The liver, a vital organ located on the right side of the upper abdomen, is the largest and most complex solid organ in the body. When the liver does not function well many body systems are affected. The normal functions of the liver include:
- Metabolic Functions: The liver metabolizes nutrients, breaks down toxins and drugs, and generates glucose for energy.
- Carbohydrates: The liver stores energy in the form of glycogen and generates glucose for energy.
- Fat: The liver has a key role in the metabolism of fat and cholesterol.
- Manufacturing of Proteins: The liver makes essential proteins including albumin, blood clotting factors, hormones, enzymes, and immune factors.
- Bile Production: The liver produces bile that aids in digestion of dietary fat and provides clearance of waste products such as bilirubin.
Many diseases and toxins can cause injury to the liver. These diseases and toxins include infections caused by viruses (such as hepatitis B and C), fatty liver disease, and alcohol. In the long-term, any of these diseases and toxins can cause scar formation in the liver. This scar formation may eventually result in cirrhosis, which is the replacement of the normal liver with scar tissue.
Cirrhosis is a slowly progressive chronic process that may cause no symptoms in the early phase. However cirrhosis causes worsening complications as the disease progresses. These complications of cirrhosis include:
- Ascites: Ascites is fluid build-up inside the abdomen. The fluid accumulation may cause discomfort, pain, and breathing difficulties. Ascites can become infected, a condition called "spontaneous bacterial peritonitis", which requires antibiotic treatment. Ascites may require periodic drainage of the fluid, called paracentesis, or special procedures to help control the fluid.
- Gastrointestinal Bleeding: Cirrhosis changes the normal blood drainage from the stomach and intestines, and can result in the development of abnormally-large blood vessels called "varices" in the esophagus and other locations. Sometimes these varices rupture internally; causing gastrointestinal bleeding (vomiting red blood or black/bloody stools). Treatment procedures are sometimes needed to treat the varices and prevent rupturing.
- Jaundice: When blood cells are broken-down by the body as part of a normal process, the hemoglobin (red pigment) is transformed into bilirubin (yellow pigment). Bilirubin is normally cleared through the bile. In cirrhosis the liver may not clear bile correctly, causing the buildup of bilirubin. Bilirubin build-up results in a yellow color that is best seen in the white part of the eyes. This is called jaundice.
- Hepatic Encephalopathy: When the liver does not clear toxins well, these toxins can build up in the body and cause lethargy, sleepiness, confusion, or even coma. These mental changes in liver disease are called "hepatic encephalopathy". Medications such as lactulose may be required to help control the symptoms of hepatic encephalopathy.
- Primary Liver Cancer: This cancer can develop in livers with cirrhosis. Surveillance for primary liver cancer with either ultrasound or CT scan plus monitoring of a tumor marker called alfa-feto protein (AFP) is required at regular intervals.
- Kidney Problems: When liver disease becomes advanced the kidneys may become affected and kidney function worsens. This may require admission to the hospital for proper treatment and even initiation of dialysis.
- Lung Problems: When liver disease advances, the lungs may be affected with fluid accumulation (hepatic hydrothorax) causing shortness of breath. Impairment of the normal oxygenation called hepatopulmonary syndrome may occur.
Patients with any of these complications of cirrhosis require extensive follow-up and monitoring to control their symptoms and prevent further complications. Our experienced team of liver physicians at the Memorial Hermann Transplant Center individualize transplant and non-transplant treatment plans for patients with advanced liver disease to minimize complications, maximize survival, and improve quality of life.