End Stage Liver Failure - Cirrhosis

I am wondering what to expect at the end stages of liver failure (due to cirrhosis).  My mother almost died last week from this.  She had the confusion, tremors, stomach distension, bleeding in her esophagus, you name it.  She was on a breathing machine in ICU for a week.  The doctor tells us that she has 10% liver function and that her liver is going to continue to dump the ammonia poisons into her body on a daily basis because it is not functioning properly.  She has to take laculose daily so she can rid her body of the toxins.  How long can this go on before her body just gives out?  She also has congestive heart failure, diabetes, COPD, etc.

[HectorSF]

I am very sorry to hear about your mother’s advanced illness.

Advanced liver disease is a very complicated issue.You questions can only be answered by your mother’s treating doctor who knows the true status of your mother's illness. Only they have the knowledge and experience to assess your mother’s true health status. ...We here can only give you generalities which may or maybe apply to your mother’s condition.

A large percentage of persons with End-Stage Liver Disease (ESLD) have hepatic encephalopathy (HE = confusion, tremor, stupor, etc.) which Lactulose is one method of treatment. It is caused by ammonia and toxins entering the brain because the liver is not healthy enough to filter out the toxins. This does not indicate how advanced her liver disease is by itself.

I assume she is being treated at a transplant center that has entire team of specialist that have diagnosed her condition and are treating her?

How ill is she? What is her prognosis? Some of that information is available in her MELD score. This is how liver centers evaluate how ill someone is and estimate how long they may have to live unless they get a transplant. The MELD score scale is from 6 – 40. As a person’s liver fails the MELD score rises. MELD scores can vary over time indicating that a patient can improve and their health stabilize. That is why a complete history must be known. Any one point in fixed time doesn’t necessarily indicate how ill someone is.

You mother is experiencing many of the “normal” complications of End-Stage Liver Disease (ESLD). Hepatic encephalopathy (HE), ascites and bleeding varices.  How serious they are it is impossible to judge. These complications can be happen in persons of a wide vary of degrees of illness. Being in ICU would usually indicate a more advanced degree of liver failure. Only her treating doctor knows.

Also you should be talking to the social workers at the hospital so you can plan for what will happen in the future, since your mother unfortunately appears not to be qualified for a life-saving liver transplant. If a patient is not a candidate for transplantation, end-of-life issues must be addressed with the patient and family. Hospice care, Advanced Directive, a Will, organ donation, etc.

What to expect at the end stages of liver failure?

The best source of information in the hospital where your mother is being treated. They should have literature on managing End-Stage Liver Disease for family members.

Also having a good team of doctors can lessen the amount of suffering your mother will experince so it is very import for her to have the best care possible.

One of the best papers I have seen…
"An HCSP Guide on Death and Dying"

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Final%20Steps.pdf

Good luck to your mother and yourself!
Hector

[leebambee]

I cannot answer your question, although I'm sure many others here can. I just wanted to say sorry for what you and your family (especially your mother) are going through. I hope she is well taken care of and comfortable.

[orphanedhawk]

Assuming that she is not on the transplant list, possibly because of her other problems, this will stretch on as long as the hospital and medical equipment allows her to remain alive.
I'm sorry to be so blunt

My liver was functioning at 8% when I had my transplant. At that time the surgeon thought I had about 6 weeks of life left but I had no other problems not related to ESLD.

Do what you can to make her last days comfortable, to know she's loved and help her be at peace.

OH

[HectorSF]

I am very sorry to hear about your mother’s advanced illness.

Advanced liver disease is a very complicated issue.You questions can only be answered by your mother’s treating doctor who knows the true status of your mother's illness. Only they have the knowledge and experience to assess your mother’s true health status. ...We here can only give you generalities which may or maybe apply to your mother’s condition.

A large percentage of persons with End-Stage Liver Disease (ESLD) have hepatic encephalopathy (HE = confusion, tremor, stupor, etc.) which Lactulose is one method of treatment. It is caused by ammonia and toxins entering the brain because the liver is not healthy enough to filter out the toxins. This does not indicate how advanced her liver disease is by itself.

I assume she is being treated at a transplant center that has entire team of specialist that have diagnosed her condition and are treating her?

How ill is she? What is her prognosis? Some of that information is available in her MELD score. This is how liver centers evaluate how ill someone is and estimate how long they may have to live unless they get a transplant. The MELD score scale is from 6 – 40. As a person’s liver fails the MELD score rises. MELD scores can vary over time indicating that a patient can improve and their health stabilize. That is why a complete history must be known. Any one point in fixed time doesn’t necessarily indicate how ill someone is.

You mother is experiencing many of the “normal” complications of End-Stage Liver Disease (ESLD). Hepatic encephalopathy (HE), ascites and bleeding varices.  How serious they are it is impossible to judge. These complications can be happen in persons of a wide vary of degrees of illness. Being in ICU would usually indicate a more advanced degree of liver failure. Only her treating doctor knows.

Also you should be talking to the social workers at the hospital so you can plan for what will happen in the future, since your mother unfortunately appears not to be qualified for a life-saving liver transplant. If a patient is not a candidate for transplantation, end-of-life issues must be addressed with the patient and family. Hospice care, Advanced Directive, a Will, organ donation, etc.

What to expect at the end stages of liver failure?

The best source of information in the hospital where your mother is being treated. They should have literature on managing End-Stage Liver Disease for family members.

Also having a good team of doctors can lessen the amount of suffering your mother will experince so it is very import for her to have the best care possible.

One of the best papers I have seen…
"An HCSP Guide on Death and Dying"

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Final%20Steps.pdf

Good luck to your mother and yourself!
Hector

[Advocate1955]

I'm sure it's different for each individual.  I don't know your mother's situation, but I can tell you about a friend's passing.  My friend lost her husband to ESLD last October.  He had a great deal of swelling in the lower half of his body for the last 4-6 weeks.  He became confused and disoriented and behaved differently than normal.  In the last days, he slept a lot, and the periods of lucidity were fewer than the periods of confusion.  He stopped eating, had difficulty breathing, had some bleeding internally and vomiting blood.  I believe he may have slipped into a coma in the last few hours, but they also had hospice care at home, so he had medication to keep him comfortable.  Talk to your mother's doctor and try to get answers specific to her situation.
Advocate1955

[Kimmie8124]

Thanks everyone for your responses.  She is not a candidate for a transplant due to her other illnesses and that she wouldn't survive the surgery.  I just wanted a general idea as to possibly how long her body could withstand this liver issue since it has progressed this far, and is this bad.  You guys have helped tremendously.  Thank you!

[orphanedhawk]

Calling hospice for advice might be a good idea. They deal with these issues and know how to help things go as smooth as possible.

Peace~

[susy50]

hi kimmie ,

I am not exactly sure of how serious your mothers liver failure is but I have also experienced all of those things including the bleeding in the esopahgus, swelling , confusion because of the toxins also many other complications that have kept me in hospital for over 2 months at a time .the last stay in hospital my dr inserted a shunt in my liver so the toxins do not spread and i was able to get off the lactoluse but also I have never been in a the ICU so i am not to sure if a shunt is possible for her. susy