Liver functions
The liver is the largest and one of the most complex organs in the body. It has many functions; some of the most important include:
as a biochemical factory, it processes nutrients absorbed from the gut, and makes them available for use by other parts of the body
the production of bile and its excretion into the intestine is important for absorption of fats and certain vitamins
the production of blood factors including many of those necessary for blood clotting, and for normal body fluid balance
the removal of toxins from the blood including those produced by bacteria in the gut and for the breakdown of alcohol and many drugs
the removal of germs in the blood absorbed from the gut
the processing of some hormones and vitamins
Liver disease
Unless liver damage is fairly severe or advanced, diseases of the liver are often “silent” and patients may be unaware of any problem.
The signs and symptoms of liver disease can be explained by considering the various liver functions. Different liver diseases may affect some functions more than others, resulting in variability between patients.
The impairment of processing of nutrients results in wasting of tissues, particularly muscle.
Impairment of the liver’s ability to excrete bile causes accumulation of its constituents including bilirubin pigment, responsible for the yellow discolouration of skin and urine (jaundice), and bile acids which may be responsible for the chronic itch suffered by some patients.
The decreased absorption of vitamin K and inadequate production of blood clotting factors causes easy bruising and bleeding, initially from the gums.
Massive bleeding from the gut is due, in part, to blood from the gut being diverted away from its usual course through the liver, to other channels in the oesophagus (gullet), which may rupture under pressure.
The decreased production of blood proteins involved in body fluid balance and the scarring of the liver contribute to the accumulation of fluid in the abdomen and legs.
The failure of the liver to deal adequately with poisons produced in the gut can cause drowsiness, forgetfulness, and lack of concentration, confusion and coma.
A damaged liver is also much slower at dealing with alcohol and drugs causing increasing sensitivity to their use.
Inadequate removal of micro-organisms or “germs” from the blood coming from the gut partly explains the increased incidence of serious infections in patients with liver disease.
Signs and symptoms of cirrhosis
As continued scarring and damage to the liver occur, the following signs and symptoms may appear:
Loss of appetite
Weight loss
Jaundice - yellow discoloration of the whites of the eyes and skin occurs because bile pigment can no longer be removed from the liver
Itching – due to the retention of bile products in the skin
Ascites – abdominal swelling due to an accumulation of fluid caused by the obstruction of blood flow through the liver
Vomiting of blood – frequently occurs from swollen ruptured varices (veins that burst) in the lower end of the oesophagus due to the increased pressure in these vessels caused by scar tissue formation
Encephalopathy (impending coma) – subtle mental changes ranging from poor concentration advancing to profound confusion and coma.
Treatment for these conditions
Ascites is treated by reducing the intake of salt and the administration of medications to improve excretion of salt and water (fluid tablets or diuretics). Some people are unable to take fluid tablets because of side-effects. In some instances, large amounts of fluid are removed by direct catheter drainage through the abdominal wall (a ‘tap’).
Treatment of encephalopathy includes use of specific medication such as lactulose syrup.
Treatment of bleeding from varices (internal varicose veins) includes taking medication to reduce the likelihood of bleeding or rebleeding, ‘banding’ (the placement of rubber bands on the varices at the time of endoscopy), and occasionally, a radiological procedure called transjugular intrahepatic portosystemic shunt (TIPPS).
Management of encephalopathy
When this condition develops at home it can be distressing to deal with, so if you have noticed any worrying mental changes in your family member or friend, please feel free to discuss it with a member of the transplant team. We can give you strategies to help prevent it or manage it, if it occurs.