Liver Disease: Early Signs, Chronic Symptoms, Damage & Treatment (original) (raw)

What is liver disease?

Liver Disease

Some liver diseases are potentially preventable and are associated with lifestyle choices.

Liver disease is any disturbance of liver function that causes illness. The liver is responsible for many critical functions within the body and should it become diseased or injured, the loss of those functions can cause significant damage to the body. Liver disease is also referred to as hepatic disease.

Liver disease is a broad term that covers all the potential problems that cause the liver to fail to perform its designated functions. Usually, more than 75% or three-quarters of liver tissue needs to be affected before a decrease in function occurs.

The liver is the largest solid organ in the body and is also considered a gland because, among its many functions, it makes and secretes bile. The liver is located in the upper right portion of the abdomen protected by the rib cage. It has two main lobes that are made up of tiny lobules. The liver has two different sources of blood supply. The hepatic artery supplies oxygen-rich blood that is pumped from the heart, while the portal vein supplies nutrients from the intestine and the spleen.

Normally, veins return blood from the body to the heart, but the portal vein allows nutrients and chemicals from the digestive tract to enter the liver for processing and filtering before entering the general circulation. The portal vein also efficiently delivers the chemicals and proteins that liver cells need to produce the proteins, cholesterol, and glycogen required for normal body activities.

What is the function of the liver?

As part of its function, the liver makes bile, a fluid that contains among other substances, water, chemicals, and bile acids (made from stored cholesterol in the liver). Bile is stored in the gallbladder, and when food enters the duodenum (the first part of the small intestine), bile is secreted into the duodenum, to aid in the digestion of food.

The liver is the only organ in the body that can easily replace damaged cells, but if enough cells are lost, the liver may not be able to meet the needs of the body.

The liver can be considered a factory, and its many functions include:

Cirrhosis is a term that describes permanent scarring of the liver. In cirrhosis, the normal liver cells are replaced by scar tissue that cannot perform any liver function.

Acute liver failure may or may not be reversible, meaning that on occasion, there is a treatable cause and the liver may be able to recover and resume its normal functions.

There are many types of liver disease.

Liver disease caused by alcohol and cirrhosis

The liver can be damaged in a variety of ways. Cells can become inflamed due to conditions such as hepatitis. Bile flow can be obstructed, for example, by cholestasis.

Cholesterol or triglycerides can accumulate, for example, in steatosis. Blood flow to the liver may be compromised. Liver tissue can be damaged by chemicals and minerals, or infiltrated by abnormal cells, such as cancer cells.

What are the signs of alcoholic liver disease?

Alcoholic liver disease progresses through three stages: fatty liver, alcoholic hepatitis, and cirrhosis. Each stage involves increasingly severe symptoms and complications. Identifying the disease early and cutting back on alcohol are important for stopping its progression and improving outcomes.

The signs of alcoholic liver disease include:

Early stages (fatty liver):

Progressive stages (alcoholic hepatitis):

Advanced stages (cirrhosis):

Drug-induced and supplement liver disease

Liver cells may become temporarily inflamed or permanently damaged by exposure to medications or drugs. Some medications or drugs require an overdose to cause liver injury while others may cause damage even when taken in the appropriately prescribed dosage.

QUESTION Liver disease refers to any abnormal process that affects the liver. See Answer

Hepatitis and NASH liver disease

Infectious hepatitis

The term "hepatitis" means inflammation of liver cells (anything with “itis” is inflammation such as tonsilitis and arthritis)."Hepat" is derived from Latin and Greek words for liver. Liver cells can become inflamed because of infection.

Nonalcoholic fatty liver disease (nonalcoholic steatohepatitis [NASH]) describes the accumulation of fat within the liver that can cause inflammation and a gradual decrease in liver function.

Hemochromatosis (iron overload) is a metabolic disorder that leads to abnormally elevated iron stores in the body. The excess iron may accumulate in the tissues of the liver, pancreas, and heart, which can lead to inflammation, cirrhosis, liver cancer, and liver failure. Hemochromatosis is an inherited disease.

Wilson's disease is another inherited disease that affects the body's ability to metabolize copper. Wilson's disease may lead to cirrhosis and liver failure.

Gilbert's disease. In Gilbert's disease, bilirubin metabolism is abnormal in the liver. It is a common disease that affects up to 7% of the North American population. There are no symptoms and it is usually diagnosed incidentally when an elevated bilirubin level is found on routine blood tests. Gilbert's disease is a benign condition and requires no treatment.

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Cancer and other causes of liver disease

Cancers. Primary cancers of the liver arise from liver structures and cells. Two examples include hepatocellular carcinoma, the most common type of primary liver cancer in adults, and cholangiocarcinoma, cancer of the bile duct.

Metastatic cancer (secondary cancer of the liver) begins in another organ and spreads to the liver, usually through the bloodstream. Common cancers that spread to the liver begin in the lung, breast, large intestine, stomach, and pancreas. Leukemia and Hodgkin's lymphoma may also involve the liver.

Blood flow abnormalities. Budd-Chiari syndrome is a disease in which blood clots form in the hepatic vein and prevent blood from leaving the liver. This can increase pressure within the liver's blood vessels, especially the portal vein. This pressure can cause liver cells to die and lead to cirrhosis and liver failure. Causes of Budd-Chiari syndrome include polycythemia (abnormally elevated red blood cell count), inflammatory bowel disease, sickle cell disease, and pregnancy.

Congestive heart failure, where poor heart function causes fluid and blood to back up in the large veins of the body, can cause liver swelling and inflammation.

Gallstones. Normally, bile flows from the liver into the gallbladder and ultimately into the intestine to help with the digestion of food. If bile flow is obstructed, it can cause inflammation within the liver. Most commonly, gallstones can obstruct the ducts that drain bile from the liver.

Abnormalities of the opening of the bile duct into the small intestine (sphincter of Oddi) can lead to bile flow abnormalities. The sphincter of Oddi acts as a "valve" that allows bile to flow from the common bile duct into the intestine.

Primary biliary cholangitis (PBC, formerly referred to as primary biliary cirrhosis) and primary sclerosing cholangitis can lead to progressive scarring of the bile ducts, causing them to become narrow, which results in reduced bile flow through the liver. Eventually, damage and scarring of the liver architecture occur, resulting in liver failure.

Other causes of liver disease

Since the liver is responsible for the functions that affect many other organs, liver disease and failure may cause complications. Examples include:

What are liver disease stages?

Liver disease progresses through various stages, each with increasing severity and damage to the liver. The stages include:

Stage I: Inflammation (hepatitis)

The liver becomes inflamed and enlarged from infections, alcohol consumption, or toxins.
This stage is usually asymptomatic, but some people may have discomfort in their upper right abdomen. At this point, early detection and treatment have the potential to reverse the damage.

Stage II: Fibrosis

Chronic inflammation causes scar tissue to grow in the liver, which replaces healthy functional liver tissue and impairs the liver’s functionality. The symptoms are usually mild or absent; however, some people may develop fatigue or discomfort in the stomach. If the underlying cause is identified and treated in time, the progression of fibrosis slows down and the damage may be reversed.

Stage III: Cirrhosis

At this stage, the liver tissue is scarred and fibrosed. Gradually, healthy liver tissue is replaced by scarred and fibrotic tissue, which significantly alters the liver's structure and function. The liver becomes hard and lumpy. The symptoms become increasingly severe and may include jaundice, ascites, edema, and portal hypertension symptoms. Itching (pruritis) is typically seen with cirrhosis. Itching is caused by the accumulation of bile acids in the skin and is a common indication of severe liver disease. This stage is irreversible, so it is important to intervene to manage the symptoms and complications.

Stage IV. End-stage liver disease (ESLD)

This stage is characterized by extensive liver damage and significantly reduced liver function. This stage may also involve liver cancer (hepatocellular carcinoma). Symptoms are severe and can include jaundice, ascites, variceal hemorrhage, hepatic encephalopathy, and extreme fatigue. Liver transplantation is often necessary to reduce the risk of mortality.

Stage V: Liver cancer

Liver cancer (hepatocellular carcinoma) is a malignant tumor that forms in the liver, usually because of cirrhosis. The symptoms include weight loss, upper abdominal pain, jaundice, liver enlargement, and metastases. This is a serious condition that requires aggressive treatment to reduce the risk of mortality. The treatment options include surgical removal of the tumor, followed by chemotherapy and radiotherapy. Liver transplantation is the final option to reduce mortality.

Understanding these stages helps with appropriate diagnosis, timely treatment, and management of liver disease, as early diagnosis and treatment are crucial for better outcomes.

What are the risk factors for liver disease?

Some liver diseases are potentially preventable and are associated with lifestyle choices. Alcohol-related liver disease is due to excessive consumption and is the most common preventable cause of liver disease.

What are the symptoms of liver disease?

Classic symptoms of liver disease include:

However, since there are a variety of liver diseases, the symptoms tend to be specific to that illness until late-stage liver disease and liver failure occur. Examples of liver disease symptoms due to certain conditions or diseases include:

Symptoms of cirrhosis of the liver include the following:

Additionally, there is increased pressure within the cirrhotic liver affecting blood flow through the liver. Increased pressure in the portal vein causes blood flow to the liver to slow down and blood vessels to swell. Swollen veins (varices) form around the stomach and esophagus and are at risk for bleeding.

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When should you call your doctor for liver disease?

Often, the onset of liver disease is gradual and there is no specific symptom that brings the affected individual to seek medical care. Fatigue, weakness, and weight loss that cannot be explained should prompt a visit for medical evaluation. Jaundice or yellow skin is never normal and should prompt an evaluation by a health care professional. Persistent fever, vomiting, and abdominal pain should also prompt medical evaluation as soon as possible.

Acetaminophen or Tylenol overdose, whether accidental or intentional, can cause acute liver failure. Emergent evaluation and treatment are required. Antidotes to protect the liver can be provided but are effective only when used within a few hours. Without this intervention, acetaminophen overdose can lead to liver failure. Symptoms only occur after liver damage has occurred.

What exams, tests, and procedures diagnose the cause of liver disease?

The precise diagnosis of liver disease involves a history and physical examination performed by a health care professional. Understanding the symptoms and the patient's risk factors for liver disease will help guide any diagnostic tests that may be considered.

Sometimes, history is difficult, especially in patients who abuse alcohol. These patients tend to minimize their consumption, and it is often family members who can provide the correct information.

Liver disease can have physical findings that affect almost all body systems including the heart, lungs, abdomen, skin, brain and cognitive function, and other parts of the nervous system. The physical examination often requires evaluation of the entire body. Blood tests help assess liver inflammation and function. Specific liver function blood tests include AST and ALT (transaminase chemicals released with liver cell inflammation), GGT and alkaline phosphatase (chemicals released by cells lining the bile ducts), bilirubin, and protein and albumin levels.

Other blood tests may be considered, including:

What is liver disease treatment? Will you need surgery?

Each liver disease will have its specific treatment regimen. For example, hepatitis A requires supportive care to maintain hydration while the body's immune system fights and resolves the infection. Patients with gallstones may require surgery to remove the gallbladder. Other diseases may need long-term medical care to control and minimize the consequences of their disease.

In people with cirrhosis and end-stage liver disease, medications may be required to control the amount of protein absorbed in the diet. The liver affected by cirrhosis may not be able to metabolize the waste products, resulting in elevated blood ammonia levels and hepatic encephalopathy (lethargy, confusion, coma). A low-sodium diet and water pills (diuretics) may be required to minimize water retention.

In those people with large amounts of ascites fluid (fluid accumulated in the abdominal cavity), the excess fluid may have to be occasionally removed with a needle and syringe (paracentesis). Using a local anesthetic, a needle is inserted through the abdominal wall and the fluid is withdrawn. The ascites fluid can spontaneously become infected, and paracentesis also may be used as a diagnostic test to look for infection.

Surgery may be required to treat portal hypertension and minimize the risk of bleeding. Liver transplantation is the final option for patients whose livers have failed.

IMAGES Liver Disease Symptoms, Signs, Treatment, and Life Expectancy See a medical illustration of the liver plus our entire medical gallery of human anatomy and physiology See Images

What are the complications of liver disease?

Except for gallstone disease and some viral infections such as hepatitis A, C, and infectious mononucleosis, most liver diseases are managed and not cured. Liver disease can progress to cirrhosis and liver failure.

Associated complications may include an increased risk of bleeding and infection, malnutrition, weight loss, and decreased cognitive function. Some liver diseases are associated with an increased risk of developing liver cancer.

Is it possible to prevent liver disease?

Follow these tips to help prevent liver disease:

Frequently asked questions

Medically Reviewed on 8/2/2024

References