How Do You Know If Your Liver Is Failing?

Reviewed on 8/19/2021

Liver failure symptoms and signs include yellowing skin and eyes (jaundice), abdominal distension from fluid accumulation (ascites), right upper quadrant pain or tenderness, enlarged liver (hepatomegaly), fatigue, feeling unwell (malaise), lethargy, loss of appetite, nausea, vomiting, itching, difficulty sleeping, confusion, and comatose.
Liver failure symptoms and signs include yellowing skin and eyes (jaundice), abdominal distension from fluid accumulation (ascites), right upper quadrant pain or tenderness, enlarged liver (hepatomegaly), fatigue, feeling unwell (malaise), lethargy, loss of appetite, nausea, vomiting, itching, difficulty sleeping, confusion, and comatose.

Acute liver failure is a rare and life-threatening disease that usually happens in patients who do not have cirrhosis or preexisting liver disease.

Symptoms that may be signs your liver is failing include: 

  • Yellowing skin and eyes (jaundice)
  • Abdominal distension from fluid accumulation (ascites)
  • Right upper quadrant pain or tenderness
  • Enlarged liver (hepatomegaly)
  • Fatigue
  • Feeling unwell (malaise)
  • Lethargy
  • Loss of appetite
  • Nausea 
  • Vomiting
  • Itching
  • Difficulty sleeping
  • Confusion 
  • Comatose

What Causes Liver Failure?

There are many different causes for acute liver failure, including: 

How Is Liver Failure Diagnosed?

Acute liver failure is diagnosed with a patient history and physical examination, along with the following tests: 

  • Blood tests:
    • Prothrombin time/INR
    • Blood chemistries (sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose, calcium, magnesium, phosphate, lactate dehydrogenase)
    • Liver blood tests (AST, ALT, alkaline phosphatase, GGT, total and direct bilirubin, albumin)
    • Complete blood count with differential
    • Acetaminophen level
    • Blood toxicology screen 
    • Viral hepatitis serologies 
    • Pregnancy test in women 
    • Autoimmune markers 
    • Blood type and screen
    • HIV testing
    • Amylase and lipase
  • Arterial blood gas
  • Arterial lactate
  • Arterial ammonia
  • Urine tests
    • Urine toxicology screen 
    • Urinalysis to look for protein in the urine in women who are pregnant
  • Ceruloplasmin level in patients suspected of having Wilson disease
  • Anti-hepatitis D virus antibodies in patients with acute or chronic hepatitis B
  • Anti-hepatitis E virus antibodies for patients with travel to endemic areas such as Russia, Pakistan, Mexico, India, or Africa
  • Imaging studies 
  • Liver biopsy 

QUESTION

Long-term heavy alcohol consumption can cause: See Answer

What Is the Treatment for Liver Failure?

Treatment for acute liver failure involves treating the underlying cause. Treatments may include: 

  • Acetaminophen toxicity 
  • Hepatitis B infection
    • Antiviral therapy with a nucleos(t)ide analogue 
  • Mushroom poisoning 
    • Early administration of activated charcoal 
    • Administration of silibinin and penicillin G
  • Budd-Chiari syndrome 
    • Transjugular intrahepatic portosystemic shunt placement
    • Surgical decompression
    • Thrombolysis
  • Herpes simplex virus infection 
  • Wilson disease 
    • Liver transplantation
    • Plasma exchange to remove copper may act as a temporizing measure
  • Autoimmune hepatitis 
    • Glucocorticoids 
    • Liver transplantation for patients who develop encephalopathy
  • Acute fatty liver of pregnancy 
    • No specific medical treatment 
    • Treatment is generally prompt delivery (usually emergent) once the mother has been stabilized

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Reviewed on 8/19/2021
References
https://www.uptodate.com/contents/acute-liver-failure-in-adults-etiology-clinical-manifestations-and-diagnosis?search=liver%20failure&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4

https://www.uptodate.com/contents/acute-liver-failure-in-adults-management-and-prognosis?search=liver%20failure&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838908/