Symptoms of end-stage liver disease

Written by stephanie bridger
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Liver disease currently affects one out of ten Americans. According to the American Liver Foundation, in the United States alone "liver disease and cirrhosis are the seventh leading cause of death among adults between the ages of 25 and 64." The American Cancer Society's "Cancer Facts and Figures 2008" show a ten per cent, one year increase in deaths from liver cancer. Cirrhosis is an irreversible condition that occurs with progressive liver damage. It is last stage of liver injury.

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Significance

The liver is one of the most vital organs of the human body, performing more than 5,000 important functions per minute. These functions include: storing glucose, vitamins and minerals; making protein, bile, and blood clotting factors; metabolising medications; and detoxifying bacteria, alcohol and other harmful toxins. When damaged, the liver can repair itself, causing scar tissue to develop. This build-up, called cirrhosis, makes it increasingly difficult for the liver to function. The damage usually ends in liver cancer or liver failure.

Symptoms

Liver damage occurs over time; in fact, it is rare to experience symptoms in the early stages. Signs of liver disease include: weakness, fatigue, nausea, yellowing of skin or eyes (jaundice), loss of appetite, weight loss, fever, abdominal pain, itching, and abnormal blood vessels on the skin (spider angiomas). Because symptoms occur late and are somewhat generic, a diagnosis of liver disease before moderate cirrhosis has set in is rare.

Causes

There are more than 100 types of liver disease. The most common are: viral strains of hepatitis (A, B and C), chronic alcohol consumption, fatty liver (due to obesity, diabetes, protein malnutrition or coronary artery disease), damage to bile ducts, inherited disorders that disrupt the liver's effectiveness, a build-up up drugs or other toxins, and autoimmune hepatitis (the body's immune system begins attacking the liver).

Side Effects

Cirrhosis leads to portal hypertension, an increase in blood pressure between the spleen and liver. This can cause more blood to flow into capillaries in the oesophagus (varices) or stomach, increasing the likelihood of internal bleeding. The portal hypertension also forces an enlargement of the spleen (splenomegaly) as white blood cells and platelets become trapped. The lower platelet count (thrombocytopenia) leads to an increase in external bruising and bleeding.

The difficulty of bile flow can result in gallstones. Fluid retention in the abdomen can be a breeding ground for infection (bacterial peritonitis). Cirrhosis causes resistance to insulin, leading to excess glucose building up in bloodstream, and leading to type 2 diabetes. As the liver becomes less able to filter toxins, they build up in the brain (hepatic encephalopathy) causing confusion, memory loss, difficulty concentrating, personality and sleep habit changes, and even coma. Kidney and lung failures are possible complications of cirrhosis, as is liver cancer.

Treatment

A hepatologist's (liver doctor) goals are: to treat the underlying cause of the liver disease, control the side effects caused by years of cirrhosis, and the prevention of liver cancer. Common guidelines include: abstention from alcohol, vitamin and mineral supplementation, choosing pain relievers that do not include aspirin, hepatitis A and B vaccinations, and a reduction in sodium intake. Medications depend on the condition, but can include: beta blockers, diuretics, antivirals, and corticosteroids. Liver transplants are considered when all other surgical and treatment options have been exhausted.

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