Liver failure • Symptoms, causes & course

Without targeted treatment, liver failure (hepatic insufficiency) quickly leads to death. The organ is disturbed in its function and can no longer detoxify the body. Which symptoms are typical, how can liver insufficiency be treated and what are the chances of recovery?

When the liver fails, liver function deteriorates drastically. Liver failure can be chronic, i.e. occur over a long period of time, or it can be acute. The causes of liver failure are varied.

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Liver: function in the body

What tasks does the liver perform in the body? The liver is a vital organ; it can no longer work properly, leading to a multitude of symptoms and, if left untreated, death.

The liver is a metabolic organ, among other things it is involved in the storage of vitamins and carbohydrates. With the help of vitamin K, the liver produces proteins that are important for blood clotting. The organ is also involved in lipid metabolism.

In addition, the liver filters the blood and supports the body in detoxification. Medicines and harmful metabolic products enter the bloodstream and are converted into harmless substances. For example, toxic ammonia is converted into urea, which is then excreted through the kidneys.

Liver failure: symptoms of liver failure

Liver failure is a serious condition and the symptoms are typically severe. Three symptoms are central to liver failure:

  • Jaundice (jaundice): The skin, mucous membranes and eyes become yellow.

  • Blood clotting: Liver insufficiency is associated with coagulation disorders and, as a result, a tendency to bleed; this is also known as hemorrhagic diathesis. In the course of this, punctual bleeding often occurs in the skin (petechiae). Larger hematomas can also occur.

  • Awareness: The liver failure causes neurological symptoms. Concentration problems, tiredness, confusion, fluttering and twitching of the eyelids, drowsiness and, in the worst case, coma are typical when the brain and nervous system are poisoned by metabolic products such as ammonia. This condition is known as hepatic encephalopathy.

In addition to the classic triad of symptoms, there are often other symptoms and indications of hepatic insufficiency. For example, swelling and accumulation of water in the abdomen, known as ascites, often develop over time. Varicose veins in the esophagus (esophageal varices) can also occur in the course of the disease. In addition, the progressive organ failure can lead to a foetor hepaticus: The breath of those affected smells of raw liver.

In about half of the cases, the organ failure spreads to the kidneys, this is known as hepatorenal syndrome.

Types of liver failure: acute or chronic

Liver failure can be divided into different forms depending on its course. Acute liver failure occurs suddenly and, if left untreated, can lead to death within a few days in people without previous illnesses. Chronic liver failure, on the other hand, develops over a long period of time.

If the condition of people with chronic liver failure suddenly deteriorates, experts also speak of acute-on-chronic liver failure.

What are the causes and risk factors?

Liver insufficiency usually develops chronically, i.e. gradually over the years. The causes can be varied, usually an existing illness is the reason for the liver failure. For example, cirrhosis of the liver can be the cause, for example due to heavy alcohol abuse. Some drugs such as paracetamol can also stress the organ for years and cause great damage.

Other possible causes of chronic liver failure:

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Acute liver failure (ALV) occurs suddenly and without prior damage or disease to the liver. ALV is rare, in Germany only around 200 to 500 people fall ill every year. It is a medical emergency; if left untreated, acute hepatic insufficiency leads to death within a very short time. In the vast majority of cases, a viral infection is the trigger, for example through hepatitis A, B, D and E. Other viruses are less common, including:

In very rare cases, autoimmune hepatitis is the cause of acute liver failure, in which case the own immune system is directed against liver cells. Sometimes the copper storage disease Wilson’s disease triggers the acute insufficiency. Pregnancy is also a risk, with HELLP syndrome (pregnancy poisoning) there is a risk of acute liver disease.

In addition, poisoning can lead to ALV: Consumption of death cap mushrooms leads to liver failure.

Diagnosis: how is liver failure diagnosed?

If jaundice, hepatic encephalopathy and a coagulation disorder occur, liver failure is usually present. Laboratory tests of the blood will then help to confirm the diagnosis. Relevant laboratory values ​​include:

Sometimes a sample of tissue is taken from the liver and examined for changes (liver biopsy). Antibody tests can reveal viral infections, and sometimes alcohol or medication in the blood can be tested to determine the cause of the liver failure. This is particularly necessary if the person concerned is in a coma and cannot answer any questions about alcohol or drug abuse. If Wilson’s disease is suspected, copper levels in the blood can also be determined.

The color of the urine can also play a role in making the diagnosis: if the urine is dark in color, this indicates kidney failure.

In addition to laboratory diagnostics, imaging tests and a palpation examination can show whether the liver is enlarged or reduced and whether the abdomen is swollen or whether fluid has accumulated in the abdominal cavity.

How is liver failure treated?

Liver failure, especially acute forms, must be treated as soon as possible. Therapy is primarily based on the cause. If a viral disease is the trigger, antiviral therapy, for example, can help prevent the disease from progressing.

If poisoning by the death cap mushroom is the cause of liver failure, activated charcoal and silibinin are used to neutralize the poison. Fungal residues are also removed from the stomach, for example by gastric lavage.

In addition, complications, symptoms and consequences of liver failure need to be contained and treated. If the intracranial pressure is increased in the course of hepatic encephalopathy, medication can help to reduce it. The administration of electrolytes, vitamin K or coagulation factors can stabilize the condition.

Liver dialysis can compensate for insufficient liver function, detoxify the blood and improve liver function in the short term. Dialysis can help bridge the waiting time for a donor organ: In very serious cases, only a liver transplant will help.

Prognosis: What are the chances of recovery from liver failure?

The chances of recovery from liver failure depend on many factors. In general, the earlier treatment starts, the better the prognosis. Age also plays a role, children under 10 and adults over 40 are particularly at risk.

The degree of hepatic encephalopathy is also decisive for the chances of recovery; the more the central nervous system is affected, the worse the prognosis for those affected.

Liver failure often leads to death if left untreated, but in recent years the prognosis has improved significantly as a result of medical advances. It is important to get medical help as soon as possible and start treatment if you have symptoms.

Prevention: How can you protect your liver?

Above all, it is important to reliably treat existing underlying diseases such as diabetes mellitus in order to avoid damage to the liver.

Moderate consumption or renouncing alcohol also help to relieve the metabolic organ. Medicines should only be taken after consulting a doctor, even over-the-counter active ingredients can damage the liver. Medicines like paracetamol put a lot of strain on the liver.

An overdose of vitamin A can also cause liver damage, which is why vitamin preparations should not be taken without prior blood tests.

Hepatitis: how to protect yourself

There are different strains of viral hepatitis. You can protect yourself against hepatitis A and B with a vaccination, which is recommended, for example, before traveling to risk areas. There are also the forms of hepatitis C, D and E.

The viruses have different routes of transmission, for example via contaminated food and water (hepatitis A, E), but also body fluids and sexual contacts.

Prevent hepatitis infections:

  • Safer Sex: Condoms not only protect against pregnancy, they also reduce the risk of contracting hepatitis (B, C).

  • Vaccination: Before traveling abroad, you should check whether a vaccination against hepatitis is necessary and whether it should be carried out.

  • Food: Caution is advised, especially with raw foods and drinking water. Vegetables and seafood should rather not be consumed or only cooked through in risk areas; mussels are particularly susceptible. Even tap water cannot be safely drunk everywhere, which is why it is advisable to drink mineral water bought when traveling. Meat should generally only be eaten cooked through.

  • Drugs: As certain hepatitis viruses can be transmitted through blood and other body fluids, special hygiene must be observed if drugs are consumed (do not share hypodermic needles). In addition, with regard to general health, drug use should generally be avoided.

  • Piercings/Tattoos: Infection can also occur through unsterile piercing and tattoo needles. Before the piercing, you should find out about the hygiene standards in the respective studio.

Safety when traveling: there is a risk of infection lurking here

Source: Lifeline | Das Gesundheitsportal by

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