Liver Failure Symptoms: Signs You Should Never Ignore

Your liver rarely complains. It can absorb years of quiet damage and keep working in the background, filtering toxins and manufacturing the proteins your blood needs, right up until the moment it can't anymore. That silence is exactly why liver failure catches so many people off guard and why knowing the warning signs early can be the difference between a manageable diagnosis and a medical emergency.

In fact, our gastroenterology and hepatology team routinely encounters this scenario at Mahatma Gandhi Hospital (MGH): someone comes in complaining of fatigue or a stomach upset and later finds out that they have a serious liver problem. Here are some signs to look out for and when to seek a checkup.

What is Liver Failure?

Liver failure is a condition in which the liver has lost so much of its capacity to perform normal functions that the body cannot survive without it, specifically to clot blood, remove toxins, produce bile for digestion, regulate metabolism, and produce clotting factors. It can be divided into two main types:

Acute liver failure is caused in a person who hasn't had any liver disease before and comes on within days or weeks. It's a medical emergency.

Chronic liver failure—these damaging processes continue and slowly destroy the liver over time, typically over months or years.

Acute-on-chronic liver failure (ACLF)—a sudden deterioration in a person with chronic liver disease, often caused by infection or alcohol.

Liver failure is typically the last step in a set of four steps: inflammation, fibrosis, cirrhosis, and end-stage liver disease. It is more treatable the sooner the stage is diagnosed.

Early Signs of Liver Cell Failure

The liver has a large margin of safety, which means that symptoms appear early and may be overlooked. Watch for:

• Fatigue (fatigue that doesn't go away with sleep)
• Loss of appetite or weight loss without cause
• A slight feeling of sickness or stomach upset
• A dull pain and/or tenderness located beneath the right ribs
• Rashless, itchy skin or itchy skin that does not have a rash
• Slightly yellow skin or eyes

Often these early warning signs are present in routine blood tests before they become apparent—another reason why regular checkups are important.

Symptoms as Liver Failure Progresses

As liver function deteriorates even more, signs and symptoms are more difficult to overlook.

• Yellow eyes (jaundice)—yellowing of the whites of the eyes and skin
• Fluid (ascites) in the belly area (abdomen)
• Gaining weight in the legs, ankles, and feet
• Poor blood clotting or bleeding, due to decreased clotting ability
• Pale stools and dark urine
• Hepatic encephalopathy (confusion, forgetfulness, or personality changes due to toxins accumulating in the blood)
• Tremors in the hands, red veins in the skin, and a foul-smelling odor in the breath in severe cases

If you or a loved one develops jaundice, confusion, or unexplained bleeding, seek immediate medical attention.

Have a family member who is jaundiced or confused? Liver panels and imaging are done 24 hours a day at our Mahatma Gandhi Hospital.

Acute Liver Failure: What makes it different?

Acute liver failure progresses rapidly, sometimes in days, and generally requires intensive care unit (ICU) care. Symptoms of acute liver failure include severe fatigue, jaundice, abdominal swelling, confusion, and, in severe cases, loss of consciousness. Timing is very important, and MGH's liver unit aims to quickly evaluate and assess patients for transplant in acute cases.

What Causes Liver Failure?

Acute causes are due to acetaminophen overdose, viral hepatitis (types A and B), certain medications and supplements, or toxin or poisonous mushroom exposure.

Chronic causes are long-term heavy drinking, chronic hepatitis B or C, non-alcoholic fatty liver disease (NAFLD) associated with obesity and diabetes, autoimmune hepatitis, and inherited diseases such as hemochromatosis.

Liver Disease Symptoms Beyond Failure

This is called “liver disease," and various forms have their own patterns:

• Alcoholic liver disease: Tiredness, nausea in the morning, pain in the upper right part of the abdomen, and then yellowing of the skin and bruising.
• Fatty liver disease/NAFLD: Early, it may be asymptomatic but can be picked up with routine blood tests; later signs include fatigue, discomfort, and itching.
• Chronic liver disease: Progressive weakness, weight loss, swollen abdomen, and personality or memory changes with progressive damage.

How MGH Diagnoses Liver Conditions

Our hepatology team is comprised of:

• Blood tests of liver function (blood ALT, AST, bilirubin, INR)
• Imaging tests such as ultrasound, CT, or MRI scans
• FibroScan® (transient elastography) to assess the stiffness of the liver non-invasively
• Liver biopsy, if direct tissue evaluation is required

Treatment Options at MGH

Treatment takes into account the cause and progression of disease:

• N-acetylcysteine (NAC) for acetaminophen overdose
• Treatment with antiviral drugs for hepatitis B or C
• Nutritional rehabilitation and support for alcohol withdrawal
• Dietary management for fatty liver disease with emphasis on weight and metabolism control
• Treatment of autoimmune hepatitis with immunosuppressive drugs
• Diuretics and portal-pressure medication for complications, such as lactulose
• Liver transplantation evaluation for end-stage or fulminant acute failure

The following are the times when you should visit MGH immediately:

Don't wait if you notice the following:

• Jaundice (yellowing of the skin and/or eyes)
• Rapid change in alertness or sleepiness
• Blood in vomit and black, tarry stools
• Rapid abdominal swelling
• Bleeding or bruising that does not have an apparent cause

These are indications of a liver that's really suffering and requires immediate assessment, rather than a wait-and-see attitude.

Make the First Step Towards Liver Health

Liver disease often develops silently, with few or no symptoms in its early stages. The bright side: If it's caught early, most of it can be controlled and even reversed.

For a liver screening at Mahatma Gandhi Hospital, please get in touch with us. Liver panels, imaging, and tailored treatment plans are all available at the same place from our gastroenterology and hepatology specialists.

Frequently Asked Questions

Is liver failure curable?

However, some inflammation and sometimes fibrosis may improve as the underlying cause is treated. However, cirrhosis and complete liver failure are generally not curable, and treatment will focus on slowing the progression and managing complications.

What is the difference between liver failure and liver disease?

Liver disease is the general term used for any problem that occurs in the liver. Liver failure occurs when the damage is severe enough that the liver is not able to function properly.

Who should get screened for liver problems?

Liver disease can have no outward signs and may be diagnosed when there is no reason to suspect it, especially in those who have risk factors for liver disease, including regular heavy drinking, obesity, type 2 diabetes, a family history of liver disease, and people with a diagnosis of hepatitis.