American Medical Association Family Medical Guide - American Medical Association [519]
The procedure
For a liver transplant, a person receiving the transplant is given general anesthesia, and the transplant surgeon makes an incision in the upper part of the abdomen. The surgeon then cuts the major blood vessels—the vena cava, the hepatic artery, and the portal vein—and the bile duct to remove the diseased liver. The donor liver is put in place and connected to the blood vessels and bile duct. In some cases, a small tube is inserted into the bile duct to allow bile to drain out of the body into a small bag.
The transplant recipient is connected to a ventilator to assist with breathing until his or her condition stabilizes. The new liver starts to function immediately. The bile-collecting bag may remain attached to the tube for a week or more. Once the bag is removed, the tube may be capped but will remain in place for several months to enable the doctor to perform tests to monitor the transplant. Most people who receive a liver transplant are able to lead active lives.
Cirrhosis of the Liver
Cirrhosis of the liver is a chronic condition in which scar tissue replaces healthy liver tissue, reducing the liver’s ability to perform its many vital functions. Cirrhosis has many causes; alcohol dependence (see page 733) and chronic hepatitis C (see page 787) are the most common causes in the United States. The disease can also result from other liver diseases, such as hepatitis B (see page 786), hemochromatosis (see page 961), or autoimmune hepatitis. Although liver damage from cirrhosis cannot be reversed, treatment can stop or slow progression of the disease and reduce the risk of complications.
Symptoms
In the early stages, many people with cirrhosis have no noticeable symptoms because the liver can continue functioning with fewer than normal healthy cells. As the disease progresses, a person may lose his or her appetite, lose weight, and experience general weakness and fatigue.
Eventually, a number of complications can develop. For example, if the liver loses its ability to make the proteins necessary for blood to clot, a person may bleed and bruise easily; small, red, weblike marks called spider nevi may appear on the face, arms, and upper part of the trunk. If the liver can no longer make the protein albumin, fluid can build up in the legs (edema) or abdomen (ascites). A person can develop jaundice (yellowing of the skin and whites of the eyes; see page 785) when the liver does not absorb the yellow pigment bilirubin, causing it to build up in the blood.
WARNING!
Herbal Remedies and Liver Disease
Herbal remedies and dietary supplements contain many ingredients and, because dietary supplements are not regulated by the federal government, the contents are not standardized and can vary from one brand to another. In addition, the contents listed on the label can differ from what’s actually inside. Doctors believe that many cases of sudden, severe hepatitis not related to a hepatitis virus are caused by repeated use of some herbal products. Use of these herbs causes many cases of nonviral hepatitis and unexplained cirrhosis. Herbal remedies that are thought to be potentially harmful to the liver include chaparral, a Chinese herbal product called jin bu huan, kava kava, germander, comfrey, mistletoe, skullcap, margosa oil, maté tea, gordolobo tea, and pennyroyal (squawmint oil). Always talk to your doctor about any supplement you are taking.
If blood cannot be delivered to the liver from the digestive system, blood pressure can build up in the veins around the junction of the esophagus and stomach, a condition called portal hypertension. The increased pressure in these veins causes them to bulge, making them susceptible to bursting, which can cause life-threatening bleeding (esophageal varices; see page 753). If the damaged liver can no longer remove toxins from the blood, they can build up in the brain (a condition called encephalopathy), causing