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What is the number one symptom of liver failure?

Liver failure is a condition that occurs when large parts of the liver become damaged beyond repair and the liver is no longer able to function properly. It is a serious and potentially life-threatening condition that requires immediate medical care. There are two main types of liver failure: acute liver failure, which develops rapidly over days or weeks, and chronic liver failure, which develops slowly over months or years. Some of the most common causes of liver failure include viral hepatitis, alcohol abuse, non-alcoholic fatty liver disease, autoimmune liver disease, and medication overdoses.

Liver failure affects the body in many ways and leads to a number of symptoms and complications. However, there is one symptom that is considered to be the hallmark, number one symptom of liver failure: jaundice. Jaundice refers to a yellowing of the skin and whites of the eyes that occurs when bilirubin builds up in the bloodstream. Bilirubin is a yellow pigment that is produced when old red blood cells break down. In a healthy individual, the liver filters out and excretes bilirubin. But when the liver is severely damaged and unable to properly filter bilirubin, it accumulates in the blood and causes the yellow color change. Jaundice is estimated to occur in up to 75% of all liver failure patients, making it by far the most common symptom.

What Causes Jaundice in Liver Failure?

To understand why jaundice is the number one symptom of liver failure, it helps to understand more about the role of the liver in bilirubin processing and how this breaks down in liver failure.

Here is an overview of the process:

– Old red blood cells break down into a yellow pigment called bilirubin. This process happens continuously.

– Bilirubin travels in the bloodstream to the liver, where special liver cells called hepatocytes process it.

– The hepatocytes make bilirubin water-soluble through a process called conjugation. This converts it into a form called conjugated bilirubin.

– The conjugated bilirubin is excreted into bile ducts in the liver. It travels through these ducts into the small intestine.

– In the intestine, conjugated bilirubin is broken down by bacteria and excreted in the feces. This gets rid of excess bilirubin from the body.

When the liver is severely damaged, as in liver failure, this process breaks down. The hepatocytes are unable to properly conjugate bilirubin, so unconjugated bilirubin builds up in the bloodstream. Some of this leaks out of the blood vessels into tissues, causing a yellow staining of the skin and eyes.

The technical term for this buildup of bilirubin is hyperbilirubinemia. It leads to the yellowing color change that characterizes jaundice.

Stages and Severity of Jaundice

Jaundice can occur in different degrees of severity depending on the extent of liver damage and bilirubin buildup. Mild jaundice may just cause a pale yellow tinge to the whites of the eyes. More prominent jaundice leads to a bright neon yellow coloring in the eyes and skin.

Jaundice typically starts from the head down. It first appears as yellowing in the whites of the eyes. It can then spread to cause yellowing of the skin, first seen on the face, then moving down to the chest, arms, legs and feet.

In very severe cases, bilirubin can build up in the brain. This causes a complication called bilirubin encephalopathy, which can result in permanent brain damage.

Other Signs and Symptoms of Liver Failure

While jaundice is the classic number one symptom, liver failure also causes a number of other signs and symptoms. Some other common symptoms include:

– Fatigue and weakness
– Nausea and vomiting
– Appetite loss and weight loss
– Itching of the skin
– Spider-like blood vessels on the skin
– Fluid buildup in the legs (edema)
– Tenderness or pain in the upper right abdomen
– Bleeding easily
– Confusion and impaired brain function (encephalopathy)
– Dark urine color
– Pale stool color
– Fever

The severity of symptoms depends on how advanced the liver failure is. Acute liver failure comes on quickly and causes more intense symptoms. Chronic liver failure develops more gradually and may have milder symptoms initially.

Without treatment, liver failure can be fatal. The liver carries out hundreds of vital functions. When it no longer works, toxins accumulate, metabolism is impaired, bleeding can occur, and the brain may swell. Death often occurs due to multifaceted organ failure.

When to See a Doctor

If you notice any symptoms of jaundice or other signs of possible liver failure, it’s essential to see a doctor promptly. Early treatment can improve outcomes in liver failure and prevent permanent liver damage or even death in some cases.

See a doctor right away or go to the emergency room if you have:

– Yellowing of the skin or white part of the eyes (jaundice)
– Severe nausea, vomiting or abdominal pain
– Swelling in the legs, feet or ankles
– Itching all over the body
– Recent changes in mental status, such as confusion
– Bleeding or easy bruising

Make sure to also see a doctor if you have any known liver disease and notice worsening symptoms. And see a doctor if you have risk factors for liver disease, such as long-term heavy alcohol use, and develop any concerning new symptoms. Blood tests, imaging tests, and sometimes a liver biopsy can help confirm if liver failure is present and determine the cause.

Causes and Risk Factors

Many different conditions can trigger liver failure. The most common causes include:

Viral Hepatitis

Viral infections are a leading cause of acute liver failure worldwide.

– Hepatitis A, hepatitis B, and hepatitis C can all cause liver inflammation and damage.

– Hepatitis B and C can become chronic, long-term infections and lead to progressive liver scarring, increasing the risk of liver failure.

Alcoholic Liver Disease

Drinking high amounts of alcohol for many years can lead to severe liver damage and failure through different mechanisms:

– Alcoholic fatty liver disease: Fat builds up in liver cells.

– Alcoholic hepatitis: Inflammation and death of liver cells.

– Cirrhosis: Scar tissue replaces healthy liver tissue.

Non-Alcoholic Fatty Liver Disease

Fatty liver disease that is not caused by excess alcohol also risks progressing to liver failure in some cases. Risk factors include obesity, diabetes, and metabolic syndrome.

Autoimmune Liver Disease

Autoimmune disorders where the immune system attacks liver cells can result in severe liver damage. Examples are autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis.

Medication Overdoses and Toxins

Overdoses of certain medications, like acetaminophen, as well as poisonous wild mushrooms and industrial chemicals can severely damage liver cells.

Other Causes

Some other causes include:

– Advanced liver cancers

– Biliary obstruction and damage to the bile ducts

– Chronic viral hepatitis B or C

– Genetic or metabolic liver diseases like Wilson’s disease or hemochromatosis

– Shock and anoxia from a heart attack or respiratory failure

Risk Factors

Anyone can develop liver failure, but these factors increase risk:

– Chronic alcohol abuse

– Chronic hepatitis B or hepatitis C infection

– Existing liver disease such as cirrhosis

– Obesity

– Type 2 diabetes

– Autoimmune disorders

– Age over 50 years old

Diagnosing Liver Failure

If liver failure is suspected based on symptoms, a doctor will run tests to confirm it and determine the cause. Common tests may include:

Physical Exam

The doctor will check for enlarged liver, fluid buildup, jaundice, and signs of confusion or altered mental state.

Blood Tests

Liver function tests: Levels of liver enzymes and bilirubin are elevated.

Complete blood count: May show low blood cell counts.

Coagulation tests: Impaired blood clotting.

Viral hepatitis serologies: To check for hepatitis A, B, or C.

Imaging Tests

Abdominal ultrasound: Checks liver size, texture, lesions.

CT scan or MRI: Further evaluates liver anatomy and function.

Transient elastography: Measures liver stiffness to assess cirrhosis.

Liver Biopsy

A small sample of liver tissue is examined under a microscope for damage and scarring patterns. This can help determine the cause.

Other Tests

May be done to check for contributing factors like autoimmune disorders, genetic conditions, or toxins.

Based on the test results, doctors can determine whether acute or chronic liver failure is present. The cause, severity, prognosis, and treatment options can also be assessed.

Treatment Options

Treatment for liver failure focuses on:

1) Slowing the progression of liver damage
2) Managing complications
3) Treating the underlying cause if possible
4) Liver transplant if liver function is unlikely to recover

Some key aspects of treatment include:


Many patients with liver failure need to be hospitalized, especially those with acute liver failure. This allows close monitoring and quick treatment of any life-threatening complications.


– Diuretics to reduce fluid buildup
– Lactulose or antibiotics to reduce ammonia
– Blood pressure medications
– Blood thinners
– Treatment for underlying condition, like steroids for autoimmune hepatitis

Diet & Lifestyle Changes

– Strict alcohol avoidance
– Low sodium, low protein diet
– Nutritional supplements if needed

Liver Transplant Evaluation

If liver function is unlikely to improve, transplant may be the only curative option. Timing of transplant is critical.

Other Procedures

– Plasmapheresis to filter blood
– Dialysis to remove toxins
– Endoscopic treatment of variceal bleeding

Palliative Care

For end-stage liver disease, focuses on symptom management and quality of life.


Some ways to help prevent liver failure or reduce the risks include:

– Get vaccinated for hepatitis A and hepatitis B
– Avoid alcohol abuse and limit alcohol intake
– Maintain healthy weight through diet and exercise
– Prevent and manage chronic health conditions like obesity, diabetes, high blood pressure
– Avoid unprotected sex and intravenous drug use to limit viral hepatitis exposure
– Avoid exposures to industrial chemicals and other liver toxins
– Take medications only as prescribed and avoid combining drugs without checking with a doctor first

For people with chronic liver disease, regular medical checkups are also crucial to monitor liver health and get early treatment for any complications. This can help prevent worsening to liver failure.

Prognosis and Outcomes

The prognosis for liver failure depends heavily on:

– The specific cause – Some causes have higher mortality than others
– How quickly treatment begins – Earlier treatment can improve outcomes
– Severity of liver damage – Advanced failure has higher risk of complications and death
– Availability of liver transplantation – Transplant can save lives otherwise likely to be lost

Some key prognosis facts:

– Acute liver failure mortality ranges from 50-90% without transplant. With urgent transplant, survival can improve to over 65%.

– Chronic liver failure has a gradual course. 5-year survival is 50-70% with proper long-term treatment.

– Alcoholic liver disease generally has worse prognosis than viral hepatitis or autoimmune causes.

– Patients with pre-existing cirrhosis have higher mortality rates with superimposed liver failure.

So in summary, while liver failure prognosis can be grave without treatment, early diagnosis combined with proper medical care and access to transplantation can significantly improve chances of survival for many patients.


Jaundice, or yellowing of the skin and eyes, is considered the classic hallmark symptom of liver failure. It occurs because a damaged liver is unable to filter out the yellow pigment bilirubin, leading to buildup in the bloodstream. However, liver failure can cause an array of other symptoms as well, from fatigue and nausea to mental confusion. If any signs of possible liver failure arise, timely diagnosis and treatment are imperative. Treatment focuses on slowing disease progression, managing complications, addressing the underlying cause, and potentially liver transplant. While liver failure outlook can be poor without treatment, early intervention and access to transplantation can greatly improve prognosis and survival for many patients.