Liver failure symptoms

Liver failure symptoms: what happens during liver failure

Liver is the most important organ for processing most of the chemical reactions that are essential for our survival. During liver failure, all those metabolic processes are deranged.
How long can you live without a liver functioning depends on how fast your liver fails. When your liver fails suddenly, you may die within a few hours. If your lives fails slowly over the years, it may take a few weeks to die from liver failure.

Not considering the special situation of a sudden liver failure, liver disease usually progresses in several stages before you get to end stage liver disease and liver failure.

Fatty liver disease:

Fatty liver disease is caused by the accumulation of fats inside the liver cells. The main types of fatty liver disease includes alcoholic fatty liver disease and non-alcoholic fatty liver disease. The exact cause of non-alcoholic fatty liver is still being researched. Obesity, family history of non-alcoholic fatty liver, diabetes and high triglycerides in blood are known risk factors for non-alcoholic fatty liver.

Alcoholic fatty liver disease is caused by drinking too much alcohol. Alcoholic fatty liver is an early reversible consequence of drinking too much alcohol. If you have been drinking more than 60 grams of alcohol per day for a while, chances are you already have alcoholic fatty liver disease. Here is the good news, reversing fatty liver disease from alcohol is easy. If you stop drinking, your liver will go back to normal. If you keep drinking, you may progress towards cirrhosis and liver failure.

Cirrhosis of the liver:

Symptoms of liver cirrhosis depends on the stage of the cirrhosis. There are 4 stages of liver cirrhosis

Stage 1 liver cirrhosis : This is the beginning stage. In this stage your liver is inflamed.
Stage 2 liver cirrhosis: In this stage your liver starts to get fibrosis. It means that fibre like tissues start to form and create scars in the otherwise smooth liver.
Stage 3 liver cirrhosis:In this stage, the fibrosis worsens significantly and it starts to disrupt the normal anatomy of the liver.

Cirrhosis of the liver symptoms in stages 1 to 3:
Despite having significant changes inside your liver, you do not have many symptoms when your cirrhosis goes from stage 1 to 3. Here are some of the possible symptoms:
Pain in your liver
Feeling tired
Decreased appetite

Stage 4 cirrhosis of the liver

When the cirrhosis of liver gets to stage 4, you start to have liver failure symptoms. In stage 4 liver cirrhosis, your whole liver is occupied by fibrous tissue and you have very little functioning liver tissue remaining.

Here is the list of  20 symptoms of liver failure with stage 4 cirrhosis:

  1. Jaundice
  2. Itchy skin
  3. Easy bleeding
  4. Distended abdomen filled with fluids
  5. Distended ugly veins on your skin
  6. Development of breasts in male
  7. Swelling all over the body
  8. Inability to fight infections
  9. Problems with memory and concentration
  10. Tremors
  11. Vomiting blood
  12. Signs of kidney damage from liver failure
  13. Increased fatigue
  14. Weight loss
  15. Muscle wasting
  16. Impotence and sexual dysfunction
  17. Shortness of breath
  18. confusion
  19. Bleeding under the skin
  20. Coma and death

Stage 4 cirrhosis of liver life expectancy

How long you can live with stage 4 cirrhosis depends on the severity of liver failure. Based on the severity of the symptoms and some lab tests, doctors classify patients into low, moderate and high risk of liver failure death. If you are in the high risk category, your risk of liver failure death within the next 3 months is about 40%. If you are in moderate risk category, your risk of liver failure death within the next 3 months is about 11%. If you are in the low risk category, your risk of liver failure death within the next 3 months is about 4.3%.

Cirrhosis of liver life expectancy with compensated disease

If you have some normal functioning liver tissue remaining inside your liver, you may go into a compensated stage of the disease especially if there is no ongoing liver damage. For example, if your stage 4 liver cirrhosis is secondary to alcohol abuse, you can stop drinking. After you stop drinking, the remaining functioning liver tissue will continue to function. You will remain in low risk group for liver failure death. In this compensated stage, the median survival rate is 12 about years. It means that most patients with stage 4 cirrhosis in this compensated phase with no active liver damage live for 12 years. You may live longer than that if you are otherwise in good health and follow your doctors advice.

End stage liver disease:

Patients in stage 4 cirrhosis of liver with high risk for liver failure death are also known as end stage liver disease patients. These patients have signs of multiple organ dysfunction caused by the liver failure. End stage liver disease life expectancy depends on the severity of the symptoms and lab tests. They are classified into the same 3 risk categories as stage 4 cirrhosis.

End stage liver disease symptoms before death

End stage liver disease patients who are near death may experience the following symptoms:

  1. Serious bleeding: It may be bleeding from food pipe or even bleeding diffusely from all over the body due to lack of clotting factors. Making proteins to help clot your blood is one of the important functions of the liver. When you have no normal liver tissue remaining with end stage liver disease, the blood clotting system fails and you may literally bleed to death.
  2. Severe abdominal pain and distention: Your liver stops making a special protein called albumin. Without albumin, fluids leak out of your blood and you get accumulation of fluids in your abdominal cavity. When this fluid gets infected, you develop severe abdominal pain. The infection may worsen despite treatment because you won’t have much disease fighting power remaining in your body. You may die from overwhelming infection and sepsis.
  3. Liver coma: Toxins start to accumulate in your blood. You initially get confused and lethargic. Despite treatment your condition may continue to worsen and you may slip into a coma like state. Eventually your heart may stop and you may die of end stage liver failure.
  4. Liver cancer: Liver cancer may develop at any stage of cirrhosis but if it happens when you are in end stage liver failure, that cancer will may kill you quickly.

End stage liver disease death process

The only chance of surviving a decompensated high risk end stage liver disease is by getting a liver transplant. However, not all patients qualify for liver transplant. For someone not on the transplant list, the only logical step is to accept the end stage liver disease death process and get hospice care. Unfortunately, hospice service is only utilized by a small fraction of such patients.

Finally, I will give you an example of a patient with liver failure symptoms that I treated. I hope this example will help you better understand liver failure symptoms.

Liver failure symptoms: 42 year old male construction worker with belly pain

Mr. H is a 42 year old male who has been working in construction for more than 20 years. He is always working hard and is very good at his job. He is usually very tired by the time he gets home from work. As soon as he gets home, he starts drinking beer. He usually drinks about 12 or 15 beers a day. He seems to have developed a high tolerance for beer drinking. He is very functional and can have normal conversation with his wife and his kids even after drinking that much beer. He mostly drinks at home and his co-workers are unaware of his heavy drinking problem. He had never thought about his drinking as a problem. It was just a habit for him.

For the last six moths, he had been gaining weight and he noticed his belly was getting larger. He was not thinking about liver failure symptoms but he somehow knew this was related to drinking too many beers. He thought he was finally beginning to develop a “beer belly” after so many years of drinking beer. Gradually, it grew so large it almost appeared like a pregnant woman’s belly. Slowly he started to get some pain with the distension. On day, it became really tender and called his doctor. He went to the doctor’s office and the doctor was concerned about possible liver failure symptoms. He called me as I was the on-call doctor taking new admissions in the hospital. I made arrangements to get the patient to the medical floor right away.

As soon as I examined him, I was concerned about liver failure symptoms. His belly seemed to be filled up with fluid. He had distended veins everywhere in his belly. His whole belly was tender. I ordered some work and they came back supporting the diagnosis of liver failure symptoms. His liver enzymes were elevated. His coagulation factors seemed to off which significantly increased his bleeding risks. It happens when the liver can not make the proteins needed for blood clotting. It is an important indicator of liver failure symptoms.

On top of liver failure symptoms, Mr. H seemed to have symptoms of infection. He had a low grade fever, had elevated white count indicating inflammation and he had the belly tenderness. We were worried about the infection of the fluid in his belly.

liver failure symptoms
Image courtesy of: The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

There are many factors that explain why patients with liver failure symptoms develop fluid in the belly. I will tell you two simple ones. First, in patients with liver failure symptoms from cirrhosis, the liver becomes hard and fibroid. The blood that takes nutrition from the gut to the liver will have difficult time flowing into the hard liver. Some fluids escape from the blood vessels and accumulate in the belly. Secondly, patients with liver failure symptoms have very low albumin in the blood. Failing liver makes less albumin. Albumin acts as powerful water absorbent inside the blood vessels. It keeps water from leaking out from veins. With low albumin, fluids escape out into the belly specially when the veins are under pressure.

Mr. H probably developed liver failure symptoms from alcohol slowly over the years. Alcohol is directly toxic to liver and causes some damage to liver cells every time someone drinks alcohol. But, liver cells are very regenerative and repair themselves after the alcohol is gone. With hundreds of cycles of damage and repair, some fibrous tissue and scarring may occur which makes subsequent repairs less efficient. When, most of the liver has developed scars and fibrous tissue, liver failure symptoms from fibrosis appear. Some of the changes in early stages of alcoholic fibrosis may be partially reversible. If the patient stops drinking, a small proportion of liver cells that are normal may be able to repair and sustain some normal liver function and prevent liver failure symptoms from getting worse.

Mr. H had a procedure called paracentesis in which we took out 8 liters of fluid from his belly with a small needle and a catheter. The fluid was infected. It looked almost like dirty urine. We treated his infection with antibiotics. His pain improved. I convinced him to quit drinking. I told him frankly that if he continued to drink, his liver failure symptoms would get worse and he would soon die from end stage liver failure. Mr. H was not ready to die. He was a productive functional individual who had a very strong motivation to stay alive. That motivation was enough for him to quit drinking. He did it with the help of his family doctor and his behavioral counselor.

Not all patients with liver failure symptoms have this kind of happy ending. Some patients with liver failure symptoms from alcohol can not give up drinking despite warnings from their doctors and die from end stage liver failure. Others are only diagnosed at a very late stage and can not be saved even if they stop drinking. Some develop complications from infections and die prematurely. Overall, symptoms of liver failure can be really nasty and it is wise to avoid heavy drinking in the first place. That is the best way to avoid liver failure symptoms.

I hope the story of Mr. H helped you understand more about liver failure symptoms. Please check back soon as I will be uploading more stories about patients who had liver failure symptoms.