What are the symptoms of liver failure?

Symptoms of Liver Failure

The primary symptoms of liver failure include jaundice, fatigue, right upper quadrant pain, nausea, vomiting, and in advanced stages, hepatic encephalopathy, coagulopathy, and ascites. 1

Clinical Presentation Based on Type of Liver Failure

Acute Liver Failure

• Jaundice (yellowing of skin and eyes) is a common early sign 1
• Nausea and vomiting are present in approximately 35% of cases 1
• Right upper quadrant or epigastric pain occurs in 65% of patients 1
• Malaise and general ill health are frequently reported 1
• Headache occurs in about 30% of patients 1
• Hepatic encephalopathy (confusion, drowsiness progressing to coma) is a defining feature 1
• Hypoglycemia is a dangerous complication requiring close monitoring 1
• Coagulopathy (prolonged prothrombin time) is characteristic 1
• Renal failure often develops as the condition progresses 1
• Ascites and edema may develop as the disease advances 1

Chronic Liver Disease and Cirrhosis

• Fatigue and general ill health are common, sometimes dating back years 1
• Anorexia and weight loss are frequently reported 1
• Amenorrhea is common in women 1
• Joint pains occur in 30-60% of patients 1
• Splenomegaly may be the only presenting sign in some cases 1
• Vague abdominal complaints are common 1
• Hepatomegaly with a palpable, hard, smooth, and tender liver edge 1
• Mild jaundice is common, though deeper jaundice is rare except in acute episodes 1

Advanced Liver Failure Complications

Portal Hypertension Manifestations

• Ascites (fluid accumulation in the abdomen) 1
• Variceal hemorrhage (bleeding from dilated veins in the esophagus or stomach) 1
• Edema (swelling) in the lower extremities 1

Hepatic Encephalopathy

• Progressive deterioration in mental status, ranging from mild confusion to coma 1
• Asterixis (flapping tremor of the hands) 1
• Drowsiness and seizures in severe cases 1
• Polydipsia and polyuria (excessive thirst and urination) 1

Laboratory Abnormalities

• Elevated liver enzymes (AST, ALT) 1
• Elevated bilirubin causing jaundice 1
• Prolonged prothrombin time and partial thromboplastin time 1
• Decreased fibrinogen levels 1
• Elevated ammonia levels 1
• Elevated lactate dehydrogenase 1
• Elevated uric acid 1
• Leukocytosis (increased white blood cell count) 1
• Renal impairment with elevated creatinine 1

Special Considerations for Different Types of Liver Failure

Wilson's Disease

• May present with Coombs-negative hemolytic anemia 1
• Jaundice and abdominal discomfort similar to viral hepatitis 1
• Acute liver failure in Wilson's disease occurs predominantly in young females 1
• Deep jaundice with only mildly increased transaminases is characteristic 1

Acute Fatty Liver of Pregnancy

• Occurs in the third trimester or postpartum period 1
• Headache, malaise, nausea, vomiting, and right upper quadrant pain 1
• Hypoglycemia is a characteristic feature 1
• Jaundice develops as the condition progresses 1
• Hepatic encephalopathy suggests advanced disease 1

Clinical Pitfalls and Important Considerations

• Hepatic encephalopathy may be the only sign distinguishing acute liver failure from other causes of acute hepatitis 1
• Many patients with chronic liver disease are asymptomatic until advanced stages, with only biochemical abnormalities 1
• Approximately 25% of patients with autoimmune hepatitis are asymptomatic at diagnosis, including some with cirrhosis 1
• Mild elevation of gamma-glutamyltransferase is often the earliest laboratory abnormality in chronic liver disease 1
• Hepatic encephalopathy is a rare complication in some forms of liver disease but indicates poor prognosis when present 1
• Patients with acute liver failure have increased susceptibility to infections, which may mask or exacerbate symptoms 1
• Liver failure symptoms may be indistinguishable from other conditions, requiring careful diagnostic evaluation 1

Early recognition of liver failure symptoms is critical as prompt intervention can significantly improve outcomes, particularly in acute presentations where mortality rates have improved from over 90% historically to less than 10% with modern management 1.