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Chronic Liver Disease

Chronic liver disease is one of the important causes of morbidity and mortality around the world. Excess alcohol consumption, chronic viral infection and obesity are the leading causes of chronic liver disease. Liver is a unique organ that regenerates quickly, however, progressive long-term damage leads to scarring and eventually to ‘cirrhosis’. In patients with cirrhosis the liver is stiff, shrunken and nodular. Cirrhosis leads to complications such as jaundice, blood vomiting, poor nutrition, confusion, fluid accumulation and liver cancer. Once patients develop symptoms of severe cirrhosis, less than one third of patients will survive for one year.

Symptoms of liver disease:
Liver is a fairly large organ with versatile function. Therefore the diseases affecting the liver may not cause any symptoms until late in the illness where most of the cells are damaged. Some people may feel tired but being a non-specific symptom one may not think about liver disease.

Symptoms of chronic liver disease

  • Loss of appetite
  • Fatigue & weakness
  • Jaundice
  • Blackening of skin
  • Leg swelling
  • Abdominal distension
  • Increased bleeding tendency
  • Blood vomit
  • Black motion
  • Slow speech Confusion episodes
  • Abdominal pain, fever and vomiting due to infection

Signs of liver disease that you may see

  • Muscle wasting
  • Jaundice
  • Ascites
  • Scratch marks
  • Enlarged liver
  • Enlarged spleen
  • Leg oedema
  • Prominent blood vessels on the skin
  • Endoscopy to look for oesophageal varices
  • Hyperpigmentation
  • Low blood sugar

Complications of Chronic Liver Disease

Hepatic Encephalopathy:
Here the patient becomes confused usually due to accumulation of toxins in the brain. Many times the confusion episode worsens and the patient may become frankly comatose. Most patients with hepatic encephalopathy require hospitalization; almost 50% get admitted in the ICU and few of them require incubation to protect the airway. Rarely, patients may develop seizure. Usually, there will be some precipitating event such as infection, constipation or some times sleeping medications, salt imbalance etc. This should be promptly identified and treated.

Ascites:
Ascites is the accumulation of fluid in the abdominal cavity. Most patients also have leg swelling. Most of these patients may not eat properly because of abdominal fullness. If left untreated, this will lead to progressive distension and breathing difficulty. Also, kidneys get affected in the later stages. Ascites can be controlled with salt restriction, water tablets (diuretics). With progression in liver disease, ascites may not respond to the above therapy and most of these patients require liver transplantation. Whilst awaiting transplantation they may require recurrent tapping (draining using a needle) of the fluid or rarely, TIPS

Gastrointestinal Bleeding:

Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. A trained interdisciplinary team consisting of endoscopists, hepatologists, and specialized nurses as well as interventional radiologist should administer treatment of acute bleeding related to portal hypertension.

Acute Kidney Injury:

Acute kidney injury (AKI) is associated with detrimental effect on early survival in hospitalised cirrhotic patients. Due to several hemodynamic modifications, both at the systemic and renal level, induced by cirrhosis, these patients are at increased risk to present acute kidney injury.  Regular monitoring of the renal status in cirrhotic patients is warranted as the occurrence of AKI is associated with an increased risk of long term CKD development.