Liver Disease :: Progression and Prognosis

Because of the graphic conversation in this video, we warn you this content does discuss bleeding and vomiting (14:14).  Hearing about these things can be upsetting for some, so this video or parts of the video may not be content for you. There are multiple causes of liver damage and we do not review those causes here.  By the time your disease process has reached "end stage", the diagnosis that caused the Liver decline has been determined. Many Hospice agencies will accept patients while waiting on a Transplant List as oftentimes patients die before a liver is available for them. Patients have higher quality of life with improved function from the help and education they receive from Hospice. When the liver has been damaged to the point where it is no longer able to regenerate, there are very few remaining liver cells that are able to function.  Some liver blood test results may actually appear to have normalized.  Therefore, there are other tests that physicians use to evaluate the liver, including: Albumin, Total Protein, Ammonia level, and International Normalized Ratio. The liver makes proteins, some for building muscle and repair of tissues, and especially proteins that work with your blood to form blood clots. Also the liver Detoxifies the body and blood.  When the liver is not working the patient can have elevated toxins, such as Ammonia resulting in Altered Mental Status and confusion.  Patients with confusion may be diagnosed with encephalopathy.  This is a very scary phrase to be told. Patients may have muscle wasting of extremities and even in their face.  Edema in the legs and fluid collection in the abdomen (Ascites) is very common.  Removing the fluid can be done by various methods.  Medications early in the process will help, but the fluid in the abdomen may need to be drained.  When ascites is drained, it can alleviate some symptoms of fullness, that maybe is causing shortness of breath, but this causes other issues that need to be removed on an ongoing basis.  Taking the fluid out can rob the body of vital proteins and electrolytes.  

Trigger Warning:  Development of Varicose Veins is a worrisome sign.  These often develop in atypical places: esophagus, on the surface of the abdomen, and around the rectum.  Sometimes patients can have bleeding from the veins.  We already know that the liver is not making the clotting proteins well and to have bleeding from the varicose veins that is difficult to stop, can result in a catastrophic bleeding event and sometimes patients die from these events.
Being prepared and accepting the help that is available is encouraged because this will help you live the best life you can at the highest level of function.  Accepting help provides for a longer life as has been proven in multiple studies.  We strongly recommend that you have a Palliative Physician to help guide and support you and that you at least try hospice even if you later decide this service does not meet your needs.  Please let us know of any questions or concerns by either emailing us a private message or leaving a general comment below.  

0:00 Warning and Disclaimer
0:33 Introduction Liver disease prognosis
2:02 various causes of End Stage Liver Disease
4:07 a few Liver blood tests
6:40 INR
7:30 Waiting for a Transplant
8:12 high Ammonia level and Confusion
9:10 Liver not making Protein
11:02 Ascites and the risks of removing it
13:50 other little warning hints
14:14 Varicose Veins and Liver Disease
16:10 Planning for disease progression
17:30 removing fear of the unknown
18:00 Non-judgemental Care
18:50 Summary

Trigger Warning:
If the discussion of death, dying, or the end of life process is bothersome to you, this channel is not for you. If you are made uncomfortable by the discussion of health, hospice, palliative medicine, the end of life process, or medical terminology, you may be made uncomfortable by this video.

You Only Die Once is a virtual place for sharing information, both facts and opinions, about the end of life process. Dr. Bohn and Dr. Tartaglia are both actively practicing osteopathic physicians. Both are dual boarded in family medicine and hospice and palliative medicine. You Only Die Once intends to provide a casual environment to share information about hospice and palliative medicine for the patient, the family, and the practitioner. This channel is not intended to provide medical advice, but rather as an educational resource to allow patients, providers, and families to make informed decisions.

You Only Die Once is created by Dr. Sara Bohn and Dr. Lisa Tartaglia.
You Only Die Once is produced and edited by Auburn Huhmann.

[cathydale]

Thank you for such a clear, concise, informative video

[benshearrow]

I was recently diagnosed with Fatty Liver Disease, Hienal Hernia and Esaphagitis. I was suffering with vomiting and GERD. I am finding that the root cause was my diet and lack of exercise. Now after 1 and 1/2 weeks of cutting out carbs, bread, baked goods, fried foods and sweets and eating more Salmon, Cod, broccoli, I am already feeling much better. My stomach bloating has been reduced significantly. I didn’t realize that when your stomach has a lot of inflammation, it can expand into the diaphragm and presss up against your heart. I was also having shortness of breath related to all of this. If you have Liver disease and like me not from Alcohol, seek help to see how you can help reverse the damage naturally.

[sheilabrennan]

I wish I had you tube 20 years ago, you both explained so much . I was 30 lbs overweight but very active having 4 children, allshe said me was be cautious on how much you eat and I am not a drinker

[paulamaguire]

Thank you for your very interesting and clear video. I am currently going through this with my husband. He has been a heavy drinker for over 30 years. He was hospitalised twice in 2021 with bleeding varices. He did not quite drinking. He has continuous health issues and has that sunken face, eye sockets and muscle wastage. He somehow will not connect this to alcohol in his mind and stop. I understand that none of this is good 😢

[Peglegweb]

Thanks very much for the info! Nicely explained/detailed

[donnasanford]

It is a horrible way to die. My sister-in-law went through this. It was devastating.

[lisajohnson]

My special-needs 23-year old son was diagnosed recently with benign tumors in his liver and the MRI stated these were Focal Nodule Hyperplasia. My son is non-, verbal and we have no communication with him.
I would love to know what to expect for him as I'm very concerned.

[ganeshshinde]

Can portal hypertension devlope in alcoholic fatty liver and alcoholic hepatitis ?

[dolliemaesone]

My specialist told me the first day I wasn’t eligible for a transplant due to age and health.

[katlee-reeve]

2018 cryptogenic cirrhosis due to Prednisone.