Liver failure is a serious condition that occurs when large parts of the liver become damaged beyond repair and the liver is no longer able to function properly. The liver is responsible for many essential functions in the body, including filtering toxins from the blood, metabolizing nutrients and drugs, synthesizing proteins, and producing bile. When liver failure occurs, these important functions are impaired, which can lead to a buildup of toxins in the blood, impaired metabolism, fluid retention, bleeding disorders, and eventually multi-organ failure.
What causes liver failure?
There are many potential causes of liver failure, including:
- Viral hepatitis – Hepatitis A, B, C, D, and E viruses can all cause inflammation and damage to liver cells.
- Alcohol abuse – Drinking excessive amounts of alcohol over many years can lead to alcoholic liver disease.
- Nonalcoholic fatty liver disease – Buildup of fat in liver cells, often associated with obesity, diabetes, or high cholesterol.
- Medications and supplements – Some prescription medications like acetaminophen and dietary supplements can injure liver cells.
- Autoimmune diseases – Disorders like autoimmune hepatitis cause the immune system to attack and destroy liver cells.
- Genetic diseases – Genetic disorders like hemochromatosis and Wilson’s disease cause abnormalities in liver cell function.
- Cancer – Liver cancer can disable and destroy sections of the liver.
- Infections – Viruses like herpes, Epstein Barr, and cytomegalovirus can inflame and injure the liver.
In many cases, liver failure occurs gradually over many years as more and more of the liver becomes damaged. Acute liver failure occurs more rapidly, over days or weeks, and is often caused by an acute viral infection, drug overdose, or toxin ingestion.
What are the symptoms of liver failure?
As liver function deteriorates, various signs and symptoms may appear, including:
- Jaundice – Yellowing of the skin and eyes
- Itching – Caused by bile salts depositing in the skin
- Fatigue – Due to impaired metabolism and nutrient conversion
- Nausea and vomiting – From toxin buildup and fluid retention
- Weight loss and muscle wasting – Malnutrition due to poor nutrient absorption
- Bruising and bleeding – Impaired blood clotting
- Swelling – Fluid retention in the legs, ankles and abdomen
- Confusion and impaired brain function – Buildup of toxins in the blood affecting the brain
Symptoms are often dependent on the underlying cause of liver injury and may develop slowly over time or occur suddenly. Seeking early medical care for any symptoms of liver disease is crucial.
What are the stages of liver failure?
Doctors often characterize liver failure in stages, from early injury to severe irreversible damage:
Stage 1: Mild Liver Damage
Some signs of liver injury but normal liver function. Treatment can often reverse this stage of damage.
Stage 2: Moderate Liver Damage
Some loss of liver function, possibility of tissue scarring. Close monitoring is required, some treatment options still viable.
Stage 3: Severe Liver Damage
Widespread inflammation and cell death, scarring present. Liver transplant may be considered.
Stage 4: End-Stage Liver Failure (Cirrhosis)
Major loss of liver function and extensive scarring. Requires transplant to survive. Life-threatening complications can arise.
What complications can arise with liver failure?
As liver failure progresses, serious complications can develop affecting many other organs and body systems:
- Gastrointestinal bleeding – Impaired blood clotting and increased blood pressure in the portal vein can cause varices (enlarged veins) in the esophagus, stomach, and intestines, which can rupture and bleed massively.
- Ascites – Fluid accumulation and swelling in the abdomen, which may require drainage via a paracentesis procedure.
- Kidney failure – Toxins normally filtered by the liver can damage the kidneys.
- Hepatic encephalopathy – Toxins passing into the brain cause confusion, sleepiness, and coma.
- Infections – Increased susceptibility to bacterial peritonitis and sepsis.
- Malnutrition – Inability to digest nutrients leads to wasting and cachexia.
- Liver cancer – Cirrhosis increases the risk of developing hepatocellular carcinoma.
Progression of liver failure should be closely monitored by a hepatologist, with complications addressed quickly to help preserve remaining liver function.
How is liver failure diagnosed?
Diagnosing liver failure involves blood tests, imaging, and sometimes liver biopsy. Tests may include:
- Liver function tests – Elevated liver enzymes signal liver injury. Low albumin levels and prolonged clotting times also indicate impaired liver function.
- Complete blood count – Anemia and low platelet counts are common.
- Viral hepatitis serology – Detects hepatitis A, B, C antibodies.
- Autoantibody tests – Identifies autoimmune disorders.
- Abdominal ultrasound – Checks for liver enlargement, nodularity, fluid.
- CT scan or MRI – Provides detailed images of liver damage and necrosis.
- Liver biopsy – Examines a tissue sample for fibrosis, inflammation, and fat.
Once the cause and extent of liver injury is determined, appropriate treatment can be initiated.
What treatments are available for liver failure?
Treatment options for liver failure include:
Treating Underlying Cause
If a specific cause like hepatitis or alcohol abuse is identified, treating the underlying problem is crucial to stabilize liver function. Antiviral medications, abstaining from alcohol, controlling diabetes, or stopping harmful medications may be part of the treatment plan.
Medications
Medications may include:
- Corticosteroids to reduce liver inflammation
- Antibiotics to treat infections
- Lactulose or rifaximin to reduce ammonia levels
- Diuretics to decrease fluid retention
- Blood pressure medications
- Blood thinners
Low-Protein Diet
A diet low in sodium and protein but high in carbohydrates is recommended to reduce fluid retention, muscle wasting, and the production of toxins the liver cannot process.
Supplements
Vitamin supplements can help address malnutrition while vegetable-based antioxidant supplements may help protect liver cells.
Therapies and Procedures
Other therapies that may be used include:
- Albumin infusions to maintain fluid levels
- Paracentesis to drain excess abdominal fluid
- Banding or sclerotherapy to stop internal bleeding
- Dialysis to artificially filter the blood if kidneys fail
- Liver transplant surgery in end-stage liver failure
Close monitoring in the hospital is often required to carefully manage medications, diet, and emerging complications.
Can liver damage from failure be reversed?
Whether liver failure can be reversed depends on the extent of the damage and the underlying cause:
- Early-stage liver damage – Moderate inflammation and cell death can often be reversed if the cause is effectively treated. Liver cells can regenerate completely.
- Mid-stage liver damage – Extensive cell death with scar tissue requires aggressive treatment. Recovery is possible but some liver scarring may remain.
- End-stage cirrhosis – Widespread scar tissue replacing healthy cells cannot be reversed. A transplant is the only option.
- Acute liver failure – Rarely reversible once massive necrosis has occurred. Urgent transplant required.
The key is intervening early before significant scarring develops in the liver. Even successfully treated viral hepatitis or alcohol-induced injury can return and cause progressive damage if the underlying cause is not addressed.
What is the life expectancy with liver failure?
Life expectancy with liver failure depends greatly on the stage and severity of illness:
- Compensated Cirrhosis – 1 to 2 years
- Decompensated Cirrhosis – 6 to 12 months
- End-Stage Liver Failure – Weeks to months without transplant
- Acute Liver Failure – Days to weeks without transplant
Those with liver failure from autoimmune hepatitis tend to have a better prognosis than those with cirrhosis from viruses or alcohol. Some may survive many years with cirrhosis through careful treatment. In end-stage failure, liver transplant is the only means of increasing life expectancy.
Can cirrhosis be reversed after stopping drinking alcohol?
Alcohol-related cirrhosis cannot be completely reversed in most cases, but stopping drinking alcohol can still be beneficial:
- Prevents additional liver damage and scarring
- Allows inflamed liver to potentially heal and regain some function
- May resolve symptoms like jaundice, itching, and swelling
- Suppresses formation of scar tissue
- Reduces risk of liver cancer
The liver does have a remarkable capacity to regenerate some healthy cells and repair areas of damage. But cirrhosis involves widespread scarring that cannot be undone. Stopping alcohol early is key, before significant fibrosis and nodularity. At later stages, cirrhosis is irreversible.
What foods help repair liver damage?
Some foods that may help repair liver damage include:
- Coffee – May help reduce liver inflammation and scarring due to antioxidants.
- Grapefruit – Contains antioxidant naringenin that may help protect liver cells.
- Beets and carrots – High antioxidants help neutralize toxins in liver.
- Walnuts – Omega-3 fatty acids help reduce inflammation.
- Garlic – Helps liver detoxify ammonia and other toxins.
- Green tea – Powerful antioxidant EGCG may protect liver cells.
- Fatty fish – Vitamin E and omega-3s reduce oxidative stress on liver.
- Berries – Rich in antioxidants and vitamin C to help liver function.
A generally healthy diet is also recommended – low salt, minimal processed sugars, lots of fiber, lean proteins, and plenty of hydration. Check with your doctor for liver-friendly food choices.
What vitamins are good for cirrhosis of the liver?
Helpful vitamins and supplements for cirrhosis may include:
- Vitamin D – Deficiency linked to progression of fibrosis in cirrhosis.
- Vitamin E – Potent antioxidant may help reduce liver inflammation and damage.
- Vitamin K – Essential for blood clotting which is impaired in cirrhosis.
- Zinc – Zinc deficiency exacerbates cirrhosis; supplements may help.
- Milk thistle – Silymarin helps protect liver cells from toxins.
- Selenium – Antioxidant mineral is often depleted in cirrhosis.
- Probiotics – Improve gut health and reduce ammonia production.
Multivitamins tailored for liver health may provide some of the key nutrients and antioxidants the cirrhotic liver needs. Check with your hepatologist before starting any new supplements.
What are the signs of liver recovery?
Signs that may indicate the liver is recovering and regenerating after injury include:
- Improving liver enzyme tests (ALT, AST, GGT)
- Increasing albumin and protein levels
- Resolution of jaundice and itching
- Reduced belly swelling and fluid retention
- Improved blood clotting ability
- Regression of abnormalities on MRI or CT scan
- Recovery of appetite and weight gain
- Increase in strength and energy levels
Depending on the extent of damage, recovery may occur over weeks to months. Close monitoring of liver function tests and other markers is key to assess improvement.
Can liver cirrhosis be cured?
Unfortunately, cirrhosis itself cannot be completely cured or reversed once significant scarring has occurred. However, in some cases, treating the underlying cause can stop the progression and allow the liver to regain some function:
- Alcoholic cirrhosis – Stopping alcohol prevents more scarring but does not undo existing damage.
- Chronic hepatitis – Antiviral medications may suppress viral replication and infection in the liver, allowing some healing.
- Autoimmune cirrhosis – Steroids and immune suppressants can control attacks on liver cells and prevent progression.
- NASH cirrhosis – Weight loss, diabetes control, lipid-lowering medications can help stabilize liver function.
Even with optimal treatment, cirrhosis is a chronic progressive condition eventually requiring a liver transplant. But the progression can potentially be significantly delayed by effective management.
Can the liver grow back after cirrhosis?
The liver does have a remarkable ability to regenerate and regrow healthy cells after injury. But with cirrhosis, the scar tissue cannot be reversed:
- Remaining healthy liver cells can proliferate, improving function.
- Scar tissue bands may contract or soften over time.
- Removing the cause (alcohol, viruses, toxins) allows regeneration.
- But fibrous bands and nodules of cirrhosis remain permanent.
So while some compensatory growth is possible, the extensive scarring and nodularity of cirrhosis remains irreparable. The liver essentially has to work around the residual scar tissue.
Conclusion
Liver failure is a serious condition carrying a poor prognosis at its later stages. However, significant liver recovery is possible if caught early before severe necrosis and scarring occurs. Removing the cause of injury, whether alcohol, viruses, toxins or other causes, is the first essential step to stabilize liver function. From there, medications, diet changes and vitamin supplements can all help support the liver’s natural regeneration abilities. In end-stage failure, though, transplant is the only option.
Cirrhosis represents more permanent widespread scarring that typically cannot be reversed entirely. But even in cirrhosis, treating the cause can help recover some functioning liver cells and slow further deterioration. Close monitoring and excellent care is needed throughout to help preserve liver function and prolong life.
