The liver processes the ammonia, breaks it down to something called urea, and sends it to our kidneys to be released in urine. When someone has cirrhosis, ammonia is not eliminated, builds up, travels to the brain, and causes confusion, disorientation, coma, and even death. This is hepatic encephalopathy. Hepatic Encephalopathy or HE can be managed with medications that are taken regularly. One of these medications tries to eliminate extra ammonia through increasing the number of bowel movements.
The other common medication is a powerful antibiotic which eliminates the bacteria in your digestive system responsible for creating the ammonia. Learn more about hepatic encephalopathy in our HE Resource Center. The liver is the largest filter in the body but works closely with our kidneys to eliminate waste from our bodies.
When someone has cirrhosis, they may develop a serious complication where their kidneys begin to progressively fail. This is called hepatorenal syndrome. Our red blood cells have a substance in them called hemoglobin which is responsible for carrying oxygen.
Bilirubin is a yellow chemical found in hemoglobin. Your body builds new cells to replace broken down red blood cells and the old ones are processed in the liver. The breakdown of the old cells releases bilirubin. A healthy liver processes bilirubin out of the body. If the liver cannot successfully do this function, bilirubin builds up in the body and your skin or the whites or your eyes may look yellow.
This is called jaundice. Jaundice does not only occur in people with cirrhosis. Many healthy babies have jaundice during the first week of life. Jaundice can also be due to blood diseases, genetic conditions, blockages of bile ducts, infections like hepatitis A , and even some medications.
When blood cannot flow through the portal vein into the liver it is forced to find new pathways, such as through the veins in the stomach and esophagus.
These enlarged veins are called varices. These small veins are not meant to carry so much blood. When overloaded with blood, these veins can balloon, leak blood or even rupture, causing life-threatening bleeding.
Signs of bleeding varices include:. Doctors can view these varices by inserting an endoscope a thin flexible tube through your mouth, down to your esophagus and stomach. Endoscopies are very important to avoid varices from bursting and bleeding.
Doctors use endoscopies to check on the varices and, if needed, band them, or tie them off, to strangle the vein and keep them from bursting.
Liver cancer is cancer that begins in the cells of your liver. While several types of cancer can form in the liver, the most common type of liver cancer is hepatocellular carcinoma , or HCC, which begins in the main type of liver cells hepatocytes.
Liver cancer is one of the leading causes of cancer-related deaths worldwide. Over the last 30 years, rates of liver cancer have tripled in the United States.
While most other common cancers have seen improved survival rates during this time period, liver cancer death rates have doubled. It is very rare to develop HCC without first having cirrhosis.
Because of this, when someone has been diagnosed with advanced fibrosis F3 or cirrhosis they should receive regular surveillance for liver cancer. Finding and diagnosing liver cancer as soon as possible is essential. Early detection offers more potentially curative options, like resection where the cancer and surrounding liver tissue is removed and transplant. Learn more in our liver cancer resource center. Liver transplantation is a surgical procedure performed to remove a diseased or injured liver from one person and replace it with a whole or a portion of a healthy liver from another person, called the donor.
Since the liver is the only organ in the body able to regenerate, or grow back, a transplanted segment of a liver can grow to normal size within a few months.
Often, transplanted livers are from people who were registered donors who passed away. Since the liver has such regenerative ability, however, it is possible for a living person to donate a portion of his or her liver to someone in need of a transplant. To learn more about Liver Transplantation, click here.
To learn more about living donor liver transplantation, please visit our new Living Donor Liver Transplantation Information Center. The best thing anyone can do for their health is to stay engaged in their healthcare. Be an active member of your care team by regularly visiting your healthcare provider, undergoing routine surveillance when needed, making the most of your appointments by asking questions and learning more about your health.
When possible, provide your doctor a detailed family health history to determine your own risks for liver disease. There are genetic or hereditary liver diseases that can run in families. Sometimes our genes put us at a greater risk for developing lifestyle related liver disease like Nonalcoholic Fatty Liver Disease and Alcohol Related Liver Disease. Being honest with our healthcare provider about your lifestyle is another important factor in determining risk for liver disease.
Because your liver processes everything you eat, drink, breath, or absorb through our skin, it can be impacted by many different factors. Be sure your doctor knows how often you take each type of medication and review medications that may have been prescribed by another healthcare provider. It is best to ask your healthcare provider before you begin taking any medications to be sure you are making the best choice for your health. Many medications can cause damage to the liver.
Being open with your healthcare provider about your diet, exercise, and other lifestyle habits is very important! Care Connection Ingalls For help with Ingalls Care Connection, call us at or email portalsupport ingalls. Share with facebook Share with twitter Share with linkedin. Online Second Opinions Learn how you can get second opinions without having to leave home. What is liver failure? As liver failure progresses, you may experience some or all of the following symptoms: Jaundice, or yellow eyes and skin Confusion or other mental difficulties Swelling in the belly, arms or legs Severe fatigue A tendency to bleed easily What is the difference between acute and chronic liver failure?
What treatments are available for liver failure? An innovative liver dialysis machine to help treat liver failure The Molecular Adsorbent Recirculating System MARS is a liver dialysis machine used in the treatment of liver failure to enable native liver regeneration. What is the difference between liver failure and cirrhosis?
Liver disease can go through these stages: Inflammation: Increased activity of the immune system in the liver, leading to swelling of the liver Fibrosis: Early scarring that can follow inflammation in the liver Cirrhosis: Severe scarring of the liver that accumulates with prolonged inflammation and typically cannot be reversed End-stage liver disease: Little to no liver function often called liver failure.
Can a damaged liver repair itself? How do I know if my liver function is worsening? World-Renowned Liver Disease Specialists With access to leading therapies and state-of-the-art technologies, our liver disease specialists work together to provide personalized care for each patient. Find a Liver Disease Specialist. Maryland Ave. Chicago, IL UChicago Medicine Transplant - Hinsdale.
Elm St. Suite Hinsdale, IL UChicago Medicine at Ingalls - Flossmoor. Flossmoor, IL UChicago Medicine Orland Park. La Grange Rd. Orland Park, IL UChicago Medicine River East. Grand Ave. UChicago Medicine - Schererville. Schererville, IN Why Choose UChicago Medicine for Liver Disease Care Our internationally renowned specialists have extensive expertise in treating common and complex liver diseases. Coordinated, Collaborative Care. Personalized Approach to Care.
A Tradition of Excellence. Liver Transplant Institute. Ranked Among the Nation's Best. The fluid may come back in a few weeks occasionally sooner.
But the team can drain it again. This is a medication that helps the body get rid of unwanted fluid. The doctor may also prescribe an opioid pain medication to help relieve discomfort and shortness of breath and an anti-nausea medication. Another complication of end-stage liver failure is reduced brain function. This is because toxins such as ammonia build up in the blood, causing confusion. The person may be unable to tell night from day.
He or she may also display irritability and personality changes, or have memory problems. As brain function continues to decline, he or she will become sleepy and increasingly confused. This state can progress to unresponsiveness and coma. Although there is medication that may help reduce confusion, in the final days of liver failure, it will be less useful.
The doctor may then prescribe medications to calm the person and maintain his or her comfort and dignity. As liver function declines, certain medications can further harm the liver or build up in the bloodstream, causing side effects. 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:. Cirrhosis 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.
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.
Another problem caused by high pressure in the veins of the liver is ascites. Fluid leaks out into the belly and it begins to fill it up.
This can make the abdomen enlarge like a balloon filled with water. The legs can get swollen too. This can be very uncomfortable. Eating can be a problem because there is less room for food. Even breathing can be a problem, especially when the person is lying down. But the most dangerous problem with ascites is infection, which can be life-threatening.
Ascites may go away with a low salt diet, and with diuretics water pills ordered by your provider. But sometimes a provider must actually drain the fluid from the belly using a special kind of needle. A liver that is working poorly may not be able to get rid of toxic substances like ammonia which comes from the intestines , and it may allow these substances to go into the brain and cause confusion.
Besides confusion, toxins in the brain cause changes in sleep, mood, concentration, and memory. If extremely serious, it can even cause a coma. These are all symptoms of hepatic encephalopathy.
With encephalopathy, a persons may have problems driving, writing, calculating, and performing other activities of daily living. Signs of encephalopathy are trembling and hand "flapping.
A liver that is working poorly cannot get rid of bilirubin, a substance that produces a yellowing of the eyes and skin called jaundice. Too much alcohol and some medicines can also lead to jaundice.
The model for end-stage liver disease MELD score measures the severity of cirrhosis. The MELD score was developed to predict the day survival of people with advanced cirrhosis. The MELD score is based on three blood tests:. MELD scores usually range between 6 and 40, with a score of 6 indicating the best likelihood of day survival.
The diagnosis of cirrhosis is usually based on the presence of a risk factor for cirrhosis, such as alcohol use or obesity, and is confirmed by physical examination, blood tests, and imaging. The doctor will ask about the person's medical history and symptoms and perform a thorough physical examination to observe for clinical signs of the disease. For example, on abdominal examination, the liver may feel hard or enlarged with signs of ascites.
The doctor will order blood tests that may be helpful in evaluating the liver and increasing the suspicion of cirrhosis. Patient with cirrhosis may have an upper endoscopy pronounced "en-dahs-cup-ee" periodically see figure at right. A thin tube with a camera can be inserted into the mouth to look for varices in the esophagus food tube and the stomach.
The endoscopy is repeated every few years to monitor for varices. To view the liver for signs of enlargement, reduced blood flow, or ascites, the doctor may order a computerized tomography CT scan, ultrasound, magnetic resonance imaging MRI , or liver scan. The doctor may look at the liver directly by inserting a laparoscope into the abdomen. A laparoscope is an instrument with a camera that relays pictures to a computer screen.
A liver biopsy can confirm the diagnosis of cirrhosis but is not always necessary. A biopsy is usually done if the result might have an impact on treatment. The biopsy is performed with a needle inserted between the ribs or into a vein in the neck. Precautions are taken to minimize discomfort. A tiny sample of liver tissue is examined with a microscope for scarring or other signs of cirrhosis. Sometimes a cause of liver damage other than cirrhosis is found during biopsy. Treatment for cirrhosis depends on the cause of the disease and whether complications are present.
The goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the complications of the disease. Hospitalization may be necessary for cirrhosis with complications. Because malnutrition is common in people with cirrhosis, a healthy diet is important in all stages of the disease. Health care providers recommend a meal plan that is well balanced. If ascites develops, a sodium-restricted diet is recommended. A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection.
To improve nutrition, the doctor may add a liquid supplement taken by mouth or through a nasogastric tube-a tiny tube inserted through the nose and throat that reaches into the stomach.
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