• Liver problems - Symptoms, Causes, and Disease Progression

    Liver problems - Symptoms, Causes, and Disease Progression

    Your body is a marvel of carefully balanced chemical reactions, and every organ in the body has a part to play. The liver is no exception, and liver failure can be a life-threatening problem. Whether it is from long-term exposure to toxic substances, viral infections or even sudden poisoning, there can be many sources of liver damage. Knowing what can cause liver failure, and what treatments are available, can help you make the best decisions about how to care for your liver.

    What Is Liver Failure?


    Your liver is a vital organ that helps by eliminating waste from the body, as well as helping to store energy until your body can use it. It also performs other functions related to metabolism and digestion. 

    Liver failure, simply put, is what it sounds like. It is possible for your liver to stop working entirely, leading to serious consequences for your body. All stages of liver disease can have profound effects on your health, but liver failure will lead to death if you do not receive medical intervention in a timely manner

    What are the Symptoms of Liver Disease and Liver Failure?


    Liver disease is marked by a set of common symptoms, many of which are shared with other digestive issues. This can make accurately diagnosing liver failure difficult at first. For this reason, many people with early stages of liver disease are not diagnosed immediately. Your liver plays a central role in processing out toxins from the body, so the symptoms of liver disease can show up throughout the body. A short list of common symptoms is included below:

    • pale, bloody, or black stool
    • jaundice characterized by yellow skin and eyes
    • dark-colored urine
    • vomiting
    • nausea
    • decreased appetite
    • itchy skin
    • ongoing fatigue
    • easy bruising
    • swollen ankles, legs, or abdomen

    What is the Progression of Liver Disease?


    There are many different things that can affect your liver, but the progression of damage will likely follow a similar path. The speed at which your liver progresses through the various stages of damage will differ depending on the cause or irritation that is affecting your liver, but the general steps in the progression of symptoms will often be similar regardless of the pace. 

    Inflammation is the first stage of liver disease. At this stage, an irritant, either biological or chemical, is causing inflammation in the tissue of your liver. Typically, at this stage you may not yet know there is damage being done. As inflammation worsens, you may notice tenderness in the upper portion of your abdomen around your liver. The area around your liver may be hot and painful as your inflammation gets worse. At this stage, treatment can bring about complete healing of the liver if treatment is begun in time. 

    Fibrosis is the next stage of liver disease. At this stage, chronic inflammation over a long period has begun to affect the liver. The tissue damage from ongoing inflammation will begin to cause scarring in the liver. This scar tissue eventually replaces healthy tissue, reducing the capacity of your liver to do its job. As scarring progresses, the remaining tissue in your liver has to work harder to keep your body free of toxins. This increases the strain on your remaining healthy liver tissue, which can accelerate disease progression. If your liver disease is caught at this stage, it is possible you will still be able to begin a program of treatment which can allow your liver to recover.

    If fibrosis of the liver is not treated, your liver disease could progress to the next stage. Cirrhosis is a word many people know, and for good reason. This state of scarring and damage to the liver, often associated with chronic alcoholism or other substance abuse, describes a state of damage and scarring in the liver that will have serious consequences for your health. At this stage, you will begin to develop symptoms that are evident throughout the body. The symptoms can include bleeding easily, cognitive disturbances, itchy skin and water retention. Cirrhosis is a serious condition that cannot be cured. Your treatment plan at this stage will focus on ensuring your disease does not get worse. Your goal in treatment will be to ensure you keep whatever remaining healthy liver tissue you have in the best shape possible. 

    After your liver disease has become serious enough to be diagnosed as cirrhosis, you are also at an increased risk for liver cancer. Having cirrhosis is not a guarantee of getting liver cancer, but there is a correlation between the two. It is possible for liver cancer to develop at any other stage in the progression of liver disease, but your chances increase if you have been diagnosed with cirrhosis. Hepatitis B is also a risk factor in the formation of liver cancer.

    End-Stage Liver Disease (ESLD) is a condition you may reach if your cirrhosis is not treated in time. At this point in disease progression, you may experience decompensation liver disease, which is characterized by more pronounced hepatic encephalopathy, bleeding, lung issues and impairment of kidney function. If you begin to experience decompensation, you will have reached a serious and life-threatening state in your liver disease. At this stage, you will not only be a candidate for a liver transplant, but you will be prioritized on the transplant list because of the severity of your condition. 

    Liver failure is the final stage of liver disease progression, where you will have lost more than half of your liver’s ability to function. At this point, you will be in urgent need of medical care, as you are in danger of slipping into a coma or possibly dying. One challenge in diagnosing liver problems is the symptoms are shared with a wide variety of other medical conditions. You will likely experience diarrhea, nausea, and a loss of appetite. As your symptoms progress, you will experience increased disorientation, confusion, and you may become extremely sleepy. If these symptoms are stemming from liver failure, you are in need of urgent medical care. Liver failure is deadly, and even with urgent medical treatment, you may need a liver transplant to save your life.

    Causes of Acute Liver Failure


    Most problems with your liver take years to develop, with symptoms building and growing in severity over time. In these cases, you will likely have plenty of warning as your body begins to exhibit a variety of symptoms. 

    Acute liver failure, on the other hand, can occur in as little as 48 hours. This form of liver failure is most often the result of poisoning or an overdose of some kind. As frightening as it may sound, acute liver failure is just as deadly as conditions like severe cirrhosis or cancer that take years to develop and give you time to pursue a course of medical treatment. 

    Acute liver failure can arise from a variety of causes. Some of these can happen outside of a medical treatment facility, though others can occur as a side effect of other diseases that require extensive medical treatment. A few examples of the causes of acute failure are listed below: 

    • Large doses of acetaminophen can quickly damage your liver or lead to severe illness or death. Once acetaminophen poisoning has begun, the progression of damage is very difficult to treat and is often life-threatening.
    • Eating poisonous wild mushrooms: the Amanita phalloides, or death cap, mushroom contains toxins that lead to liver failure within a matter of days after being eaten.
    • Interactions between prescription and herbal medications: these interactions can either kill liver cells outright or may damage the bile duct.
    • Septic shock: this overwhelming infection caused by conditions such as intestinal perforation can damage your liver or cause it to stop working.

    Causes of Chronic Liver Failure


    Chronic liver failure occurs when your liver has been damaged due to long-term exposure to a variety of challenging conditions. This could include exposure to industrial toxins, alcoholism, auto-immune disorders, and even extreme, chronic malnutrition. Chronic liver failure can come about from many different causes, and the progression of your symptoms will vary due to a wide variety of factors. A few of these are listed below:

    • The herpes simplex virus can lead to cirrhosis and other forms of liver damage
    • Several viruses including the Epstein-Barr virus, hepatitis A, B, and E, hepatitis C, and cytomegalovirus can cause extensive liver damage
    • Autoimmune hepatitis: similar to viral hepatitis, this condition is characterized by your own immune system attacking your liver
    • Wilson’s disease is a genetic disease preventing your body from removing copper, which can damage the liver
    • Acute fatty liver of pregnancy: In this rare condition, excess fat gathers on your liver and damages it
    • Budd Chiari syndrome: this rare disease blocks and narrows the blood vessels in your liver
    • Industrial toxins: carbon tetrachloride, a degreaser and cleaner, and other chemicals can damage your liver

    Other conditions such as nonalcoholic fatty liver disease can slowly damage the liver over time. Primary biliary cirrhosis is another condition in which damage to your bile duct can cause a buildup of bile in the liver, eventually resulting in liver damage. 

    Chronic hepatitis is another cause of serious concern for your liver. The long-term effects of various kinds of hepatitis, both viral and autoimmune,  can slowly damage the liver by producing a state of chronic inflammation that will slowly build up scar tissue in the liver, progressing from fibrosis to cirrhosis over time. 

    Liver Disease Diagnosis and Tests


    If your doctor suspects you have chronic liver failure, he or she will begin with a series of blood tests to begin determining what could be wrong. This can help diagnose conditions such as hemochromatosis where levels of iron build up in your body to a point where they begin to impair liver function. Your healthcare provider will also likely put you through a series of liver function tests to determine the extent of liver damage you have experienced. 

    The best way for your doctor to understand what is going on in your liver is to take a sample of your liver itself. In a procedure known as a liver biopsy, a small sample of liver tissue will be removed for examination. This can help your doctor understand the possible causes of liver disease you have been exposed too, and what the best course of treatment may be. 

    How Is Liver Failure Treated?


    Treatment options will depend on whether you are facing chronic or acute liver disease. When symptoms are mild, conservative treatment options are usually prescribed. The liver has an amazing ability to heal itself if damage has not progressed too far. If your symptoms have gotten severe enough, you will be hospitalized to stabilize you and keep you alive. 

    Blood transfusions may be necessary if you have begun bleeding excessively. You may be placed on a ventilator if you are having trouble breathing. It is also possible you may receive a liver transplant from a healthy donor if you meet the necessary criteria for liver transplantation. In most cases this involves replacing the entirety of your liver, though it is possible for some transplant centers to only replace a portion of your liver.

    Acute liver disease is typically treated in a hospital setting as the onset and progression of symptoms are quite rapid. The goal of treating acute liver failure is to flush the toxins out of your body while keeping you stable. This may involve intravenous (IV) fluids, laxatives, or enemas to remove toxins, closely monitoring your blood pressure, and glucose monitoring to ensure your blood sugar does not drop to dangerous levels.  

    Treatment of chronic liver disease is a more complex matter. Depending on the cause and severity of your disease, many different options are available. The first line of treatment will be reducing your exposure to alcohol, medications or other substances that are contributing to your disease, or could make healing more difficult. Beyond this, treatment will depend on the cause of your condition. Viral hepatitis, primary sclerosing cholangitis, and chronic alcohol abuse can all damage and scar the liver, but treatment for each of these conditions will differ considerably. 

    If you have chronic liver disease of any kind, your healthcare provider will likely prevent alcohol consumption, even if alcohol abuse is not the cause of your liver failure. You will also likely be placed on a diet that reduces strain on your liver by lowering the number of fatty foods, meats, and cheeses that you eat. Reducing the amount of salt in your food, and avoiding adding more salt as a seasoning, will also help your liver. If you are overweight or have metabolic issues, you will likely also be placed on a diet designed to lower the overall amount of calories you consume. 

    When Should I Talk to My Doctor About Liver Disease?


    Liver disease shares many common symptoms with other conditions, so judging by symptoms alone is difficult. For acute cases, it is important you seek medical treatment immediately. Especially in cases where poisoning may have occurred, liver failure could happen quickly, and receiving immediate treatment could be the difference between life and death. 

    For chronic cases, it is important to talk to your doctor if you are experiencing symptoms, or if you have some of the risk factors for chronic liver disease. This could include diabetes, chronic alcohol abuse, hepatitis C, hepatitis B, autoimmune hepatitis, Wilson disease or exposure to industrial pollutants and certain chemicals. If you have been exposed to these risk factors, it may be time to talk to your doctor.  If you are experiencing symptoms of liver disease, request an appointment. Managing your diet, getting enough exercise, lowering or ending your alcohol use and other changes in lifestyle can have a profound impact on how your liver disease will progress. Liver disease does not always progress to liver failure, but if it does your life could be in danger. Understanding your risks early can help you find ways of treating and managing your condition to stop liver failure before it starts.