Liver Problems - Liver Dysfunction (Hepatotoxicity) Brought On By Chemotherapy

Related: Bilirubin blood level, elevated liver enzymes, and hepatotoxicity.

Common Liver Examinations:

The following are common tests or examinations that your healthcare provider may perform on you to determine whether you have liver damage caused by chemotherapy (such as hepatotoxicity):

Computerized Tomography (CT) Scan - This test is more specific than plain x-rays, as a computer takes x-rays of your chest, abdomen or pelvis region, from different angles, to show a cross-sectional view of your organs in your body. How it works:

• As you lie on a movable table, a scanner inside of a machine moves around you. X-rays are taken at different angles, as the computer records the pictures. The computer then puts the pictures in a certain order, so that the specialist can interpret the findings.
• Sometimes, you are required to drink a dye solution (called oral contrast), or a liquid dye is injected into a large vein. This helps to improve the picture, as the computer can then notice abnormalities as the dye passes through your body.
• You may be required to fast (not eat) after midnight the day of the exam. Your healthcare provider will provide specific instructions to you.

ERCP (Endoscopic Retrograde Cholangiopancreatography): Using a long, narrow tube, an ERCP allows your healthcare provider to see your liver, gallbladder, pancreas and sphincter of Oddi in your body.

• Your gall bladder, pancreas and liver are connected to your small intestine by way of the common bile duct.
• Your pancreas is connected to the common bile duct (CBD) by way of the pancreatic duct.
• The sphincter of Oddi is a muscular organ that opens and closes for fluid contents to pass into your small intestine. This helps with digestion.
• You may receive this exam if you:
• Have a stone or blockage in the CBD, or pancreatic duct.
• If there is a suspected growth in the pancreatic or your bile duct.
• If you have a certain form of jaundice or icterus (yellowing of the skin, eyes and mucous membranes).
• During the procedure, after you have not eaten after midnight that day, your doctor will pass a thin tube down your throat, through your esophagus (the tube that connects your throat to your stomach). Down this long, narrow tube, your doctor will be able to visualize the liver, pancreas, gall bladder and your sphincter of Oddi.
• Your doctor may be able to break the blockage, if present, or place a stent to redirect the bile fluid that may have accumulated.
• Your doctor or healthcare provider will give you specific instructions on what to expect with this procedure, including the risks, benefits and alternatives of treatment.

Liver Biopsy: A liver biopsy is where the physician takes a sample of liver tissue for examination. You may be ordered this test if your doctor or healthcare provider suspects that chemotherapy may have resulted in liver dysfunction or damage. It may tell your doctor if there is damage to the liver due to infection, or tumor, or due to another cause.

• This procedure may be done under local or general anesthesia.
• You will be asked to eat nothing after midnight on the day of your exam.
• After the procedure, you will be monitored for any signs of bleeding.
• Your doctor or healthcare provider will give you specific instructions on what to expect with this procedure, including the risks, benefits and alternatives of treatment.
• If you have any questions or concerns, make sure to ask questions.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.<

Common Liver Conditions:

Bilirubin Blood Level

What is a bilirubin blood level?

• Bilirubin is a chemical that is released into your blood, which results from the breakdown of red blood cells. Bilirubin is used by the liver, to make bile.
• Normally, only a small amount of bilirubin is present in your blood. When the blood bilirubin levels are increased, it may be a sign of a liver or blood problem.
• Because bilirubin can appear to be somewhat reddish in color, as the levels in the blood go higher, the whites of your eyes (sclerae) may turn yellow. Also, your skin may look yellow. This is called jaundice, or icterus.
• You may have this test performed if your healthcare provider wants to:
• Check for blockage in your bile duct, liver or gall bladder - Bile is released into your intestines by way of the common bile duct. If there is a blockage in the gallbladder or liver, your blood bilirubin levels will rise as a result.
• Check to see how your liver is working - if there is an infection or damage to the liver due to chemotherapy, the bilirubin levels may rise
• See if there are certain blood problems, such as hemolytic anemia - This form of anemia results from the breaking down or destruction of red blood cells. Bilirubin is released from red blood cells. If there is increased destruction, the bilirubin levels will rise.
• Other reasons for increased bilirubin levels:
• You may have an infection or inflammation of your liver (hepatitis), or gall bladder.
• Certain medications, including chemotherapy drugs, can cause increased bilirubin levels and liver dysfunction.
• Certain genetic conditions, such as Gilbert's syndrome, may cause slightly increased bilirubin levels.

Normal Biliribin Level* 0.2-1.2 mg/dL > 3.0 jaundice may appear *normal values may vary from laboratory to laboratory

What are some symptoms to look for?

• Some people with elevated bilirubin levels do not notice any difference in their activity or energy levels.
• With higher bilirubin levels, you may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities.
• You may have abdominal pain associated with your jaundice. You may not have any pain at all. Notify your healthcare provider if you have any jaundice with or without pain.
• Your skin, eyes, mucous membranes (the moist areas of your eyes, and mouth especially), may become yellow.
• When you have a bowel movement, your stools may be lighter in color than they normally are. Bile is released into your intestines through the common bile duct. If there is a blockage, and the bile (or bilirubin) is flowing through your blood instead of being released into the intestines, your stools may be clay colored.

Things you can do if you suspect chemotherapy has caused liver dysfunction or damage:

• If you notice that you are jaundiced, notify your healthcare provider immediately.
• Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). Do not take Tylenol^®, aspirin or products containing aspirin unless your healthcare provider permits this.
• Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease.
• You may be at risk for bleeding. Use an electric razor and soft toothbrush to minimize bleeding. Also notify your healthcare provider with any signs of bleeding.
• You should avoid alcohol and acetaminophen (Tylenol^®). Alcohol and Tylenol are processed through the liver. If you have liver damage, your liver can be further damaged with alcohol and Tylenol intake.
• If you are ordered a medication to treat this disorder, do not stop taking any medication unless your healthcare provider tells you to. Take the medication exactly as directed. Do not share your pills with anyone.
• If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
• Keep all your appointments for your treatments.

Drugs that may be prescribed by your doctor for liver dysfunction:

• There are no drugs to specifically treat increased bilirubin levels, unless there is an infection, blockage or tumor. Treatment is aimed at correcting the underlying cause of increased bilirubin levels, and minimizing further damage to your liver, if damage is present.
• Many chemotherapy drugs are processed through the liver, which can cause further damage. Depending on the extent of liver damage you have experienced, and your overall health status, your doctor may recommend reducing the dose of certain medications, or avoiding them all together. Below are a few medications that may be prescribed with severe liver damage:
• Diuretics - May be known as "water pills" as they work to prevent or treat fluid accumulation by making you urinate out extra fluid. Some examples of this medication may include furosemide (Lasix^®)and Hydrochlorothiazide. You may receive these drugs if your liver is not working properly, and you are accumulating fluid in your body. You may receive this medication alone or in combination with other medications.
• Pain medicine- your healthcare provider may order medication for pain, if you have any. Many of these are processed through the liver, but in certain dosages are safe. You should avoid Tylenol, however, as it may worsen liver damage.
• Do not stop any medications abruptly, as serious side effects may occur

If you begin to see signs of liver damage or dysfunction either during or after chemotherapy treatments, the following guide gives advice about when to call your doctor or health care provider:

• Severe fatigue, or worsening jaundice
• Abdominal pain, severe nausea and vomiting
• Bleeding that does not stop after a few minutes
• Any new rashes on your skin.
• Any unusual swelling in your feet and legs, or weight gain of greater than 3 to 5 pounds in 1 week.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.