Worsening Liver Function – Action & Prevention

Chances are your diagnosis of liver disease surprised you. Many medical conditions, like NASH/MASH, are asymptomatic, meaning they give little to no signs that something is going on in the body. Sometimes the signs are hard to pinpoint as a liver issue. For example, fatigue and abdominal pain can easily be dismissed as digestive issues or a stressful work/life balance.

Having a medical condition develop without you knowing or recognizing it can be scary. Sometimes it’s hard to trust your body. How will you know if things are getting better or worse? What else could happen without you realizing? Information and a plan can help put to rest some of these concerns. Here are two things to discuss with your doctor:

Take action if you notice signs of liver failure

As mentioned above, liver problems may not give any signs or they may be subtle enough that you don’t connect what you’re feeling to your liver. However, if you know what to look for and you’ve already been diagnosed with NASH/MASH, then chances are you’ll be more likely to catch changes in your health. Common signs of liver dysfunction include:

• Ascites: Ascites is fluid buildup in your abdomen. Many people notice this when their breathing changes. It can be hard to take deep breaths or you can feel short of breath. You also may feel bloated and less hungry. Swelling can happen in other parts of the body, too, like the legs and feet.¹
• Jaundice: This is a yellowish color in your skin and the whites of your eyes. Talk with a loved one about this sign because they may be able to recognize changes in your skin color more quickly than you might.¹
• Skin changes: Look for the development of tiny red, purple, or blue blood vessels on your cheeks and nose. These are called spider veins. Your skin may feel extremely itchy. Pay attention to cuts and bruising. If you notice that you bruise more easily or bleed longer after getting a cut or scrape, that can be a sign of declining liver health.¹
• Other changes: Your urine may be a darker, more brownish color, while your stools may be pale.  Changes in mood can happen if levels of ammonia (a waste your liver helps eliminate from your body) build up too high. Sodium changes can also happen and affect brain function. Any changes in personality, mood swings, or confusion should prompt a call to your doctor.¹

Discuss signs and symptoms of worsening liver function with your provider and make sure you know what they want you to report specifically. Also, discuss when you should go to the emergency room vs. when to call their office.

Protect your liver health

Most people living with NASH/MASH already know they need to familiarize themselves with their liver lab results and how often monitoring will be done. What often gets missed by those with liver disease is the other factors that influence their liver health. 3 factors include:

• Screening and managing other diseases: Other health conditions related to NASH/MASH include cardiovascular disease, chronic kidney disease, and type 2 diabetes (T2D).^2,3 Nearly 75% of people with T2D also have NASH/MASH.⁴ T2D increases the risk of worsening liver health. In fact, those with NASH/MASH who also have T2D have a higher risk of cirrhosis and liver cancer than those who do not have T2D.⁴  Screening for these other health conditions and managing them well is incredibly important.
• Vaccines: Routine vaccines are a key tool for protecting liver health. Viral and bacterial illness can cause extra strain on an already struggling liver. In some cases, certain infections can increase your risk of liver complications. For example, getting hepatitis B when you have chronic liver disease raises your risk for liver cancers.⁵ Vaccines are a simple, effective way to protect liver health long-term. The sooner you get recommended vaccines, the better. Your liver is an important part of your immune system. Higher liver function often results in better immune response to vaccines.⁵
• Pharmacists are critical: The number one cause of liver injury in the United States is acetaminophen (Tylenol) overdose. The second leading cause is drug related (both prescription and alternative medications/supplements).⁶ That means your medicine cabinet and any supplements you use likely pose the biggest risk to your liver health. You need to know safe medication options and doses for things like illness and pain. Ask for a referral to a clinical pharmacist from your provider. They can help you navigate over-the-counter options, supplements, and prescriptions through the lens of liver health. Bring all your prescription medications, non-prescription medications (like vitamins and supplements), and openly discuss your drug and alcohol use with both the provider and pharmacist. Eliminating or reducing stressors on liver health can protect it from injury and/or reduce the progression of NASH/MASH.