Liver diseases of some kind affect one in ten Americans. End stage liver disease is the seventh most common cause of death in those between the ages of 25 and 65. The liver is a vital organ and a robust one, a healthy liver being able to regenerate itself if damaged, unlike many other organs of the body. It helps with or is central to many bodily functions including the digestion of food, especially fats, protein manufacture, storage of nutrients, and processing of vitamins and the metabolism of medications.
The term “liver” literally means “that which lives,” and shows that from ancient times, people have understood how vital the organ is; in fact, before the advent of modern medical science many people believed that the liver rather than the brain was the organ of thought. They were wrong about that, but not wrong in recognizing the importance of the liver.
Most serious liver diseases, including cirrhosis and cancer of the liver, are ongoing, progressive diseases that go through recognizable stages. “End stage” liver disease, or ESLD, is a term used to refer to any liver disorder that has progressed to the point where hepatic function is very severely impaired and the damage is extensive, irreversible, and quite likely fatal.
Life Expectancy And Prognosis
Prognosis of end stage liver disease is very poor and life expectancy is not promising. Although treatments for the common symptoms do exist, when the disease reaches its end stage the damage cannot be undone and the liver can no longer regenerate itself. Barring the receipt of a liver transplant, the likelihood of survival for five years with ESLD is low.
Symptoms
While liver diseases can be asymptomatic in earlier phases, ESLD always exhibits symptoms, normally quite severe ones. Symptoms can include:
Ascites, a bloating of the abdomen as fluid accumulates due to hepatic dysfunction (often a painful condition and one that interferes with breathing by putting pressure on the abdomen).
Hepatic encephalopathy, a nerve and brain condition resulting from the buildup of toxins in the blood as the liver’s blood-
Portal hypertension, a result of constriction of the blood vessels through the liver, causing blood vessels in other parts of the digestive system to hyper-
Hepatorenal syndrome, a failure of the kidneys secondary to increased toxins in the blood due to hepatic dysfunction, again a potentially fatal complication.
In addition, patients with ESLD also often exhibit many of the symptoms of earlier stages of liver disease, such as jaundice, abdominal swelling, and chronic abdominal pain.
Treatment
Depending on exactly what is causing the liver failure, various treatments may be undertaken. If liver cancer is present, or hepatitis, treatments specific to those diseases will be undertaken. In all cases, patients should eliminate alcohol consumption (even if alcohol is not the primary cause of the liver disorder), and may need to make other dietary changes such as a low-
Medications and other treatments to remove contaminants from the blood may be used. In case of severe ascites, use of a needle to extract abdominal fluid under local anesthesia may be necessary periodically.
The only “cure” for end stage liver disease is a liver transplant. There is considerable risk involved in this procedure but improvements in recent years have raised the success rate to nearly 90%. However, a long waiting list exists and the availability of donor organs is not great.
There may be a wait of as long as three years, depending on blood type and other factors, and the problem may be keeping the patient alive long enough for a transplanted organ to become available.