Hepatic Impairment: What Is It And What Causes It?

What is hepatic impairment?

Hepatic impairment, also known as hepatic failure or liver failure, is when the liver stops working properly and cannot perform its basic functions. The liver is the second largest organ in the human body. 

Its functions include:

• Breaking down saturated fat

• Producing cholesterol

• Eliminating unwanted foreign substances in the bloodstream (alcohol, drugs, toxins)

• Helping the body to restore sugar (glucose) in the form of glycogen

• Manufacturing bile

• Making blood proteins used for blood clotting, oxygen transportation, and supporting the immune system. 

These functions ensure your entire body is working as it should. Hepatic impairment results from the liver failing to perform one or more of the above functions. 

Exposure to harmful chemicals and viruses can damage the liver and result in liver failure or hepatic impairment. This is a serious condition that requires immediate diagnosis and treatment. 

What are the signs and symptoms of hepatic impairment?

Diagnosing hepatic impairment can be challenging, especially since the early signs and symptoms of liver failure are typically similar. Symptoms of hepatic impairment can include:

• Loss of appetite

• Nausea

• Fatigue

• Diarrhea

• Weight loss

• Edema

• Itching

• Bruising or bleeding easily

• Ascites (abdominal swelling).

However, as hepatic impairment progresses, the signs and symptoms can become more severe, increasing the need for urgent medical attention. 

Extreme symptoms of hepatic impairment include:

• Swollen belly

• Mental confusion (also known as hepatic encephalopathy)¹

• Jaundice

• Possible kidney failure.

Hepatic impairment signs and symptoms can be linked to other conditions, making diagnosing it difficult. Symptoms may also fail to manifest until the hepatic impairment has progressed to an advanced stage. 

Classification of hepatic impairment

Hepatic impairment can be categorized as either moderate or severe.

Moderate hepatic impairment

Moderate hepatic impairment, also known as chronic liver failure, develops more slowly than severe hepatic impairment. It can take weeks or even months for the symptoms to show.

Moderate hepatic impairment is typically the result of liver cirrhosis, a condition where scar tissues replace healthy liver tissues. The liver tends to become inflamed in moderate hepatic impairment, leading to the formation of scar tissues. 

As the moderate hepatic impairment advances,  the liver loses its range of functions, which can ultimately result in the organ ceasing to function. 

Severe hepatic impairment

Severe hepatic impairment, such as acute liver failure, strikes faster than moderate liver failure. These conditions can occur within a matter of days or weeks. 

In many cases, individuals with severe hepatic impairment usually lack any type of liver damage or condition prior to the damage. It can happen without any prior symptoms.

Severe hepatic impairment is a rare condition in which the liver unexpectedly loses its functional ability. It typically happens after poisoning or a medicine overdose, typically acetaminophen (Tylenol), as well as after other acute critical illnesses.

What are the causes of hepatic impairment?

The causes of hepatic impairment are generally different for moderate and severe hepatic impairment.

Causes of moderate hepatic impairment (chronic liver failure)

Moderate hepatic impairment results from long-term inflammation leading to fibrosis, which is the scarring of healthy liver tissues. When scar tissues replace healthy liver tissues, it leads to a condition known as liver cirrhosis. 

Common triggers or causes of moderate hepatic impairment include:

Hepatitis C infection

Hepatitis C patients are at a higher risk of developing moderate hepatic impairment. In some cases, individuals can experience significant liver damage before detecting Hepatitis C infections in their bodies. 

5-25% of Americans with chronic Hepatitis C typically develop liver cirrhosis within 10-20 years. Hepatitis C is among the most common causes of liver failure.²

Alcohol overconsumption

10-20% of individuals who use alcohol excessively are at increased risk of developing liver failure (cirrhosis). Alcohol contains toxins that trigger liver inflammation, gradually leading to moderate hepatic impairment.³

Causes of severe hepatic impairment (acute liver failure) 

Severe hepatic impairment can occur without a prior liver condition. One common cause of this condition is an acetaminophen overdose. Acetaminophen is an over-the-counter drug that helps to resolve pain and fever. 

Other causes of severe hepatic impairment include:

• Toxins

• Viral infections like hepatitis (A, B, and C)

• Certain herbal supplements and drugs, such as kava, ephedra, skullcap, and pennyroyal

• Some prescription medications, such as antibiotics, nonsteroidal anti-inflammatory drugs, and anticonvulsants

• Heat stroke

• Metabolic diseases, such as Wilson's disease and acute fatty liver of pregnancy.

Severe hepatic impairment can also be genetic. Consult your healthcare provider to determine if you have a genetic liver disease.  

How is hepatic impairment diagnosed?

Identifying the cause and degree of hepatic impairment is necessary for formulating a treatment plan. The doctor can evaluate you by examining your symptoms, your health history, and a thorough physical examination. 

Methods of diagnosis may include:

• Blood tests. The doctor can use a group of tests known as liver function tests to diagnose liver diseases and failures. They can also conduct other blood tests to look for specific liver problems.

• Imaging tests. The doctor can also use an ultrasound, CT scan, and MRI to show liver damage. 

• Assessing tissue samples. A liver biopsy (removing a tissue sample from the liver) involves the doctor inserting a long needle via the skin to extract a tissue sample sent to the lab for testing. 

Based on the findings of one of these hepatic impairment diagnosis methods, the doctor can make recommendations for appropriate treatment plans. 

Hepatic impairment treatment

Liver failure is treated by a specialist known as a hepatologist. Hepatic impairment treatment depends on whether it's moderate or severe. For moderate hepatic impairment, treatment includes the lifestyle changes mentioned below. 

For severe hepatic impairment, treatment may include:

• Medications such as laxatives or enemas to flush out toxins

• IV fluids to maintain blood pressure

• Blood glucose monitoring.

The doctor may recommend a liver transplant in certain situations.

Hepatic impairment prevention

Ways to prevent moderate or severe liver failure include:

• Maintain a healthy weight

• Cut or reduce alcohol consumption

• Eat a proper diet from all food groups

• Practice safe sex (to avoid hepatitis) 

• Get a hepatitis vaccination or immunoglobulin shot to prevent hepatitis

• Avoid sharing personal items such as razors, toothbrushes, and needles

• Follow medication instructions carefully

• Most importantly, ensure you schedule regular doctor visits for checkups.

Precautions to take with hepatic impairment

If you have or are at risk of developing hepatic impairment, take the following precautions:

• Avoid alcohol or medications that pose risks to your liver. Follow directions when using certain medications, such as acetaminophen (Tylenol®). 

• Reduce intake of certain foods such as eggs, cheese, and red meat.

• Cut down on your salt intake (avoid adding salt to your food directly).

• Reduce or manage your weight appropriately.

• Manage risk factors such as high blood pressure and diabetes properly. 

How does hepatic impairment affect drug prescription and dosage?

The liver is responsible for the metabolism and clearance of different drugs and their metabolites. Due to the liver's importance in eliminating drugs from the system, injuries or diseases affecting liver function (hepatic impairment) can impact how some drugs interact with the body. 

A drug's pharmacokinetics can be changed in a manner that decreases or increases exposure to the parent drug or its metabolites. Consequently, this negatively affects the drug's safety by increasing exposure to a highly toxic dose range. It also affects the drug's effectiveness by minimizing exposure to its pharmacologically active metabolite. 

If you have impaired liver function, you should speak with your doctor to determine if your medication dosages need to be adjusted for safety.

The lowdown

Hepatic impairment, also known as liver failure, occurs when the liver ceases normal functioning. It can be life-threatening and should be treated immediately. Moderate liver failure happens gradually, whereas severe liver impairment can be sudden. 

Common symptoms include nausea, fatigue, weight loss, appetite loss, and diarrhea. Fortunately, early diagnosis and treatment can help reduce the severity of this condition. 

Prevention methods can include lifestyle changes to diets, avoiding alcohol consumption, proper medication use, and getting hepatitis vaccinations since hepatitis can be a leading cause of liver failure. Consult your doctor immediately if you notice early signs of hepatic impairment. 

Frequently asked questions

What does hepatic impairment mean?

Hepatic impairment is a condition where common liver functions are impaired. 

What causes hepatic impairment?

Some common causes of hepatic impairment are hepatitis, drug and alcohol overdose, and poisoning from a range of substances. 

How do you monitor hepatic impairment?

Liver function tests help to diagnose and monitor hepatic impairment. They help determine the extent of liver failure and provide relevant management and viable treatment options.