End Stage Liver Disease

What is End Stage Liver Disease

End Stage Liver Disease (ESLD) is the last stage occurring after cirrhosis, where liver function has deteriorated to the point of irreversible damage. ESLD is used to describe advanced liver disease, liver failure and decompensated cirrhosis. Worldwide, ESLD is a common cause of death and suffering. In 2010, an estimated 1 million patients died of ESLD equating to 2% of all deaths.

Symptoms are necessarily same as of cirrhotic patient, can vary from patient to patient. It is not necessary for every patient to have all the symptoms. Sicker patient would have more symptoms and in more severity. The symptoms include:

  • Jaundice (yellowness of eyes and skin)
  • Fluid accumulation in the abdomen, medically known as ascites
  • Swelling of feet
  • Increased risk of internal bleeding, related to coagulopathy owing to increased prothrombin time/ INR and low platelets and esophageal varices
  • Altered mental status, confusion, increased sleepiness, caused due to increased ammonia

Complications Associated with ESLD:

  • Portal hypertension (increased difficulty in blood flow through the liver due to permanent damage to the liver cells)
  • Ascites (distension of abdomen due to fluid buildup)
  • Spontaneous bacterial peritonitis – Infection in ascitic fluid. The most common bacteria causing infection in ascites, are from patient’s gastrointestinal tract.
  • Hepatic encephalopathy – Deterioration of brain function due to increase in toxins within the body, owing to improper functioning of liver.
  • Gastrointestinal bleeding from esophageal and gastric varices
  • Hepatorenal syndrome is a medical condition in which diseased liver affects the kidney function and can be life threatening
  • Chances of renal failure is more in ESLD patients, owing to diseased liver, fluid shifts, higher chances of infection.
  • Hepatopulmonary syndrome

Treatment:

  • The only real effective treatment for ESLD is liver transplant, as it is impossible to reverse the damage that has already occurred.
  • Other treatments may be done to reduce the patient’s symptoms and complication and help slowing down the worsening of their condition.
  • After transplant, its of utmost importance to take care of the primary cause of the liver disease, if viral infection, it needs to be treated appropriately. Other causes like alcohol, obesity need to be corrected by reducing weight and stopping alcohol.