Although there are a lot of conditions that can lead to someone in Anamosa and elsewhere needing end of life care, liver disease is fairly high on the list.
According to the Lancet, liver disease is the third most common cause of death among working people. But it is also a health condition that doesn’t necessarily lead to more people needing hospice care, in some cases because they don’t know about it in time.
The team at Above and Beyond Home Health Care and Hospice are happy to educate members of the Eastern Iowa community about different care options whatever their condition and however much time they’ve been told they have.
Advanced liver diseases are unique. Some people may be diagnosed with an end-stage condition but placed on a transplant list. However, these lists can be long, candidates may not be in good health for transportation, so in many cases, people pass away before they are able to be connected with a donor.
They may be already in poor health due to a failing liver or other chronic health conditions and may have already received multiple hospitalizations. But they also may not have been told about hospice programs in their area.
Studies have shown that patients with liver problems often learn about hospice options too late, and would likely benefit more from these services and have a better quality of life if they began them earlier. In comparison, patients with other end-of-life conditions like cancer are hospitalized less but learn about hospice options sooner.
Liver failure
Livers can break down for a number of reasons, from infections and disease like hepatitis to trauma to lifestyle conditions such as chronic alcohol use. As one of the body’s key tools for dealing with toxins, eventually, it can grow weaker and become more damaged.
As a liver declines, it reaches a stage called “decompensated cirrhosis,” a condition that presently can’t be reversed and is fatal, unless a donor’s liver is transplanted.
Cirrhosis is a condition where scar tissue replaces healthy liver tissue, a process that can take years, even decades. Eventually, the surface of the liver becomes so scarred that the entire organ becomes smaller and it doesn’t function well.
As the liver breaks down, it also affects how toxins are managed in the body, so an imbalance in one area can lead to other negative health conditions.
Palliative care
Patients with liver-related health conditions are encouraged to look into palliative care, which is a medical philosophy where the patient’s quality of life is focused on more than treatment methods that are risky or may not have great odds.
It often can involve helping a patient with effective pain management methods rather than more painful treatments, and in some cases, letting them receive treatments at home rather than remaining in a more stressful clinical environment like a hospital or medical center.
Hospice care is one example of a type of palliative care, but some palliative care efforts may also lead to recovery or perhaps may give someone with a failing liver enough time to make it to the top of an organ transplant list.
Awareness of palliative care as an option has been increasing in several areas of medicine in the last decade.
Part of the reason for a growing interest in palliative care is due to more attention to treatment options for end-stage liver disease.
The Liver Foundation said palliative care can provide relief from pain and allow you to continue daily life. It will also make you feel more in control of your health and personal health decisions, and also reduce physical and mental stresses, everything from nausea to general anxiety.
Not every patient is aware that they can request palliative care early in their medical treatment plan, and some providers either forget, don’t know much about it, or may want to continue fighting using aggressive treatment methods.
Depending on your community, declaring “I want to consider palliative care options” can often activate a team of health care professionals familiar with these types of care options. These can include doctors, nurses, social workers, and others.
The palliative team can discuss what’s happening with you, your family, your provider, your caregivers and any other medical officials who have worked with you. They also can discuss your health goals and objectives and give suggestions on how to get there.
While “a complete recovery” might be a long shot for someone with advanced liver disease, they can learn different options available at this point of their life, including seeking a transplant, trying to heal without a transplant, trying other medical solutions such as surgery, or focusing on spending your final days with family members and other loved ones.
Your provider is welcome to be part of the palliative care team of experts but there are also other experts available. However, having someone familiar with you, your liver condition and general medical history may be able to provide useful insight.
Liver Awareness
This month is a great opportunity to learn more about liver conditions, current research and the importance of early detection. October is L iver Cancer Awareness Month, which is a type of cancer that’s increasing while many other types are decreasing.
When the liver is failing, time is of the essence. At the Center for Liver Diseases at the University of Chicago Medicine, we have a team of highly experienced specialists dedicated to helping adults with liver failure. When liver failure is suspected, we work together to recommend the best approach for you or your loved one.
Whenever there is a treatment for the cause of your liver failure, we will start that treatment immediately. However, in many cases, the definitive treatment for liver failure is a liver transplant. Unlike kidney failure where dialysis can be used to do the function of the kidney, there are no machines available yet to replace the work of the liver.
To determine whether you or your loved one is a candidate for a transplant, we have a fast-tracked, comprehensive evaluation protocol for patients in liver failure. Every member of our team is alerted to the urgency of your situation, and we rapidly conduct all the necessary tests and evaluations, which can be completed in two to three days in the inpatient setting. Our patients who are candidates can get on the waitlist faster and, therefore, receive an organ sooner.
Learn more about the liver transplant process.
What is liver failure?
Liver failure means your liver is shutting down or has shut down. The liver handles a number of important functions in the body, including getting rid of harmful substances, producing proteins that allow for adequate clotting, and making bile, which is needed to digest food.
When the liver is failing, it can no longer complete these vital tasks. As a result, the body does not work properly. As liver failure progresses, you may experience some or all of the following symptoms:
- Jaundice, or yellow eyes and skin
- Confusion or other mental difficulties
- Swelling in the belly, arms or legs
- Severe fatigue
- A tendency to bleed easily
What is the difference between acute and chronic liver failure?
Liver failure can develop slowly or rapidly, depending on the cause and the condition of the liver.
Chronic liver failure: The most common type of liver failure is chronic, which can take months or years to develop. Chronic liver failure is a slow decline in liver function that occurs alongside cirrhosis, or severe scarring of the liver. Cirrhosis may be caused by excess alcohol intake, hepatitis, nonalcoholic fatty liver disease, bile duct diseases and various hereditary conditions.
At UChicago Medicine, our liver disease team helps hundreds of patients a year with cirrhosis. We focus on controlling or slowing the progression of cirrhosis with lifestyle changes, medicines and other treatments.
Over time, however, cirrhosis can slowly lead to a decline in liver function and, ultimately, liver failure. We perform periodic testing to monitor the health of your liver so we will know if and when your liver begins to fail. Once cirrhosis progresses to liver failure, the definitive treatment is a liver transplant.
Acute liver failure: When liver failure develops rapidly, typically over days to a few weeks, it is known as acute liver failure. This form of liver failure is rare and often happens in people who have never had previous liver problems. Causes of acute liver failure include:
- Taking too much acetaminophen or combining acetaminophen with alcohol use
- Hepatitis (A, B and autoimmune)
- Ingesting toxins, such as poisonous mushrooms
- Unexpected liver toxicity from medications
- Certain diseases, including Budd-Chiari syndrome and Wilson’s disease
Acute liver failure is considered a medical emergency. Patients suffering from acute liver failure are monitored in our state-of-the-art intensive care units. Treatment will depend on the cause of your underlying liver failure. Medications may help treat hepatitis, acetaminophen overdoses, poisonings and other causes. If treatment is not effective, you or your loved one will be evaluated for a possible liver transplant.
Acute-on-chronic liver failure: Sometimes people with chronic liver failure who are clinically stable suddenly develop rapid progression of the liver failure. There are various causes for the rapid worsening of the liver function, including an infection, drinking some alcohol despite having a cirrhotic liver or ingesting medications that may unexpectedly harm the liver.
What treatments are available for liver failure?
Patients with acute-on-chronic liver failure may see their livers fail over weeks to months, compared to months to years as is typical in chronic liver failure.
As with acute liver failure, we focus first on treating the underlying cause of sudden liver failure before considering a possible liver transplant.
In many cases, the only treatment for liver failure is a liver transplant. However, liver failure is sometimes brought on by an acute or hereditary cause that can be treated. For instance, when liver failure is caused by ingesting too much acetaminophen (an over-the-counter pain reliever), we will use medicine to counteract the effects of this common drug to reduce liver damage. When liver failure results from a hereditary copper-overload disease, we will use medications to remove the copper out of the body. Or when liver failure is precipitated by an infection in patients with cirrhosis, we will use antibacterial medicines to fight the infection to, hopefully, return the liver to its previous functional state.
An innovative liver dialysis machine to help treat liver failure
The Molecular Adsorbent Recirculating System (MARS) is a liver dialysis machine used in the treatment of liver failure to enable native liver regeneration. It removes protein-bound and water-soluble toxins from the blood and reduces the amounts of toxins that reach the brain. The MARS system helps prevent irreversible organ failure and improves liver regeneration and recovery. UChicago Medicine is the only center in the Chicagoland area to offer this complex medical therapy.
What are the early signs of liver damage?
Early on, liver damage may not cause any symptoms. A failing liver is usually detected with blood tests. Over time, you may notice jaundice and other symptoms highlighted above.
What is the difference between liver failure and cirrhosis?
Liver failure is when the liver has shut down or is shutting down. Cirrhosis is a late stage of liver disease where the liver is severely scarred but may still be able to perform its function to support life. When the liver is no longer able to perform its work adequately, its goes into liver failure. Most patients who develop chronic liver failure have underlying cirrhosis. Liver disease can go through these stages:
- Inflammation: Increased activity of the immune system in the liver, leading to swelling of the liver
- Fibrosis: Early scarring that can follow inflammation in the liver
- Cirrhosis: Severe scarring of the liver that accumulates with prolonged inflammation and typically cannot be reversed
- End-stage liver disease: Little to no liver function (often called liver failure)
Can a damaged liver repair itself?
A liver with no cirrhosis has a high capacity to regenerate itself. If patients follow treatment recommendations, their livers can regain normal function. Treatment often involves adopting healthy behaviors, such as reducing alcohol intake for people with alcoholic liver disease or weight reduction for those with nonalcoholic fatty liver disease that is precipitated by excess weight.
However, once cirrhosis develops, there’s little chance that the liver can repair itself.
How do I know if my liver function is worsening?
One of the ways we determine if your liver is failing is through blood tests, which helps us determine your MELD score, or Model for End-Stage Liver Disease score. We look at four lab results:
- Bilirubin, which tells how well your liver is expelling bile
- Creatinine, which reflects the kidney function, an organ that is affected by liver failure
- INR or prothrombin time, which measures the function of blood-clotting factors produced by the liver
- Sodium, which is an electrolye in the blood that is affected by advanced liver disease
Your MELD score will range from 6 to >40. The worse your liver function, the higher your MELD score will be, and the higher your risk of death. The MELD score is also used to determine a person’s priority on the transplant list, with sicker patients receiving higher priority. The MELD score can be calculated using a programmed equation.
With access to leading therapies and state-of-the-art technologies, our liver disease specialists work together to provide personalized care for each patient.
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