Liver damage typically has four stages, beginning with inflammation and progressing all the way to cirrosis and end-stage liver disease (ESLD).
Liver disease refers to any condition that inflames or damages your liver.
Damage to your liver can accumulate through several stages of liver disease. Each stage has a cumulative effect on your liver’s ability to function properly.
The four stages of liver damage or disease are:
- end-stage liver disease (ESLD)
Learn more about liver damage and disease.
Damage from liver disease can accrue throughout several stages. With each stage, your liver’s ability to function is increasingly affected.
In this early stage, your liver becomes enlarged or inflamed. Many people with liver inflammation don’t experience symptoms. If the inflammation continues, permanent liver damage can occur.
Fibrosis happens when an inflamed liver begins to develop scars.
The scar tissue that’s generated in this stage takes the place of healthy liver tissue, but it can’t perform the same functions. This can start to affect your liver’s ability to function optimally.
Liver fibrosis can be hard to detect because symptoms aren’t often present.
In cirrhosis, severe liver scarring has occurred, leading to a buildup of scar tissue. Because there isn’t as much healthy liver tissue, it becomes very difficult for your liver to function properly.
While symptoms may not have been present in earlier stages, you may begin to experience symptoms of liver disease.
End-stage liver disease (ESLD)
ESLD is an umbrella term that can be used to describe conditions such as:
- decompensated cirrhosis, or advanced cirrhosis
- stage 4 hepatitis C
- chronic liver failure
At this stage, liver function has deteriorated dramatically.
ESLD is associated with complications such as ascites (a type of abdominal swelling) and hepatic encephalopathy (reduced brain function). The only treatment that can reverse ESLD is a liver transplant.
Liver failure is when your liver can’t work well enough to perform its many vital functions, such as clearing your blood of toxic substances and producing bile to help you digest food.
Liver failure can occur due to liver damage caused by liver disease. However, it’s not inevitable that liver damage and disease will lead to liver failure.
Liver failure can be a life threatening emergency, and it may be acute or chronic.
Acute liver failure comes on quickly and often occurs in people who don’t have a preexisting liver condition. Chronic liver failure occurs due to liver damage that develops slowly over time.
Causes of liver damage and failure include:
- viral infections, such as:
- genetic conditions, such as Wilson’s disease
- autoimmune conditions, such as autoimmune hepatitis
- alcohol misuse
- alcohol-related liver disease
- nonalcoholic fatty liver disease
- diseases that affect your bile ducts, such as cholangitis
- conditions that affect the veins of the liver, such as Budd-Chiari syndrome
- overdose of acetaminophen (Tylenol)
- reactions to other medications, such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), or antiepileptic drugs
- reactions to herbal supplements, such as ma huang and kava kava
- exposure to toxins, such as those found in industrial chemicals or poisonous wild mushrooms
The cause of liver failure can depend on whether the liver failure is acute or chronic. In some cases, the exact cause of acute liver failure may be unknown. Chronic liver failure is associated with liver damage or disease.
Inflammation and fibrosis, the earliest stages of liver damage or disease, rarely cause noticeable symptoms. Symptoms are associated with more advanced stages.
Symptoms of cirrhosis
Early on, cirrhosis may cause symptoms such as:
- tiredness or weakness
- loss of appetite
- unexplained weight loss
- mild abdominal pain
- nausea and vomiting
Symptoms of ESLD
The symptoms of ESLD can include:
- confusion or disorientation
- severe skin itching
- easy bruising or bleeding
- the buildup of fluid in your abdomen, arms, or legs
- abdominal discomfort or pain
- loss of appetite
- darkening of your urine
- pale stools
- blood in your vomit or stool
- nausea or vomiting
They may be present if you have a condition like decompensated cirrhosis, chronic hepatitis C, or advanced chronic liver failure.
When to seek medical attention
Acute liver failure is always a medical emergency. If you’re experiencing symptoms consistent with acute liver failure, seek medical attention immediately.
These symptoms include:
- tiredness or sleepiness
- confusion or disorientation
- abdominal pain or abdominal swelling
- nausea or vomiting
- malaise, or feeling unwell
Chronic liver failure can sometimes be a medical emergency, especially in cases where:
- you develop confusion
- you have internal bleeding
- swelling becomes severe
To diagnose liver issues, a doctor will start by taking your medical history and performing a physical examination.
Afterward, they may perform a variety of additional tests, including:
- Liver function tests: Liver function tests assess the levels of various proteins and enzymes in your blood. These proteins and enzymes can indicate how well your liver functions.
- Other blood tests: The doctor may also perform a complete blood count or test for conditions that can cause liver damage, such as viral hepatitis or genetic conditions.
- Imaging tests: Imaging technology such as an ultrasound, a CT scan, or an MRI can help the doctor visualize your liver.
- Biopsy: Taking a tissue sample from your liver can help the doctor see if scar tissue is present. The sample can also help them identify what may be causing your condition. Learn more about liver biopsy.
Various treatments are available for liver damage, disease, and failure.
Antiviral medications can treat a viral hepatitis infection, and immune-suppressing medications can treat autoimmune hepatitis.
The doctor may recommend lifestyle changes as part of your treatment. These changes can include:
- abstaining from alcohol
- losing weight, if you have overweight
- avoiding certain medications
Acute liver failure treatment
Acute liver failure is often treated in a hospital’s intensive care unit (ICU). You’ll receive supportive care to help stabilize your condition and help you manage any complications during treatment and recovery.
If a healthcare professional suspects a medication overdose or reaction, they may give you drugs to reverse the effects. A doctor may also recommend a liver transplant for some people with acute liver failure.
Can liver damage be reversed?
According to the advocacy group American Liver Foundation, damage from the inflammation and fibrosis stages of liver failure may be reversed and healed over time if properly identified and treated early.
The liver damage caused by cirrhosis is often not reversible, although it can be slowed or stopped.
If you have ESLD, you may require a liver transplant. During a transplant, a surgeon removes the diseased liver and replaces it with a liver from a healthy donor.
You can help prevent liver damage, disease, and failure by making lifestyle changes that keep your liver happy and healthy. Here are some tips for improving liver health:
- Drink alcohol in moderation, and never mix medications with alcohol.
- Take medications only when needed, and carefully follow any dosing instructions.
- Consult a doctor before mixing medications.
- Maintain a moderate weight. There’s a connection between obesity and fatty liver disease.
- Get vaccinated against hepatitis A and hepatitis B.
- Have regular physicals during which your doctor performs liver function tests.
If you’re in the early stages of liver damage or disease, you can often heal over time with proper treatment and lifestyle changes.
However, the later stages aren’t reversible and sometimes require a liver transplant.
Liver failure can be a life threatening emergency that requires prompt medical intervention, regardless of whether it’s acute or chronic.
People diagnosed with liver disease are often monitored throughout their lives to ensure that their condition is not worsening or causing further liver damage. If you have concerns about liver health or liver failure, talk with a doctor.