Liver Disease

What Is Liver Disease?

The liver is the largest organ inside the body and the center of metabolism. It helps your body process nutrients absorbed from the digestive tract, make proteins, store energy and remove toxins. About 4.5 million adults in the U.S. have liver disease. It is twice as common in men than women.

There are many different liver diseases, including:

• Autoimmune conditions such as autoimmune hepatitis, primary biliary cirrhosis (PBC) and primary sclerosing cholangitis
• Fatty liver disease,= caused by metabolic dysfunction or too much alcohol
• Inherited conditions such as hemochromatosis and Wilson disease
• Liver cancer
• Viral diseases such as hepatitis A, hepatitis B and hepatitis C

The liver can regenerate after damage, but long-term inflammation results in scar tissue. As the liver develops more scar tissue, it becomes harder for the organ to function properly. Untreated liver disease can cause liver damage, which can eventually lead to cirrhosis and liver failure.

It is possible to prevent liver disease by:

• Minimizing alcohol use
• Eating a nutritious diet
• Exercising regularly
• Maintaining a healthy body weight
• Getting vaccinated for hepatitis A and B
• Managing blood pressure, diabetes, and cholesterol
• Practicing good hygiene
• Using medications as directed

Many liver conditions are manageable when caught early.

Causes of Liver Disease

Liver disease can be caused by viral infection, autoimmune conditions, genetic conditions, cancer, long-term alcohol use, metabolic dysfunction and other factors.

• Alcohol-induced hepatitis: Heavy alcohol use can cause acute or chronic hepatitis (inflammation). It can cause cirrhosis and liver failure if it goes on long enough.
• Autoimmune conditions: Autoimmune disorders can cause chronic inflammation and scarring in the liver or bile ducts.
• Biliary stasis: Conditions you are born with, including biliary atresia and cystic fibrosis, can interfere with the flow of bile from your bile ducts causing buildup and liver injury.
• Vascular diseases: Conditions that affect blood flow to and from the liver can lead to chronic liver damage.
• Genetic disorders: Genetic disorders such as glycogen storage disease, Wilson disease, Gaucher disease and hemochromatosis, can cause toxic material to build up in the blood. This can lead to chronic liver damage.
• Metabolic dysfunction or Non-alcohol related fatty liver disease: Issues with high blood sugar, high blood cholesterol, high blood pressure, and obesity can cause excess fat storage in the liver. This can cause liver inflammation and damage.
• Viral infections: A viral hepatitis infection causes the immune system to fight off the infection. This can lead to inflammation and scarring of the liver.

Signs and Symptoms

Symptoms of liver disease depend on the underlying cause. Some patients with liver disease may have no symptoms. 

Early symptoms can include:

• Jaundice (yellowing of the skin or eyes)
• Dark urine
• Easy bruising or bleeding
• Fatigue
• Itchy skin
• Loss of appetite
• Unintentional weight loss
• Pale stools
• Red, blotchy palms
• Spider veins

Symptoms that may indicate advanced or severe liver damage include:

• Dark-colored urine
• Confusion or Encephalopathy (a brain issue that causes changes in mood, sleep and cognition)
• Enlarged stomach
• Lack of appetite
• Muscle loss
• Pale or bloody stool
• Yellow skin and eyes (jaundice)

Chronic liver failure happens when a significant part of the liver is damaged and can’t function properly. Liver failure related to liver disease and cirrhosis typically takes years to develop.

Liver Disease Risk Factors

Lifestyle, genetics, metabolic disorders and autoimmune conditions can increase the risk of developing liver disease.

• Diabetes
• Exposure to blood and other bodily fluids
• Exposure to toxins or pesticides
• Family history of liver disease
• Heavy alcohol use
• High cholesterol
• Obesity
• Sharing needles
• Unprotected sex

Diagnosis

A doctor who specializes in gastroenterology and hepatology can diagnose liver disease.

To make the diagnosis, your doctor will review your medical history and if there is any family history of liver problems. They will also ask about your symptoms and eating and drinking habits. Your doctor may order imaging tests, lab tests or procedures such as a liver biopsy to help diagnose your liver condition.

Imaging Tests

Abdominal ultrasound, CT scan and MRI: These tests show the size, shape and texture of the liver. They may show inflammation, swelling, growths, scarring or tumors.

Elastography: This is a test that uses ultrasound or MRI technology to determine the level of stiffness or scarring on the liver.

Lab Tests

Complete blood count test: A blood test that measures red blood cells (the cells that carry oxygen), white blood cells (the cells that fight infection), hemoglobin (the protein that carries oxygen in red blood cells) and platelets (help the blood clot).

Liver function test: This blood test measures different substances and proteins made in the liver. Liver function tests show how well your liver is working or if it’s damaged.

Coagulation tests (INR): Blood tests that show how well the blood clots. Clotting proteins are made in the liver, so this shows how well the liver is functioning.

Basic metabolic panel: Includes electrolytes and kidney function, which can be affected with liver disease.

Diagnostic Procedures

Endoscopy: This procedure uses a camera on a thin flexible tube to view the esophagus, stomach, and duodenum. This can help diagnose varices (enlarged veins) in the digestive tract that can stem from liver disease. Additional types of endoscopy (EUS or ERCP) allow for viewing of the bile ducts to diagnose biliary causes of liver disease.

Liver biopsy: A small sample is removed from your liver to examine it for signs of damage or disease.

Treatment

Many liver diseases are chronic, which means they may never go away. Treating liver disease includes managing your disease with medications and procedures, and following up regularly with a gastroenterologist or hepatologist. Making lifestyle changes that reduce the toxic load on your liver also is important.

Medications

Medications for liver disease address specific causes and complications.

• Antibiotics
• Antiviral drugs to treat hepatitis
• Blood pressure medication
• Diuretics (water pills)
• Immunosuppressants to treat autoimmune conditions
• Laxatives
• Medications to address specific symptoms, such as itchy skin, high blood pressure
• Steroids to lower liver inflammation
• Medications for metabolic-dysfunction associated fatty liver disease
• Medications for bile duct diseases

Be careful when starting new supplements, as the supplement industry is not regulated and many supplements have been shown to cause liver inflammation. Discuss with your gastroenterologist/hepatologist before starting a new supplement.

Procedures

Early detection of liver disease is not always possible. If you have cirrhosis or liver failure, you may need advanced procedures to treat your condition.

Liver Transplant. In severe cases when the liver no longer functions well enough to keep you alive, liver transplant may be necessary.

The liver is the only organ in the body that can fully grow back. A transplanted portion of a liver can grow to normal size within a few months. This makes it possible for a living person to donate part of their liver to someone who needs a transplant. Most transplanted livers are from registered donors who passed away.

Transjugular Intrahepatic Portosystemic Shunt. This procedure places a stent in the liver to reduce blood pressure and manage complications of cirrhosis.

Surgery. Removing tumors or other types of surgery can help manage liver disease complications.

Ablation Therapy. This treatment uses a hot or cold probe to kill cancer cells in the liver.

Chemoembolization. This procedure delivers chemotherapy drugs to the liver.

Lifestyle Management

Lifestyle changes can be enough to control symptoms for some people. These can include:

• Staying hydrated
• Eating a liver-friendly diet (avoiding unhealthy fats, refined sugar and salt)
• Keeping a healthy weight
• Avoiding all alcohol
• Other dietary changes depending on the condition, such as limiting foods containing copper