Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Patients with cirrhosis may have few or no symptoms and
signs of liver disease.
Some of the symptoms may be nonspecific, that is, they don't suggest that the
liver is their cause. Some of the more common symptoms and signs of cirrhosis
include:
Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the
blood
As cirrhosis of the liver becomes severe, signals are
sent to the kidneys to retain salt and water in the body. The excess salt and
water first accumulates in the tissue beneath the skin of the ankles and legs
because of the effect of gravity when standing or sitting. This accumulation of
fluid is called edema or pitting edema. (Pitting edema refers to the fact that
pressing a fingertip firmly against an ankle or leg with edema causes an indentation in the skin that
persists for some time after release of the pressure. Actually, any type of
pressure, such as from the elastic band of a sock, may be enough to cause
pitting.) The swelling often is worse at the end of a day after standing or
sitting and may lessen overnight as a result of the loss of the effects of
gravity when lying down. As cirrhosis worsens and more salt and water are
retained, fluid also may accumulate in the abdominal cavity
between the abdominal wall and the abdominal organs. This accumulation of fluid
(called ascites
) causes swelling of the abdomen, abdominal discomfort, and increased
weight.
Spontaneous bacterial
peritonitis (SBP)
Fluid in the abdominal cavity (ascites) is the perfect
place for bacteria to grow. Normally, the abdominal cavity contains a very small
amount of fluid that is able to resist infection well, and bacteria that enter the abdomen (usually
from the intestine) are killed or find their way into the portal vein and to the
liver where they are killed. In cirrhosis, the fluid that collects in the
abdomen is unable to resist infection normally. In addition, more bacteria find
their way from the intestine into the ascites. Therefore, infection within the
abdomen and the ascites, referred to as spontaneous bacterial peritonitis or
SBP, is likely to occur. SBP is a life- threatening complication. Some patients
with SBP have no symptoms, while others have fever, chills,
abdominal pain and tenderness, diarrhea, and worsening ascites.
Bleeding from esophageal
varices
In the cirrhotic liver, the scar tissue blocks the flow of blood returning to
the heart from the intestines and raises the pressure in the portal vein (portal
hypertension). When pressure in the portal vein becomes high enough, it causes
blood to flow around the liver through veins with lower pressure to reach the
heart. The most common veins through which blood bypasses the liver are the
veins lining the lower part of the esophagus and the upper part of the stomach.
As a result of the increased flow of blood and the resulting increase in
pressure, the veins in the lower esophagus and upper stomach expand and then are
referred to as esophageal and gastric varices; the higher the portal pressure,
the larger the varices and the more likely a patient is to bleed from the
varices into the esophagus or stomach.
Bleeding from varices usually is severe and, without immediate treatment, can be
fatal. Symptoms of bleeding from varices include vomiting blood (the vomitus can
be red blood mixed with clots or "coffee grounds" in appearance, the latter due to
the effect of acid on the blood), passing stool that is black and tarry due to
changes in the blood as it passes through the intestine (melena), and
orthostatic dizziness or fainting (caused by a drop in blood pressure especially
when standing up from a lying position).
Bleeding also may occur from varices that form elsewhere
in the intestines, for example, the colon, but this is rare. For reasons yet unknown, patients
hospitalized because of actively bleeding esophageal varices have a high risk of
developing spontaneous bacterial peritonitis.
Hepatic encephalopathy
Some of the protein in food that escapes digestion and
absorption is used by
bacteria that are normally present in the intestine. While using the protein for
their own purposes, the bacteria make substances that they release into the
intestine. These substances then can be absorbed into the body. Some of these
substances, for example, ammonia, can have
toxic effects on the brain.
Ordinarily, these toxic substances are carried from the intestine in the portal
vein to the liver where they are removed from the blood and detoxified.
As previously discussed, when cirrhosis is present, liver cells cannot function
normally either because they are damaged or because they have lost their normal
relationship with the blood. In addition, some of the blood in the portal vein
bypasses the liver through other veins. The result of these abnormalities is
that toxic substances cannot be removed by the liver cells, and, instead, the
toxic substances accumulate in the blood.
When the toxic substances accumulate sufficiently in the
blood, the function of the brain is impaired, a condition called hepatic encephalopathy. Sleeping during the day rather than at night (reversal of the
normal sleep pattern) is among the earliest symptoms of hepatic encephalopathy.
Other symptoms include irritability, inability to concentrate or perform
calculations, loss of memory,
confusion, or depressed levels of consciousness. Ultimately, severe hepatic
encephalopathy causes coma and death.
The toxic substances also make the brains of patients
with cirrhosis very sensitive to drugs that are normally filtered and detoxified
by the liver. Doses of many drugs that normally are detoxified by the liver have
to be reduced to avoid a toxic buildup in cirrhosis, particularly sedatives and
drugs that are used to promote sleep. Alternatively, drugs may be used that do not need to be
detoxified or eliminated from the body by the liver, for example, drugs that are
eliminated by the kidneys.
Hepatorenal syndrome
Patients with worsening cirrhosis can develop the
hepatorenal syndrome. This syndrome is a serious complication in which the
function of the kidneys is reduced. It is a functional problem in the kidneys,
that is, there is no physical damage to the kidneys. Instead, the reduced
function is due to changes in the way the blood flows through the kidneys
themselves. The hepatorenal syndrome is defined as progressive failure of the kidneys to clear substances
from the blood and produce adequate amounts of urine even though some other
important functions of the kidney, such as
retention of salt, are maintained. If liver function improves or a healthy liver is transplanted into a patient with
hepatorenal syndrome, the kidneys usually begin to work normally. This suggests
that the reduced function of the kidneys is the result of the accumulation of
toxic substances in the blood when the liver fails. There are two types of
hepatorenal syndrome. One type occurs gradually over months. The other occurs
rapidly over a week or two.
Hepatopulmonary syndrome
Rarely, some patients with advanced cirrhosis can
develop the hepatopulmonary syndrome. These patients can experience difficulty
breathing because certain hormones released in advanced cirrhosis cause the
lungs to function abnormally.
The basic problem in the lung is that not enough blood flows through the small
blood vessels in the lungs that are in contact with the alveoli (air sacs) of
the lungs. Blood flowing through the lungs is shunted around the alveoli and
cannot pick up enough oxygen from the air in the alveoli. As a result the
patient experiences shortness of breath, particularly with exertion.
Hypersplenism
The spleen normally acts as a filter to remove older red blood cells, white
blood cells, and platelets (small particles that are important for the clotting
of blood.). The blood that drains from the spleen joins the blood in the portal
vein from the intestines. As the pressure in the portal vein rises in cirrhosis,
it increasingly blocks the flow of blood from the spleen. The blood "backs-up"
and accumulates in the spleen, and the spleen swells in size, a condition
referred to as splenomegaly.
Sometimes, the spleen is so swollen that it causes abdominal pain.
As the spleen enlarges, it filters out more and more of
the blood cells and platelets until their numbers in the blood are reduced.
Hypersplenism is the term used to describe this condition, and it is associated
with a low red blood cell count (anemia), low white blood cell count
(leucopenia), and/or a low platelet count (thrombocytopenia). The anemia can cause weakness, the leucopenia
can lead to infections, and the thrombocytopenia can impair the clotting of
blood and result in prolonged bleeding.
Liver cancer (hepatocellular
carcinoma)
Cirrhosis due to any cause increases the risk of primary
liver cancer
(hepatocellular carcinoma). Primary refers to the fact that the tumor originates
in the liver. A secondary liver cancer is one that originates elsewhere in the
body and spreads (metastasizes) to the liver.
The most common symptoms and signs of primary liver
cancer are abdominal pain and swelling, an enlarged liver, weight loss, and fever. In addition, liver
cancers can produce and release a number of substances, including ones that
cause an increased in red blood cell count
(erythrocytosis), low blood sugar (hypoglycemia), and high blood calcium (hypercalcemia ).
Cirrhosis of The Liver - Symptoms at Onset of DiseaseQuestion: The symptoms of cirrhosis of the liver can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Hyponatremia is a condition where the level of sodium in the blood is low. Causes of hyponatremia can occur from excess fluid in the body, or a loss of sodium in body fluid. Some of the symptoms of hyponatremia include headache, muscle cramps or spasm, seizures, weakness and confusion. Treatment of hyponatremia depends on the cause.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes).
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Hereditary hemochromatosis (iron overload) is an inherited disorder in which there is excessive accumulation of iron in the body. Individuals may have no symptoms or signs, or they can have severe symptoms and signs of iron overload. The most effective treatment for hemochromatosis is therapeutic phlebotomy.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
Primary Biliary Cirrhosis is a chronic disease characterized by progressive inflammation and destruction of small bile ducts within the liver. The bile ducts transport bile from the liver to the intestine for the absorption of fat and elimination of waste products. The causes of Primary Biliary Cirrhosis may involve autoimmunity, infection, or genetic predisposition, acting alone or in combination. There are many medications and treatment options available for those with this and other associated diseases of Primary Biliary Cirrhosis.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Gynecomastia, an enlargement of the gland tissue in the male breast is the caused by an imbalance of hormones. Certain medical conditions may also lead to gynecomastia such as cirrhosis, malnutrition, disorders of the male sex organs, kidney failure, thyroid disorders, and medications. Gynecomastia is generally treated with medication, and if necessary surgery.
Portal hypertension is most commonly caused by cirrhosis, a disease in which results from scarring of a liver injury. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from teh liver to the heart, and a parasitic infection called schistosomiasis.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Digestion RSS
Healthy Living Tips
This site complies with the