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Old 07-31-2008, 09:48 PM   #5
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Re: Questions re: end stages of cirrhosis/what to expect??

Hi again 4jem,

First off, I just wanted to say I'm sorry to hear about your sister in law. Liver disease is a very difficult thing obviously for patients, but also for their families because it's hard to watch a loved one deteriorate like that.

When the liver stops working properly there are two main types of problems that happen. The first type of problem is based on the liver not being able to do its job of detoxifying the blood and building proteins and such. There are many manifestations of this clinically, but the main one is that the liver is not able to breakdown things like ammonia. Ammonia can build up in the blood and cause the patient to be confused and disoriented. One of the ways to try to cut down on this is for the person to take a laxative so that not too much protein is absorbed. The more protein that is absorbed, the more they are broken down and the more ammonia that is produced. The liver also has trouble producing clotting factors so the person has trouble with bleeding.

The second big category of symptoms has to do with the fact that the liver, instead of being a nice spongy type organ that blood can flow through easily, becomes a scarred up hard structure which liquid can't flow through. Because of this, there is a lot of back pressure which causes veins in different parts of the body to swell, but most importantly in the esophagus and in the rectum. The dilated veins, especially the ones in the esophagus can burst and cause life threatening bleeding. The back pressure also results in the seepage of fluid out of the vessels and it ends up collecing in the feet and also especially in the abdomen--it's called ascites.

The thing with end-stage liver disease is that it's either stable, and patients can live for a few years on medical therapy to prevent complications. Unfortunately, it sounds like your sister in law is in a form of "decompensated" liver disease which means that there are symptoms of serious dysfuction such as confusion, bleeding, ascites etc. The biggest reasons for patients with end-stage liver disease to die is either a large variceal bleed (i.e. the rupture of a dilated esophageal vein), or a serious infection.

Unfortunately, once you get to severe decompensated liver disease, there are forms of medical treatment (i.e. banding of varices, antibiotics etc) that can temporarily help, but unless the liver is transplanted (and some patients are too sick for this) there is nothing else that can be done.