Complaints & connections · borters.ch
The liver has so much reserve that nothing shows for a long time — and the two checks that decide the course are ultrasound and endoscopy.
Also known as: liver cirrhosis · end-stage liver scarring
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Over years the liver replaces lost tissue with scar. The treacherous part is its own generosity: it has so much reserve that nothing shows for a long time — and when something does show, it is things nobody connects with the liver. Tiredness put down to age. Itching without a rash. Calf cramps. A belly that grows fuller while the arms grow thinner. Red palms and small spider-like vessels on chest and shoulders. The commonest causes are alcohol, fatty liver with overweight and diabetes, chronic viral hepatitis, and more rarely autoimmune, inherited and drug-related forms. The decisive distinction is between two phases: as long as the liver still manages its tasks, one can live well with cirrhosis for a very long time and the course can be influenced. If it tips, fluid in the belly, jaundice, confusion or bleeding from varices in the gullet follow — and then every week counts. Two examinations therefore shape everyday life: the regular ultrasound check and the endoscopy that looks for those varices before they announce themselves.
Iron overload is one of the few causes of liver scarring that can be halted by simple means. It belongs excluded once in any unexplained liver disease — transferrin saturation and ferritin.
Regardless of whether it was the cause. It is the one measure that changes the course measurably at every stage — even late on.
Early detection of liver cancer runs through this appointment. It is unspectacular and the reason some courses end well.
An endoscopy looks for them before they bleed. If any are found, there are drugs and procedures that prevent exactly that.
The old advice to avoid protein no longer holds. Muscle loss worsens the outlook, and portions spread across the day with a late evening snack are today’s advice.
Anti-inflammatory painkillers are especially delicate here, and some herbal products too. Paracetamol at a reduced dose is usually the better choice — the doctor decides.
A scarred liver makes infections more likely, and an infection can tip a stable situation. Fever therefore belongs assessed earlier than otherwise.
The eggs scar the tissue around the portal vein while the liver cells stay healthy for a long time. With origin in an endemic area this belongs on the list.
The fox tapeworm grows by infiltration over years, dams the bile ducts and scars the tissue. It is often taken for a tumour; a blood test tells the two apart.
The medicines treat the consequences: diuretics the fluid in the belly, lactulose the clouding of the mind, beta blockers the pressure in the oesophageal varices. The scar tissue itself stays. What changes the course is removing the cause — with alcohol and fatty liver the liver does reverse at early stages.
The liver has a large reserve — symptoms often appear only when a large part is scarred, and with alcohol and fatty liver that usually takes ten to twenty years. Compensated cirrhosis without complications has a life expectancy of over twelve years, decompensated considerably less — the transition is the decisive point. With known cirrhosis, an ultrasound for cancer screening is done every six months and a scope looks once for varices in the oesophagus.
The reserve is so large that many are only noticed when a blood count or ultrasound is done for another reason.
All over, worse at night, with nothing to see on the skin. It is regularly taken for dry skin.
Fluid collects in the belly while muscle is lost. That combination says more than the weight on the scales.
Reddened palms, small spider-like vessels on chest and shoulders, brittle nails, bruises from the slightest knock.
Yellow eyes, a growing belly, confusion or a reversed day-night rhythm, black stools or vomiting blood — any one of these means hospital at once.
If water collects in the abdomen, less room is left for the stomach. That explains a growing belly and a shrinking appetite at once.
One of the proteins only the liver makes. If it falls, that says more about the liver’s performance than any liver enzyme — and it explains the fluid in the tissues.
The clotting factors also come from the liver. A rising value without blood thinners is a measure of performance, not a clotting problem.
When it rises, the eyes yellow first. Together with albumin and INR it gives the picture by which severity is graded.
Falling platelets are often the very earliest sign — they show the back-pressure before the liver, long before anything is felt.
The store lasts only a few weeks and empties quickly with alcohol and poor food. A lack hits nerves and brain first — which is why it is corrected here early and without hesitating.
The liver is the store, and alcohol disturbs both the uptake and the storing. A lack shows in the blood count as red cells that are too large.
With advanced liver disease a lack is common and contributes to loss of taste, poor wound healing and states of confusion.
The old rule of restricting protein in liver disease no longer holds. Too little of it breaks muscle down, and muscle is an important part of the reserve in this illness.
Branched-chain amino acids are one of the few supplements with data in cirrhosis: they improve nutritional state and muscle mass. Studied over months, often as an evening portion.
In cirrhosis zinc is often low, and a deficiency worsens the confusion in hepatic encephalopathy. Measure before supplementing.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
The liver breaks hormones down. When it can no longer manage that, the balance shifts: in men this leads to breast enlargement, loss of body hair and smaller testicles — visible signs of an internal reckoning.
With cirrhosis this hormone is no longer properly broken down and at the same time produced more. It holds sodium and water back — that is the core of the fluid in the belly, and why of all things an aldosterone blocker works here.
Almost all of the body’s IGF-1 comes from the liver. With advanced cirrhosis it falls — one of the reasons for the muscle wasting that shapes the course.
Studied in cirrhosis without clear benefit on survival or complications. Important: in advanced liver disease herbal preparations are broken down more slowly — this belongs discussed with the treating team.
Muscle loss in cirrhosis worsens the outlook. Strength training counters it; in studies it improved muscle mass and stamina over 12 weeks.
The bitter compounds in the root stimulate bile flow — that is the traditional use. With advanced liver disease it changes nothing about the course, and there the amount of fluid and salt matters more.
Here as a warning: wormwood contains thujone and is traditionally set in alcohol. Both are the wrong thing with a damaged liver.
Here as a warning: essential oils are broken down in the liver, and the sharp phenolic oils such as oregano and thyme-thymol are borderline internally even with a healthy liver. With cirrhosis they do not belong in the mouth.
Aristolochic acid in individual Chinese herbs has caused severe kidney and liver damage — the warning is in the TCM tool.