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"What are the symptoms of liver failure?"
A loved one just heard from th doctor that she is entering liver failure, due to damage her liver sustained from an illness when she was young. She is also sleeping most of the day. Is this due to her liver failure, or is it a sign of something else (like depression)?
Liver failure can manifest in several ways, depending on the severity of the disease. As the liver's ability to detoxify the blood becomes diminished, the patient may notice alteration of their sleep/wake cycle, such that it may become partly or fully reversed. Patients may also become more confused and forgetful at times. If the liver is severely compromised, patients may become very sleepy and somnolent. As the liver fails, it also causes an increase in blood pressure in the veins that supply the liver (ie portal hypertension). This process can result in an enlarged spleen, dilated veins in the esophagus and stomach that are prone to bleeding, and dilated veins on surface of the abdomen. If the pressure becomes high enough, fluid may begin to seep out of the vessels and into the abdominal cavity, causing a swollen belly (called ascites). This process can lead to weight gain, low sodium levels in the blood (which can contribute to mental status changes), abdominal pain associated with distention. While increased sleep could be a result of increasing liver failure, it is also important to exclude other causes, including depression, which can certainly cause someone to increase their sleep time. It would be advisable for the patient to talk with his physician about his symptoms of increased fatigue and make sure the appropriate history and physical exam is performed.
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