Section 10. Liver and Gallbladder Disorders

Chapter 135. Clinical Manifestations of Liver Disease

Topics: Introduction | Jaundice | Cholestasis | Liver Enlargement | Portal Hypertension | Ascites | Liver Encephalopathy | Liver Failure

Liver Failure

Liver failure is a 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. A large portion of the liver must be damaged before liver failure occurs. Liver failure may develop rapidly over days or weeks (acute liver failure) or gradually over months or years (chronic liver failure).

Symptoms and Diagnosis

A person with liver failure usually has jaundice, a tendency to bruise or bleed, ascites, liver encephalopathy, and generally failing health. Other common symptoms include fatigue, weakness, nausea, and a 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 clinical manifestations alone provide strong evidence of liver failure. Blood tests usually show severely deteriorated liver function.

Prognosis and Treatment

Treatment depends on the cause and on the specific clinical manifestations. The urgency of treatment depends on whether the 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; too little can cause weight loss. Sodium consumption is kept low to help keep ascitic fluid from accumulating in the abdomen. Alcohol is completely avoided because it can worsen the liver damage.

Ultimately, liver failure is fatal if it is not treated or if the liver disease is progressive. Even after treatment, liver failure may be irreversible. In terminal cases, the person may die of kidney failure (hepatorenal syndrome), because liver failure can eventually lead to kidney failure. Liver transplantation (see Section 16, Chapter 187), if performed soon enough, can restore a person to normal health, but it is suitable for only a small number of people with liver failure.