Liver Disease
A group of conditions affecting the liver's structure and function
Table of Contents
Overview
The liver is one of the body's most vital organs, performing over 500 essential functions including filtering toxins from blood, producing bile for digestion, storing nutrients, and manufacturing proteins. Liver disease encompasses various conditions that impair these functions, ranging from temporary inflammation to permanent scarring.
Liver disease affects millions of people worldwide and is among the top causes of death globally. In the United States, approximately 4.5 million adults have been diagnosed with liver disease, though many more may be undiagnosed. The liver has remarkable regenerative capacity, but chronic damage can lead to irreversible scarring (cirrhosis) and liver failure.
Early stages of liver disease often produce no symptoms, making regular screening important for at-risk individuals. When caught early, many forms of liver disease can be managed or even reversed through lifestyle changes and medical treatment. However, advanced liver disease may require liver transplantation, making prevention and early detection crucial.
Types of Liver Disease
Viral Hepatitis
Hepatitis A
Acute infection spread through contaminated food or water. Usually resolves without lasting damage. Vaccine available for prevention.
Hepatitis B
Can be acute or chronic. Spread through blood and body fluids. Chronic infection can lead to cirrhosis and liver cancer. Vaccine available.
Hepatitis C
Usually chronic infection spread through blood. Leading cause of liver transplants. Now curable with antiviral medications in most cases.
Fatty Liver Disease
Non-Alcoholic Fatty Liver Disease (NAFLD)
Fat accumulation in liver not caused by alcohol. Associated with obesity, diabetes, and metabolic syndrome. Most common liver disease in developed countries.
Non-Alcoholic Steatohepatitis (NASH)
More severe form of NAFLD with inflammation and liver damage. Can progress to cirrhosis and liver failure.
Alcoholic Fatty Liver Disease
Early stage of alcohol-related liver damage. Reversible with alcohol cessation but can progress to alcoholic hepatitis and cirrhosis.
Cirrhosis
Description
Late stage of scarring (fibrosis) caused by many forms of liver disease. Permanent damage that disrupts liver function. Common causes include chronic alcohol abuse, chronic viral hepatitis, and NASH.
Other Types
Autoimmune Hepatitis
Immune system attacks liver cells. More common in women. Treated with immunosuppressive medications.
Primary Biliary Cholangitis
Autoimmune disease affecting bile ducts. Causes bile buildup and liver damage. More common in middle-aged women.
Hemochromatosis
Genetic disorder causing iron overload. Excess iron damages liver and other organs. Treated with regular blood removal.
Wilson's Disease
Genetic disorder causing copper accumulation. Affects liver and brain. Treated with medications to remove copper.
Symptoms
Liver disease symptoms vary depending on the type and stage. Early liver disease often has no symptoms, while advanced disease can cause multiple signs:
Common Symptoms
Early Warning Signs
- Fatigue and weakness
- Loss of appetite
- Mild abdominal discomfort
- Unexplained weight loss
- Nausea or vomiting
Advanced Symptoms
Signs of Cirrhosis
- Ascites: Fluid accumulation in abdomen
- Spider angiomas: Spider-like blood vessels on skin
- Palmar erythema: Red palms
- Gynecomastia: Breast enlargement in men
- Testicular atrophy: In men
- Confusion: Hepatic encephalopathy
- Easy bruising: Due to clotting problems
- Muscle wasting: Loss of muscle mass
Seek Immediate Medical Care If:
- Severe abdominal pain and swelling
- Mental confusion or disorientation
- Vomiting blood or black stools
- Severe jaundice (yellow skin/eyes)
- High fever with abdominal pain
Causes and Risk Factors
Liver disease can result from various factors that damage liver cells or interfere with liver function:
Common Causes
Viral Infections
- Hepatitis A, B, C, D, and E viruses
- Epstein-Barr virus
- Cytomegalovirus
- Herpes simplex virus
Alcohol and Toxins
- Chronic alcohol abuse
- Prescription medications (acetaminophen overdose)
- Herbal supplements
- Industrial chemicals
- Aflatoxins from moldy foods
Metabolic Factors
- Obesity
- Type 2 diabetes
- High cholesterol
- Metabolic syndrome
- Rapid weight loss
Risk Factors
Lifestyle Factors
- Heavy alcohol consumption
- Intravenous drug use
- Unprotected sex
- Tattoos or piercings with unsterile equipment
- Exposure to infected blood
Medical Conditions
- Diabetes
- Obesity
- Autoimmune diseases
- Inherited disorders
- History of liver disease
Demographics
- Age (risk increases with age)
- Family history of liver disease
- Certain ethnicities (higher risk of specific conditions)
- Gender (some conditions more common in women)
Diagnosis
Diagnosing liver disease involves various tests to assess liver function, identify the cause, and determine the extent of damage:
Blood Tests
Liver Function Tests (LFTs)
- ALT and AST: Liver enzymes elevated with liver damage
- Alkaline phosphatase: Elevated in bile duct problems
- Bilirubin: Elevated causes jaundice
- Albumin: Low levels indicate poor liver function
- Prothrombin time: Tests blood clotting ability
Viral Hepatitis Tests
Blood tests to detect hepatitis A, B, C, D, and E antibodies and viral RNA/DNA.
Autoimmune Markers
Tests for autoantibodies if autoimmune liver disease suspected.
Imaging Tests
Ultrasound
First-line imaging to assess liver size, texture, and detect masses or fluid.
CT Scan
Detailed images to evaluate liver structure and detect tumors or cirrhosis.
MRI
High-resolution images, especially useful for detecting fatty liver and tumors.
FibroScan (Transient Elastography)
Non-invasive test measuring liver stiffness to assess fibrosis and cirrhosis.
Liver Biopsy
Gold standard for assessing liver damage. Small tissue sample examined under microscope to determine:
- Degree of inflammation
- Extent of fibrosis or cirrhosis
- Specific cause of liver disease
- Response to treatment
Treatment
Treatment depends on the specific type of liver disease, its severity, and underlying causes:
Medical Treatments
Antiviral Medications
- Hepatitis B: Tenofovir, entecavir, peginterferon
- Hepatitis C: Direct-acting antivirals (DAAs) with cure rates >95%
- Duration: Varies from 8-48 weeks depending on type
Immunosuppressants
For autoimmune hepatitis: Prednisone, azathioprine. Require careful monitoring for side effects.
Ursodeoxycholic Acid
For primary biliary cholangitis. Helps improve bile flow and slow disease progression.
Medications for Complications
- Diuretics: For fluid retention and ascites
- Beta-blockers: To prevent variceal bleeding
- Lactulose: For hepatic encephalopathy
- Antibiotics: For infections
Procedures
Paracentesis
Removal of excess fluid from abdomen in patients with ascites.
TIPS (Transjugular Intrahepatic Portosystemic Shunt)
Creates new pathway for blood flow to reduce portal hypertension.
Endoscopic Procedures
Banding or sclerotherapy for esophageal varices to prevent bleeding.
Liver Transplantation
For end-stage liver disease when other treatments fail:
- Evaluation process includes extensive testing
- MELD score determines priority on waiting list
- Living or deceased donor options
- Requires lifelong immunosuppression
- 5-year survival rates around 75%
Lifestyle Modifications
- Alcohol cessation: Critical for all liver disease
- Weight loss: For fatty liver disease
- Exercise: Improves liver health
- Dietary changes: Low sodium, adequate protein
- Medication review: Avoid hepatotoxic drugs
Living With Liver Disease
Managing liver disease requires ongoing care and lifestyle adjustments to maintain quality of life and prevent progression:
Dietary Guidelines
- Balanced nutrition: Adequate calories and protein
- Low sodium: Less than 2,000mg daily for cirrhosis
- Limited protein: Only if hepatic encephalopathy present
- No alcohol: Complete abstinence essential
- Coffee: May have protective effects
- Small frequent meals: Better tolerated
Activity and Exercise
- Regular moderate exercise as tolerated
- Avoid contact sports if low platelets
- Rest when fatigued
- Maintain muscle mass
Medical Monitoring
- Regular blood tests: Monitor liver function
- Imaging: Ultrasounds every 6 months for cirrhosis
- Endoscopy: Screen for varices if cirrhotic
- Vaccinations: Hepatitis A/B, flu, pneumonia
- Cancer screening: For hepatocellular carcinoma risk
Medication Safety
- Avoid acetaminophen or limit to 2g daily
- No NSAIDs with cirrhosis
- Careful with herbal supplements
- Inform all providers about liver disease
- Adjust medication doses as needed
Managing Complications
- Ascites: Daily weights, fluid/salt restriction
- Encephalopathy: Take lactulose as prescribed
- Itching: Moisturizers, antihistamines
- Fatigue: Energy conservation, planned activities
Prevention
Many forms of liver disease are preventable through healthy lifestyle choices and protective measures:
Primary Prevention
- Limit alcohol: No more than 1 drink/day for women, 2 for men
- Maintain healthy weight: Prevent fatty liver disease
- Practice safe sex: Prevent hepatitis B and C
- Don't share needles: Avoid blood-borne infections
- Get vaccinated: Hepatitis A and B vaccines
- Handle chemicals safely: Use protective equipment
Screening Recommendations
- Hepatitis C: One-time screening for adults born 1945-1965
- Hepatitis B: Screen high-risk individuals
- Liver enzymes: During routine physical exams
- Ultrasound: For those with risk factors
Risk Reduction
- Control diabetes and cholesterol
- Exercise regularly
- Eat a balanced diet
- Avoid toxins and pollutants
- Use medications responsibly
- Regular medical check-ups
Complications
Advanced liver disease can lead to life-threatening complications:
Portal Hypertension
Increased pressure in portal vein system leading to varices, splenomegaly, and ascites. Can cause life-threatening bleeding.
Ascites
Fluid accumulation in abdomen. Can become infected (spontaneous bacterial peritonitis) requiring immediate treatment.
Hepatic Encephalopathy
Brain dysfunction due to toxin accumulation. Causes confusion, personality changes, and can progress to coma.
Variceal Bleeding
Ruptured enlarged veins in esophagus or stomach. Medical emergency requiring immediate treatment.
Liver Cancer
Hepatocellular carcinoma risk increases with cirrhosis. Regular screening essential for early detection.
Kidney Failure
Hepatorenal syndrome - kidney failure secondary to liver disease. Often requires dialysis.
Liver Failure
Complete loss of liver function. Life-threatening condition requiring immediate hospitalization and possible transplant.