Your liver is a large and powerful organ that performs hundreds of essential functions in your body. One of its most important functions is filtering toxins from your blood. While your liver is well-equipped for this job, its role as a filter makes it vulnerable to the toxins it processes. Too many toxins can overwhelm your liver’s resources and ability to function. This can happen temporarily or over a long period of time.
When healthcare providers refer to liver disease, they’re usually referring to chronic conditions that do progressive damage to your liver over time. Viral infections, toxic poisoning and certain metabolic conditions are among the common causes of chronic liver disease. Your liver has great regenerative powers, but constantly working overtime to restore itself takes its toll. Eventually, it can’t keep up.
What are the stages of chronic liver disease?
While causes and types may vary, the progression of the disease and damage that occurs is similar. Liver disease can generally be broken down into four stages ranging from minor to severe.
Stage 1: Inflammation or hepatitis
In the early stages, the liver will become swollen or inflamed as the body’s natural response to injury. Liver inflammation, or hepatitis, can also occur when there are more toxins in the blood than the liver is able to manage.
The earlier the diagnosis, the better. This is especially important because the liver is able to repair itself in the early stages of disease. However, many people do not experience symptoms during the first stage and are unaware of the damage as a result.
Stage 2: Fibrosis
Untreated inflammation leads to scarring of the liver, or fibrosis. This hinders the liver’s abilities, as it can restrict blood flow through the organ.
Once healthy liver cells are replaced by scar tissue, those parts of the liver cannot be repaired on their own. If detected early enough, though, fibrosis is still treatable. Because this stage is still mild to moderate, many people will still not experience symptoms.
Stage 3: Cirrhosis
Cirrhosis refers to severe, irreversible scarring of the liver. There can be several years—decades, even—between the second and third stages of disease, so act early if you have any reason to suspect you are at risk.
During this stage of disease, symptoms become more noticeable: pain and discomfort, fatigue, appetite loss, fluid retention, jaundice, and an itchy feeling around the liver. Those with cirrhosis are also more susceptible to developing liver cancer.
Stage 4: Liver Failure
When the liver stops functioning altogether, this refers to liver failure: the final stage of disease. At this stage, the liver cannot be repaired on its own or with treatments; a liver transplant is the only option for recovery.
Liver failure can be acute or chronic. Acute liver failure happens quickly (within 48 hours), generally as a reaction to toxicity or a drug overdose. Chronic liver failure, on the other hand, happens gradually over time as the liver progresses through each of the four stages.
Symptoms of liver failure include diarrhea, weight loss, appetite loss, confusion, and disorientation.
Because symptoms of disease in the liver are either nonexistent or can also be indicators of other health issues, it may not always be properly diagnosed. For early detection and prevention, it’s a good idea to get regular blood tests.
Your liver performs many important functions, supporting many different body systems. When these begin to fail, you’ll notice the effects throughout your body. For example, you might notice:
- General toxicity, feeling ill, tired, foggy or confused.
- Toxins interfering with your brain, nerves and motor functions.
- Digestive difficulties, malabsorption and malnutrition.
- Reduced blood clotting, easy bleeding and bruising.
- Reduced immunity and frequent infections.
Diagnosis
Tests and procedures used to diagnose acute liver failure include:
Blood tests
Blood tests are done to determine how well your liver works. A prothrombin time test measures how long it takes your blood to clot. With acute liver failure, blood doesn’t clot as quickly as it should.
Imaging tests
Your health care provider may recommend an ultrasound exam to look at your liver. Such testing may show liver damage and help determine the cause of your liver problems. Your provider may also recommend abdominal computerized tomography (CT) scanning or magnetic resonance imaging (MRI) to look at your liver and blood vessels. These tests can look for certain causes of acute liver failure, such as Budd-Chiari syndrome or tumors. They may be used if your provider suspects a problem and ultrasound testing is negative.
Examination of liver tissue
Your provider may recommend removing a small piece of liver tissue (liver biopsy). Doing so may help your provider understand why your liver is failing. Since people with acute liver failure are at risk of bleeding during biopsy, a transjugular liver biopsy may be performed. This procedure involves making a tiny incision on the right side of your neck. A thin tube (catheter) is then inserted into a neck vein, through the heart and into a vein exiting the liver. A needle is then threaded through the catheter to retrieve a sample of liver tissue.
Liver failure treatment
Liver failure is a complex syndrome requiring intensive care, liver transplant facilities, and prompt treatment, along with diagnostic workup, to prevent complications. Depending on the cause, liver failure can be treated by:
Medications
Antidote for NSAIDS overdose
Antivirals for hepatitis viruses induced liver failure
Steroids for autoimmune induced liver failure
Antibiotics for mushroom poisoning
Surgical interventions
Liver transplant
Endoscopic band ligation and injection sclerotherapy
Trans jugular intrahepatic portosystemic shunt (TIPS)