Signs of End-Stage Alcoholic Liver Disease

Gillian May
Photo by Steven HWG on Unsplash

End-stage alcoholic liver disease, or otherwise known as decompensating cirrhosis, is when the liver has tipped its balance and can no longer function properly. For some people, this can cause very rapid death. But for others, it can be a chronic condition that impedes the quality of life considerably.

What many don’t understand about alcoholic liver disease is that you can live decently with only a small percent of liver functioning. The liver is good at compensating for liver cells that have died or become too scarred to work well. This means that a person can continue living normally with about 25–30% of their liver functioning according to one study.

However, once the liver falls below that 25–30%, problems start to happen. The quality of life and ability to survive depends on how many healthy liver cells remain. Unfortunately, if the percentage is too low, death may be imminent. If there is still a small percentage left, a person may continue to live for a few months to a few years, albeit with considerable discomfort and disability.

The other thing people don’t understand is that the by-products of a failing liver have an impact on other critical organs like the kidneys, brain, and cardiovascular system. Once the liver begins to fail, these by-products can cause a cascade of events that speed up liver failure and cause other critical organs to fail as well. However, with treatment, (and so long as there is enough liver cells left) these by-products can be kept to a minimum and extend the life of the individual for a few more years.

Below, we will look at the signs of end-stage alcoholic liver disease. These signs happen to both those people who progress to death quickly as well as those who live with chronic liver failure. It should be noted that the survival rate for end-stage alcoholic liver disease can range between a few months and five years.
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Swelling in the abdomen

End stage alcoholic liver disease causes blood proteins to decrease which increase fluid build-up outside of the cells. This fluid gets retained in the abdomen (called ascites) and can also fall into the legs and feet. Abdominal swelling often requires regular drainage to decrease pain and discomfort.

Hepatic encephalopathy

This is perhaps the most uncomfortable symptom that also considerably decrease quality of life. A failing liver causes an increase in by-products like ammonia and bilirubin. These by-products are toxic to the brain and can cause dementia-like symptoms. Liver failure can also affect the rest of the nervous system outside of the brain as well leading to nerve pain, problems with balance, muscle control, and emotions.

Hepato-renal syndrome

As mentioned above, the by-products of a failing liver can be toxic to important organs. Unfortunately when the liver fails, the kidneys also fail alongside it. This is because substances like bilirubin and ammonia are also toxic to the kidneys. But also, problems with fluid balance and impairments to the kidneys blood supply from a failing liver, can also lead to kidney dysfunction.

Portal hypertension

The portal vein is responsible for the blood supply to the liver. When the liver becomes scarred and unable to function properly, blood can’t flow through the liver. This causes a back-up of blood in the upper abdomen and thoracic area. The back up of blood increases blood pressure and causes blood vessels to bulge around the esophagus, stomach, and heart. Often these blood vessels can burst causing serious bleeding.

Spontaneous bleeding

As stated above, portal hypertension can increase the likelihood of bleeding. However, there’s another reason why bleeding also occurs in end-stage alcoholic liver disease. The liver helps create blood clotting products. When the liver is too damaged to function properly, these clotting properties decrease, which increases the possibility of spontaneous bleeding.

Chronic nausea and anorexia

The liver is a big part of the digestive process. It creates bile and other products that help aid in the breakdown and absorption of food and nutrients. It also helps clear toxins and medications. When the liver isn’t functioning properly it can’t fulfill its functions in digestion very well, which creates chronic nausea, sometimes vomiting, and lack of appetite leading to weight loss. Also, if it can’t filter out toxins and cope with medications, these build up in the body causing further nausea.

These are the most important and problematic signs of end-stage alcoholic liver disease. When these signs are present, it means the liver is not functioning well enough to sustain a good quality of life. People with alcoholic liver disease that have progressed to these signs often die quickly. But if the liver still has a little functioning a person can survive a few years with these signs being a constant chronic issue.

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I'm a former nurse turned freelance writer. I have extensive experience in administration, frontline care, and education in mental health, public health, and geriatrics. However, after 20 years, I needed a change and always wanted to write. I have personal and family experience in mental health and addictions, so I'm passionate about advocacy and education in those areas. I'm also a traveler, photographer, and artist. I funnel all my various expertise into my writing and hope to provide valuable content that is entertaining and educational. Join my email list if you want to read more of my work - I also have a book on Alcoholic Liver Disease coming out in 2021.


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