Stages of liver disease and liver failure.

Your liver is a football-sized organ under your ribcage. It is your largest internal organ. Your liver performs many vital tasks, including filtering your blood and helping with digestion.

Sometimes your liver develops a disease. When doctors consider the stages of liver disease, they focus on how widespread and severe the liver damage is. Common causes of liver disease include:

  • Viruses.
  • Excessive alcohol use.
  • Obesity.
  • Autoimmune disease.
  • Genetics.
  • Acute reactions to medications, poisons, or street drugs.

Regardless of your diagnosis, liver damage occurs in predictable stages. The experts at the UPMC Center for Liver Diseases can provide full-spectrum care for all liver-related conditions.

Stage 0: Healthy Liver

According to the American Liver Foundation, your liver performs more bodily functions than any other organ except your brain. Your liver helps keep you healthy by:

  • Helping to digest food.
  • Removing toxins from the blood.
  • Storing energy.
  • Breaking down medications and other drugs.
  • Controlling blood clotting.
  • Fighting infections.

With so many jobs to do, damage to your liver can affect your whole body.

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Stage 1: Beginning of Liver Damage

The first stage of liver disease is usually inflammation of the liver, or hepatitis. When the body tries to heal an infection or injury, inflammation (swelling) results.

When hepatitis continues over time, the result can be scarring in the liver. People with hepatitis often have no symptoms, so they may not seek medical attention. Mild symptoms at this stage can include abdominal pain and swelling.

Your doctor will treat hepatitis based on its type. There are a few things you can do to help yourself heal from any form of hepatitis:

  • Stop drinking alcohol immediately.
  • Avoid taking medications that can damage the liver, including acetaminophen (found in Tylenol® as well as many other over-the-counter and prescription meds).
  • Ask your doctor or pharmacist if any of your current medications increase the risk of bleeding, like preventive aspirin. Your doctor may tell you to discontinue such drugs.

Liver damage from early-stage liver disease is likely to be temporary. That is because the liver can usually heal itself before serious damage has occurred.

Stage 2: Moderate Liver Damage

The second stage of liver disease typically involves fibrosis, the formation of scar tissue in the liver. As scar tissue crowds out healthy liver tissue, your liver may not work as well over time.

As with stage one liver disease, people with stage two liver disease may not feel any symptoms. At this stage, the liver should still be able to heal itself eventually with proper treatment.

Stage 3: Significant Liver Damage

In stage three liver disease, significant damage has occurred. Fibrotic scar tissue has crowded out more of the healthy tissue, making it much harder for the liver to function.

By this time, people with stage three liver disease may notice more symptoms. These include:

  • Low-grade fever.
  • Nausea.
  • Diarrhea.
  • Itchy skin.
  • Joint pain.
  • Jaundice (yellowed eyes or skin).
  • Loss of appetite.

Left untreated, moderate-to-severe fibrosis can lead to cirrhosis and liver cancer. But it still may be possible for the liver to heal at this stage.

Stage 4: Severe Liver Damage (Cirrhosis)

In cirrhosis, liver damage happens faster than the healthy cells can regenerate. People with cirrhosis have much more scar tissue in their livers than healthy tissue. At this point, the liver can barely function.

People with cirrhosis usually have a variety of symptoms, including:

  • Loss of appetite.
  • Fatigue.
  • Nausea.
  • Weight loss.
  • Abdominal pain.
  • Spider-like blood vessels on the skin.
  • Severe itching.

Cirrhosis often leads to serious complications, including:

  • Gallstones.
  • Excessive bruising and bleeding.
  • Internal bleeding.
  • Fluid buildup in the legs (edema).
  • Fluid buildup in the abdomen (ascites).
  • Damage to other organs, especially the kidneys.

Liver cancer is much more likely when you have cirrhosis. People with cirrhosis need to have a doctor screen them for liver cancer regularly.

Goals for treating cirrhosis include preventing more liver damage and treating symptoms and complications.

Liver Failure (End-Stage Liver Disease)

Liver failure, or end-stage liver disease, occurs when the liver can no longer function. Early symptoms of liver failure can include any or all symptoms from the previous stages.

As liver failure progresses, symptoms may include:

  • Confusion.
  • Extreme tiredness.
  • Kidney failure.
  • Coma.

When liver failure occurs gradually, doctors refer to it as chronic liver failure. Acute liver failure occurs suddenly, often in reaction to poisoning or medication overdose. Severe viral hepatitis can also cause acute liver failure.

Sources

American Liver Foundation. The Progression of Liver Disease. Link

American Liver Foundation. The Progression of Liver Disease (brochure). Link

U.S. National Library of Medicine. Medline Plus. Liver Diseases. Link

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