Liver Disease and End-Stage Liver Disease Treatment

Many diseases and disorders can cause the liver to function improperly or stop functioning. These include hepatitis, liver tumors and cirrhosis. Hepatologists (physicians who specialize in liver disease) at Froedtert & the Medical College of Wisconsin provide care for people with acute and chronic liver disease as well as end-stage liver disease. Most people with liver disease can be treated without surgery.

Team members, including hepatologists, physician assistants, nurses and others, are highly trained and experienced in all types of liver disease, gastrointestinal disorders and transplant. Outpatient care is provided in the GI/Hepatology Clinic at Froedtert & the Medical College of Wisconsin, where staff provides care for cases ranging from mild liver disease to post-transplant care. Hepatologists also provide consultation on the care of inpatients with liver disease.

Causes of Liver Disease

Many liver diseases and disorders can cause the liver to function improperly or stop functioning. 

• Hepatitis B and C — inflammation of the liver caused by the hepatitis B virus or the hepatitis C virus, both blood-borne infections
• Fatty liver disease — a buildup of fat in the liver cells, which may be caused by alcohol abuse, obesity, hepatitis C, diabetes or other causes
• Cirrhosis — an irreversible scarring of the liver that may be caused by many conditions.
• Non-cancerous liver tumors — including hemangioma, focal nodular hyperplasia, adenoma, cysts, hamartomas, regenerative nodules and lipomas
• Cancer from iron overload, viral hepatitis or cirrhosis
• Metabolic diseases — such as hemochromatosis (excess iron in the liver) and Wilson’s disease (a buildup of copper in the liver)
• Autoimmune disease — a disease in which the immune system inappropriately attacks liver cells including bile duct cells; this can result in liver failure, cirrhosis, liver cancer and the need for liver transplantation 
• Drug-induced liver disease — drugs that injure the liver and disrupt its normal function; drugs may include prescribed medications, over-the-counter medications, vitamins, hormones, herbs, illicit drugs and environmental toxins 
• Alcohol-induced liver disease — damage to the liver caused by excessive alcohol intake 
• Disease of the bile ducts of the liver 
• Abscesses — single or multiple collections of pus within the liver as a result of infection by bacteria or other agents
• End-stage liver disease — the last phase of progressive liver disease (terminal disease)

Liver Cancer Prevention

Your doctor may discuss different treatments for your underlying liver disease to reduce the chance of cirrhosis, which is a risk factor for liver cancer. Take these steps to help prevent liver disease and liver cancer.

• Receive treatment of underlying liver disease.
• Drink alcohol sparingly or in moderation.
• Maintain a healthy diet and weight in combination with exercise.
• Eliminate tobacco.
• Get vaccinated against hepatitis B.
• Know the health status of sexual partners.
• Avoid intravenous drugs.
• Seek safe and clean shops for tattoos and piercings.

Liver Cancer Screening

Some people are at higher risk for developing liver cancer. If you are in one of the groups below, ask your doctor about ultrasound screening, which is recommended every six months for higher risk individuals. Additionally, any patient with cirrhosis should have an ultrasound every 6 months to screen for liver cancer.

• Hepatitis B — Asians and African Americans
• Hepatitis B — people with cirrhosis
• Hepatitis C — people with cirrhosis
• Cirrhosis from any cause (autoimmune, alcohol, non-alcoholic fatty liver, hemochromatosis etc.).
• Family history of liver cancer
• Asian men older than 40
• Asian women older than 50
• African American men and women older than 20 who have a family history of liver cancer

Liver Failure, End-Stage Liver Disease & Liver Transplant

Liver failure can occur suddenly, or it can be the end result of chronic liver disease. A liver transplant may be considered for a patient whose liver function is declining. The Froedtert & MCW Liver Transplant Program performs about 40 liver transplants each year.

Many team members work together to coordinate the many aspects of a liver transplant, including transplant surgeons, hepatologists, social workers, psychologists, pharmacists, dietitians and others. Team members meet with transplant surgeons each week to discuss all liver transplant candidates. 

Patients with end-stage liver disease are evaluated in the GI/Hepatology Clinic to determine if they are appropriate candidates for transplant. Blood tests to assess the degree of liver function are conducted. The results are used to calculate the patient’s chance of survival over the next one, three and five years. This helps to determine if the chance of survival is higher with the patient’s own liver or with a transplanted liver. 

Patients who undergo organ transplant receive care in the Froedtert & MCW dedicated inpatient transplant unit, staffed by nurses specially trained to care for transplant patients. Post-transplant patients are seen daily by hepatologists for the medical component of their care, and by surgeons for post-surgical care. Long-term follow-up care for transplant patients continues under the care of a hepatologist in the Transplant Clinic, where transplant surgeons are also readily available.

For patients with end-stage liver disease who are not candidates for a liver transplant, palliative care is offered.