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   Posted 10/23/2003 11:57 AM (GMT -6)   
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Post Edited (Admin) : 11/22/2005 12:00:44 PM (GMT-7)

Pink Grandma
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Date Joined Nov 2006
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   Posted 8/16/2009 3:10 PM (GMT -6)   
Note: The information in this section is a compilation of information provided by several of our members and former and current Moderators.

Part 1:

The liver is on the right side upper portion of your abdomen. It has 4 lobes and is the only organ in the body that can regenerate itself. If you have surgery to remove part of the liver they can leave 25% of the liver and remove 75% and amazingly it will grow back, if the 25% remaining is healthy!

Part 2:

Functions of the Liver:
a.) Produces and excretes bile
b.) Metabolizes carbohydrates
3.) Metabolizes lipids (fats)
4.) Produces coagulation factors
5.) Breaks down hemoglobin
6.) Converts ammonia to urea (so you dump excess ammonia)
7.) Breaks down toxins to be secreted (This includes medicines we take-keeping the good and excreting the bad)
8.) Stores vitamins and minerals (so your body can use these)
9.) In the first trimester of pregnancy your liver produces red blood cells for the fetus
10.) The liver is the sieve for immunological effects

When the liver is sick or diseased it can no longer function at its peak performance level. Thus we retain byproducts that will hurt us and make us fell sicker. Such is the case with the ammonia levels. We don't dump the ammonia out and consequently our ammonia levels rise. This is a toxin and consequently we have toxic levels of ammonia. Lactulose is often given so that we excrete the excess ammonia through our stools.

General information of the liver:

The goal to better health is education. Unfortunately, not everyone explains things the same way. Some people make it really hard to understand and others can explain things in common terms. If you understand what is happening and you have the basic facts it makes it easier. So, here we go…a healthy liver has more jobs than any other organ in the body. The liver is the second largest organ in the body, your skin believe it or not is the largest. Yes, it’s true…your skin is an organ. The liver is about the size of a football, weighs in at about 2.5 to 4 pounds, is divided into two lobes, and is the second most complex organ, the brain being the most complex. The liver is also the only internal organ that can regenerate itself. Even if 75% of the liver is removed it will start regenerating immediately and return to a full sized liver after several months.

Normal function of a healthy liver:

The liver produces immune agents required to fight infections, filters our blood to remove harmful toxins, detoxifies our blood from harmful agents, produces blood clotting agents such as fibrinogen and prothrombin to keep us from bleeding to death, and blood thinning agents so we don’t produce blood clots (keeping both the clotting factors and thinning agents in balance), synthesizes proteins, helps to control blood pressure, converts proteins and carbohydrates into fats (which are stored until our bodies need it), and the liver produces blood protein and enzymes that aid in digesting food. When the liver breaks down the protein it produces urea made from ammonia and carbon dioxide. Urea is excreted from the kidneys as waste. Further; all of our blood is passed through the liver many times a day removing toxins and generally cleaning the blood by ridding it of harmful things. (One of the toxins most familiar to people is ammonia.)The liver also converts sugar into glycogen then stores it for when we need it for energy, produces and secretes bile then sends the bile to the gallbladder which releases the bile when we need it to aid in digesting fatty acids and regulates hormones. The liver also stores minerals, vitamins, and trace elements and sends it out to the blood stream when needed. These are just some of the functions the liver performs. So; as you can see the liver is a very busy and important organ and we cannot survive without it.

Sick livers:

When the liver becomes damaged it is less functional and we have problems. As you can see from the list above a healthy liver does an awful lot to keep us well. When it is damaged it can no longer complete those tasks it was made to do. There are about 30,000 deaths each year as a result of liver disease. When liver disease develops, the liver's ability to perform its metabolic, detoxification and storage functions is impaired. Because the liver has such an important role to play when it becomes sick the entire body is affected.

Another problem is we don’t always know that there is damage present until we start to have symptoms. Some of the symptoms are common to other illnesses or disease processes so the doctor has to test for what he/she thinks it could be. Sometimes when your doctor is testing you for something completely different they find out there is a problem with the liver. This may be found through blood tests, MRI’s, CAT scans, etc. They aren’t necessarily looking for liver problems in the beginning but inadvertently find them. When there are no symptoms of liver disease we most often continue doing whatever we were doing that caused the problem in the first place. Later, when the liver can no longer handle the strain the symptoms appear. When the liver can’t do its job, for example, we see the high ammonia levels which in turn cause the side effects associated with the increased ammonia in the body. That’s sometimes when we are tested, probed, biopsied, and told we actually have liver disease, the stage, and the cause. Also, keep in mind that there are over 100 types of liver disease that have been identified. Their common feature is that they all involve damage to the liver that disturbs its ability to function normally. Almost every other organ is affected when the liver malfunctions. Kidneys can’t throw off waste products in the urine resulting in high ammonia levels for one. Portal hypertension can develop because of the pressure of blood being forced through alternate channels and in turn ascites develops. Blood can no longer be purified so several blood related issues arise. The immune system becomes compromised and the person becomes more prone to infection. These are just a few of the things that can and do occur. As you can see it is like a vicious cycle. One thing affects the other and so on and so on.

Signs and Symptoms:

The signs and symptoms are listed in other educational threads. When signs and symptoms are listed, understand that not everyone has every single symptom. The symptoms can range from itchy, dry skin to acute ascites, shortness of breath, and confusion. There are varied symptoms and no one set of rules on how or when they will appear. Lists include every possible symptom which usually starts with the most commonly seen. Symptoms typically appear in stages based on the severity of the disease process and are normally rated from mild to severe.


Treatment has been discussed in other educational threads. Again, there is no ONE treatment for liver disease. The doctor will decide what course of action he/she will follow. I would encourage anyone with liver issues to seek a hepatologist because they are the experts in liver disease.


The end result of a sick liver varies depending on the degree or stage of disease and/or damage. There is no ONE way to treat liver disease as noted above. Understanding the disease process based on what a healthy liver does versus what a sick liver can no longer do is essential. The causes may vary i.e.; alcoholism, hepatitis, injury, among others. but the result is the same. There are many positive steps that can be taken by those affected, including a healthy diet, absolutely no alcohol intake, no drug use unless prescribed by your doctor, positive attitude, educating oneself as to treatment, symptoms, and keeping the body healthy, to name a few.

Most of us are familiar with the symptoms that are displayed when the liver becomes damaged, but for many people it is all frightening and new. Hopefully, after reading and understanding why and how a failing liver affects all those functions, it finally makes sense. The key is NEVER GIVE UP………learn everything you can about the disease, follow doctor’s orders, and do EVERYTHING you can to improve your health. Don’t be afraid to ask questions, and most importantly be proactive in your own care and treatment. The only way to accomplish this is to be educated. For us, the days of sitting idly by and just following orders are over. Learn everything you can, ask questions, speak up, and be a part of your own care!

Signs and Symptoms of Liver Disease:

These are just some of the things that ESLD patients can experience or develop:

Early symptoms are:

Extreme fatigue, Itching, Edema (swelling), Confusion (encephalopathy), Anxiety, Anger, Bruises easily, Bleeding (hard to stop), Always feels cold, Jaundice (yellowing of the skin and eyes), Weight loss (unintentional), Decrease in appetite.

Ascites, Gallstones , Bleeding varices, Seizures, Strokes, Foul breath and foul odor to the skin, Liver Cancer, Kidney failure,Coma, Death.

Stages of Liver Disease:

Minimal encephalopathy. The changes are almost undetectable because the changes are minimal. Some minor changes in mood and concentration. The marker is the inability to maintain concentration.

Stage 1: Sleep disturbances (often sleeping during the day and awake at night, hypersomnia, or insomnia), mood swings including depression, irritability, and sometimes euphoria. Increased talkativeness, poor concentration, poor attention span, restlessness, and often some tremors in the hands. Mild confusion is noticeable. They have minute changes is concentration, memory, and coordination. The patient isn’t able to do some basic arithmetic like adding and subtracting numbers or drawing figures like stars or circles. Possible Asterixis (arm flapping when arms are extended).

Stage 2: Some noted arm flapping (asterixis) when the arms are extended, changes in reflexes (usually slower), difficulty with articulating words, and uncoordinated muscle movement. Lethargy or apathy, slurred speech, noticeable difficulty performing mental tasks, inappropriate behavior, drowsiness, noted personality changes, disorientation especially regarding time, possible sweet odor to their breath called “Fetor Hepaticus”, and a decrease in body temperature may be present along with rapid breathing “hyperventilation”.

Stage 3: Aggressive behavior, talks in monotonous tones, an increase in reflexes, decreased level of consciousness, sleeps a lot but can be aroused when you wake them, increased confusion and disorientation, at times incomprehensible speech (muttering nonsense) occasionally they will have fits of rage, amnesia, and can not perform mental tasks. Probable “Fetor Hepaticus”. Decreased body temperature is often noted. They sleep most of the time.

Stage 4:Coma.

Hepatic Encephalopathy: Hepatic encephalopathy is a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood. Here is an excellent website that describes the causes, symptoms and treatments . . .

HE usually starts with some subtle changes that caregivers notice after awhile like memory loss, poor concentration, and extreme tiredness, lack of interest in daily activities, and some cognitive loss and daytime sleepiness. Patients often describe flu-like symptoms that include muscle aches and pains. Personality changes are some of the first signs. As it worsens the person may suffer from muscle twitching in one muscle or a group of muscles called “myoclonus”, they may also suffer from very rapid eye movement (the eyes are actually twitching up and down and side to side) this is called “nystagmus”. (Nystagmus causes severe nausea and vomiting because it makes the person feel dizzy). Sometimes the affected person gets tremors, muscle weakness, some dementia, difficulty swallowing, inability to speak, and possibly seizures. Permanent brain damage is a possibility. Coma can follow and it can result in death. Now keep in mind that this is a candid list of potential symptoms. By no means am I implying that everyone with encephalopathy will have all of the symptoms listed.

The exact cause of hepatic encephalopathy is really unknown. What they do know is that in cirrhosis or hepatitis blood circulation does not enter the liver properly or adequately. As a consequence of improper circulation to the liver the toxins that are normally metabolized and eliminated by the liver are now collecting and increasing all the time building up in the bloodstream. This buildup of toxins causes the encephalopathy. When someone has end stage liver disease this can and usually does become chronic. This is the main reason that Dr’s don’t want to give Liver failure patients barbiturates or any sedatives. They can’t metabolize them properly and again it causes toxic effects. Also, most patients are on low protein diets because the protein can’t be metabolized properly. There are other factors that can increase symptoms such as a GI bleed, infections, kidney disease, etc.

Definitions of Medical Terms Associated With Liver Disease:

Ascites: Fluid in the peritoneal cavity. (Abdomen)

Cirrhosis: An abnormal liver condition characterized by irreversible scarring of the liver.

Coma: A state of deep unarousable unconsciousness.

Edema: An excessive accumulation of serous fluid in tissue spaces or a body cavity.

Esophageal Varices: Abnormally enlarged veins in the lower part of your esophagus, the tube that connects your throat and stomach. These veins may rupture and bleed.

Hepatic Encephalopathy: Toxic substances normally removed by the liver accumulate in the blood and impair the function of brain cells.

Hepatitis: Injury to the liver characterized by the presence of inflammatory cells in the tissue.

GI doctor: A gastroenterologist who specializes in diagnosing and treating liver diseases and gastrointestinal problems.

Jaundice: Yellowish discoloration of the whites of the eyes, skin, and mucous membranes caused by deposition of bile salts in these tissues. Dark yellow to orange urine will occur and clay colored stools.

Lethargy: State or disorder characterized by overpowering fatigue, drowsiness or sleep.

Liver Failure: The appearance of severe complications rapidly after the first signs of liver disease, and indicates that the liver has sustained severe damage.

Portal Hypertension: A syndrome characterized by raised blood pressure in the portal vein entering the liver. Portal hypertension can be associated with pulmonary hypertension where it is termed Porto-pulmonary Hypertension.

Protein and Liver Disease: Protein is an essential part of our diet and helps the body, grow tissue, regulate hormones, control metabolism, repair muscle, and defend against illness. The human body has to have protein to survive. Proteins are made from lots of amino acids that cluster together and convert to protein. Amino acids are made of carbon, nitrogen, hydrogen, and oxygen atoms, and are the building blocks of the human body These different proteins are dispersed to perform different functions in the body. Since the body can’t store protein it has to be replenished daily. There are several natural proteins in our blood but others have to come from dietary sources.

The amino acids that are not used up as proteins (because we can’t store it) are converted into urea. Urea is broken down protein made in the liver and sent to the kidneys to be excreted as urine (urea is toxic and must be excreted as waste). The Dr can measure urea by doing a blood test called a BUN. It stands for Blood Urea Nitrogen. Remember that the amino acids are made of many things including nitrogen which is measurable. It is one of the kidney function tests Dr’s do. When the body can’t remove the urea from the blood the BUN level is high. Liver Disease is one of the causes for a low BUN levels as well as the cause of elevated BUN levels. When urea isn’t excreted it builds up to toxic levels causing elevated ammonia levels. The elevated ammonia levels then causes confusion etc. (THAT’S A WHOLE OTHER STORY)

This is all like a vicious cycle when patients have liver disease. One thing leads to another. Too much protein and the sick liver can’t process it properly and the urea builds up which causes the ammonia levels to rise. As a result the kidneys can’t spill either one so now the kidneys are affected too.

Too little protein and the body hunts for it. It‘s like robbing Peter to pay Paul. Since we have to have protein to survive the body reacts when we don’t have enough. It actually will take protein from other places. Instead of the protein going to their destinations for use in the body the brain steals it from the muscles, tendons, bones and other organs to keep it in the bloodstream. Thus; there are muscle wasting, muscle cramps, profound fatigue, and many other undesirable effects.

It is a constant battle to maintain adequate levels of protein and yet not over or under do them.

As a caregiver (or patient), you may not realize the subtle changes in the patient’s condition. This is in regard to muscle wasting and ascites. Someone that visits occasionally will really notice a difference and might actually be shocked. When Harvey's brother arrived late November, I overheard his phone conversations to the rest of the family . . . "It's a matter of days." He was shocked by Harvey's appearance.

Supplements: We think before anyone takes a supplement sold over the counter they should be aware of what they are taking. In our collective search to ease the pain and suffering of liver disease patients we get to a point of feeling totally frustrated. The medical teams are not giving us enough information, we don't understand what is happening, our loved ones are in pain and their health is declining fast, and we simply can't get any definitive information right? I know the feeling too. Many of you know that my mom passed away in November of 07 from liver cancer and I stopped being an experienced RN and became the daughter of a very ill woman who I loved very much. I was really incapable for awhile of being objective and I just wanted them to "fix" her. I would have tried anything to make her feel better and not suffer so much. Now, after some time I am able to use my education and experience to help others deal with this illness. I think I can help educate people to make informed choices so I will address the electrolyte topic that was mentioned in another thread. As always I encourage people to make their own decisions as to their care but at least you'll be informed.

Magnesium: Magnesium is a mineral requirement in the body and is a vital electrolyte. It is needed for several reasons including nerve function, maintaining heart rhythm, supports a healthy immune system, maintains blood pressure and blood sugar levels, and protein synthesis. about 50% of our magnesium is found in our bones. There are approximately 300 different ways that the body uses magnesium. Vital for heart and nervous system function. Magnesium is excreted from the kidneys.

Normal levels- Normal plasma magnesium levels range from 1.5 to 2.5 mEq/liter.

Uses: Magnesium (Mg.++) is utililized in smooth muscle tissue for relaxing the muscle. Many muscles in the body are considered smooth muscles, examples include: male and female reproductive organs, urinary bladder, stomach lining, and intestinal lining. These muscles are used involuntarily by the body. Even though the heart is an involuntary muscle they are not called smooth muscles but rather cardiac muscles. Even when you are sitting still and not participating in any activity these muscles are constantly moving or “working”. These are just a few ways that the body uses magnesium.

Elevated Mg++ Levels: Called “Hypermagnesemia”, is any blood level above 2.5 mEq/liter and is cause for serious concern. Kidney disease is the major cause of elevated Mg++ because the kidneys can no longer excrete electrolytes properly. Therefore the levels remain in the cells and the levels rise. Symptoms of an elevated Magnesium levels or hypermagnesiemia include:

* thirst
* orthostatic hypotension (blood pressure falls sharply when you stand up from a sitting position)
* dry mouth and mucous membranes
* dark, concentrated urine
* loss of elasticity in the skin
* irregular heartbeat or tachycardia (rapid)
* irritability
* fatigue
* lethargy
* heavy, labored breathing
* muscle twitching and/or seizures

Low Mg++ Levels: Called “Hypomagnesemia” is any blood level below 1.5 mEq/liter.

Symptoms include:

* nausea, abdominal cramping, and/or vomiting
* headache
* edema (swelling)
* muscle weakness and/or tremor
* paralysis
* disorientation
* slowed breathing
* seizures
* coma

Magnesium is just one of several electrolytes that the body has to have in order to function properly. Other electrolytes are potassium, calcium, chloride, phosphate, sodium, etc. They all work together to maintain body function. Doctors check electrolytes when they draw blood during the course of various illnesses as well as routinely during the year. It is a common blood test and can reveal many health problems.

Taking over the counter electrolyte medications without a doctor authorizing it is not recommended. Major health issues can occur as a result of high levels of any electrolyte. Major heart problems are the most common and often fatal. PLEASE check with your doctor before taking any of these meds.


Systolic (S) = Top number / Measures pressure when the heart muscle contracts
Diastolic (D) = Bottom number / Measures pressure when the heart muscle relaxes

210 / 120 Stage 4 High Blood Pressure
180 / 110 Stage 3 High Blood Pressure
160 / 100 Stage 2 High Blood Pressure
140 / 90 Stage 1 High Blood Pressure
130 / 85 High Normal
120 / 80 NORMAL Blood Pressure
110 / 75 Low Normal
60 / 40 TOO LOW Blood Pressure
50 / 33 DANGER Blood Pressure

HIGH Blood Pressure Symptoms:
Stressed, Sedentary, Bloated, Weak, Failing, Headache, Neck ache, Anxiety

LOW Blood Pressure Symptoms:
Weak, Tired, Dizzy, Fainting, Coma


Normal glucose levels fall between 70 and 150 mg. Levels typically are lower in the morning, and rise after meals. Test for blood sugar immediately before a meal.

Blood sugar levels falling consistently above 150 are indicative of hyperglycemia, or high blood sugar. Persistent hyperglycemia (over 150) results in diabetes mellitus, which is the most common disease related to blood sugar regulation failure. Diabetes can cause eye, kidney and nerve damage.

Chronic low levels, falling below 70, characterize hypoglycemia, or low blood sugar. Hypoglycemia is a potentially fatal condition. Symptoms of this condition are lethargy, impaired mental functioning, irritability and loss of consciousness.

Normal Lab Values for the Liver based on Adults (Values may differ depending on the lab)


This test measures the levels of bilirubin in the blood. Bilirubin is produced by the liver and is excreted in the bile. Elevated levels of bilirubin may indicate an obstruction of bile flow or a problem in the processing of bile by the liver.


This test is used to measure the level of albumin (a protein in the blood) and aides in the diagnosis of liver disease.

ALP or Alk-Phos = Serum Alkaline Phosphatase Test:

This test is used to measure the level of alkaline phosphatase (an enzyme) in the blood. Alkaline phosphatase is found in many tissues, with the highest concentrations in the liver, biliary tract, and bone. This test may be performed to assess liver functioning and to detect liver lesions that may cause biliary obstruction, such as tumors or abscesses.

ALT = Serum Aminotransferases (transaminases):

This enzyme is released from damaged liver cells.


The prothrombin time test measures how long it takes for blood to clot. Blood clotting requires vitamin K and a protein that is made by the liver. Prolonged clotting may indicate liver disease or other deficiencies in specific clotting factors.


This test measures the level of alanine aminotransferase (an enzyme found predominantly in the liver) that is released into the bloodstream after acute liver cell damage. This test may be performed to assess liver function, and/or to evaluate treatment of acute liver disease, such as hepatitis.

AST or SGOT = Aspartate Transaminase Test:

This test measures the level of aspartate transaminase (an enzyme that is found in the liver, kidneys, pancreas, heart, skeletal muscle, and red blood cells) that is released into the bloodstream after liver or heart problems.

GGTP or GGT = Gamma-Glutamyl Transpeptidase Test:

This test measures the level of gamma-glutamyl transpeptidase (an enzyme that is produced in the liver, pancreas, and biliary tract). This test is often performed to assess liver function, to provide information about liver diseases, and to detect alcohol ingestion.

This test can detect tissue damage and aides in the diagnosis of liver disease.

Lactic dehydrogenase is a type of protein (also called an isoenzyme) that is involved in the body's metabolic process.

This test measures the levels of 5'- nucleotidase (an enzyme specific to the liver). The 5'- nucleotidase level is elevated in persons with liver diseases, especially those diseases associated with cholestasis (disruption in the formation of, or obstruction in the flow of bile).

AFP = Alpha-Fetoprotein Test:

Alpha-fetoprotein (a specific blood protein) is produced by fetal tissue and by tumors. This test may be performed to monitor the effectiveness of therapy in certain cancers, such as hepatomas.

Mitochondrial Antibodies test:

The presence of these antibodies can indicate primary biliary cirrhosis, chronic active hepatitis, and certain other autoimmune disorders.

An ammonia test measures the amount of ammonia in the blood. Most ammonia in the body forms when the liver normally converts ammonia into urea, which is then eliminated in urine.

When these values are elevated it tells the DR if the liver is healthy or not working properly. He/She can then order tests and medicines to try to get the values back to normal. Frequent Lab tests are ordered to monitor the progress of the liver function and to evaluate if the medicines (if given) are working.

Record Keeping:

You can help yourself and the doctors by documenting vitals daily (weight, blood pressure, temperature, and blood sugar) and by taking body measurements. Measure the girth of the abdomen (around the love-handles to just under the belly button), upper arms (bicep), thighs and ankles. Measure the abdomen in a standing position and in a sitting position. Also note mental status on a scale of 1 to 10. Try to do this at the same time everyday. It will provide invaluable clues as to what is going on inside the body. Take this information with you to all doctor’s appointments.

Start yourself a spreadsheet and capture this information both morning and at night. Most medications are taken with food, so do this immediately before breakfast and again before your evening meal. Make notes beside the date whenever medications are changed or adjusted.

Blood Pressure = Portal hypertension increases overall blood pressure

Weight = To monitor for fluid retention and/or muscle wasting

Temperature = To monitor for infection

Mental Status = To monitor for encephalopathy (scale of 1 to 10)

Measurements = To monitor for muscle wasting and ascites

Blood Sugar (Glucose) = To monitor for liver function* (ask your doctor)

*If you are already monitoring blood sugar, that’s great. If you not, the doctor can provide you with a free meter and write a prescription for the lancets and strips. They are expensive, but know that all transplant patients must monitor their blood sugar and take insulin if necessary.

Ring Binder Tip:

To All Caregivers,

A three ring binder can be a life saver. Have tabs for each section, this only takes a few minutes to set up and will save you so much stress and time.
The front should have a calendar with upcoming appointments.

1. Medical proxy info..... who and what their expectations are for care

2. All insurance information, photo copies front and back of cards

3. Prescriptions/Dosages etc., make extra copies to hand to EMTs ERs etc. keep this updated for every change and maybe why the change ex: drug removed because of adverse effects, this helps if another facility recomends a drug again

4. Print out of all labs, if you get them the day of or at Dr office there is no charge, sometimes there is a charge to get them later.

5. Admission and discharge summaries, again if you go back later to get copies they may charge you. This can also include day procedures ie: a tap with how many litres and whether or not albumin given and how much, endoscopies etc.

6.You can keep a chart for blood sugars and insulin amounts given, blood pressure,temperatures.

In the back pouch you can keep a copy of prescription print out that had all side effects listed.


An ultrasound is a noninvasive test that uses high frequency sound waves to produce a picture, and usually written on paper as US--short for ultrasound. There are a few types of ultrasounds: Conventional-which shows a flat picture, 3-D images, and 4-D which is 3D in motion. Doppler Ultrasound is a specialized technique that shows blood flowing through the veins and arteries. Ultra Sound can be used for several reasons which include visualizing organs, tissues, vessels, and tumors to detect any changes. It is also used to assist in needle guided biopsies, and to visualize the heart. The machine which is computerized can produce graphs and calculate numerical equations. The later is very important in relation to the heart.

A portable machine is brought to the bedside then the technician applies a clear gel onto the surface of the skin. The technician holds a transducer or the handheld device in their hand and runs it on the area where the gel was applied. The frequency waves produce a picture that is transmitted to a TV screen. The technician is able to save those pictures and print them out on paper for the doctor.

“CT” Scan is short for Computed Tomography scan, and is also called a “CAT” Scan short for Computed Axial Tomography Scan. This is a sophisticated x-ray that takes multiple images of bone, blood vessels, and soft tissue. The computer then creates what is called “cross sections” or slices of the images. Normal x-rays cannot visualize or see the details that a CT scan can.

The procedure is painless and normally requires the insertion of an IV so dye can be injected allowing the machine to see the details of the soft tissue, bone, or blood vessel.

MRI stands for “Magnetic Resonance Imaging”. More sophisticated than a standard x-ray or even a CT Scan the MRI is a machine that uses magnetism, computer, and radio waves to produce the images the doctor wants to see. The images are created by the radio wave signals sent to the body that in turn forms a picture. The images are very accurate and specific. When completed it produces a clear and precise image of the organ, bone, vessel, etc.

A doctor may order the MRI with or without contrast. That largely depends on what the doctor is doing the MRI for. If contrast is ordered, then an IV is inserted in a vein and the contrast is injected to help with the visualization of the area the doctor wants to see.

Because the MRI utilizes a large magnet. patients are asked to fill out an MRI form. The reason is quite simple: If a person has a pacemaker, metal artificial joint, or other metal in the body the MRI may be cancelled. The magnet could cause the pacemaker to stop working for example. So the doctor and the technologist has to know if any of these things are present. The machine is actually a large tube that has a sliding bed that goes into it. The bed stays stationary but the hollow tube rotates around the patient. As the tube rotates it makes a knocking sound. This is how the picture is actually taken at every angle. The door is closed and sealed and then the process of the MRI begins. If someone is claustrophobic then it is recommended that they have what is called an “open MRI”. In an open MRI there is no door and the table slides into the hollow tube with both ends open.

Liver Biopsy:

The word “biopsy” is scary because we assume that it means cancer but that is not true. Biopsies are obtained to find out if an organ is diseased. So when a liver biopsy is ordered by your doctor it is because he/she suspects liver disease, not necessarily cancer. The biopsy is normally performed on an outpatient basis and doesn’t usually require a night in the hospital.

The procedure allows for a small piece of the liver to be obtained by the doctor who uses a special biopsy needle. A small incision is made and the needle is inserted into the liver. Then the needle is removed and the tissue in the needle is put in a sterile container and taken to the lab for analysis. Once in the lab the specimen is examined by the pathology lab under a microscope for any sign of damage or disease. A biopsy is a definitive test when looking for disease of an organ.

The portal vein is a large vein that carries the blood from your intestines directly to the liver. Once the portal vein becomes hypertensive it causes the blood to flow backwards and sends it into the hepatic veins (the 3 veins that are supposed to carry the blood away from the liver.) The pressure becomes so great that the blood is being pushed up into the stomach, lower esophagus, and intestines. This causes the vessels to become enlarged; bleeding may occur (esophageal varices), ascites (accumulation of fluid) in the abdomen, and fluid in the lungs. After these problems occur the decision may be made to have the TIPS procedure done.

TIPS is performed by a radiologist when there is an increase in the pressure of the portal vein (portal hypertension). When the radiologist performs the TIPS procedure it is done under what they call imaging (they can see the procedure as they are doing it on a TV screen.) The doctor makes a small tunnel into the liver to connect the portal vein to one of the hepatic veins. They insert a small metal tube called a “stent” into the tunnel to keep the path open. This will keep the blood flow going in the correct direction to and from the liver. Once the stent is placed it should reduce the pressure and hopefully eliminate the fluid buildup and bleeding from the varices.

On Death and Dying:

The question arises often in these threads "How will I know that my loved one is actually dying?" This is difficult to answer because there is no set way that someone passes. I can tell you some of the signs we look for in the hospital in evaluating end of life. Usually, sleep patterns become longer and longer, with liver disease the patient sleeps most of the time, interaction is limited and lucidity is minimal even when awake. Often the skin and eyes turn yellow (jaundice), urinary output is minimal, urine is dark and often foul smelling due to kidney failure. In the final stages, the patient's breathing patterns change and become shallower and they only breathe about 6-8 times a minute which decreases as death approaches. (Normal breathing patterns are 12-16). As the patient slips into coma there is no verbal interaction at all. They sleep until the end of life as we know it. I have always told families to continue talking to the patient, express your love, and forgive them for whatever has happened. I am convinced that the hearing is the last thing to go so make sure that whatever you want to say or have been afraid to say should be said then. Lastly, I also believe that death is more peaceful for the person if we tell them it is OK to go. It brings them and us a sense of peace. I think I should add that if the patient is awake and able to swallow they should be medicated to make sure they are out of pain. If they are not awake but we know the end is near we get their morphine (most commonly used) in dissolving liquid. (It is such a small amount that is given in a dropper so they don't choke. I hope this helps a little. Just remember that there is no ONE way to die. Everything is variable.

INFORMATION ON TREATING THE LIVER WELL at RealAge online, the Drs. Oz and Roizen site:

Click here: 4 Ways to Baby Your Liver - realage.com

Post Edited By Moderator (hep93) : 6/1/2013 3:59:50 PM (GMT-6)

Pink Grandma
Veteran Member

Date Joined Nov 2006
Total Posts : 2445
   Posted 9/6/2011 8:08 PM (GMT -6)   
MEDICAL WORD LIST (and some regular words, too.)

The Medical Word List has been transferred to this stickied thread. I've also added some "regular" words that some seem to have a problem spelling correctly.



ADVICE (Please give me your advice, thanks for your advice.) Advice is a noun. It is used more often than advise (something to remember when you start to write "Thanks for the advise.")

ADVISE (Please advise me, let me advise you) Advise is a verb.

AFP (alpha-fetoprotein)

AIH = Autoimmune Hepatitis

ALB = Albumin

Aldactone (spironolactone)

ALT = alanine (amino) transaminase

AST = aspartate aminotransferase

alkaline phosphatase (alk-phos)

Alzheimer's disease






arteriovenus malformation (AVM)
















Crohn's disease













EOT - End Of Treatment



esophageal varices



fetor hepaticus

flatulent, flatulence


gall bladder





hepatic encephalopathy (HE)










jaundice, jaundiced





Lasix (furosemide)



Lortab (hydrocodone)

Lose/losing (Did you lose weight? Are you losing weight?))

Loose (These pants are loose.)

Loosing - No such word. It would be loosening: After loosening his belt, he felt more comfortable. She is distraught after losing her husband.



magnesium oxide (aka mag oxide)


MELD (Model for End-Stage Liver Disease)

metastasis, metastasize


metolazone (Zaroxolyn, Mykrox)

MRSA (methicillin resistant staphyloccus aureus)


NASH (non-alcoholic steatohepatitis aka fatty liver disease)


Nexavar (sorafenib)



omeprazole (Prilosec)









Percocet (oxycodone)

PICC line (peripherally inserted central catheter) Also shortened to PIC.





Prograf (tacrolimus)

propranolol (Inderal)

protease inhibitor

Prothrombin Time (PTT)



regimen - a regulated course of exercise, meds, etd., to preserve or restore health
regime - a system of rule or government
regiment - a military unit of ground forces




scarred - left a mark

scared - afraid

scary - something that causes one to be scared.



serosanguinous (fluid)

spider nevi

spironolactone (generic of Aldactone)

SBP - Spontaneous Bacterial Peritonitis

SVR - Sustained Viral Response (regarding hep C treatment.)


TEDS (thromboembolitic deterrent stockings)


their - possessive pronoun - It is their car. She is their mom.
there - denotes place or situation - I put it over there. There should not be discrimination.



TIA (transient ischemic attack or mini stroke)

TIPS (transjugular intrahepatic portosystemic shunt)


trach (abbreviation for tracheotomy)



URI (upper respiratory infection)

UTI (urinary tract infection)









Xifaxan (rifaximin)


your - possessive pronoun - Is that your phone? I am sorry for your loss.
you're - Contraction of you are. You're recovering nicely.


zinc<span style="COLOR: black">

Post Edited By Moderator (hep93) : 9/14/2013 11:25:32 AM (GMT-6)

Elite Member

Date Joined Jul 2005
Total Posts : 12014
   Posted 2/22/2012 10:06 AM (GMT -6)   
For assistance with obtaining Xifaxan (xifaxamin) open this link:

Forum moderator - Hepatitis

"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

Elite Member

Date Joined Jul 2005
Total Posts : 12014
   Posted 2/28/2013 12:22 AM (GMT -6)   
Links for finding and rating doctors:



Forum moderator - Hepatitis

"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

Elite Member

Date Joined Jul 2005
Total Posts : 12014
   Posted 6/8/2013 2:22 PM (GMT -6)   

The following pharmaceutical companies offer patient assistance programs for Hep C treatment:

GENENTECH/ROCHE - For interferon (Roferon-A), peginterferon (PegIntron) plus ribavirin (Copegus) call:
1-888-941-3331 or visit www.pegassist.com.

KADMON PHARMACEUTICALS/AMGEN - For interferon (Infergen) or ribavirin (Ribasphere) call:
1-888-668-3393 or visit www.kadmon.com.

MERCK/SCHERING - For interferon (Intron A), peginterferon (PegIntron) or ribavirin (Rebetol) call:
1-866-363-6379 or 1-800-521-7157 or visit www.merckhelps.com.

For Boceprevir (Victrelis) call 1-866-363-6379 or visit www.victrelis.com.

VERTEX PHARMACEUTICALS - For telaprevir (Incivek) call 1-855-837-8394 or visit www.incivek.com.

(Victrelis or Incivek are the protease inhibitors used in the 3-drug/triple treatment for hep C. All oral treatment without interferon is expected to become available by the end of the year.
Forum moderator - Hepatitis

"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

Elite Member

Date Joined Jul 2005
Total Posts : 12014
   Posted 6/12/2013 12:32 PM (GMT -6)   

Hep C has four stages:

1. Acute - this bares no relation to the severity of the disease, but rather the 6 months following infection during which the virus takes hold.
2. Chronic - the period after six months, during which the majority of sufferers will have failed to clear the virus spontaneously. This is when the illness is considered a chronic one and it is during this stage that fibrosis will eventually start to occur.
3. Compensated cirrhosis - the point at which the chronic infection has resulted in irreversible damage to the liver. Whilst it is not possible to reverse the fibrotic changes to the hepatic architecture, the liver continues to perform its vital functions without manifesting any of the symptoms of decompensation.
4. Decompensated cirrhosis, or end-stage liver disease. The point at which the virus has caused the cirrhosis to progress to the stage that the signs of decompensation occur - i.e., HE, refractory ascites, HRS, variceal haemorrhage.

NOTE: HRS = Hepatorenal Syndrome

The four stages of cirrhosis (taken from livestrong.com)

The Merck Manuals Online Medical Libraries indicate that this stage of cirrhosis is characterized by the presence of inflammation, meaning there is swelling, an influx of inflammatory-promoting immune cells and some destruction of liver tissue. Additionally, there may also be the growth of abnormal connective tissue. These two factors, inflammation and abnormal connective tissue, are confined to the portal area of the liver. The portal area is the region surrounding the large hepatic artery, vein and bile duct. This is the area where blood and fluid flow into and out of the liver.

The second stage of cirrhosis is also characterized by inflammation, but fibrosis is also beginning to occur. The American College of Gastroenterology describes fibrosis as the replacement of normal liver tissue with scar tissue. There are no symptoms at this stage of cirrhosis because the remaining normal liver tissue is able to compensate for the non-functional scar tissue that is starting to form. However, scar tissue can never progress back into normal functioning liver tissue, meaning this transformation is permanent.

As cirrhosis progresses, the damage to the liver becomes increasingly more severe. In this stage of cirrhosis, the fibrosis forms "bridges," and is called bridging fibrosis. The Merck Manuals describe how these bridges makes abnormal connections between the hepatic artery, vein and other vessels that cause abnormal blood flow and increased blood pressure in the liver. This increased blood pressure, called hepatic hypertension, can cause even more liver damage.

Stage 4 is the most advanced stage and the growth of scar tissue has progressed to the point that the liver is not functioning normally. Whereas the previous stages are not normally associated with symptoms, advanced-stage cirrhosis has many symptoms. According to the American College of Gastroenterology, these symptoms are: bleeding in the digestive tract; jaundice, which is yellow coloring of the eyes and skin; mental effects such as confusion, unusual sleepiness and slurring of speech; the build-up of fluid in the body, medically termed edema; and intense and unexplained skin itching.

It appears that Stage 3 of Hep C progression coincides with stage 2 of cirrhosis progression, and Stage 4 appears both in terms of Hep C and Cirrhosis to be ESLD - i.e., at Stage 4 they are essentially one and the same.
Forum moderator - Hepatitis

"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

Post Edited (hep93) : 9/14/2013 11:18:53 AM (GMT-6)

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