Liver Complications after Bariatric surgery.
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Types of liver complications after bariatric surgery.
1. Transient elevation of liver enzymes.
After bariatric surgery, the transient elevation of liver enzymes (SGPT and SGOT) is the most frequent liver dysfunction of liver dysfunction.
Often, the elevation is temporary and improves after a few weeks of the operation.
Rarely, the elevation may become severe, leading to acute hepatitis and the risk of acute liver failure.
In addition, The elevation may become persistent for months or years.
2. Permanent elevation of liver enzymes.
Elevated liver enzymes can become persistent for years (chronic hepatitis). This carries a risk of liver damage, and it can predispose to liver failure years later.
Elevated liver enzymes can be a result of fatty liver. Fatty liver or non-alcoholic fatty liver disease (NAFLD) is very common among obese patients.
Elevated liver enzymes due to the fatty liver are often present before surgery. However, the new elevation of liver enzymes after surgery can be due to various other factors (explained in the next section).
Work with your doctor to define the cause of permanently elevated liver enzymes after surgery.
Persistent elevation of the liver enzymes should be treated to protect your liver from damage.
3. Acute liver failure.
Acute liver failure in the first 30 days after bariatric surgery is very rare nowadays.
Previously, it was as high as 10% due to a specific type of bariatric surgery called (Jejunoileal bypass). Fortunately, doctors abandoned this operation nowadays.
symptom of liver failure include:
- Yellowish discoloration of eye whites and the skin.
- Dark (tea-colored) urine.
- Right upper abdominal pain.
- Generalized fatigue.
- As the inflammation continues, loss of consciousness may occur, with lower limb and abdominal swelling.
Call your doctor immediately if you experience tea-colored urine or yellow eye whites.
4. Chronic liver damage and liver cirrhosis.
Liver damage can lead to chronic liver failure (liver cirrhosis). This can be a result of untreated chronic hepatitis or chronic malnutrition.
Liver cirrhosis symptoms include:
- Jaundice (yellow skin, eye whites, and dark urine).
- Ascites (swelling of the abdomen).
- Lower limb swelling (edema).
- Loss of consciousness or confusion (hepatic encephalopathy).
- Vomiting of blood.
- Passage of dark stool (melena).
- Loss of weight and loss of appetite.
5. hyperammonemic encephalopathy (without liver cirrhosis).
Another rare complication of the Roux-en-Y bariatric surgery. The patients experience symptoms typical for hepatic encephalopathy without having liver cirrhosis.
We don’t fully understand why this happens, but nutritional deficiencies such as zinc and albumin and elevated ammonia may cause it.
Jaundice can develop due to acute or chronic liver failure. Also, it can be a result of bile duct obstruction by a stone.
Patients who undergo bariatric surgery lose weight rapidly. Unfortunately, rapid weight loss increases the risk of gallstones. Eventually, gallstones can cause acute cholecystitis or slip and obstruct the bile ducts.
Causes liver dysfunction after bariatric surgery?
Liver dysfunction after bariatric surgery is not rare. The most common is the transient elevation of liver enzymes (SGPT, SGOT).
Acute liver failure and liver cirrhosis is rare but significant complication.
We currently don’t fully understand the causes of liver dysfunction after bariatric surgery.
Several theories explain the injury:
- Lipotoxicity: the rapid weight loss after the operation leads to excess Free Fatty Acids (FFA). Too much FFAs lead to toxic effects on the liver and may cause damage to the liver.
- Bile acid overload: Bile acid gets absorbed back from the intestine into the liver due to the bypass. The excess of bile can also produce liver dysfunction.
- Malnutrition: Severe malnutrition leads to a deficiency of antioxidants, and other protective factors lead to liver dysfunction.
- Bacterial overgrowth in the digestive tract: bacterial toxins cause inflammation and damage of the liver cells.
- Poor success of the bariatric surgery (no significant loss of weight: Loss of weight improves fatty liver inflammation. When the operation fails, severe liver inflammation may continue and cause liver dysfunction.
- Pre-operative factors: the degree of obesity, the degree of fatty liver, and the older age increase liver dysfunction risk.
- Also, If you have any other liver diseases before the surgery may contribute.