Liver failure means the liver can no longer carry out its essential work: clearing toxins, making clotting proteins and albumin, processing bile and regulating sugar. Acute liver failure develops over days to weeks in a previously healthy liver. Chronic liver failure, or decompensated cirrhosis, is the end stage of years of liver damage.
Both are serious. Acute liver failure is an intensive care emergency in which some people recover fully and others need an urgent transplant. Chronic liver failure is managed by treating the cause and the complications, and transplantation is the definitive treatment for suitable patients.
Symptome
- Yellowing of the skin and whites of the eyes
- Swelling of the abdomen with fluid (ascites) and swollen legs
- Confusion, reversed sleep pattern, slowed speech or a flapping tremor of the hands
- Easy bruising and bleeding gums or nose
- Vomiting blood or passing black stools from swollen veins in the gullet
- Profound tiredness, muscle wasting and poor appetite
- Itching and dark urine
- Reduced urine output when the kidneys become affected
Ursachen und Risikofaktoren
The main causes of chronic failure are alcohol, fatty liver disease linked to weight and diabetes, hepatitis B and C, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, iron overload and Wilson disease. Acute failure is most often due to paracetamol overdose, other medicines and herbal products, acute viral hepatitis A, B or E, wild mushroom poisoning, autoimmune hepatitis, Wilson disease, and rare complications of pregnancy. In a proportion no cause is found. In people with cirrhosis, infection, bleeding, alcohol or a new medicine can tip stable disease into failure.
Wie es diagnostiziert wird
- Blood tests: Bilirubin, albumin, INR, creatinine, sodium, ammonia and blood count. INR and bilirubin are the core markers of how well the liver is working.
- Severity scores: MELD and Child-Pugh scores combine blood results to estimate severity and set priority for transplant assessment.
- Cause screen: Viral serology, autoantibodies, immunoglobulins, iron and copper studies, paracetamol level and a careful drug and supplement history.
- Ultrasound with Doppler, CT or MRI: Show liver texture, spleen size, ascites, vein patency and any liver cancer.
- Upper endoscopy: Looks for varices in the gullet and stomach so that bleeding can be prevented.
- Ascitic fluid sampling: A needle sample to exclude infection of the fluid, which is common and dangerous.
Behandlungsmöglichkeiten
- Treating the cause: Complete abstinence from alcohol, antivirals for hepatitis B or C, steroids for autoimmune hepatitis, and acetylcysteine for paracetamol injury.
- Managing fluid: Salt restriction, spironolactone and furosemide, and drainage of large volumes with albumin cover. TIPS, a shunt placed through the neck vein, for fluid or bleeding that does not respond.
- Preventing and treating encephalopathy: Lactulose to achieve two to three soft stools a day, with rifaximin added for recurrence.
- Preventing variceal bleeding: Beta blockers such as carvedilol, or endoscopic banding.
- Nutrition: Adequate protein and calories with a late evening snack. Protein restriction is outdated and harmful.
- Liver transplantation: Assessment for those with a high MELD score or recurrent complications. Alcohol abstinence, heart and lung fitness and social support are all reviewed.
- Liver cancer surveillance: Ultrasound every 6 months.
Wenn es dringend ist
Liver failure complications are emergencies and must be treated at the nearest hospital: vomiting blood or black stools, new confusion or drowsiness, fever or abdominal pain with ascites, very little urine, or rapidly deepening jaundice. Suspected paracetamol overdose or mushroom poisoning needs immediate treatment even if the person feels well.
Reisen nach Türkiye zur Behandlung
People in unstable liver failure should not take long flights, and acute liver failure cannot be managed by travelling. For someone with stable cirrhosis, a visit may provide a hepatology second opinion, procedures such as variceal banding or TIPS, or a transplant assessment. Turkish law requires a living related donor with ethics committee approval, and donors are not arranged for you. Transplant also means months of close follow-up and lifelong immunosuppression, so a plan for care at home is essential before you start.
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Häufig gestellte Fragen
Can the liver recover?
In acute failure, yes, sometimes completely, because the liver regenerates. In cirrhosis the scarring is largely permanent, but function often improves markedly once alcohol is stopped or hepatitis is treated.
Who qualifies for a liver transplant?
People whose liver disease is severe enough that transplant offers a better outlook than medical care, who are fit for major surgery and, for alcohol-related disease, who have shown sustained abstinence.
Which painkillers are safe with cirrhosis?
Paracetamol at a reduced dose, usually up to 2 grams a day, is preferred. Ibuprofen and similar drugs should be avoided as they harm the kidneys and provoke bleeding.
Are stem cell therapies for cirrhosis proven?
No. They remain experimental, and trials so far have not shown consistent benefit. They should be offered only within registered clinical studies.