The hepatitis C virus (HCV) has the potential to infect the liver and cause chronic damage and inflammation. Over time, this has the potential to result in a condition known as cirrhosis, which is characterized by replacement of normal liver tissue with fibrous scarring. Cirrhosis is irreversible and liver failure results, with many signs and symptoms reflecting the various body systems affected.
Swelling
Patients with liver failure tend to have swelling in the abdomen and lower limbs from fluid buildup. The scarring in the liver increases pressure in certain veins and the fluid inside is forced out into body spaces, such as the abdomen or legs. In addition, the liver is the source of protein synthesis in the body. Decreased amounts of proteins in the blood from liver failure also result in a tendency for fluid to leave the blood vessels into other spaces, such as the abdomen and lower limbs.
Spleen Enlargement
Enlargement of the spleen is known as splenomegaly, and is caused by the increased venous pressure that results from liver failure. The blood in the veins tends to back up into the spleen and collect there, causing congestion. This increased volume of blood in the spleen tends to enlarge it, quite considerably at times.
Blood Shunting
The increased pressure in the veins also causes shunts in the body to open between blood vessels. A good example of this is in the anus where the enlarged blood vessels from shunting result in hemorrhoids. Another example is in the esophagus, where blood vessels also enlarge, and are known as varices. This is quite dangerous as bleeding from the varices can be quite rapid and life threatening.
Lung Problems
Lung dysfunction is common in those with liver failure. The liver tends to clear many enzymes from the blood, some of which cause dilation of blood vessels in the lungs. This tends to diminish the lung response to decreased oxygenation and makes compensation difficult for the patient. In addition, the fluid buildup that occurs in the abdomen can push on the lungs and impair proper breathing. Fluid can also build up around the lungs (known as effusion) and cause lung compression.
Kidney Problems
Various enzymes that cause blood vessel dilation can build up in the body due to the liver's decreased ability to clear them from the bloodstream. This results in low blood pressure, with decreased flow to vital organs such as the kidney. Over time, this can result in kidney failure.
Nervous System Problems
Normally the liver is responsible for clearing ammonia from the bloodstream. In liver failure, ammonia levels tend to increase and have toxic effects on the brain. This manifests with confusion, irritability and altered mental status which can even include coma.
Cardiovascular System Problems
The heart tends to have a higher output and lower blood pressure in the blood vessels in liver failure. This is due to increased estrogen levels, causing dilation of vessels, and compensation by the heart results. In addition, the liver's failure to clear proteins that cause blood vessel dilation (that cause problems with lung and kidney function as well) can cause additional dilation when coupled with the effects of estrogen.
Blood System Abnormalities
The liver is the site of synthesis of various proteins that affect blood clotting. As a result, liver failure tends to affect the blood clotting cascade and results in prolonged bleeding.
Endocrine System Problems
The liver is also where hormones such as estrogen are cleared from the blood stream. Increased estrogen levels have various effects on the body, depending on gender. In men it can result in infertility, decreased libido, gynecomastia and impotence. In women, infertility and problems with menstruation are common. In addition, estrogen has effects on blood vessels and can result in redness of the palms and dilation of veins which can result in typical swellings known as "spider nevi."
References
- Robbins and Cotran Pathologic Basis of Disease, Professional Edition, 8th Edition;" Kumar; 2009
- "Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 8th Edition;" Feldman; 2006
- "Millers Anesthesia, 7th Edition;" Miller; 2009
