What is liver failure?

Liver failure is when your liver becomes so damaged that it doesn't work properly. It happens as the last stage of many liver diseases. This is known as chronic liver failure.

The liver is the largest organ in the body. It sits under the ribs, on the right side of the abdomen. It has many important functions, including:

• making and storing sugars and fat to be used for energy
• making bile to help digest your food
• making important proteins for use in the body
• breaking down harmful chemicals

There are different stages of chronic liver disease. If a healthy liver becomes sick, it becomes inflamed (called hepatitis). Over time the liver gets stiff and scarred (called liver fibrosis). After a while, cirrhosis may develop, which eventually, if not treated, can become liver cancer.

Chronic liver failure may occur after a long period of chronic liver disease — slow, progressive damage to the liver caused by alcohol, viruses or medical conditions. For this reason, chronic liver failure is sometimes known as 'end-stage liver disease' or decompensated chronic liver failure.

In some cases, the liver may become damaged suddenly and severely. This is known as acute liver failure.

What are the symptoms of liver failure?

As liver failure develops, it can cause symptoms such as:

• jaundice — yellowing of the skin and whites (sclera) of the eyes
• very itchy skin
• easy bruising or bleeding
• vomiting blood, due to burst varices — these are veins in your oesophagus (food pipe) and stomach that can enlarge and burst
• a swollen belly, caused by ascites (fluid build-up in your abdomen), or swollen ankles
• confusion or sleepiness

Symptoms may be mild at first, and gradually become more intense as your condition worsens, especially if you have a history of chronic liver disease.

Symptoms of liver failure don't usually vary between males and females.

If you have acute liver failure, you may develop severe symptoms suddenly (over 48 hours). Seek urgent medical attention.

What causes liver failure?

Liver failure can be caused by anything that significantly damages the liver, making it unable to perform its function. This can include infections, toxins (poisons), medicines or supplements and medical conditions.

Chronic liver failure may be caused by:

• chronic or untreated hepatitis B or C
• autoimmune disease
• long-term, heavy alcohol use
• diseases that affect the liver including fatty liver disease, haemachromatosis and Wilson's disease

Acute liver failure may be caused by:

• overdose of some medicines — the most common cause is paracetamol overdose
• toxins contained in herbs, supplements or poisonous mushrooms
• some viruses, including hepatitis A, B and C, Epstein-Barr virus and cytomegalovirus
• autoimmune conditions
• complications of pregnancy
• severely low blood pressure

Paracetamol overdose is the most common cause of acute liver failure in Australia.

If you think you or your child has swallowed a poison or overdosed on a medicine, call the Poisons Information Centre on 13 11 26.

When should I see my doctor?

If you develop symptoms of acute liver failure, such as jaundice (yellowing of your skin and the whites of your eyes), abdominal swelling or confusion, seek urgent medical attention.

If you have been diagnosed with hepatitis or liver disease, you should see your doctor regularly so they can check your condition.

How is liver failure diagnosed?

Your doctor will check you for liver failure if you have symptoms, or a condition that leads to liver disease. They will give you a physical examination, and may refer you for blood tests or imaging tests such as ultrasound and CT scans to confirm the diagnosis.

How is liver failure treated?

Your doctor will recommend a treatment for liver failure based on the likely cause. They will also consider how severe your condition is and what other health conditions you have when recommending or prescribing a treatment plan.

You will usually be treated in hospital until your condition stabilises so that your healthcare team can:

• identify and treat complications caused by acute liver failure
• support your body to give your liver a chance to heal and return to performing its normal functions

Treatments may include:

• blood tests or scans to determine the severity of your condition and check for complications
• careful observation of your medical condition in an intensive care unit (ICU)
• intravenous fluids
• antibiotics or antiviral medicines, if you are at risk of or have been diagnosed with an infection
• draining fluid build-up (ascites) from your abdomen — this procedure is known as paracentesis
• breathing support, such as intubation, if you become very drowsy or unconscious

Treatment for specific causes of acute liver failure

Some causes of acute liver failure also have specific treatments:

• Paracetamol overdose is treated with an intravenous (through a drip) medicine called N-acetylcysteine (NAC). NAC may also be used in some other cases of acute liver failure.
• If liver failure is a complication of pregnancy, your doctor may recommend birthing your baby early.
• Suspected poisoning, for example with poisonous mushrooms, can be treated with gastric lavage ('pumping the stomach'), IV fluids and activated charcoal.
• Steroid medicines are used to treat liver failure caused by some types of autoimmune disease.

Liver transplants

If your liver is severely damaged and your doctors think it's unlikely to heal on its own, they may recommend a liver transplant. This recommendation will depend on your individual circumstances.

Visit Transplant Australia to learn more about living with a transplant.

Can liver failure be prevented?

Not all causes of liver failure can be prevented, but living well can reduce your chance of developing it:

• Maintain a healthy diet and aim for a healthy weight range.
• Keep physically active.
• Reduce or quit drinking alcohol, especially if your liver failure was caused by alcohol.
• Use medicines only as directed by your doctor or pharmacist.
• Quit smoking.
• Ask your doctor about vaccinations recommended for your age group and circumstances.

These tips can also help slow down or stop the progression of liver disease.

If you have liver disease or a history of liver failure, it's important to check with your doctor or pharmacist before taking any medicines, including herbs or supplements.

Complications of liver failure

Advanced or severe liver failure can lead to complications including:

• build-up of fluid on the brain (cerebral oedema)
• problems with blood clotting
• infections
• kidney failure

With severe liver failure, toxins may build up and impair the brain's functioning (hepatic encephalopathy).

Left untreated, severe liver failure is likely to be fatal.

Resources and support

• The Liver Foundation has information about liver failure and many other conditions that affect the liver.
• LiverWELL has information and support for people with liver disease and their communities.
• For free and confidential advice about alcohol and other drugs, call the National Alcohol and Other Drug hotline on 1800 250 015. It will automatically direct you to the Alcohol and Drug Information Service in your state or territory.
• The National Hepatitis Infoline provides information and support services people living with or at risk of hepatitis B or C, and their friends and families. Call 1800 HEP ABC (1800 437 222).
• LiverWELL has a range of fact sheets and resources in a variety of community languages.
• See LiverWELL's Healthy Living Guide for the Aboriginal Community.