Liver Failure: Causes, Symptoms and Treatment

When your liver is failing, time is of the essence. At the Center for Liver Diseases at the University of Chicago Medicine, we have a team of highly experienced specialists dedicated to helping you manage your liver disease.

Your treatment will depend on the cause of your liver failure. However, in many cases, the best treatment for advanced liver disease is a liver transplant.

Our liver transplant team is among the most experienced and skilled in the country. To determine whether you are a candidate for a transplant, we provide a fast-tracked, comprehensive evaluation, which can be completed in two to three days in the hospital. If you are considered a transplant candidate, we can get you on the waitlist faster, so you may receive an organ sooner.

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Liver Disease Stages

Without proper treatment, liver disease often gets worse over time. The stages of liver disease are:

Inflammation: In this early stage of liver disease, your liver is swollen but you may not notice any symptoms.
Scarring (fibrosis): Over time, inflammation turns healthy liver tissue into scar tissue, which is called fibrosis. Fibrosis makes it harder for your liver to work properly, but it is often reversible.
Cirrhosis: When your liver becomes severely and permanently scarred, this is called cirrhosis. Cirrhosis may be caused by heavy alcohol use, viral hepatitis, autoimmune hepatitis, fatty liver disease, bile duct diseases and various hereditary conditions. At UChicago Medicine, our liver disease team helps hundreds of patients each year with cirrhosis. We focus on controlling or slowing the progression of cirrhosis with lifestyle changes, medicines and other treatments. We also perform regular testing to monitor the health of your liver so we will know if and when your liver begins to fail.
End-stage liver disease (liver failure): Over time, cirrhosis can slowly lead to a decline in liver function and, ultimately, end-stage liver disease. This means your liver has shut down and can no longer perform important functions like getting rid of harmful substances, producing proteins that allow for adequate clotting and making bile, which is needed to digest food. Once cirrhosis progresses to this advanced stage, the definitive treatment is a liver transplant.

Liver Failure Symptoms

When the liver is failing, it can no longer complete its vital tasks. As a result, the body does not work properly. As chronic liver disease progresses, you may experience some or all of the following symptoms:

Jaundice, or yellow eyes and skin
Confusion or other thinking difficulties
Swelling in the belly, arms or legs
Severe fatigue
A tendency to bleed easily

Chronic vs. Acute Liver Failure

Chronic liver failure is a slow decline in liver function that occurs alongside cirrhosis, or severe scarring of the liver. It can take months or years to develop.

Acute liver failure occurs when the liver fails rapidly, typically over days to a few weeks. Unlike chronic liver failure, acute liver failure is rare and often happens in people who have never had previous liver problems. Taking certain medications or consuming toxins are possible causes.

Liver Failure Treatments

In many cases, the only treatment for a failing liver is a liver transplant. But sometimes, an acute or hereditary cause can be treated to reverse the condition. For instance, when liver disease is caused by taking too much acetaminophen (an over-the-counter pain reliever), medicines can reduce liver damage. When a hereditary copper-overload disease causes liver damage, medications can help remove the copper out of the body. Or when a viral infection in patients with cirrhosis causes the liver to fail, antiviral medicines can fight the infection to help restore liver function.

An innovative liver dialysis machine for acute liver failure

The Molecular Adsorbent Recirculating System (MARS) is a liver dialysis machine used to perform some of the function of the liver. It removes protein-bound and water-soluble toxins from the blood and reduces the amounts of toxins that reach the brain. The MARS system helps support the body’s needs during acute liver failure and gives time for the liver to recover from the injury, if feasible. UChicago Medicine is the only center in Chicagoland to offer this complex medical therapy.

Living Donor Liver Transplantation

Waiting for a donor liver is not the only option available to liver failure patients. Living liver donors can give part of their healthy liver to a transplant patient and end their long wait for treatment.

Learn about our liver transplant evaluation services

Frequently Asked Questions about Liver Failure

What is the difference between acute and chronic liver failure?

A failing liver can develop slowly or rapidly, depending on the cause and the condition of the liver.

Chronic liver failure: This condition can take months or years to develop and occurs alongside cirrhosis, or severe scarring of the liver. Common causes include heavy alcohol use, fatty liver and viral infections.

Acute liver failure: This occurs when the liver fails rapidly, typically over days or weeks. This condition is rare and often happens in people who have never had previous liver problems. Causes include:

Taking too much acetaminophen or combining acetaminophen with alcohol use
Autoimmune hepatitis
Ingesting toxins, such as poisonous mushrooms and some herbs
Unexpected liver toxicity from medications
Certain diseases, including Budd-Chiari syndrome and Wilson’s disease

Acute liver failure is a medical emergency, and UChicago Medicine has state-of-the-art intensive care units for monitoring patients with this condition. Treatment will depend on the cause of your underlying liver failure. Medications may help treat viral hepatitis, autoimmune hepatitis, acetaminophen overdoses, poisonings and other causes. If treatment is not effective, our liver specialists will evaluate you for a possible liver transplant.

Can you have acute and chronic liver failure at the same time?

Sometimes people with chronic liver failure who are clinically stable suddenly develop rapid progression of the disease. This is called acute-on-chronic liver failure. This may be caused by an infection, drinking alcohol despite having a cirrhotic liver or taking medications that may unexpectedly harm the liver.

Patients with acute-on-chronic liver failure may see their livers fail over weeks to months, compared to months to years as is typical in chronic liver failure. As with acute liver failure, we focus first on treating the underlying cause before considering a possible liver transplant.

What are the early signs of liver damage?

What happens when the liver shuts down?

When your liver stops working, you need immediate treatment to survive. Get emergency help if you notice these symptoms:

Yellow eyes and skin (jaundice)
Fluid build-up in the abdomen (ascites)
Swelling in the arms or legs (edema)
Vomiting blood
Black stools
Mental confusion
Shortness of breath

Our liver specialists at UChicago Medicine have extensive experience managing these conditions and will work with you to develop a care plan that meets your needs.

What is the difference between liver failure and cirrhosis?

Liver failure is when the liver has shut down or is shutting down and can no longer work properly. Cirrhosis is a late stage of liver disease where the liver is severely scarred but may still work. Most patients who develop chronic liver failure have underlying cirrhosis.

Liver disease can go through these stages:

Inflammation: Increased activity of the immune system in the liver, leading to swelling of the liver
Fibrosis: Early scarring that can follow inflammation in the liver
Cirrhosis: Severe scarring of the liver that accumulates with prolonged injury or inflammation and typically cannot be reversed
End-stage liver disease: A liver that no longer works (often called liver failure)

Can a damaged liver repair itself?

How do I know if my liver function is worsening?

One of the ways we determine if your liver is failing is through blood tests, which help us determine your MELD, or Model for End-Stage Liver Disease, score. We look at five lab results:

Bilirubin, which tells how well your liver is getting rid of bile
Creatinine, which reflects your kidney function, which is affected by the liver
PT/INR (prothrombin time and international normalized ratio), which measures the function of blood-clotting factors produced by the liver
Sodium, which is an electrolyte in the blood that is affected by advanced liver disease
Albumin, which is a protein produced by the liver

Your MELD score will range from 6 to more than 40. The worse your liver function, the higher your MELD score will be, and the higher your risk of death. The MELD score is also used to determine a person’s priority on the transplant list, with sicker patients receiving higher priority. The MELD score can be calculated using a programmed equation.

We may also recommend other tests to monitor how well your liver is working. These include:

Imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans
Liver biopsy, which involves taking a small sample of your liver tissue

Dr. Fung and Dr. Charlton, co-directors of the transplant institute

World-Renowned Liver Disease Specialists

With access to leading therapies and state-of-the-art technologies, our liver disease specialists work together to provide personalized care for each patient.

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