Alpha-1 Liver Disease Associated Conditions

Reviewed by Karina A. Serban, MD, Robert A. Sandhaus, MD, PhD, FCCP

How does Alpha-1 liver disease affect other organs and systems?

The liver is anatomically or physiologically connected to all the body’s vital systems (e.g., brain, heart, kidneys).

Toxins in the blood and brain

Toxins build up in the blood and brain, because a cirrhotic liver is ineffective at removing them. Toxins can slow mental functioning and cause changes in personality, forgetfulness, trouble concentrating, neglect of personal appearance, changes in sleep habits, unresponsiveness, coma and even death.

 

Low blood pressure (hypotension)

Hormones that dilate the systemic blood vessels and lower the blood pressure are present in higher concentrations in people with cirrhosis. They may experience lightheadedness and syncope (fainting). This condition will make the heart pump faster and stronger and eventually lead to heart failure.

 

High blood pressure in the pulmonary artery (pulmonary hypertension)

This condition will lead to low oxygen saturations (hypoxemia) and difficulty breathing (dyspnea). A cardiac ultrasound can suggest the diagnosis. A right heart catheterization confirms it. Pulmonary hypertension is a severe complication of liver cirrhosis, and its diagnosis is a strong indication of the need for liver transplant.

 

High blood pressure in the liver circulation (portal hypertension)

In cirrhosis, blood flow through the liver is blocked by scar tissue formation and backs up enlarging the spleen and the blood vessels of the stomach and esophagus. Enlarged blood vessels of this type are called varices.  Varices cannot handle high flow or elevated pressure without bursting easily. When distended, these varices can burst and cause severe bleeding (a serious emergency that requires immediate medical attention).

 

Bruising and bleeding

The liver makes important clotting factors, proteins that help blood form clots. Therefore someone with Alpha-1 liver disease will bleed or bruise more easily, and for a longer period of time.

 

Edema and ascites

The protein albumin is produced in the liver. Albumin is important in bodily fluid regulation. As the liver loses its ability to make this protein, water accumulates in the abdomen (ascites) and legs (edema).

 

Sensitivity to medication

A cirrhotic liver eliminates certain medications (e.g., pain medications or sleeping aids) more slowly than a healthy liver. Therefore, the drugs stay active for longer than expected, and can build up in the system and lead to increased side effects.

 

Liver cancer

The cancer arising from the hepatocytes is called hepatocellular carcinoma. It is a cancer with a high mortality if not found in its earliest stages in patients with cirrhosis from Alpha-1 liver disease.

 

Kidney failure

The systemic low blood pressure and the high pressure inside the abdomen due to ascites can make the kidneys lose their ability to efficiently filter the blood and concentrate urine.

 

Diabetes and hypoglycemia

Insulin is a hormone produced by the pancreas that helps regulate glucose (blood sugar) levels. The cirrhotic liver does not respond to insulin. Thus, glucose cannot enter the cells and stays elevated in the blood (diabetes). People with cirrhosis are not able to mobilize glucose out of the body’s reserves, and they can easily develop low blood sugar (hypoglycemia).

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