Liver failure

Liver failure happens when your liver can no longer function properly. It’s a life-threatening condition and results from cirrhosis — permanent scarring on your liver. But the good news is, many lifestyle changes can reduce your risk of developing several conditions that lead to liver failure.

• What is liver failure?
• What causes liver failure?
• Liver failure symptoms
• Liver failure treatment
• Liver failure prevention

What is liver failure?

Liver failure is a life-threatening condition. It’s when your liver can’t function properly and as a result, can no longer support your body.

In most cases, this is something that develops over many years as a complication of advanced liver disease or cirrhosis (extensive scarring of the liver). This is known as chronic liver failure or end-stage liver disease. It can also be sudden, within days or weeks of an incident to your liver — this is acute liver failure, which fortunately is rare. 

There’s also an acute-on-chronic liver failure, where a chronic liver disease or cirrhosis takes a sudden, life-threatening turn.

To check your liver function, you can do a blood test with your GP or by using a home blood test.

What causes liver failure?

Often chronic liver failure is the result of cirrhosis. Many different conditions and diseases can lead to cirrhosis and chronic liver failure. 

The most common causes of liver failure are:

• alcohol-related liver disease (ARLD) — damage to your liver from years of alcohol misuse
• non-alcoholic fatty liver disease (NAFLD) — a build-up of fat in your liver, linked to obesity and type 2 diabetes
   

Acute liver failure is most commonly caused by:

• viral infections — like hepatitis A, B, and E
• overdose of certain drugs — a paracetamol overdose is the most common and leads to greater severity of symptoms

Find out more about how alcohol affects your body.

Liver failure symptoms

It can take years for chronic liver failure to develop. You’ll typically notice signs of liver dysfunction long before liver failure — like abdominal pain, swelling (ascites), and spider-like blood vessels on your skin.

The most common chronic and acute liver failure symptoms are often the same, including:

• jaundice — yellowing of your skin
• breathlessness
• sleep disturbance
• confusion (encephalopathy)
• pain — especially in your upper right abdomen
• fatigue
• feeling sick (nausea)
• loss of appetite
• vomiting

Liver failure treatment

A key part of liver failure treatment is to address the underlying cause early to stop your liver function from getting worse and for it to repair itself. This might include:

• antiviral medication — for viral infections
• N-acetyl cysteine — for paracetamol overdose 
• stopping drinking alcohol — for alcohol-related liver disease

Liver failure is a severe and life-threatening condition. When your liver fails to function correctly, most treatment options aim to:

• manage liver failure symptoms 
• prevent major complications leading to an emergency liver transplant or death

Some liver failure treatment options include reducing your salt intake to avoid complications associated with swelling (ascites). And being prescribed beta-blockers to prevent internal bleeding (haemorrhaging) — works by slowing down your heart.

Micronutrient deficiencies are also a big concern in liver failure. The most common deficiencies are vitamin A, vitamin D, vitamin E, vitamin K, and zinc. These can be treated with increased calorie and protein intake. Or you might need to take them in supplement form depending on how ill you are. 

If your liver failure is at an advanced stage, or you develop a serious complication, and other treatments don’t appear to work, a specialist might refer you for a liver transplant. 

Liver failure prevention

The best way to prevent chronic liver failure is to slow the damage and scarring of your liver or to prevent developing these conditions altogether.

The good news is that lifestyle changes can reduce your risk of developing many conditions that lead to liver failure. This includes the two most common conditions — NAFLD and ARLD.

Manage your weight

The key lifestyle changes that can prevent NAFLD are weight loss if you’re overweight and managing any metabolic conditions you might have, like type 2 diabetes. 

Find out more about weight management.

Mediterranean diet

The Mediterranean diet is a great way to reduce your risk of insulin resistance. This involves eating a diet rich in vegetables, whole grains, and unsaturated fats. It’s also linked to reducing fatty deposits in your liver associated with NAFLD.

Reduce your alcohol intake

The key lifestyle change for ARLD is reducing how much alcohol you drink. The damage done to your liver increases the more you drink, which is why the current UK guidelines are to consume less than 14 units a week regularly. This equals 6 pints of beer or 10 small glasses of wine.

Anything that affects the health of your liver has the potential to progress the damage, even if it’s not the root cause of that condition. For example, drinking alcohol and obesity can increase the chance of mortality for all types of liver disease. So managing your weight and reducing your alcohol intake to below-recommended limits can help prevent the development of liver failure from multiple causes.

References

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Hajifathalian, K., Torabi Sagvand, B., & McCullough, A. J. (2019). Effect of alcohol consumption on survival in nonalcoholic fatty liver disease: a national prospective cohort study. Hepatology, 70(2), 511-521

Hart, C. L., Morrison, D. S., Batty, G. D., Mitchell, R. J., & Smith, G. D. (2010). Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies. Bmj, 340.

Jayalakshmi, Vadivukkarasi T.; Bernal, William Update on the management of acute liver failure, Current Opinion in Critical Care: April 2020 - Volume 26 - Issue 2 - p 163-170 doi: 10.1097/MCC.0000000000000697

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Lee, W. M., Hynan, L. S., Rossaro, L., Fontana, R. J., Stravitz, R. T., Larson, A. M., ... & Acute Liver Failure Study Group. (2009). Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology, 137(3), 856-864.

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Plauth, M., Bernal, W., Dasarathy, S., Merli, M., Plank, L. D., Schütz, T., & Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition in liver disease. Clinical Nutrition, 38(2), 485-521.

Ryan, M. C., Itsiopoulos, C., Thodis, T., Ward, G., Trost, N., Hofferberth, S., ... & Wilson, A. M. (2013). The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. Journal of hepatology, 59(1), 138-143.

Sheron, N. (2016). Alcohol and liver disease in Europe–Simple measures have the potential to prevent tens of thousands of premature deaths. Journal of Hepatology, 64(4), 957-967.

Thoma, C., Day, C. P., & Trenell, M. I. (2012). Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults: a systematic review. Journal of hepatology, 56(1), 255-266

UK Chief Medical Officers. (2016). UK Chief Medical Officers’ Low Risk Drinking Guidelines. Retrieved 2 December 2021 from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf