Liver Failure: When a Versatile Organ Can’t Keep Up

The liver is a vital and fascinating organ. Unlike the kidneys, where we have dialysis or the lungs, where we have ventilators, there is no replacement therapy for a failing liver. The only possible replacement treatment for a failed liver is a transplant.

There is a long list of tasks in the liver’s job description. It helps detoxify and modify chemicals that enter our body, including food, medications and other substances. The liver is one of the ways that outside dangers are made safe when they enter the body. The liver is essential in vitamin conversion, energy storage and other basic functions.
Bile, a green substance that is stored in the gall bladder, is made by the liver. Bile is important in the digestion of fats, and it takes waste products from the liver and carries them into the intestines for final delivery outside of the body.

Many diseases can attack the liver, leading to decreased function. Usually, the final common pathway to liver failure is cirrhosis of the liver. The word “cirrhosis” means a fibrotic scarring of the liver from an inflammatory or toxic process. The most common causes of cirrhosis of the liver in the United States (according to Medscape) are chronic hepatitis C infection (26%), alcoholic liver disease (21%), chronic hepatitis C with alcoholic liver disease (15%), miscellaneous causes (15%) and unknown causes (18%). It turns out that many of the “unknown causes” are fatty liver disease, an accumulation of fat, mainly in obese patients, that irritates and scars the liver.

According to the Centers for Disease Control and Prevention (CDC), about 4.5 million adult Americans have liver disease, with approximately 45,000 dying annually. National Institute of Diabetes and Digestive and Kidney Diseases estimates that one in 400 Americans has cirrhosis of the liver.

When the liver’s function begins to diminish, patients may experience several things. If bilirubin, a liver product, accumulates, the skin may turn yellow, a condition known as jaundice. Sometimes the skin will itch intensely due to bile salt accumulation. Liver scarring will lead to elevated pressures in the blood vessels that traverse the liver. The increase in pressure can cause bulging varicose veins in the esophagus that are prone to rupture, sometimes leading to catastrophic bleeding. Cirrhosis can also cause fluid accumulation in the abdomen, called “ascites.”

The build-up of ammonia and other toxic wastes can lead to a confused state, called “hepatic encephalopathy.” Since the liver makes clotting factors, patients with cirrhosis are prone to bleeding.

Finally, cirrhosis of the liver can lead to hepatocellular carcinoma (HCC), a cancer originating in liver cells. It is quite rare for a person without cirrhosis to develop HCC.

There is no liver machine that can replace the function of the liver. In patients with cirrhosis, treatments aim to decrease fluid accumulation, move wastes out of the body and reduce the pressure in the liver’s blood vessels. In the case of esophageal hemorrhage, endoscopic procedures can help stop bleeding.

When symptoms like swelling, fatigue, trouble breathing, bleeding, confusion, itching, low mood and insomnia cannot be controlled with standard medications and other treatments, palliative care may be considered. Elizabeth Palliative Care is an integral part of the services offered at The Elizabeth Hospice. This medical approach provides patients relief from the symptoms, pain and stress of chronic conditions like liver failure. Working with your primary care physician and other physicians, the palliative care team offers an added layer of support.

The palliative team will facilitate discussions about care goals with patients, family members, doctors, nurses and others. This is an opportunity for everyone to assess what is working, what is not working, what is helping, and what is causing more harm than good. Sometimes, people realize that they do not want to go to the hospital anymore but want to continue aggressive treatments at home and in the doctor’s office.

Some end-stage liver patients reach a point where the burdens of disease-modifying treatments are too great to bear, or they find that the treatments are futile. Hospice care from The Elizabeth Hospice, focusing on relieving symptoms, is an excellent option for them. As the largest nonprofit hospice provider in San Diego County and Southwest Riverside County, we offer a comprehensive program that goes beyond managing symptoms and relieving pain. We become our patients’ trusted companions and customize the comfort care experience to meet their unique needs and wants. Our focus is not on the illness but on embracing experiences that bring meaning and joy to a person’s life.

The Elizabeth Hospice provides all the necessary durable medical equipment, like walkers, hospital beds and bedside commodes, as well as hospice-related medicines. Each patient is placed under the care of an interdisciplinary team comprised of a hospice doctor or nurse practitioner, registered nurse case manager, social work, home health aide and spiritual counselor. The team will customize the treatment plan because we know that no two people are alike. The two things that are highlights of all plans are compassion and the highest quality of care.

Our team brings expertise, compassion and innovation to all the patients and families we treat. Patients will literally be able to breathe more easily, and family members will have the freedom to relax and be loving family members, with the burdens of planning many of the details of nursing and medical care lifted off their shoulders. To find out how your loved one who has been diagnosed with liver failure can benefit from palliative care or hospice care, contact The Elizabeth Hospice at 800.797.2050.

By George Delgado, MD, Chief Medical Officer, The Elizabeth Hospice