Liver Failure Treatment in Delhi, India

Liver failure is a serious medical condition in which the liver loses its ability to perform its essential functions. These functions include filtering toxins from the blood, producing proteins necessary for blood clotting, storing nutrients, and aiding in digestion. When the liver is damaged beyond repair, it can no longer carry out these tasks effectively, leading to a build-up of toxins in the body and other serious health problems. Without prompt medical treatment, liver failure can be life-threatening.

Liver Failure can be distinguished into two main types:

Acute Liver Failure

Acute liver failure occurs suddenly, often within days or weeks, in a person who may not have had any previous liver issues. It’s typically caused by factors such as drug overdose, viral infections like hepatitis A or B, or reactions to certain medications and toxins. The rapid onset of acute liver failure can lead to severe complications, including bleeding disorders, brain swelling (encephalopathy), and multi-organ failure. Due to its quick progression, acute liver failure is a medical emergency that requires immediate hospitalisation and intensive care. Early intervention is crucial for survival, and in some cases, a liver transplant may be necessary.

Chronic Liver Failure

Chronic liver failure, also known as end-stage liver disease, develops gradually over time, often as a result of long-term liver damage. Conditions like cirrhosis, which is the scarring of liver tissue due to chronic alcohol abuse, hepatitis B or hepatitis C infections, and non-alcoholic fatty liver disease (NAFLD) are common causes. Unlike acute liver failure, chronic liver failure progresses slowly, allowing the liver to partially compensate for its declining function until it reaches a critical point. Symptoms may include jaundice, fluid accumulation in the abdomen (ascites), and confusion. Managing chronic liver failure typically involves treating the underlying cause, lifestyle modifications, and medications to manage symptoms. In advanced cases, liver transplantation may be the only option for long-term survival.

Liver failure can be triggered by a variety of factors that damage the liver over time or cause a sudden, severe injury to the organ. Here are some of the most common causes:

Viral Hepatitis

Chronic infections with hepatitis B and C viruses are leading causes of liver failure, particularly chronic liver failure. These viruses cause long-term inflammation and damage to liver tissue, eventually leading to cirrhosis and liver failure if left untreated. Acute liver failure can also result from a sudden and severe hepatitis infection, though this is less common.

Alcohol Abuse

Excessive and prolonged alcohol consumption is a major contributor to liver damage, leading to conditions such as alcoholic hepatitis and cirrhosis. Over time, heavy drinking causes inflammation, fatty liver disease, and scarring, which can progress to chronic liver failure.

Non-Alcoholic Fatty Liver Disease (NAFLD)

NAFLD is a condition where fat builds up in the liver, not due to alcohol use. It is commonly associated with obesity, diabetes, and metabolic syndrome. Over time, this fat accumulation can cause inflammation and scarring (non-alcoholic steatohepatitis or NASH), which may lead to liver failure if not managed properly.

Drug Toxicity

Certain medications and toxins can cause acute liver failure if taken in high doses or if the liver is particularly sensitive to them. Paracetamol overdose is one of the most common causes of drug-induced liver failure. Other drugs, including some prescription medications, herbal supplements, and illegal substances, can also damage the liver.

Autoimmune Liver Diseases

In autoimmune liver diseases like autoimmune hepatitis, the body's immune system mistakenly attacks healthy liver cells, leading to chronic inflammation and damage. Over time, this can result in cirrhosis and liver failure if not effectively controlled.

Genetic Disorders

Inherited conditions such as Wilson's disease and haemochromatosis can lead to liver failure. In Wilson's disease, copper accumulates in the liver and other organs, while in haemochromatosis, excess iron is stored in the liver, causing damage over time.

Bile Duct Disorders

Conditions that block or damage the bile ducts, such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), can prevent bile from flowing out of the liver. This can lead to liver inflammation, scarring, and eventually, liver failure.

Infections and Toxins

Exposure to certain environmental toxins, severe bacterial infections, and parasitic infections can cause liver damage and lead to liver failure. For example, certain types of mushroom poisoning can result in acute liver failure within days of ingestion.

Understanding the underlying cause of liver failure is crucial for determining the most effective treatment approach and preventing further damage to the liver.

Liver failure is a serious condition with a wide range of symptoms that can vary depending on the stage of the disease. 

Early Signs

In the early stages of liver failure, the symptoms may be subtle and often mistaken for other less serious conditions. These early signs include:

• Fatigue: Persistent tiredness and lack of energy, even after sufficient rest, is one of the most common early signs of liver failure.
• Nausea and Vomiting: Feeling sick to the stomach, accompanied by vomiting, can occur as the liver starts to lose its ability to process toxins.
• Loss of Appetite: A reduced desire to eat or a feeling of fullness after small meals may indicate early liver issues.
• Abdominal Pain: Discomfort or pain in the upper right side of the abdomen, where the liver is located, may be an early symptom.
• Jaundice: A yellowing of the skin and eyes, known as jaundice, occurs when the liver is unable to process bilirubin, a substance produced during the breakdown of red blood cells.
• Swelling: Mild swelling in the legs and ankles, known as oedema, can be an early sign of liver dysfunction as fluid balance in the body is affected.

Advanced Liver Failure Symptoms

As liver failure progresses, the symptoms become more severe and indicate significant liver damage. Advanced liver failure symptoms include:

• Severe Jaundice: The yellowing of the skin and eyes becomes more pronounced as the liver’s ability to remove bilirubin is further compromised.
• Confusion and Cognitive Impairment (Hepatic Encephalopathy): The buildup of toxins in the blood can affect brain function, leading to confusion, forgetfulness, and difficulty concentrating. In severe cases, it can progress to coma.
• Ascites: The accumulation of fluid in the abdomen, known as ascites, causes significant swelling and discomfort. This condition occurs due to increased pressure in the blood vessels around the liver.
• Bleeding and Bruising: As liver function deteriorates, the production of clotting factors decreases, leading to easy bruising and prolonged bleeding from cuts or injuries.
• Intense Itching: The buildup of bile salts in the skin can cause severe itching that is difficult to relieve.
• Dark Urine and Pale Stools: The colour of urine may become darker, while stools may appear pale or clay-coloured due to changes in bile production and excretion.
• Weight Loss: Unintended weight loss may occur as the liver’s ability to process nutrients and maintain muscle mass declines.
• Muscle Wasting: Loss of muscle mass, known as sarcopenia, is a common symptom in advanced liver failure, often linked to malnutrition and metabolic changes.
• Frequent Infections: The immune system becomes compromised, leading to an increased risk of infections, particularly in the abdomen and blood.

Physical Examination

A physical examination is often the first step in diagnosing liver failure. During this exam, a healthcare provider carefully assesses the patient for signs of liver dysfunction. The doctor will look for symptoms such as jaundice, which is the yellowing of the skin and eyes that indicates a buildup of bilirubin in the blood. Swelling in the abdomen, known as ascites, and in the legs or feet (oedema) may also be present, pointing to fluid retention due to liver dysfunction. The doctor may palpate the abdomen to feel for an enlarged or tender liver, which could indicate inflammation or damage. Other signs that may be observed include spider angiomas—tiny, spider-like blood vessels visible on the skin—and increased bruising or bleeding, which suggest that the liver's ability to produce clotting factors is compromised.

Blood Tests

Blood tests are crucial in diagnosing liver failure and understanding its severity. Common blood tests include:

• Liver Function Tests (LFTs): These tests measure levels of enzymes and proteins in the blood that indicate how well the liver is functioning. Key markers include alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and bilirubin levels.
• Prothrombin Time (PT): This test measures how long it takes for blood to clot. A prolonged PT can indicate liver dysfunction.
• Albumin Levels: Low levels of albumin, a protein produced by the liver, may suggest liver damage.
• Complete Blood Count (CBC): A CBC can help detect anaemia, infection, or other abnormalities that might be linked to liver failure.
• Serum Ammonia Levels: Elevated ammonia levels in the blood can indicate hepatic encephalopathy, a complication of advanced liver failure.
• Viral Hepatitis Panel: This test checks for the presence of hepatitis viruses, which are common causes of liver failure.

Imaging Tests

Imaging tests provide visual information about the liver's structure and help detect abnormalities such as scarring, tumours, or blockages. Common imaging tests include:

• Ultrasound: This non-invasive test uses sound waves to create images of the liver. It can detect abnormalities like liver enlargement, fatty liver, or ascites.
• CT Scan (Computed Tomography): A CT scan provides detailed cross-sectional images of the liver, helping to identify structural abnormalities, tumours, or blockages in the bile ducts.
• MRI (Magnetic Resonance Imaging): MRI offers high-resolution images of the liver and can help in assessing the extent of liver damage, detecting tumours, and evaluating blood flow in the liver.
• FibroScan: This specialised ultrasound measures liver stiffness, which can indicate the degree of fibrosis or scarring in the liver.

Liver Biopsy

A liver biopsy is a procedure in which a small sample of liver tissue is removed for microscopic examination. This test is usually recommended when other diagnostic tests do not provide a clear picture of the liver’s condition or when the cause of liver failure is uncertain. A liver biopsy can reveal the extent of liver damage, including the degree of fibrosis (scarring), inflammation, and liver cell damage. It can also help identify the underlying cause of liver failure, such as viral hepatitis, fatty liver disease, autoimmune disorders, or cancer. Additionally, a biopsy can offer insights into how advanced the liver disease is, which is crucial for guiding treatment decisions and determining the prognosis. Although it is an invasive procedure, a liver biopsy is invaluable for obtaining detailed information about liver health.

Medications

Medications play a significant role in managing liver failure, especially for acute liver failure treatment or when specific factors cause the condition. The treatment approach may include:

• Antiviral Medications: For liver failure caused by viral hepatitis, antiviral drugs can help reduce the viral load, slow the progression of liver damage, and in some cases, improve liver function.
• Diuretics: These medications help reduce fluid build-up in the body, particularly in cases of ascites (fluid accumulation in the abdomen) and oedema (swelling in the legs and feet). By promoting urine production, diuretics help alleviate swelling and discomfort.
• Lactulose: Used to treat hepatic encephalopathy, a condition where toxins accumulate in the brain due to liver failure, lactulose helps reduce the production of ammonia in the intestines and facilitates its removal from the body.
• Steroids: In cases of autoimmune hepatitis, steroids can help reduce inflammation and suppress the immune system’s attack on liver cells, potentially improving liver function.
• Vitamin K and Blood Clotting Factors: To address bleeding disorders associated with liver failure, vitamin K supplements and clotting factors may be administered to improve blood clotting ability.
• Pain Management: Medications for pain relief are carefully prescribed, as many pain relievers can be toxic to the liver. Only those with minimal impact on liver function are used.

Liver Transplant

A liver transplant is often the only definitive treatment for advanced liver failure when the liver is no longer able to perform its essential functions and other treatments are ineffective. The procedure involves replacing the damaged liver with a healthy one from a donor. Key aspects of liver transplantation include:

• Eligibility: Candidates for liver transplantation are carefully selected based on factors such as the severity of liver failure, overall health, and the likelihood of success post-transplant. Patients with irreversible liver damage, such as from liver cirrhosis or acute liver failure, are typically considered for this option.
• Donor Liver: The donor liver can come from a deceased donor (cadaveric transplant) or a living donor, who donates a portion of their liver. The liver has the unique ability to regenerate, so both the donor and recipient can achieve full liver function after the transplant.
• Surgical Procedure: The transplant surgery is complex and involves removing the diseased liver and replacing it with the donor liver. Post-surgery, the patient will require close monitoring and lifelong immunosuppressive medications to prevent the body from rejecting the new liver.
• Recovery and Outlook: Recovery from a liver transplant can take several months, with regular follow-ups and medication adjustments. While a transplant can offer a new lease on life, it requires a commitment to lifelong medical care and lifestyle changes to ensure the success of the transplant.

Liver failure can lead to several serious complications that significantly impact health and quality of life. Each complication arises from the liver’s diminished ability to perform its essential functions, affecting various body systems. Here are some key complications associated with liver failure:

Hepatic encephalopathy

Hepatic encephalopathy is a condition where toxins that are normally processed by the liver build up in the brain, leading to neurological symptoms. As liver function declines, the liver struggles to detoxify these substances, causing:

• Mental Confusion: Patients may experience confusion, memory loss, and difficulty concentrating.
• Altered Sleep Patterns: Changes in sleep patterns, including insomnia or excessive sleepiness, are common.
• Behavioural Changes: Personality changes, mood swings, and erratic behaviour can occur.
• Severe Cases: In advanced stages, hepatic encephalopathy can lead to a coma.

Ascites

Ascites are the accumulation of fluid in the abdominal cavity due to increased pressure in the liver’s blood vessels (portal hypertension) and decreased production of proteins that help retain fluid in the bloodstream.

Kidney failure

Kidney failure, or acute kidney injury, can occur as a complication of liver failure. The kidneys may struggle to filter waste products from the blood, leading to:

• Fluid Imbalance: Accumulation of fluid and electrolytes in the body, leading to symptoms like swelling and changes in urination.
• Elevated Waste Products: Increased levels of waste products in the blood, such as urea and creatinine, indicating impaired kidney function.

Managing kidney failure involves addressing the underlying liver disease, controlling fluid balance, and in severe cases, renal replacement therapies like dialysis.

Risk of infections

Liver failure increases infection risk due to weakened immune function and compromised liver ability to filter toxins. Fluid build-up from ascites can foster bacterial growth, leading to infections like peritonitis. Managing this risk involves vigilant monitoring and prompt treatment with antibiotics to address any infections that arise.

Liver failure cannot always be entirely prevented, but several strategies can significantly reduce the risk:

1. Healthy Lifestyle: Maintaining a balanced diet, regular exercise, and avoiding excessive alcohol consumption helps keep the liver healthy.
2. Vaccinations: Vaccinating against hepatitis B and C can prevent liver infections that may lead to liver damage.
3. Safe Medication Use: Avoiding the overuse of medications and using prescription drugs responsibly can prevent drug-induced liver damage.
4. Regular Check-ups: Routine medical check-ups can help detect liver conditions early and manage risk factors effectively.

Adopting these practices supports liver health and reduces the likelihood of liver failure.

Is liver failure hereditary, and can it run in families?

Liver failure itself is not typically hereditary, but certain genetic conditions that can lead to liver failure, such as Wilson's disease or haemochromatosis, can run in families. These conditions cause abnormal accumulation of substances like copper or iron in the liver, leading to liver damage over time.

How is liver failure different from liver cirrhosis?

Liver cirrhosis is a late stage of chronic liver disease characterised by scarring (fibrosis) of the liver tissue, which can lead to liver failure if it progresses. Liver failure, on the other hand, is the end-stage condition where the liver loses its ability to function properly, whether due to chronic conditions like cirrhosis or sudden causes like acute liver injury. In essence, cirrhosis is a cause, and liver failure is the resulting condition when the liver's function becomes critically impaired.

Can liver failure be reversed, or is it always a progressive condition?

Whether liver failure can be reversed depends on the cause and stage of the disease. In some cases, particularly in early stages or with acute liver failure, the condition may be reversible with prompt treatment. For example, stopping alcohol consumption in alcoholic liver disease or treating viral hepatitis can sometimes lead to recovery. However, in advanced stages, especially with chronic liver failure, the damage is often irreversible, and management focuses on slowing progression and addressing symptoms.

What lifestyle changes are recommended for someone with liver failure?

For individuals with liver failure, lifestyle changes are crucial to managing the condition and preventing further damage. These may include:

• Avoiding Alcohol: Complete abstinence from alcohol is essential to prevent further liver damage.
• Following a Low-Sodium Diet: Reducing sodium intake helps manage fluid retention and swelling.
• Eating a Balanced Diet: Focusing on a diet rich in fruits, vegetables, lean proteins, and whole grains can support overall health.
• Limiting Protein Intake: In some cases, limiting protein intake can help manage hepatic encephalopathy by reducing toxin build-up in the blood.
• Avoiding Toxins: Staying away from substances that can harm the liver, such as certain medications and environmental toxins, is important.

What are the long-term effects of liver transplantation?

A liver transplant can offer a new lease on life for those with end-stage liver failure, but it comes with long-term considerations. Patients will need to take immunosuppressive medications for life to prevent rejection of the new liver, which can increase the risk of other infections and other complications. Regular follow-up appointments are necessary to monitor liver function and overall health. Despite these challenges, many patients experience a significant improvement in quality of life and longevity after a successful transplant.

Can liver failure affect other organs in the body?

Yes, liver failure can have widespread effects on other organs. The liver plays a crucial role in filtering toxins, producing essential proteins, and regulating metabolism. When it fails, these processes are disrupted, leading to complications such as kidney failure (hepatorenal syndrome), brain dysfunction (hepatic encephalopathy), and increased risk of infections. Additionally, liver failure can affect the heart, lungs, and blood clotting systems, further complicating the patient's condition. Managing these systemic effects is a key part of treating liver failure.

Reviewed By Dr. Piyush Gupta, Senior Consultant, Gastroenterology, Hepatology & Endoscopy on 26 February 2025.