Chronic liver failure, also called end-stage liver disease, progresses over months, years, or decades. Most often, chronic liver failure is the result of cirrhosis, a condition in which scar tissue replaces healthy liver tissue until the liver cannot function adequately. Patients with abnormal liver function who develop ascites, variceal hemorrhage, hepatic encephalopathy, or renal impairment are considered to have end-stage liver disease (ESLD). Show
While liver transplantation is a viable treatment option for ESLD, with increasing waiting times for organ transplantation, nearly 17% of patients on the transplant wait list die annually; others are not candidates for a liver transplant. Patients with ESLD have a constellation of symptoms and disease-related complications that affect survival and health-related quality of life. What causes cirrhosis?When a substance or disease attacks and damages the liver, liver cells are killed and scar tissue is formed. This scarring process is called fibrosis (pronounced "fi-bro-sis"), and it happens little by little over many years. When the whole liver is scarred, it shrinks and gets hard. This is called cirrhosis, and usually this damage cannot be undone. Any illness that affects the liver over a long period of time may lead to fibrosis and, eventually cirrhosis. Some common causes are heavy drinking, viruses, a buildup of fat in the liver, inherited diseases, toxic effects from drugs and autoimmune diseases. These are more fully explored in the next section. Cirrhosis has numerous causes. In the United States, heavy alcohol consumption and chronic hepatitis C have been the most common causes of cirrhosis. Obesity is becoming a common cause of cirrhosis, either as the sole cause or in combination with alcohol, hepatitis C, or both. Many people with cirrhosis have more than one cause of liver damage. Cirrhosis is not caused by trauma to the liver or other acute, or short-term, causes of damage. Usually years of chronic injury are required to cause cirrhosis. By BruceBlaus (Own work) [CC BY-SA 4.0], via Wikimedia Commons Common Causes of Cirrhosis
Complications of CirrhosisBecause the liver becomes lumpy and stiff in cirrhosis, blood cannot flow through it easily, so pressure builds up in the vein that brings blood to the liver. This vein is called the portal vein. When pressure is high in the portal vein, the condition is called portal hypertension. In order to relieve this pressure, the blood passes through other veins. Some of these veins, called varices, can be found in the pipe that carries food from your mouth to your stomach (the esophagus) or in your stomach itself. When a person has cirrhosis, the high pressure in the portal vein backs up into another organ called the spleen, which becomes enlarged and destroys an excessive number of platelets, the blood particles that help with blood clotting.
With cirrhosis, entrance of blood to the liver is blocked and substances such as ammonia that would normally be cleaned by the liver, escape into the general circulation. Aside from the problems with liver blood flow, when cirrhosis is advanced there aren't enough healthy worker cells to get all the work done, so these cells cannot make the substances such as albumin and clotting factors that the liver normally makes. Liver cancer, also known as hepatocellular carcinoma (HCC), can also develop in cirrhosis when some of the damaged liver cells start to multiply out of control. As liver function deteriorates, one or more complications may develop, often the first signs of the disease.
Symptoms of CirrhosisInitially, a person may have no symptoms at all. This is called compensated cirrhosis. In fact, a person may live many years with cirrhosis without being aware that his or her liver is scarred. This is because the pressure in the portal vein is not yet too high and there are still enough healthy liver cells to keep up with the body's needs. However, if nothing is done about the cause of cirrhosis, (continuing to drink heavily, for example) or if the underlying disease such as hepatitis goes untreated, the pressure in the portal vein may increase to the point where the few remaining worker cells are overwhelmed. As cirrhosis progresses, the most common symptoms are:
Decompensated CirrhosisCirrhosis is said to have progressed from compensated to decompensated cirrhosis when serious conditions develop as it worsens. These complications can be life-threatening and requires a new liver to replace the diseased one through a liver transplant. As discussed earlier, another serious complication of cirrhosis is liver cancer, which may occur in the compensated or decompensated stage. There may be no signs of liver cancer until the tumor i slarge and causing pain.
Bleeding varices (internal bleeding)Large blood vessels (varices) in the food tube get bigger and bigger over time and can burst open. When this happens, a person may vomit blood or have stool that is black and tarry. The risk of bleeding from varices can be reduced by blood pressure medicines known as beta-blockers or by a surgical procedure in which tiny rubber bands are tied around the varices.
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