End Stage Liver Disease
Article Date: 3/4/2004

The liver has an amazing ability to function even in an advanced state of
hepatitis C (HCV) infection.

However, ongoing infection may eventually damage the liver so severely that it
slowly loses the ability to provide the functions necessary for life.

In previous articles, we have reviewed how the hepatitis C virus infects the
cells of the liver, causing inflammation. This inflammatory process causes
specialized cells in the liver to begin forming scar tissue, a condition called
fibrosis.

Eventually, scar tissue distorts the structure and function of the liver,
resulting in cirrhosis. Although cirrhosis is a serious health issue, many
people with cirrhosis live long lives and may have few symptoms of liver
disease.

As long as the patient's health status is stable, their cirrhosis is said to be
"compensated."

Unfortunately, cirrhosis can cause very serious symptoms in some patients, such
as jaundice, ascites and edema, bleeding and mental confusion.

When these conditions develop, the patient is said to have "decompensated"
cirrhosis.

The development of decompensated cirrhosis signals the onset of end-stage liver
disease, which is also called chronic liver failure.

End-Stage Liver Disease / Liver Failure

There are two forms of liver failure.

Acute Liver Failure. Also called Fulminant Hepatic Failure, this condition can
develop very rapidly, in days or weeks. Common causes of acute liver failure
include:

Exposure to toxic chemicals


Ingestion of poisonous mushrooms (Amanita Phalloides)


Hepatotoxic drugs, such as an overdose of acetaminophen; or an interruption
of blood flow to the liver


Simultaneous infection (coinfection) by hepatitis A and C viruses, or
hepatitis B and D viruses

Acetaminophen does not appear to damage the liver when ingested as prescribed,
even when cirrhosis is present. However, when taken in large amounts, or with
alcohol, it can cause massive liver damage and lead to acute liver failure.

Chronic Liver Failure. Also known as end-stage liver disease (ESLD), this
condition usually develops slowly, over years to decades. Not everyone with
hepatitis C infection will develop end-stage liver disease.

Diagnosing End Stage Liver Disease

Physicians can determine that a patient has ESLD months or years in advance. The
diagnosis is based on symptoms, in addition to laboratory studies. The signs
are very similar to advanced cirrhosis, and may include:

Jaundice (yellowing of the skin)


Ascites (swelling of the abdomen due to fluid accumulation)


Edema (swelling of the extremities)


Changes in laboratory values (ALT, AST, Bilirubin, and other common liver
tests)


Encephalopathy (confusion, stupor or coma)


Bleeding abnormalities


Malnutrition.

Not everyone who becomes infected with hepatitis C will develop these advanced
complications. According to the Centers for Disease Control and Prevention, of
every 100 persons infected with HCV:

75 to 85 persons may develop long-term infection


70 persons may develop chronic liver disease


15 persons may develop cirrhosis over a period of 20 to 30 years


Less than 3 percent of persons may die from liver cancer or cirrhosis.

Sources

Herrera J. Hepatitis Open Forum, March 2, 2004. The Hepatitis Neighborhood.
http://www.hepatitisneighborhood.com/

Canio J. Understanding Acute Liver Failure.
http://www.ucdmc.ucdavis.edu/transplant/

Liver Failure. Merck Manual, Section 10, Chapter 135. http://www.merck.com/

Viral Hepatitis C - Frequently Asked Questions. Centers for Disease Control and
Prevention.





Sandra Tara Balduf (Ane)

Frontline Hepatitis Awareness

Support for patients and educational materials

http://frontline-hepatitis-awareness.com

1-866-Hep-GoGo 866-437-4646




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