Liver damage most commonly occurs through a process called cirrhosis. During this process, normal liver tissue becomes damaged and dies. In its place new tough scar tissue grows but has limited functionality compared with healthy tissue. When enough liver tissue becomes severely damaged, symptoms arise. The American Academy of Family Physicians reports that as much as 80 to 90 percent of liver tissue is effected before symptoms even arise. The most common causes of cirrhosis include habitual alcohol abuse, obstruction or the bile ducts, and chronic hepatitis infection.
Gastrointestinal and Abdominal Symptoms
Liver damage causes several undesirable symptoms related to the gastrointestinal system. An important function of the liver is to metabolize food, nutrients and vitamins, but in patients with liver damage, this ability becomes impaired. "Medical Surgical Nursing" lists common gastrointestinal symptoms as nausea, vomiting, bleeding, indigestion and excess gas. Weight loss due to malnutrition and loss of appetite also commonly occurs. A condition referred to as ascites, caused when fluid leaks from the damaged liver in to the abdominal cavity where it becomes trapped, also causes bloating, pain and shortness of breath.
Skin Changes
Jaundice commonly occurs and consists of a yellowing or orange appearance of the skin and sclera of the eyes. This discoloration is caused by the build up of toxic amounts of bile in the body. The Merck Manual also reports changes to skin that include dry, itchy skin; spider veins; and red or purple spots. Nail beds may develop white bands mixed with pink or red bands.
Bleeding and Infection
Bleeding occurs frequently in patients with liver damage. The liver becomes unable to process vitamin K which is necessary for the clot formation blood. Due to this impairment, blood thins and the risk for bleeding increases. In addition poor blood circulation in the liver causes a backing up of blood into the gastrointestinal system. Engorged veins in the esophagus, stomach, and intestines are at risk for rupture and bleeding. According to the American Academy of Family Physicians about 50 percent of patients with cirrhosis develop these engorged veins.
Infection also commonly occurs due to the liver's inability to rid the body of bacteria as it normally would. The fluid that accumulates in the abdomen also frequently becomes infected and can even lead to death.
Cognitive Dysfunction
An important job of the liver is to filter the blood and remove toxic materials and extra amounts of normal substances from the blood. With impaired liver function the liver becomes unable to carry out this function leading to a build up of toxins in the blood. This build-up is known as hepatic encephalopathy and causes a number of cognitive changes: Impaired thinking and judgment, behavior changes, slurred speech, muscle contractions, confusion, and even coma and death commonly occur during the progression of liver damage.
References
- "Medical Surgical Nursing"; Ignatavicius, D. MSN, Workman, L. PhD.; 2002
- American Academy of Family Physicians: Cirrhosis and Chronic Liver Failure Part II
- Merck Manual: Cirrhosis
