Liver Disease: Causes and Stages

Definition

End-stage liver disease (ESLD) refers to the advanced stage of liver disease, characterized by severe liver dysfunction and failure.

Causes

• Cirrhosis: Scarring of the liver tissue, leading to loss of liver function
• Hepatitis B and C: Viral infections causing inflammation and liver damage
• Alcoholic liver disease: Chronic alcohol consumption leading to liver damage and scarring
• Non-alcoholic fatty liver disease (NAFLD): Build-up of fat in the liver, leading to inflammation and scarring
• Other causes: Autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis

Pathophysiology

Liver Function Impairment

• Decreased detoxification: Impaired clearance of toxins and bilirubin
• Decreased protein synthesis: Impaired production of albumin and clotting factors
• Decreased metabolism: Impaired breakdown of nutrients and hormones

Portal Hypertension

• Increased blood pressure in the portal vein: Caused by scarring and cirrhosis
• Development of portosystemic shunts: Abnormal connections between the portal vein and other blood vessels
• Esophageal varices: Dilated blood vessels in the esophagus, prone to bleeding
• Ascites: Fluid accumulation in the abdominal cavity

Hepatic Encephalopathy

• Impaired brain function: Caused by accumulation of toxins in the blood
• Ammonia toxicity: Increased levels of ammonia in the blood, contributing to encephalopathy
• Cognitive impairment: Confusion, disorientation, and altered mental status

Malnutrition and Wasting

• Decreased nutrient absorption: Impaired digestion and absorption of nutrients
• Increased energy expenditure: Increased metabolic rate due to liver disease
• Muscle wasting: Loss of muscle mass and strength

Complications

• Spontaneous bacterial peritonitis: Infection of the ascitic fluid
• Hepatorenal syndrome: Kidney failure due to liver disease
• Liver cancer: Increased risk of hepatocellular carcinoma in ESLD patients

Definition

• End-stage liver disease (ESLD) is the advanced stage of liver disease, characterized by severe liver dysfunction and failure.

Causes

• Cirrhosis causes ESLD by scarring liver tissue and leading to loss of liver function.
• Hepatitis B and C viral infections cause ESLD by inflaming and damaging the liver.
• Alcoholic liver disease causes ESLD by damaging the liver and leading to scarring due to chronic alcohol consumption.
• Non-alcoholic fatty liver disease (NAFLD) causes ESLD by building up fat in the liver, leading to inflammation and scarring.
• Other causes of ESLD include autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis.

Pathophysiology

Liver Function Impairment

• Decreased detoxification impairs clearance of toxins and bilirubin.
• Decreased protein synthesis impairs production of albumin and clotting factors.
• Decreased metabolism impairs breakdown of nutrients and hormones.

Portal Hypertension

• Portal hypertension increases blood pressure in the portal vein due to scarring and cirrhosis.
• Portosystemic shunts are abnormal connections between the portal vein and other blood vessels.
• Esophageal varices are dilated blood vessels in the esophagus prone to bleeding.
• Ascites is fluid accumulation in the abdominal cavity.

Hepatic Encephalopathy

• Hepatic encephalopathy impairs brain function due to toxin accumulation in the blood.
• Ammonia toxicity contributes to encephalopathy due to increased levels of ammonia in the blood.
• Cognitive impairment causes confusion, disorientation, and altered mental status.

Malnutrition and Wasting

• Decreased nutrient absorption impairs digestion and absorption of nutrients.
• Increased energy expenditure increases metabolic rate due to liver disease.
• Muscle wasting causes loss of muscle mass and strength.

Complications

• Spontaneous bacterial peritonitis is an infection of the ascitic fluid.
• Hepatorenal syndrome is kidney failure due to liver disease.
• Liver cancer increases the risk of hepatocellular carcinoma in ESLD patients.

Definition and Prevalence

• End-stage liver disease (ESLD) is characterized by severe liver dysfunction and cirrhosis.
• ESLD is a leading cause of morbidity and mortality worldwide, with an estimated 1 million deaths annually.

Pathophysiology

Liver Cirrhosis

• Cirrhosis is a late-stage consequence of chronic liver injury, resulting in fibrosis and scarring.
• Hepatic stellate cells are activated, leading to collagen deposition and fibrosis.
• Cirrhosis disrupts liver architecture, impeding blood flow and impairing liver function.

Portal Hypertension

• Portal hypertension occurs when the portal vein is obstructed, leading to increased blood pressure.
• Causes of portal hypertension include cirrhosis, portal vein thrombosis, and hepatic veno-occlusive disease.
• Complications of portal hypertension include esophageal varices, ascites, and hepatic encephalopathy.

Hepatic Encephalopathy

• Hepatic encephalopathy is a neuropsychiatric disorder caused by liver dysfunction.
• Toxins, such as ammonia, accumulate in the bloodstream, affecting brain function.
• Symptoms of hepatic encephalopathy include confusion, altered mental status, and coma.

Coagulopathy

• Coagulopathy is a bleeding disorder caused by liver dysfunction.
• Liver produces clotting factors, which are impaired in ESLD.
• Symptoms of coagulopathy include easy bruising, bleeding, and petechiae.

Renal Dysfunction

• Hepatorenal syndrome is a complication of ESLD, characterized by renal failure.
• Causes of hepatorenal syndrome include liver dysfunction, circulatory dysfunction, and nephrotoxicity.
• Symptoms of hepatorenal syndrome include oliguria, azotemia, and electrolyte imbalance.

Malnutrition

• Malnutrition is a common complication of ESLD, caused by impaired digestion and absorption, increased energy expenditure, and decreased protein synthesis.
• Consequences of malnutrition include muscle wasting, weakness, and impaired immune function.

Other Complications

• Infections, such as spontaneous bacterial peritonitis, pneumonia, and urinary tract infections, can occur in ESLD patients.
• Malignancy, specifically hepatocellular carcinoma, is a complication of ESLD.
• Osteoporosis, characterized by bone loss and fractures, can also occur.

Clinical Features

• Symptoms of ESLD include fatigue, jaundice, pruritus, and abdominal pain.
• Signs of ESLD include ascites, edema, and encephalopathy.
• Laboratory findings in ESLD include elevated liver enzymes, bilirubin, and ammonia levels.

Learn about the advanced stages of liver disease, including its causes such as cirrhosis, hepatitis, and fatty liver disease. Understand the effects of liver dysfunction and failure.