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Fatigue Affecting People with Liver Disease

Why do patients with liver disease become fatigued and what can they do about it?

One of the most common and debilitating symptoms among individuals with liver disease is fatigue. It is universal to all varieties of liver disease from Primary Biliary Cirrhosis to Chronic Hepatitis C. In some patients, fatigue begins several years after the diagnosis of liver disease is made. In others, it was the primary reason for seeking medical attention. In such individuals multiple visits are made to a variety of physicians in search of a cause of their extreme lassitude. Some patients even seek psychiatric evaluation, as an accompanying symptom is often depression.

Fatigue may occur at any time of day but is most common in the morning about an hour after awakening. By 9 a.m. one may already feel the exhaustion of a full workday. Others describe weakness and a lack of energy throughout the entire day. Their usual "pep" is now gone. Even little tasks become more trying and around 4 p.m., they simply must lie down to take a nap.

The treatment of fatigue can be challenging. First, a search for all other potential causes should be made, as some are easily treated. Thyroid disease and anemias commonly coexist with liver disease and can worsen any existing lethargy. Nutritional deficiencies as well as disturbances in fluid balance also contribute to exhaustion. Primary depression from causes other than liver disease lead to fatigue and may require pharmacological control. Finally, all medications that the patient is taking must be reviewed and the unnecessary ones eliminated.

If all of the above conditions are corrected, and fatigue continues to persist, there are a few simple measures that may be of help. A healthy, low fat, well balanced diet, cessation of smoking, alcohol intake in moderation, and a daily exercise routine are all essential lifestyle adjustments. Any excess weight should be eliminated with a sound weight reducing diet. The demands of a hectic job or home life may need to be modified, as an overworked, overwhelmed person even without liver disease may suffer from fatigue. If possible, a 30-45 minute daytime nap can help to rejuvenate the patient, and may need to be incorporated into a schedule. Finally, one must remember that the treatment for fatigue does not come in a bottle as many medications, whether over-the-counter or prescription,may adversely affect the liver (as well as the wallet). One must always consult with the hepatologist prior to trying any new fad products that promise to cure fatigue.

Copyright 1997 by Melissa Palmer, M.D.

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