What is end stage liver disease (ESLD) or cirrhosis?
Some diseases destroy healthy liver cells or replace them with scarred (fibrous) tissues causing loss of liver function. When a large part of the liver is scarred it is called cirrhosis. Cirrhotic liver loses its capacity to re-grow or regenerate causing loss of liver function; this is often progressive and irreversible. Cirrhosis cannot be treated or reversed with any medicines.
Liver has the capacity to regenerate. Even if 70% of liver is damaged, the remaining liver can provide adequate organ function. However, damage beyond this causes loss of liver function or organ failure, called End Stage Liver Disease (ESLD).
Although cirrhosis cannot be reversed, if diagnosed at an early stage, treating its cause such as viral or autoimmune hepatitis or abstinence from alcohol can halt its progression.
What are the signs and symptoms of liver disease?
Patients with cirrhosis feel normal until ESLD sets in, when following signs and symptoms may develop:
- Yellowness of skin and white portions of the eyes or passing dark yellow urine (jaundice)
- Swollen abdomen - fluid build-up in abdomen (ascites)
- Excessive sleepiness, inability to sleep, becoming forgetful, drowsy or confused (encephalopathy), due to build-up of ammonia and other toxins
- Throwing up blood (blood vomiting), passing tarry black stools or fresh red bleeding in stools due to bleeding in intestines
- Passing light or clay coloured stools
- Easy or excessive bruising or bleeding even from simple wounds
- Constant & severe itching (pruritus) all over the body
- Feeling tired or weak
- Feeling tired or weak
- Unintentional weight loss
- Loss of appetite
- Loss muscle mass
- Swelling (edema) of hands and feet.
Patients with mild liver damage might not experience any of the above symptoms and may only require medical or endoscopic therapy. Occurrence of above symptoms is called as decompensation and generally indicates poor or inadequate liver function or failure of medical therapy. Some symptoms are more serious than others; especially fever, blood vomiting and mental confusion demand immediate medical attention.
Unfortunately, by the time patients undergo tests and are diagnosed with liver problems, they already have decompensation (worsening) or advanced chronic liver disease with limited reserve and short life expectancy.
Some common findings on initial tests in cirrhotic patients are:
- High bilirubin
- Low albumin
- High prothrombin time (INR)
- Low platelet count
- Radiology imaging showing shrunken liver, enlarged spleen, ascites and dilated collaterals
What is acute or fulminant liver failure?
Acute liver failure (ALF) is a devastating and life-threatening condition in which there is sudden and rapidly progressive damage to the liver developing over a few days or weeks in an otherwise normal individual. Its signs and symptoms typically start with jaundice and have a rapidly worsening course. Patients may become forgetful, drowsy or confused and may progress to coma over few hours to days.
Some diseases causing acute liver failure are:
- Infection with Hepatitis A or E virus
- Side effects of medicines (anti-tubercular, paracetamol, ayurvedic drugs)
- Fatty liver during pregnancy