Liver disease is the 12th leading cause of death in America, according to a 2011 report by the Centers for Disease Control and Prevention (1). The liver is the largest internal organ in the human body and works hard to efficiently purify blood, store vitamins, produce immune factors and aid in digestion (2). When compromised by problems like infection, immune issues and alcohol abuse, the liver becomes diseased and ultimately fails if left untreated. While there are varying types of liver disease, the sequence of damage is similar: inflammation, fibrosis, cirrhosis and failure, with one leading to the next if left untreated (9)
In the beginning stage of chronic liver disease, the liver becomes swollen and inflamed. This condition -- hepatitis -- may occur because of viral infection, injury, alcohol abuse, autoimmune disease or as a reaction to drugs (3, 9). Acute hepatitis is short term and lasts several months, while chronic hepatitis develops slowly and is usually without symptoms (3). Some people report feeling very tired and ill with a poor appetite (3). Hepatitis is usually diagnosed with blood tests or liver biopsy and is followed by treatment that is dependent upon on the source of inflammation (3). The good news is that this stage is highly treatable so that the resultant scarring of chronic inflammation, or fibrosis, can be prevented (3).
The immune system acts to repair the damage that is causing hepatitis, but since the liver's ability to process collagen and other substances is hindered, scar tissue builds up faster than it can be broken down and accumulates over time, resulting in fibrosis (4, 9). The functional part of the liver is now left at a disadvantage and has to work extra hard to complete the tasks of the entire organ (4). Fortunately, fibrosis is treatable and can be detected using non-invasive imaging, blood tests or liver biopsy (4). If fibrosis progresses, it can lead to cirrhosis -- a state in which scarring is severe and the flow of blood through the liver becomes restricted (4)
Years of increasing liver fibrosis causes severe damage and can bring on cirrhosis, a condition in which the liver becomes stiff due to nodules surrounded by scar tissue (4, 6, 7, 9). In compensated cirrhosis, the liver is extremely scarred, but can still carry out important tasks and may not have symptoms (4, 6). Small varices, or abnormal veins in the esophagus and stomach may be silently present at this point (6). Compensated cirrhosis turns into decompensated cirrhosis when signs of serious complications begin to show (4, 6, 7). People in the phase often feel tired, nauseous, have a weakened appetite and may bruise easily (7). Complications are treated as they arise until things become so serious that a medical team may consider surgical options (4, 5, 6, 7).
Decompendated Cirrhosis and Liver Failure
Decompensated cirrhosis occurs when there is such significant scarring that the liver can't function properly and fails -- a process known as chronic liver failure that can take place over months or years (4, 5, 6, 7). In this stage, prolonged high blood pressure in the portal vein system causes major complications -- swelling in the abdomen and lower limbs, jaundice, deterioration of brain function, spleen enlargement and hemorrhage (4, 5, 6, 7). Gastrointestinal issues, malnutrition, impaired kidney function and other life threatening issues can surface and the chances of developing liver cancer increase (7). Initial symptoms of liver failure -- tiredness, diarrhea, loss of appetite and nausea -- mimic many common illnesses and make diagnosis difficult (7). More serious symptoms of mental confusion, sleepiness and disorientation warrant immediate medical treatment (7).
Warnings and Precautions
Abnormal swelling, sleep problems, yellowing of eyes or skin, muscle loss, tremors, black or tarry stool and confusion should prompt a call to a liver specialist for the best course of action (4, 6, 7). Seek emergency medical assistance if severe disorientation, drowsiness and confusion occur or in the case of vomit that is bloody or looks like coffee grounds -- when in doubt, call 911 (8). Having an open dialogue with a family doctor about liver disease is important for prevention, early detection and treatment.
- Centers for Disease Control and Prevention: National Vital Statistics Reports
- Merck Manual: Liver Structure and Function
- Merck Manuals: Overview of Chronic Hepatitis
- Hepatology: Textbook and Atlas, 3rd Edition; Erwin Kuntz, et al.
- Hepatology: Now There Are Many (Stages) Where Before There Was One: In Search of a Pathophysiological Classification of Cirrhosis
- The Washington Manual of Outpatient Internal Medicine, 2nd Edition; Thomas M. De Fer, et al.
- Merck Manual: Cirrhosis
- University of Maryland Medical Center: Cirrhosis
- American Liver Foundation: Progression of Liver Disease