Everything You Should Know About Liver Failure: Causes & Signs

Severe deterioration of liver function, liver failure is due to a disease or a substance that damages the liver. It no longer functions well, which causes many complications for the person suffering from it. Liver failure can be chronic and develop over the years. It can also be acute and be accompanied by neurological manifestations (this is called fulminant hepatitis). In all cases, it is a medical emergency because the patient’s state of health can deteriorate rapidly.

Located in the upper right part of the abdomen, the liver is an organ essential to the proper functioning of the body. Its missions are to:

• Metabolize most of the nutrients in the foods we eat that are absorbed through the intestines;
• Synthesize proteins, break down toxins and waste from the body (alcohol, medications, chemical substances, etc.), then evacuate through stools and urine;
• Generate a digestive juice called bile or produce many essential substances, especially that which allows the blood to clot in the event of haemorrhage.

Like all other organs, the liver’s functioning can be disrupted by several disorders. We speak of liver failure when it is affected by a significant imbalance: this causes a certain number of symptoms that can affect the quality of life of the person concerned. How can this liver failure be identified? What are its main causes, and what treatment should be put in place quickly to stop this pathology? Can liver failure be prevented by taking care of your liver on a daily basis? Our specialist will answer your questions.

Definition: What is liver failure?

Liver failure refers to poor liver function: not only does its functional mass decrease (this can be due to the destruction of liver cells called hepatocytes) but a large part of its functions are impaired.

The consequences on the liver are then significant, but they also affect all the organs: coagulation disorder, increased heart rate and output, encephalopathy, kidney disorders, immune system deficiency, metabolic disorders (metabolic acidosis), pulmonary edema, etc. In the event of acute liver failure (major deterioration in the patient’s state of health in a few days to a few weeks, when the liver was previously fine), the patient’s prognosis can quickly be compromised. Liver failure can be fatal: sometimes, a liver transplant is necessary to save the patient.

Liver disease: acute or chronic failure, what’s the difference?

Liver failure can develop in a few days (in this case, it is acute, in reaction to sudden poisoning – paracetamol, for example -) or over several years: in this case, it is called “chronic” and occurs as a consequence of the development of certain diseases (viral hepatitis, cirrhosis of the liver, cancers, etc.). 

The severity of liver failure is assessed using the prothrombin rate (PT), which measures liver function: if this rate is less than 50%, we speak of severe acute hepatitis. If the patient also shows signs of neurological damage, it is fulminant hepatitis, also called “hepatic encephalopathy”: it includes a set of serious disorders leading to coma.

Viral hepatitis, especially hepatitis B and hepatitis C, is also a leading cause of liver failure in countries with poor sanitation.

Causes: What causes liver failure?

Liver failure occurs when a large part of the liver is damaged.

This can be damaged by diseases such as:

• Viral hepatitis ( most often hepatitis B or C, but also A or E): swelling of the liver caused by a virus;
• Other viral pathologies  such as cytomegalovirus, Epstein-Barr virus, herpes simplex virus, parvovirus B19, human herpes virus 6, varicella-zoster virus and viruses that cause hemorrhagic fevers,
• Cirrhosis (liver disease in which normal liver tissue is replaced by scar tissue): liver damage caused by alcohol, often in the terminal stage.

But also by the abuse of certain substances such as:

• Alcohol ;
• Medicines or toxins (paracetamol in particular, which causes poisoning; but also amoxicillin/clavulanic acid, halothane, isoniazid, NSAIDs – non-steroidal anti-inflammatory drugs) or the mushroom (Amanita phalloides);
• Drugs.

Viral hepatitis is usually the most common cause in countries with poor sanitation. In countries with good sanitation systems, toxins are more often implicated.

There are also other less common causes:

• Vascular disorders;
• Metabolic disorders;
• Autoimmune hepatitis;
• An immunological disorder;
• A hereditary disease (such as a buildup of copper in the body);
• Poor vascularization of the liver (heart dysfunction, blood clot in a vessel that drains the liver).

Finally, it happens that no cause is found (in 20% of cases).

Liver disease and symptoms: what are the signs of poor liver function?

Liver functions are impaired, which results in clinical signs:

• Jaundice (yellowing of the skin and eyes due to the accumulation of bilirubin under the skin, not metabolized by the liver);
• Stellate angiomas (small, visible star-shaped vessels on the skin);
• Extreme tiredness, weakness or nausea;
• Bad breath ;
• Increased abdominal volume (due to the appearance of water, called ascites, in the peritoneal cavity);
• Bruising and bleeding (due to poor blood clotting secondary to liver dysfunction);
• Tachycardia , tachypnea, hypotension;
• Tendency to infections due to lowered immune system.

Prevention of liver disorders is based on reducing risk factors, including limiting alcohol consumption and preventing viral hepatitis.  In cancer patients, particularly those undergoing chemotherapy, the risk of liver failure is increased due to the central role of the liver in the metabolism of anticancer treatments.