend on the suspected cause, the symptoms and the course of the liver failure. Sometimes the doctor will take a sample of the liver tissue for laboratory testing (liver biopsy). Imaging procedures such as a special ultrasound examination (duplex sonography) or an X-ray of the chest are also sometimes carried out.
In a specific test called “invasive blood pressure measurement,” a catheter is sometimes used to measure blood pressure in certain blood vessels. If there is a suspicion of an accumulation of fluid in the brain (cerebral oedema), the doctors measure the intracranial pressure with a probe through a small hole in the skull.
Liver failure: prevention
In order to prevent liver failure, it is important to control the risk factors for various liver diseases and poisoning. The following measures are useful for this:
- Make sure you consume alcohol in moderation.
- Avoid excess sugar and fat in your diet.
- Always have chronic diseases (like diabetes) properly treated and adjusted.
- Abstain from drugs; if necessary, ensure the use of sterile needles.
- Protect yourself with condoms during sexual intercourse if you are not sure about possible infections of the sexual partner.
- Before traveling abroad, make sure you have adequate vaccination protection (e.g. against hepatitis A and B).
- Pay attention to the rules on food and drinking water hygiene, especially when traveling abroad.
- Strictly adhere to the recommended dosages when taking any medication. Keep them out of the reach of children.
- Refrain from eating mushrooms and plants whose type and origin you are not sure of. Poisoning is a common cause of acute liver failure.