Q. What are some of the symptoms of liver disease ?
The most important thing to recognize about liver disease is that up to 50 percent of individuals with underlying liver disease have no symptoms. The most common symptoms are very non-specific and they include fatigue or excessive tiredness, lack of drive, occasionally itching.
Signs of liver disease that are more prominent are jaundice or yellowing of the eyes and skin, dark urine, very pale or light colored stool or bowel movements, bleeding from the GI tract, mental confusion, and retention of fluids in the abdomen or belly.
Liver Diseases
Some of the most common liver diseases that lead to liver transplantation include : -
The liver is a unique organ. It is the only organ in the body that is able to regenerate... that is completely repair the damage. With most organs, such as the heart, the damaged tissue is replaced with scar, like on the skin. The liver, however, is able to replace damaged tissue with new cells.
An extreme example is a patient who suffers an overdose from Tylenol. In this example up to 50 - 60 percent of the liver cells may be killed within 3 - 4 days. However, if no other complications arise, the patient's liver will repair completely, and a liver biopsy after 30 days will appear completely normal with no signs of damage and no scar. However, the long-term complications of liver disease occur when regeneration is either incomplete or prevented by progressive development of scar tissue within the liver.
This occurs when the damaging agent such as a virus, a drug, alcohol, etc., continues to attack the liver and prevents complete regeneration. Once scar tissue has developed it is very difficult to reverse that process. Severe scarring of the liver is the condition known as cirrhosis. The development of cirrhosis indicates late stage liver disease and is usually followed by the onset of complications.
Forms of Liver Disease
The many possible liver diseases can be grouped loosely into three categories: hepatocellular diseases, cholestatic diseases, and mixed forms. In hepatocellular diseases, the liver is typically inflamed and shows signs of injury. Over time, liver cells may begin to die. Causes of hepatocellular liver disease include alcoholic cirrhosis and viral hepatitis, both of which attack liver cells directly. In cholestatic diseases, the flow of fluid through the liver is blocked by such things as gall stones, liver cancer, or biliary cirrhosis. In mixed forms of liver disease, both conditions are present.
The pattern and onset of symptoms can help physicians determine what kind of liver disease is present. Symptoms of liver disease include jaundice, fatigue, itching, pain in the upper abdomen, distention of the abdomen, and intestinal bleeding. However, many forms of liver disease have no symptoms and are diagnosed only during routine blood tests that detect abnormalities in the markers of liver function.
Cirrhosis is an end-stage liver disease. It is characterized by chronic injury to the liver cells, fibrosis (scarring) within the liver, and the formation of regenerative nodules.
The causes of cirrhosis include the following : -
Alcohol consumption. Excess alcohol consumption is a primary cause of cirrhosis. However, only 10 percent to 20 percent of alcoholics develop cirrhosis.
Because heavy drinkers consume a substantial number of calories as alcohol, they consume less vitamin- and mineral-rich food than they otherwise might, exacerbating alcohol-induced nutritional deficiencies. Virtually all individuals with alcoholic hepatitis suffer from malnutrition to a degree more or less proportional to the severity of their disease (Mendenhall CL et al 1984).
Hepatitis. Hepatitis, another common cause of liver cirrhosis, is caused by infection with the hepatitis B or C virus. Because the symptoms of infection are mild and flulike, viral hepatitis often goes undiagnosed. Blood donors sometimes find out they are infected when their donated blood undergoes routine screening.
Viral hepatitis causes chronic liver inflammation, which results in cirrhosis in the majority of those infected.
Nonalcoholic fatty liver disease. The most common cause of fatty liver disease is alcohol consumption, but it can also be caused by a number of other conditions, including obesity, diabetes, and elevated triglyceride levels. If the condition is associated with obesity, it is sometimes called nonalcoholic fatty liver disease, or NAFLD. Up to one-third of patients with NAFLD also have type 2 diabetes, high cholesterol levels, or both.
NAFLD is closely associated with metabolic syndrome, which is a related cluster of conditions, including obesity, diabetes, elevated triglycerides, and high blood pressure, that is considered a major risk factor for heart attack. Fatty liver disease is exacerbated by inflammation within the liver, which may hasten its progression to cirrhosis.
Biliary cirrhosis. Biliary cirrhosis results from prolonged obstruction of or injury to the biliary system. One of the liver's functions is to secrete bile, which is used in the gut in the normal breakdown and absorption of fats from the diet, among other things. Primary biliary cirrhosis, which has no known cause, is characterized by inflammation of the liver and the destruction of the liver bile ducts by scar tissue. It is associated with various autoimmune diseases, such as Raynaud's phenomenon.
Cardiac cirrhosis. Cardiac cirrhosis occurs when prolonged, severe right-sided congestive heart failure leads to chronic liver injury and inflammation and the formation of scar tissue in the liver (fibrosis). A heart in this condition cannot handle the venous circulation, causing blood to back up in the body's major veins. Eventually, the liver becomes engorged and swollen.
Inherited disorders. Various inherited disorders can cause cirrhosis.
Whatever the cause of cirrhosis, it is a difficult disease to manage in its advanced stages, in part because of the complications that it causes. For example, people suffering from cirrhosis also frequently suffer from portal hypertension, or elevated blood pressure in the vein that drains into the liver.
This, in turn, can cause complications in the stomach and esophagus, such as ascites (see below). Portal hypertension occurs in about 60 percent of cases of cirrhosis in the United States (Kasper DL et al 2005). The treatment of portal hypertension often focuses on relieving the underlying liver disease. In serious cases, drugs such a diuretics might be prescribed to reduce blood pressure.
Cirrhosis may entail other complications : -
Esophageal varices. Portal hypertension can cause varicose veins in the esophagus. They can rupture, requiring emergency surgery.
Ascites. The pressure created by portal hypertension can also cause the liver and intestines to exude fluid into the abdominal cavity, which can become swollen and distended, a condition known as ascites.
Hepatoma. Not surprisingly, a compromised liver is more susceptible to cancer. Hepatocellular carcinoma occurs in about 10 percent to 20 percent of cirrhotic patients (Wolf DC 2001). Liver cancer is relatively asymptomatic. It is usually not detected until it has progressed significantly. Consequently, the patient's prognosis is usually poor.
Hepatic encephalopathy. This is a complex condition characterized by psychological and personality disturbances. Its specific cause is unknown; in serious cases, it can result in coma or death.
While cirrhosis is irreversible, it is usually the result of a chronic condition and thus takes a long time to develop. In fact, many people with developing liver disease (e.g., fibrotic livers) have no symptoms, and their condition is detected only by routine blood tests. If the condition is detected early enough, the patient may have an opportunity to arrest the cirrhotic process before it goes too far.
Treatment of Liver Disease
The goal of medicine with regard to the liver is to prevent liver disease and, if it is diagnosed, to stop its progression toward cirrhosis. Cirrhosis is an end-stage disease with a poor prognosis and can require a liver transplant if liver failure occurs. Thus, lifestyle changes that support liver health, especially abstention from alcohol, are the cornerstone of treatment for liver disease. No matter the cause of cirrhosis, alcohol aggravates the condition and should be avoided.
In addition, physicians will attempt to treat the complications of cirrhosis, including portal hypertension and ascites, with various medications. In general, however, the use of medications must be approached with caution in people with liver disease because the liver metabolizes many of these substances. For example, aspirin should be avoided in patients with cirrhosis because of its effects on coagulation and the gastric mucosa.
The following conventional medicines are often prescribed to treat cirrhosis or fibrotic liver disease : -
Corticosteroids. These drugs have been shown to reduce the inflammation that characterizes liver disease. While they may be helpful to patients with alcoholic hepatitis and encephalopathy, they are less helpful to patients with alcoholic cirrhosis.
Ursodiol. Among people with biliary cirrhosis, this drug replaces lost biliary acids. Side effects are rare. This drug may not halt progression of the disease (Kasper DL et al 2005).
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