John M. Vierling M.D. is Professor of Medicine and Surgery at the Baylor College of Medicine in Houston, Texas, where he also serves as Director of Baylor Liver Health and Chief of Hepatology. In addition, he is the Director of Advanced Liver Therapies, a center devoted to clinical research in hepatobiliary diseases at St. Luke's Episcopal Hospital. Dr. Vierling is board certified in internal medicine and gastroenterology and a Fellow of the American College of Physicians.
Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
Patients with advanced liver disease and portal hypertension can sometimes
develop the hepatorenal syndrome. This syndrome is a serious problem with the
functioning of the kidneys without actual physical damage to the kidneys
themselves. The hepatorenal syndrome is defined by progressive failure of the
kidneys to clear substances from the blood and produce adequate volumes of urine
even though some other kidney functions, 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 often begin to work normally.
This restoration of kidney function indicates that liver failure is associated
with an inability of the liver to either produce or detoxify substances that
affect kidney function.
Rarely, some patients with advanced cirrhosis can develop the hepatopulmonary
syndrome. These patients can experience difficulty with breathing because
certain hormones released in advanced cirrhosis cause abnormal functioning of
the lungs. The basic lung problem in the hepatopulmonary syndrome is that the
blood flowing through the small vessels in the lungs does not come in sufficient
contact with the alveoli (air pockets) of the lungs. Therefore, the blood cannot
pick up enough oxygen from the air that is breathed and the patient experiences
difficulty breathing.
Patients with PBC that develop cirrhosis have an increased risk of developing
a primary cancer of the liver cells (hepatocytes) called liver cancer
(hepatocellular carcinoma). Primary refers to the fact that the tumor originates
in the liver. A secondary tumor originates elsewhere in the body and can spread
(metastasize) to the liver.
Cirrhosis due to any cause increases the risk of liver cancer. Therefore, the
development of a primary liver cancer in an individual with PBC is not
unexpected. However, the risk of hepatocellular carcinoma in PBC appears to be
lower than the risk in cirrhosis caused by some other liver diseases, such as
chronic viral hepatitis. A recent report indicated that hepatocellular carcinoma
might be more common in men than women with PBC. Indeed, this one series of 273
patients with advanced PBC found hepatocellular carcinoma in 20% of the men
compared to only 4.1% of the women. The way hepatocellular cancer develops in
PBC, however, is not understood.
The most common symptoms and signs of primary liver cancer are abdominal pain
and swelling, an enlarged liver, weight loss, and fever. In addition, these
liver tumors can produce and release a number of substances, including ones that
cause an increase in red blood cells (erythrocytosis), low blood sugar
(hypoglycemia), and high blood calcium (hypercalcemia).
The most useful diagnostic tests for hepatocellular carcinoma are a blood
test called an alpha-fetoprotein and an imaging study of the liver (either a CT
Scan or an MRI with intravenous dye/contrast). The best screening tests for
early detection of hepatocellular carcinoma in patients with cirrhosis are
serial alpha-fetoprotein levels and ultrasound examinations of the liver every 6
to 12 months. It is important to note that about 40% of hepatocellular cancers
do not produce elevated levels of alpha-fetoprotein.
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.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
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.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Sjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
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).
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
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.
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.
Thyroiditis is the inflammation of the thyroid gland. The inflamed thyroid gland can release an excess of thyroid hormones into the blood stream, resulting in a temporary hyperthyroid state. Some forms of thyroiditis can be diagnosed based on tenderness and enlargement of the thyroid gland. A thyroid scan sometimes is used in making the diagnosis. Thyroiditis can also be diagnosed with a biopsy of the thyroid gland.
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