Progression Of Liver Disease

Progression ofLiver Disease

Why is the liver important?The liver is the second largest organ in your bodyand is located under your rib cage on the rightside. It weighs about three pounds and is shapedlike a football that is flat on one side.The liver performs over 500 essential jobs in yourbody. Its biggest job is to filter the blood to processwhat you eat and drink into energy and nutrientsyour body can use. The liver also removes harmfulsubstances from your blood.The liver is an organ that can repair itself, orregenerate, even if scar tissue has formed. Ifsomeone’s liver disease can be treated, wellmanaged, or cured early in the progression of liverdisease, the liver will often be able to recover fromdamage.Many people with liver disease do not look or feelsick but damage is still happening. At a certainpoint in the progression of liver disease, oncepeople start having symptoms, the damage tendsto become irreversible and can lead to liver failure,liver cancer, or death.What are common causes of liverdisease?Common causes of liver disease include: Viruses Poor diet and/or obesity Excessive alcohol use Genetics Autoimmune disease Reactions to medications, street drugs, ortoxic chemicalsMost liver diseases result in similar damageto the liver and for many, the progression ofliver disease looks the same regardless of theunderlying disease.1Progression of Liver Disease

What is hepatitis, or inflammation,of the liver?Inflammation (swelling) of the liver, also known ashepatitis, is usually the first stage of liver disease.Inflammation is generally a sign that the body istrying to fight an infection or heal an injury. Whenliver disease is present, inflammation continuesover time. This leads to scarring of the liver.Many people with hepatitis have no symptoms;however, some may feel tired or have abdominal(belly area) discomfort.Hepatitis is often diagnosed through blood andimaging tests. If the liver disease is diagnosed andtreated successfully at this stage, the inflammationmay go away.What is fibrosis?Fibrosis is the formation of scar tissue in the liverthat replaces healthy tissue. As scar tissue buildsup, the liver may not work as well as it once did.The scar tissue affects the flow of blood in the liver,making it hard for the liver to function. Peoplewith fibrosis usually do not have symptoms ofillness until it progresses to cirrhosis. Peoplewith fibrosis may have normal liver functiontests because the liver is working even thoughdamage is happening. Many people live withfibrosis for many years without knowing theyhave liver disease. It is important to rememberthat the process of fibrosis progressing to cirrhosishappens over a long period of time. The time ittakes for fibrosis to progress is different for everydisease and every person. Not everyone whodevelops fibrosis will progress to cirrhosis. Noteveryone who gets cirrhosis will get cancer.Fibrosis is diagnosed by blood and imaging tests.A liver biopsy may be needed to check how muchliver scarring has formed. During a biopsy, a smallpiece of liver tissue is removed with a needle andProgression of Liver Disease 2

STAGES OF LIVER DAMAGE210Healthy liverModerateliver damageBeginning ofliver damage3Significantliver damage4Severeliver damage(Cirrhosis)looked at under a microscope. The tests a doctordoes to diagnose fibrosis will provide informationabout the stage of fibrosis a person has. The mostcommon scale used in the United States uses arating of 0-4. A stage 0 is no fibrosis. A stage 4 isdefinite or likely cirrhosis.If the liver disease is diagnosed and successfullytreated in the stage of fibrosis, the liver may beable to heal on its own over time.If you have been diagnosed with liver disease, it isimportant to know the stage of your liver damage.Knowing the stage of your liver disease will affectthe decisions you and your care team make aboutyour health. People with more advanced fibrosis orcirrhosis will need to be monitored for liver cancer.They may need to avoid certain medications, andthey may need to be seen by their doctors morefrequently for blood tests.3Progression of Liver Disease

What is cirrhosis?Cirrhosis is severe scarring of the liver. It can takemany years for liver disease to lead to cirrhosis.As the amount of scar tissue in the liver increases,replacing healthy tissue, the liver may not be ableto perform its jobs.Symptoms of cirrhosis may include: Loss of appetite Tiredness Nausea Weight loss Abdominal pain Spider-like blood vessels on the skin Severe itchingCirrhosis can lead to complications, which mayinclude: Jaundice (yellowing of the skin and whitesof the eyes) Gallstones Bruising and bleeding easilyFluid buildup and painful swellingof the legs (edema) and abdomen (ascites) Mental confusion (hepatic encephalopathy) Infection Internal bleeding from enlarged veins Damage to other organs, often the kidneysThe liver needs to lose about 90% of its functionto lead to some of the more serious complicationslisted above.Cirrhosis is diagnosed by symptoms and throughblood and imaging tests. A liver biopsy may beneeded to check how much of the liver has beendamaged.Progression of Liver Disease 4

Treatment for cirrhosis depends on the cause andthe level of liver damage. The goals of treatmentare to prevent further liver damage and to treatthe symptoms and complications of cirrhosis.What is liver cancer and whencan it develop?Liver cancer is the growth and spread of unhealthycells in the liver. Cancer that develops in the liveris called primary liver cancer. The most commonform is called hepatocellular carcinoma. Cancerthat starts in another part of the body and spreadsto the liver is called metastatic liver cancer.Primary liver cancer can develop during theprogression of liver disease. It often occurs onlyif cirrhosis is present. There are people withoutcirrhosis, however, who may develop liver cancer.For example, people with chronic (long-term)hepatitis B are at risk for developing primary livercancer without first having cirrhosis.Often there are no symptoms of liver cancer untilit is in an advanced stage. When symptoms dooccur, they may include: Fatigue BloatingPain on the right side of the upper abdomen,back, or shoulder Nausea Loss of appetite Weight loss Weakness Fever JaundiceLiver cancer is usually diagnosed by blood andimaging tests. A liver biopsy may be needed todetermine if the cells are cancerous.5Progression of Liver Disease

Liver cancer treatment depends on:The overall health of the liverThe size, location, and number of tumors Whether the cancer has stayed within orspread outside of the liver The person’s age and overall health What happens when liver failureoccurs?Liver failure, or end-stage liver disease, occurs ifthe liver is losing or has lost all function.The first symptoms of liver failure are usually: NauseaLoss of appetiteFatigueDiarrheaAs liver failure progresses, symptoms mayinclude: ConfusionExtreme tirednessComaKidney failureChronic liver failure indicates the liver has beenfailing gradually, possibly for years. Acute liverfailure occurs suddenly and is often a reactionto poisoning or medication overdose. It mayalso occur due to acute viral hepatitis or othercauses of liver disease. If the liver is failing, aliver transplant may be needed.What is liver transplant?A liver transplant is the process of replacing asick liver with a donated, healthy liver. Livertransplants require that the blood type andbody size of the donor match those of theperson receiving the transplant.Progression of Liver Disease 6

Liver transplants are often performed usinglivers from registered organ donors who havedied. However, because livers can regenerate(rebuild themselves), it is possible to acceptdonations of partial livers from living donors.Liver transplant surgery usually takes betweenfour and 12 hours. Most patients stay in thehospital for up to three weeks after surgery. Inthe United States, the number of people whoneed liver transplants is higher than the numberof available livers for transplantation.The transplant list is organized by somethingcalled a MELD score. The MELD score (or Modelfor End Stage Liver Disease) is based on bloodwork and assesses the severity of chronic liverdisease. Scores range from 6 to 40 (40 being verysick). This score is used to ensure that the sickestpeople get livers first. Points may be added orremoved as someone waits for a transplant.Some conditions, like liver cancer, add extrapoints to someone’s MELD score because theirrisk of death increases.The evaluation process to determine if someoneis a candidate for liver transplantation beginswith a referral from the patient’s doctor for anevaluation at a transplant hospital. The patientthen meets with members of the transplantteam (clinical coordinator, doctor/surgeon,financial coordinator and/or social worker, anddietitian). The team assesses:All aspects of the patient’s physicalcondition, including MELD score The patient’s psychological well-beingThe patient’s financial needs that must bemet before, during, and after the transplant The patient’s nutritional needs before andafter the transplant The patient’s available emotional supportnetwork (family and friends)7Progression of Liver Disease

Every hospital has its own conditions aboutwho it accepts for transplant. If the team at apatient’s preferred hospital finds that he or sheis eligible for a liver transplant, they will addthat person to the transplant waiting list.There are many factors that determine howlong a person will be on the transplant waitinglist. These factors include: Whether the liver disease is acute orchronic The person’s level of illness How well the patient matches with apotential donor (e.g., blood type, bodysize) The number of available donors in thetransplant candidate’s regionAfter receiving a liver transplant, the patientmust take medicines to help prevent their bodiesfrom rejecting the transplanted organ. Thesemedicines are called immunosuppressants, oranti-rejection drugs. Most patients are on thesemedications for the rest of their lives.People usually stay in the hospital for a week toten days following transplant surgery. Recoverytimes can vary, but most people can return tonormal activities within a few months to oneyear after their transplants.In some cases, the liver disease a person hadbefore a transplant can come back and affectthe new liver. If this happens, the person mayneed treatment or possibly a second livertransplant.Progression of Liver Disease 8

Notes9Progression of Liver Disease

Progression of Liver Disease 10

American Liver 465-4837)/Liverinfo/LiverUSA/AmericanLiverThe American Liver Foundation is solely responsiblefor this content. 2020 American Liver Foundation. All rights reserved.

Liver failure, or end-stage liver disease, occurs if the liver is losing or has lost all function. The first symptoms of liver failure are usually: Nausea Loss of appetite Fatigue Diarrhea As liver failure progresses, symptoms may include: Confusion Extreme tiredness Coma Kidney failure Chronic liver failure indicates the liver has been