The end stage of liver disease is characterized by the scarring of healthy liver tissue and the blockage of blood flow through the liver. At the end stage, the liver can no longer efficiently regenerate healthy cells. The normal functions of the liver to control infections, detoxify the body of toxins, produce bile, metabolize nutrients and synthesize proteins needed for blood to clot are all severely impaired. The symptoms of end-stage liver disease include hepatic encephalopathy, variceal bleeding and spontaneous bacterial peritonitis.
Hepatic Encephalopathy
One of the most serious symptoms of end-stage liver disease is hepatic encephalopathy. When the liver can no longer remove toxins from the blood , brain function is impaired. Lynn A.Kelso, RN APRN, lists increased circulating levels of ammonia as the most popular theorized cause of hepatic encephalopathy. She and her coauthors of the article “Cirrhosis: Caring for Patients With End-Stage Liver Failure” include another possible cause as increased levels of false neurotransmitters. Mild symptoms of hepatic encephalopathy include forgetfulness, personality and mood changes, and mild confusion. According to MedlinePlus, more severe symptoms include disorientation, agitation and slurred speech.
Variceal Bleeding
The extensive scarring of the liver increases the resistance of blood flow out of the liver and back into the general circulation. The increase in pressure causes portal hypertension. The Merck Manual describes portal hypertension as abnormally high blood pressure in the portal vein, which is the large vein that transports blood from the intestines to the liver. If the pressure remains high for a significant amount of time, varices, or dilated vessels, develop at the lower end of the esophagus or at the top of the stomach. Serious bleeding occurs when these vessels rupture. Kelso says that an estimated 50 percent of patients with cirrhosis experience variceal bleeding. Immediate medical intervention includes intubation of the patient to maintain an open airway, intravenous replacement of lost blood and fluids, and control of the bleeding.
Spontaneous Bacterial Peritonitis
Patients with end-stage liver disease are at high risk for developing life-threatening infections. The reason being that the liver fails to detoxify and bacteria from the intestinal tract enters the bloodstream. Patients with end-stage liver disease are often malnourished, which decreases their ability to fight infections. Spontaneous bacterial peritonitis is suspected in patients who already have ascites, fever and abdominal tenderness. Ascites is the accumulation of fluid in the abdominal cavity resulting from portal hypertension. Spontaneous bacterial infection occurs when bacteria such as E. coli move from the intestines into the peritoneum. The peritoneum is the thin membrane that lines the abdominal and pelvic cavities. Early initiation of antibiotic treatment prevents the infection from progressing to sepsis. Sepsis is a life-threatening infection in which bacteria overpowers the bloodstream.
