8 Warning Signs of a Dying Liver.

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A saying liver can be a consequence of either acute liver failure or chronic liver failure (liver cirrhosis).

Acute liver failure is different from acute hepatitis (acute liver inflammation). Most cases of acute hepatitis resolve without significant liver damage.

However, a small subset of acute hepatitis may progress to acute liver failure.

Acute and chronic liver failure means progressive liver damage.

The common warning signs of a dying liver include jaundice, skin bruising, altered conscious level (hepatic encephalopathy), swollen belly and limbs, bleeding, and severe muscle wasting.

Today, You will learn about the warning signs of a dying liver. In summary, the most important symptoms include:

  • Jaundice: especially if persistent over weeks (in acute liver failure) or progressive (with liver cirrhosis).
  • Skin bruising and easy bleeding.
  • Ascites (swollen belly due to fluid collection).
  • Lower limb edema (swelling).
  • Gastrointestinal bleeding (passage of tarry black stool or vomiting of blood).
  • Itchy skin.
  • Severe muscle wasting.

1. Jaundice.

Jaundice refers to yellowish discoloration of your skin and eye whites. Jaundice is a sign of significant liver injury. Bilirubin is the chemical substance that is responsible for jaundice development.

An increase in bilirubin levels in the blood can occur as a result of simple acute hepatitis (such as acute hepatitis A) or a failing (dying) liver.

Also, Jaundice occurs as a result of the conditions such as:

  • Obstruction of your bile ducts by a gallstone or tumor.
  • Destruction of red blood cells (a type of anemia called hemolytic anemia).

So, Not every jaundice is a sign of a dying liver. It can be a temporary condition that can be reversed.

Jaundice is a sign of a dying liver when it is persistent for weeks or months or associated with other signs of acute liver failure such as hepatic encephalopathy.

2. Skin brushing and easy bleeding.

Your liver is responsible for synthesizing some coagulation factors that prevent bleeding.

People with acute or chronic liver failure may have skin bruises, rashes, and easy bleeding.

Your doctor will diagnose the condition by laboratory tests such as:

  • Prothrombin time, concentration, and International Normalized Ratio (INR) levels.
  • Platelet count.

The affection of these lab results is an indicator of poor liver function.

3. Swollen belly (ascites).

People who get a diagnosis of liver cirrhosis may stay quite normal for several years.

However, as cirrhosis progresses with time, liver function deteriorates.

The development of ascites (a collection of fluid within the spaces of the abdomen) is a sign of advanced liver cell failure (dying liver).

The 2-year death rate in people with cirrhotic ascites is about 50% (reference).

4. Swollen Lower limbs.

Swollen lower limbs on both legs are also a sign of a failing liver. The swelling of the limbs occurs when the liver fails to manufacture a protein called (albumin).

Albumin helps prevent fluid flow out of your blood vessels to the subcutaneous areas.

Bilateral lower limb edema often starts in the foot. As the severity of liver failure progress, the edema progresses upwards to the legs, things, and even the lower abdomen and the back.

The more severe the edema, the more severe the liver condition. Edema of the lower limbs and ascites can occur due to other diseases such as kidney diseases and right-sided heart failure.

5. Black stool (melena)/vomiting of blood.

The failing liver often leads to a condition called (esophageal and gastric varices). In these conditions, dilated veins form in the esophagus and the stomach walls.

Eventually, These vessels may rupture spontaneously and cause significant bleeding in the stomach.

The blood in the stomach either passes through the stool and appears as a (jet-black, sticky, loose stool) or vomiting as reddish or dark clots.

The passage of black tarry stools is called (melena), while the vomiting of blood is called (hematemesis).

Both melena and hematemesis are signs of saying liver in patients with advanced liver cirrhosis. Melena and hematemesis are severe life-threatening complications.

People with melena or hematemesis should seek emergency medical help as soon as possible.

6. Altered conscious level (hepatic encephalopathy).

Hepatic encephalopathy is a group of neurological and psychiatric symptoms that affect people with liver cell failure.

Hepatic encephalopathy is a result of the profound failure of the liver function in both:

  • Acute fulminant liver failure (as with paracetamol toxicity or complicated acute viral hepatitis).
  • Chronic end-stage liver cirrhosis.

Hepatic encephalopathy is a sign of a dying liver. The one-year survival rate after the first attack of encephalopathy is only 42% (reference).

Hepatic encephalopathy has four different grades (reference):

 

HE GradeSymptoms
Grade I– Behavioral changes.
– Sleep disturbances (inverted sleep rhythm).
– Difficulty in concentration.
– Mild confusion/sluggish reactions.
Grade II– Lethargy (lack of energy)
– Moderate confusion.
– Disorientation.
Grade III– Sleepy most of the time (but can be aroused).
– Marked agitation and occasional aggression.
Grade IV– Coma (sleepy and cannot be aroused).

The first attack of hepatic encephalopathy is a warning sign that the liver is saying. The more profound and frequent the attacks, the more damage the liver.

In acute liver cell failure (fulminant hepatic failure), encephalopathy develops within eight weeks of the onset of symptoms. Therefore, encephalopathy is considered a sure sign of fulminant hepatic failure (dying liver).

7. Itchy skin.

Itchy skin is a very common symptom. The most common cause of itchy skin is allergic skin diseases.

However, itchy skin can be a warning sign of liver damage in a subset of people.

Itching occurs due to the increase in bile salts in your body. It can occur due to liver conditions such as ICP (intrahepatic cholestasis of pregnancy) or acute liver failure.

Consider itchy skin as a sign of liver damage when you have other warning signs of liver damage such as jaundice, swollen limbs, skin bruises, etc.

8. Severe muscle wasting.

Sarcopenia is a medical term that describes the decrease in muscle mass.

Sarcopenia or muscle wasting occurs in patients with liver cirrhosis (chronic liver cell failure).

Cirrhotic patients begin to lose their muscles (in limbs and muscles of the face). Consequently, patients with advanced liver damage have significant cachexia.

Patients with cirrhosis and sarcopenia die earlier than cirrhotic patients without sarcopenia.

One study assessed the survival rate of patients with cirrhosis (with and without sarcopenia), and the results were as follows (reference):

  • Patients with cirrhosis without sarcopenia lived an average of 34 months.
  • While patients with cirrhosis and sarcopenia liver only 19 months on average.