LIVER Disease SYMPTOMS

Liver disease is a broad term describing any single number of diseases affecting the liver. Many are accompanied by jaundice caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; normally, the liver removes bilirubin from the blood and excretes it through bile.

Liver Diseases

• Hepatitis, inflammation of the liver, caused mainly by various viruses but also by some poisons, autoimmunity or hereditary conditions.
• Cirrhosis is the formation of fibrous tissue in the liver, replacing dead liver cells. The death of the liver cells can for example be caused by viral hepatitis, alcoholism or contact with other liver-toxic chemicals.
• Haemochromatosis, a hereditary disease causing the accumulation of iron in the body, eventually leading to liver damage.
• Cancer of the liver (primary hepatocellular carcinoma or cholangiocarcinoma and metastatic cancers, usually from other parts of the gastrointestinal tract).
• Wilson’s disease, a hereditary disease which causes the body to retain copper.
• Primary sclerosing cholangitis, an inflammatory disease of the bile duct, likely autoimmune in nature.
• Primary biliary cirrhosis, autoimmune disease of small bile ducts.
• Budd-Chiari syndrome, obstruction of the hepatic vein.
• Gilbert’s syndrome, a genetic disorder of bilirubin metabolism, found in about 5% of the population.
• Glycogen storage disease type II, the build-up of glycogen causes progressive muscle weakness (myopathy) throughout the body and affects various body tissues, particularly in the heart, skeletal muscles, liver and nervous system.

There are also many pediatric liver disease, including biliary atresia, alpha-1 antitrypsin deficiency, alagille syndrome, and progressive familial intrahepatic cholestasis, to name but a few.

Symptoms of a Diseased Liver

The external signs include a coated tongue, bad breath, skin rashes, itchy skin, excessive sweating, offensive body odor, dark circles under the eyes, red swollen and itchy eyes, acne rosacea, brownish spots and blemishes on the skin, flushed facial appearance or excessive facial blood vessels.

Other symptoms include jaundice, dark urine, pale stool, bone loss, easy bleeding, itching, small, spider-like blood vessels visible in the skin, enlarged spleen, fluid in the abdominal cavity, chills, pain from the biliary tract or pancrea, and an enlarged gallbladder.

The symptoms related to liver dysfunction include both physical signs and a variety of symptoms related to digestive problems, blood sugar problems, immune disorders, abnormal absorption of fats, and metabolism problems.

The malabsorption of fats may lead to symptoms that include indigestion, reflux, hemorrhoids, gall stones, intolerance to fatty foods, intolerance to alcohol, nausea and vomiting attacks, abdominal bloating, and constipation.

Nervous system disorders include depression, mood changes, especially anger and irritability, poor concentration and “foggy brain”, overheating of the body, especially the face and torso, and recurrent headaches (including migraine) associated with nausea.

The blood sugar problems include a craving for sugar, hypoglycaemia and unstable blood sugar levels, and the onset of type 2 diabetes.

Abnormalities in the level of fats in the blood stream include elevated LDL cholesterol, reduced HDL cholesterol, elevated triglycerides, clogged arteries leading to high blood pressure heart attacks and strokes, build up of fat in other body organs (fatty degeneration of organs), lumps of fat in the skin (lipomas and other fatty tumors), excessive weight gain (which may lead to obesity), inability to lose weight even while dieting, sluggish metabolism, protuberant abdomen (pot belly), cellulite, fatty liver, and a roll of fat around the upper abdomen

1. Chest Pain or Chest Discomfort

Few symptoms are more alarming than chest pain. In the minds of many people, chest pain equals heart pain. And while many other conditions can cause chest pain, cardiac disease is so common – and so dangerous – that the symptom of chest pain should never be dismissed out of hand as being insignificant.

“Chest pain” is an imprecise term. It is often used to describe any pain, pressure, squeezing, choking, numbness or any other discomfort in the chest, neck, or upper abdomen, and is often associated with pain in the jaw, head, or arms. It can last from less than a second to days or weeks, can occur frequently or rarely, and can occur sporadically or predictably. This description of chest pain is obviously very vague, and as you might expect, many medical conditions aside from heart disease can produce symptoms like this.

Causes of Chest Pain

When Is Chest Pain Considered an Emergency?

2. Heart Palpitations

Palpitations, an unusual awareness of the heartbeat, is an extremely common symptom. Most people who complain of palpitations describe them either as “skips” in the heartbeat (that is, a pause, often followed by a particularly strong beat,) or as periods of rapid and/or irregular heartbeats.

Most people with palpitations have some type of cardiac arrhythmia — abnormal heart rhythms. There are many types of arrhythmias, and almost all can cause palpitations, but the most common causes of palpitations are premature atrial complexes (PACs), premature ventricular complexes (PVCs), episodes of atrial fibrillation, and episodes of supraventricular tachycardia (SVT).

Unfortunately, on occasion, palpitations can signal a more dangerous heart arrhythmia, such as ventricular tachycardia.

Understanding Heart Arrhythmias

In-Depth: Palpitations

3. Lightheadedness or Dizziness

Episodes of lightheadedness or dizziness can have many causes, including anemia (low blood count) and other blood disorders, dehydration, viral illnesses, prolonged bed rest, diabetes, thyroid disease, gastrointestinal disturbances, liver disease, kidney disease, vascular disease, neurological disorders, dysautonomias, vasovagal episodes, heart failureand cardiac arrhythmias. Because so many different conditions can produce these symptoms, anybody experiencing episodes of lightheadedness or dizziness ought to have a thorough and complete examination by a physician. And since disorders of so many organ systems can cause these symptoms, a good general internist or family doctor may be the best place to start.

4. Syncope (Fainting/Loss of Consciousness)

Syncope is a sudden and temporary loss of consciousness, or fainting. It is a common symptom – most people pass out at least once in their lives – and often does not indicate a serious medical problem. However, sometimes syncope indicates a dangerous or even life-threatening condition, so when syncope occurs it is important to figure out the cause.

The causes of syncope can be grouped into four major categories: neurologic, metabolic, vasomotor and cardiac. Of these, only cardiac syncope commonly leads to sudden death.

Cardiac-Related Syncope

Non-Cardiac Causes of Syncope

Vasomotor Syncope, by far the most common cause of this symptom.

5. Fatigue, Lethargy or Daytime Sleepiness

Fatigue, lethargy or somnolence (daytime sleepiness) are very common symptoms. Fatigue or lethargy can be thought of as an inability to continue functioning at one’s normal levels. Somnolence implies, in addition, that one either craves sleep – or worse, finds oneself suddenly asleep, a condition known as narcolepsy – during the daytime.

While fatigue and lethargy can be symptoms of heart disease (particularly, of heart failure), these common and non-specific symptoms can also be due to disorders of virtually any other organ system in the body. Similar to lightheadedness and dizziness, individuals with fatigue and lethargy need a good general medical evaluation in order to begin pinning down a specific cause.

Somnolence is often caused by nocturnal sleep disorders such as sleep apnea, restless leg syndrome or insomnia. All these sleep disturbances, however, are more common in patients with heart disease.

6. Shortness of Breath

Shortness of breath is most often a symptom of cardiac or pulmonary (lung) disorders. Heart failure and coronary artery disease frequently produce shortness of breath. Patients with heart failure commonly experience shortness of breath with exertion, or when lying flat on their backs. They also can suddenly wake up at night gasping for breath, a condition known as paroxysmal nocturnal dyspnea. Other cardiac conditions such as valvular heart disease or pericardial disease can produce this symptom, as can cardiac arrhythmias.

Numerous lung conditions can produce shortness of breath including asthma, emphysema, bronchitis, pneumonia, or pleural effusion (a fluid accumulation between the lung and chest wall).

If someone is suspected to have a liver disease, the doctor carefully watches the person’s symptoms and conducts a physical examination. Depending on the nature of the symptoms, the doctor may also ask the person to undergo other tests such as a CT scan, liver function test, ultrasound, or liver biopsy. Among the most common liver disease symptoms are jaundice, liver enlargement, cholestasis, liver failure, ascites, portal hypertension and liver encephalopathy.

In jaundice, the levels of bilirubin or bile pigments in the bloodstream become abnormally high leading to a yellow discoloration of the skin and eye whites. Urine often takes a dark color, and other abnormalities are found in the liver cells. In newly born children, jaundice sometimes occurs because of the breakdown of a huge number of red blood cells. Jaundice is more often than not the first sign, and sometimes the only sign, of liver disease.

Cholestasis means diminished or stopped bile flow. The flow may be blocked inside or outside the liver and the symptoms include jaundice, dark urine, pale stool, bone loss, easy bleeding, enlarged spleen or gallbladder, itching, fluid in the abdominal cavity, pain from the biliary tract or pancreas and appearance of small, spider-like blood vessels in the skin. Cholestasis may be caused by alcoholic liver disease, primary biliary cirrhosis, hepatitis, bile duct problems like cancer or narrowing, pancreas cancer or inflammation etc.

When someone’s liver gets enlarged, it usually indicates liver disease, even though there are hardly any symptoms linked with a slightly enlarged liver. If one’s liver is grossly enlarged, its symptom is usually a feeling of discomfort in the abdomen or ‘feeling full.’ Portal hypertension is excessively high level of blood pressure in the portal vein, which supplies the liver with blood from the intestine. Its symptoms include a distended abdominal cavity (ascites), bleeding of the varicose veins at the lower end of the esophagus and in the stomach lining.

Ascites means accumulation of fluid in the abdominal cavity as a result of fluid leaks from the surface of the liver and intestine. Caused usually by liver cirrhosis (especially cirrhosis caused by alcoholism), chronic and alcoholic hepatitis, obstruction of the hepatic vein, ascites has symptoms such as a distended abdominal cavity, which causes discomfort and shortness of breath

Liver encephalopathy occurs when there is deterioration of brain function because of the build-up of toxic substances building up in the blood, which are usually removed by the liver. Liver encephalopathy’s symptoms include impaired consciousness or judgment; alterations in logical thinking, personality, and behavior; confusion; mood swing; drowsiness; sluggish speech and movement, coma, loss of consciousness etc. Liver failure is a disease that occurs when the liver is badly damaged resulting in severe deterioration of liver function. Symptoms of this liver disease include jaundice, tendency to bruise or bleed easily, impaired brain function, ascites, fatigue, poor overall health, nausea, loss of appetite, fatigue, weakness etc.

Any person experiencing one or more of the symptoms mentioned above should immediately consult his doctor as he/she is most probably suffering from a liver disease which needs immediate medical attention. Otherwise, if left untreated, it could well take a serious turn.

The various functions of the liver are carried out by the liver cells or hepatocytes. Currently, there is no artificial organ or device capable of emulating all the functions of the liver. Some functions can be emulated by liver dialysis, an experimental treatment for liver failure.

Each of the lobes is made up of lobules, a vein goes from the centre of each lobule which then joins to the hepatic vein to carry blood out from the liver. On the surface of the lobules there are ducts, veins and arteries that carry fluids to and from them.

Synthesis

1. A large part of amino acid synthesis
2. The liver performs several roles in carbohydrate metabolism:

* Gluconeogenesis (the synthesis of glucose from certain amino acids, lactate or glycerol)
* Glycogenolysis (the breakdown of glycogen into glucose)
* Glycogenesis (the formation of glycogen from glucose)(muscle tissues can also do this)

3. The liver is responsible for the mainstay of protein metabolism, synthesis as well as degradation
4. The liver also performs several roles in lipid metabolism:

* Cholesterol synthesis
* Lipogenesis, the production of triglycerides (fats).

5. The liver produces coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, as well as protein C, protein S and antithrombin.
6. In the first trimester fetus, the liver is the main site of red blood cell production. By the 32nd week of gestation, the bone marrow has almost completely taken over that task.
7. The liver produces and excretes bile (a greenish liquid) required for emulsifying fats. Some of the bile drains directly into the duodenum, and some is stored in the gallbladder.
8. The liver also produces insulin-like growth factor 1 (IGF-1), a polypeptide protein hormone that plays an important role in childhood growth and continues to have anabolic effects in adults.
9. The liver is a major site of thrombopoietin production. Thrombopoietin is a glycoprotein hormone that regulates the production of platelets by the bone marrow.

Liver Breakdown

• The breakdown of insulin and other hormones
• The liver breaks down hemoglobin, creating metabolites that are added to bile as pigment (bilirubin and biliverdin).
• The liver breaks down toxic substances and most medicinal products in a process called drug metabolism. This sometimes results in toxication, when the metabolite is more toxic than its precursor. Preferably, the toxins are conjugated to avail excretion in bile or urine.
• The liver converts ammonia to urea.

Liver Other Functions

• The liver stores a multitude of substances, including glucose (in the form of glycogen), vitamin A (1–2 years’ supply), vitamin D (1–4 months’ supply), vitamin B12, iron, and copper.
• The liver is responsible for immunological effects- the reticuloendothelial system of the liver contains many immunologically active cells, acting as a ’sieve’ for antigens carried to it via the portal system.
• The liver produces albumin, the major osmolar component of blood serum.

Diseases of the liver

Many diseases of the liver are accompanied by jaundice caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; normally, the liver removes bilirubin from the blood and excretes it through bile. There are also many pediatric liver diseases, including biliary atresia, alpha-1 antitrypsin deficiency, alagille syndrome, progressive familial intrahepatic cholestasis, and Langerhans cell histiocytosis to name but a few. Liver diseases may be diagnosed by liver function tests, for example, by production of acute phase proteins.

Liver Regeneration

The liver is the only internal human organ capable of natural regeneration of lost tissue; as little as 25% of a liver can regenerate into a whole liver. This is predominantly due to the hepatocytes re-entering the cell cycle. That is, the hepatocytes go from the quiescent G0 phase to the G1 phase and undergo mitosis. This process is activated by the p75 receptors. There is also some evidence of bipotential stem cells, called ovalocytes or hepatic oval cells, which are thought to reside in the canals of Hering. These cells can differentiate into either hepatocytes or cholangiocytes, the latter being the cells that line the bile ducts.

Liver Transplantation

Human liver transplants were first performed by Thomas Starzl in the United States and Roy Calne in Cambridge, England in 1963 and 1965 respectively. Liver transplantation is the only option for those with irreversible liver failure. Most transplants are done for chronic liver diseases leading to cirrhosis, such as chronic hepatitis C, alcoholism, autoimmune hepatitis, and many others. Less commonly, liver transplantation is done for fulminant hepatic failure, in which liver failure occurs over days to weeks.

Liver allografts for transplant usually come from non-living donors who have died from fatal brain injury. Living donor liver transplantation is a technique in which a portion of a living person’s liver is removed and used to replace the entire liver of the recipient. This was first performed in 1989 for pediatric liver transplantation. Only 20% of an adult’s liver (Couinaud segments 2 and 3) is needed to serve as a liver allograft for an infant or small child.

More recently, adult-to-adult liver transplantation has been done using the donor’s right hepatic lobe which amounts to 60% of the liver. Due to the ability of the liver to regenerate, both the donor and recipient end up with normal liver function if all goes well. This procedure is more controversial as it entails performing a much larger operation on the donor, and indeed there have been at least 2 donor deaths out of the first several hundred cases. A recent publication has addressed the problem of donor mortality, and at least 14 cases have been found. The risk of postoperative complications (and death) is far greater in right sided hepatectomy than left sided operations.

With the recent advances of non-invasive imaging, living liver donors usually have to undergo imaging examinations for liver anatomy to decide if the anatomy is feasible for donation. The evaluation is usually performed by multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI). MDCT is good in vascular anatomy and volumetry. MRI is used for biliary tree anatomy. Donors with very unusual vascular anatomy, which makes them unsuitable for donation, could be screened out to avoid unnecessary operations.