What is liver disease? What is pancreatic cancer? What are liver tumors

How do I get treatment?

For further information and appointments please see the below contact numbers:

For Mr Rob Hutchins:

020 7234 2940

For the following Consultants:

020 7234 2730

Professor Nigel Heaton
Mr Parthi Srinivasan
Mr Andreas A. Prachalias
Dr Phil M. Harrison
Dr Michael Heneghan

Liver Disease Treatment, London

What is Liver Disease?

Liver disease and failure occurs for a number of reasons. Occasionally the liver stops working because of severe acute damage to the liver (hepatitis or a drug overdose for example) leading to acute liver failure. More often, liver failure occurs due to chronic injury or insult to the liver. This is known as chronic liver disease. The majority of patients undergoing liver transplant assessment at London Bridge Hospital do so as a consequence of development of chronic liver disease and its complications.

Occasionally people can develop cirrhosis through immune damage to the liver (autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis.) There are also some genetic or inherited causes for chronic liver disease including iron deposition in the liver (known as haemochromatosis), copper overload (Wilson’s Disease) and Alpha 1 antitrypsin deficiency. There also are rare occassions when it is not possible to identify the exact cause of liver failure.

Inflammation of the Liver

A patient will more than likely become aware when the liver is inflamed when faced with symptoms including darkened urine and yellowing of the skin, which may also be accompanied by intense itching. This is a condition which needs urgent medical attention and is known as an acute attack of hepatitis.

Any degree of liver inflammation, whether or not it comes from a viral source, is known as hepatitis. Chronic hepatitis occurs when the liver has been inflamed for six months or more leading to fibrosis (which is scar tissue in the liver). Depending on the patient, a fibrotic liver can still function, though not as well as it should, however, treating the inflammation would hopefully prevent further scar tissue formation and may even reverse some of the damage done.

Cirrhosis is the next stage and, contrary to public perception, cirrhosis is not only the prerogative of people who drink too much. Cirrhosis can occur where inflammation and fibrosis have spread throughout the liver changing its shape and function.

An ultrasound may well show that a patient has cirrhosis of the liver, however, the patient may still not have any symptoms. If the cell structure of the liver has been badly damaged and the liver is unable to regenerate or renew, then permanent damage has been caused.

Permanent damage can either lead to liver failure or even liver cancer. The liver - with its many functions deals with all the chemicals and waste products produced by the body, a failing liver finds this function difficult and so the whole body can become gradually poisoned by toxins.

This stage is known as end-stage liver disease and can affect many organs, leading on to multi-organ failure. Unfortunatley death is likely to follow.

Symptoms of Chronic Liver Disease

With the liver behaving as a factory performing a number of functions, when these fail, people can develop significant problems which may show themselves as:

  • Ascites (fluid overload)
  • Coagulopathy (bruising easily and bleeding)
  • Encephalopathy (neuropsychiatric abnormalities) or confusion
  • Fatique (tiredness)
  • Jaundice (yellowing of the skin)
  • Variceal bleeding

The following symptoms and signs seem to be very common in people in the final stages of liver disease, which is known as “end stage liver disease” or cirrhosis:

Ascites

Ascites is fluid accumulation within the abdominal cavity and is a common symptom in people with cirrhosis and end stage liver disease. This occurs because of high pressure within the liver. The liver scarring and the increase in pressure causes fluid to accumulate in the abdomen causing ascites. Fluid in the abdomen is uncomfortable and can cause difficulty in breathing and restrict movement.

Occasionally this fluid can be infected (spontaneous bacterial peritonitis) and treatment with antibiotics may be required. This is a serious complication and can result in death for people with liver disease. Recurrent episodes of infection of this abdominal fluid are an indication for transplantation.

Whilst awaiting transplantation, you may be treated with diuretics (water tablets) to help the fluid pass through your body. Alternatively you may have the fluid drained with a needle (paracentesis). However, this is something that will only be performed if absolutely necessary since there are risks associated with the procedure including bleeding, introduction of infection and occasionally perforation of an organ within the abdomen. Your consultant will tell you more about htis option.

Coagulation

The liver produces factors which help the blood to clot and when the liver is not working well, these factors are not produced and therefore increase the risk of bleeding and bruising. Occasionally, vitamin K may be prescribed to help improve the clotting function.

Bleeding

When high blood pressure (portal hypertension) develops within the veins going to the liver, other veins may open up within the abdomen to help relieve this pressure. These opened veins develop into varices (varicose veins) in the lining of the oesophagus or gullet and stomach. If the pressure becomes very high, these veins can rupture and bleed. This is a serious complication and if you vomit blood or notice a change in the colour of your stools towards black, you must go immediately to your local hospital as black stools could be a sign of bleeding. If you do have variceal bleeding, this can usually be controlled with drugs and endoscopy therapy. To help prevent bleeding, you may be prescribed a drug called Propranolol (Inderal). This drug may cause your blood pressure to fall so it is important that you report any dizziness.

Encephalopathy

Since the liver processes all of the substances which come into the body, if it is not working well, the broken-down products of proteins cannot be processed as efficiently as before, resulting in a build up of ammonia with the blood. When ammonia goes to the brain it can cause confusion. This is called encephalopathy and can be as mild as a feeling of sleepiness during the day or as severe as a coma.

Encephalopathy usually manifests itself through changes in behaviour – either increased aggression or increased fatigue and sleepiness. Occasionally a build up of ammonia can be detected by a sweet smell from the breath. If you are at risk of developing encephalopathy you may be prescribed lactulose. This helps keep the gut clear of excess bacteria and causes loose stools – you should then have two or three loose stools per day. This usually prevents encephalopathy or keeps it under control.

Jaundice

Jaundice occurs when bilirubin, a pigment normally eliminated through the bile accumulates within the blood stream. This is frequently the case when the liver is failing and may result in yellow discolouration to the skin and eyes and in itching which can be very difficult to control.

Sexual function

Both men and women with end stage liver disease and cirrhosis often report problems with sexual function. For men, this can mean reduction in libido or desire, difficulty in obtaining or sustaining erections. This coupled with fatigue and a number of other symptoms, makes life difficult for many patients.

For women, these problems manifest themselves as irregularity or absence of periods or difficulty in becoming pregnant. These symptoms are common for many women with end stage liver disease or cirrhosis. In many women cirrhosis also results in a reduced libido or desire.

Development of liver cancer

If you develop chronic liver disease and cirrhosis, you will have an increased risk of developing liver cancer (hepatocellular carcinoma.) Liver cancer in itself is a valid reason to perform transplantation, however, experience has shown that only people with cancers within a certain size range and that have cancer which is confined to the liver will benefit from liver transplantation.

In general, transplantation is offered to people with either one area of cancer within the liver of no more than 5cm in size or to people with three areas of cancer within the liver, the total volume of which is no greater than 7cm.

People with cirrhosis, particularly that related to viral hepatitis (HBV or HCV) or alcohol are advised to have ultrasound scans of the liver every six or twelve months to screen for hepatocellular carcinoma.

If a patient has liver cancer, he or she will undergo scanning whilst on the waiting list and may be offered some form of treatment to reduce the size or the growth of the tumour.