Many of you are aware of the different stages that determine how advanced the diagnosis of liver disease is determined. On the other hand many do not. I thought that it may be helpful to post them so we can all see what the criteria is and what the symptoms are for the different stages. The following list may seem a bit ambiguous but to date it is what Dr’s are using. It is called the West Haven Classification System.
Stages of Liver Disease:
Stage 0: 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
I hope this helps you all to at least have some idea at how the Dr’s determine how severe the liver disease is. This does not address lab values. It is solely based on behavior both physically and mentally.