Symptoms of Liver Failure

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The symptoms of liver failure are often attributable to renal impairment and / or blockage of blood flow or the bile.

General Considerations

In the early stages, liver disease may escape to an early detection. General symptoms of liver failure include:

Fatigue

Weight loss

Nausea

Anorexia

Fever

SPECIFIC SYMPTOMS OF LIVER FAILURE

With the advancement of the disease, and with the deterioration of liver function, symptoms of liver failure become more specific:

Jaundice

Cholestasis

Enlargement of the Liver

Neurological symptoms

Gastrointestinal symptoms

Dermatological disorders

Hormonal Disorders

Liver Jaundice is an important clinical manifestation of suffering impairment. It consists of a yellowing of the skin, sclera (the white around the iris of the eye) and mucous membranes, which is due to deposition of bilirubin in these tissues.

Jaundice occurs because when the liver is not able to process the bilirubin, which then accumulates in the circulating serum exceeding the normal values, ranging 3 and 17 mmol / L (hyperbilirubinemia).
Jaundice, however only becomes apparent when the serum bilirubin exceeds the value of 40 mmol / L.
Jaundice may be associated with the presence of stools, clay-colored (due to the decrease of bile pigment eliminated by the liver in the gut) and dark urine (the increase of bilirubin from the blood that passes in urine). Moreover, a person with jaundice may complain of itching of the skin, even if this occurs more commonly in chronic cholestasis.

Cholestasis: bile is an aqueous solution produced by the liver composed of bile salts, conjugated bilirubin, electrolytes, protein, cholesterol, phospholipids and mucus. It helps digestion and facilitate both the absorption of dietary fats and fat-soluble vitamins and the elimination of toxic substances and drugs.
Bile is produced by the liver, and is concentrated in the gallbladder before being poured into the duodenum (the upper small intestine). Cholestasis in the flow of bile from the liver to the duodenum is reduced or blocked as a result of mechanical obstruction of the bile ducts, so the bilirubin accumulates in the blood.

The characteristic symptoms of cholestasis are derived mainly from the effects of high concentrations of serum bilirubin (jaundice, dark urine, feces hypochromic and itching of the skin).
The stool may also contain high concentrations of fat (steatorrhea), given the lack of bile in the intestine, which normally allows the digestion and absorption of dietary fats. A prolonged cholestasis can lead to reduced absorption of vitamin D (required for the production of bone tissue) and K (necessary for blood clotting), causing damage at the level of bone tissue and an increased tendency to bleed.

The enlargement of the liver, is a typical sign of liver disease, but many people with liver disease may have a liver of normal size or even reduced.
The enlargement of the liver produces a feeling of discomfort and sometimes a feeling of fullness. If the volume increase is rapid, the liver can present a serious decline on palpation.

With the accumulation of toxic substances in the blood, patients may experience drowsiness, dizziness, slow in speech and movements. Disorientation is common.

Gastrointestinal symptoms of liver failure: because of the accumulation of fluid in the abdominal cavity (ascites) the abdomen can become stretched causing considerable discomfort to the patient.

Dermatological symptoms of liver failure: itching and scratching are symptoms often associated with hyperbilirubinemia. The spider naevi are small spider-shaped red pigment, visible on the skin of the trunk, face, forearms and hands, which typically disappear when pressed. They are often present in individuals with cirrhosis and may be due to increased concentrations of circulating estrogen (due in turn to decreased clearance and metabolism of these hormones by the liver).
The palmar erythema is a reddening of the palms and fingertips and may be due to salt and water retention in patients with liver cirrhosis. Are also possible opaque coloring of the skin and the formation of lipid deposits in the skin (xanthelasma), in addition to abrasions and injuries due to constant itching, scratching in chronic cholestasis.

Haematological disorders: various hematologic abnormalities may occur at the beginning of liver failure.
Coagulation disorders are common and complex, and they can lead to an increased tendency to bleed.

Hormonal Disorders( symptoms of liver failure): damage to the liver may cause hormonal imbalances. The female patients may have secondary amenorrhea and reduced fertility. The males may show atrophy of the testicles, impotence and feminization caused by a reduced synthesis of testosterone, in addition to increased conversion of circulating testosterone to estrogen. If the ability to catabolize insulin is compromised, you can observe an increase in insulin.

Fibrosis Damage or inflammation of the liver parenchyma triggers a process called fibrogenesis. It is a dynamic process that is supposed to help limit the extent of inflammation. Fibrosis is characterized by the deposition of collagen and other extracellular matrix proteins and their organization in complex molecules. These molecules are insoluble, causing a reversal of the structure impairment. Therefore, although fibrosis is a first time, beneficial because it reduces the extent of inflammation, may become a pathological process when the infection or the damage continue. In chronic hepatitis, fibrosis begins around the portal and extends gradually into the lobules towards the central veins, with formation of membranes and "bridges" fibrosis.

Cirrhosis: among the different symptoms of liver failure, the final stage of fibrosis is cirrhosis, characterized by extensive fibrosis and nodular regeneration of liver parenchyma. Cirrhosis causes irreversible damage to the architecture of the lobules, with diffuse fibrous bands of scar tissue surrounding nodules of regenerating hepatocytes. Cirrhosis may be asymptomatic for years, but eventually may lead to progressive weight loss, fatigue, chronic jaundice, bleeding from rupture of esophageal varices, intractable ascites and portosystemic encephalopathy. Death may occur as a result of hemorrhage, hepatic coma, infection of the abdominal cavity or kidney failure. Patients with cirrhosis are also at risk of developing hepatocellular carcinoma. Cirrhosis is the culmination of many common diseases of the liver, since the inflammation and cellular necrosis at the end lead to a framework of fibrosis, or scarring. Chronic viral hepatitis, autoimmune diseases and those diseases caused by alcoholism are the predominant cause of cirrhosis in developed countries. Viral infection can be diagnosed by specific laboratory testing, suitable for the determination of antigens or antibodies. The cirrhosis from alcoholism may be suspected after a history that confirms a chronic consumption of alcohol. A biopsy may be helpful in evaluating the different etiologies of cirrhosis, but, even in some patients is not possible to go back to a certain cause (cryptogenic cirrhosis). Cirrhosis can also be caused by metabolic disorders (Wilson disease, hemochromatosis and alpha1-antitrypsin deficiency, which can all be diagnosed through laboratory tests or liver biopsies), or toxic substances (diagnosed through a history time evaluation of the use of drugs and environmental or industrial exposure to toxic substances, and enforcement of specific drug tests).

Hepatic failure: liver failure is a condition caused by complications due to systemic dysfunction of the liver.
The decompensated liver failure can lead to multi-organ failure, including kidney. Mortality exceeds 50%. It can occur in the absence of preexisting liver disease, or may overlap with chronic liver disease.
The signs and symptoms of liver failure include: jaundice, a tendency to hemorrhage, ascites, hepatic encephalopathy and impaired general health status. In cases of acute liver failure, a patient may move from a state of good health to a state much compromise in a few days, while chronic insufficiency can progress gradually to be exacerbated by a traumatic event (eg bleeding from varices oesophageal).

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