Decompensated Liver Disease
Facts About Decompensated Liver Disease
In order to understand what happens in decompensated liver disease, you need to understand some of the many functions of the liver and what happens in liver disease. Decompensated when used in this way, really means unstable. Someone can have liver disease for many years, and while they may not be in great health, they are not in immediate risk of liver failure.
This liver is the only organ that has the ability to regenerate itself after it is injured in some way. When the liver is injured repeatedly, but still regenerates, it becomes fibrous in texture. When enough damage has occurred and the liver can no longer repair itself, that is called cirrhosis. At that point, the liver damage is permanent.
The liver makes bile. Bile is necessary to break down fats and therefore a healthy liver is needed for the body to be able to use fat soluble vitamins. The fat soluble vitamins that doctors worry about are A, D, E, and K. Most people with compensated, or stable, liver disease will take supplements of those vitamins in order to avoid deficiencies.
Another major function of the liver is to clean the blood. Blood flows from the spleen through the portal vein to the liver. It then profuses through the liver like water goes through a sponge. If the liver is cirrhotic, it will be too hard and the blood can’t go through it as fast as the body needs. The main chemical that builds up in the blood that causes problems for people is ammonia. Ammonia is mainly created as the body breaks down proteins. When ammonia builds up in the blood of a person with liver disease, they will have a specific type of body odor. The ammonia also is able to cross the blood – brain barrier. A person with too much ammonia in their blood will become, lethargic and confused and this can even lead to coma. This is called hepatic encephalitis.
Another complication of the blood not being able to adequately flow through the portal vein and through the liver (called portal hypertension) is an enlarged spleen. In itself, an enlarged spleen is not a large concern, but as the spleen enlarges it tends to attract platelets and white blood cells. This, and the vitamin K deficiency, will cause the blood to not be adequately able to clot. It also causes the immune system to be compromised. People with an enlarged spleen also need to be careful that they do not take a direct blow to the spleen. A ruptured spleen is a life threatening event.
The human body is an amazing thing and will always try to find a way to make things work. When a person with liver disease has portal hypertension the blood backs up into the spleen. The spleen can only handle so much, but the pressure is still in the portal vein. That’s when the body creates new veins to carry the blood. These are called varices. These veins can be seen on the stomach of someone with severe portal hypertension. They seem to radiate from the belly button and are called caput medusai, because they look the Medusa’s hair. Varices become a concern because they tend to rupture and bleed. The varices that are most likely to bleed are the ones surrounding the esophagus. A bleed of this sort can be massive and life threatening.
Decompensated liver disease is when any of these complications become a problem, or when the complications begin to deteriorate at a fast rate. Many people live with cirrhosis and portal hypertension for years at a time. When a person has decompensated liver disease, the only available medical intervention is a liver transplant. In most cases this will be a cure and many of the complications will disappear. Unfortunately not everyone that is listed for a liver transplant receives an organ in time.