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Liver Diseases

General Information

The liver is your largest internal organ. About the size of a football, it's located mainly in the upper right portion of your abdomen, beneath the diaphragm and above your stomach, but a small portion extends into the upper left quadrant.


Causes of Liver Disease

Liver disease has many causes.


Infection

Parasites and viruses can infect the liver, causing inflammation. Subsequently, this can lead to a reduction or disruption of liver function. The viruses that cause liver damage can be spread by blood or semen, contaminated food or water, or close contact with a person who is infected. The most common types of viral liver disease are secondary to the various hepatitis viruses. These include:


Immune system abnormalities

Diseases in which the human immune system attacks certain parts of the body (autoimmune) can affect the liver adversely. Examples of autoimmune liver diseases include:

Autoimmune Hepatitis

Primary Biliary Cholangitis (PBC)

Primary Sclerosing Cholangitis (PSC)


Genetic Disease

An abnormal gene can cause various substances to build up in the liver and subsequently result in liver damage. Genetic liver diseases include:

Alpha-1 Antitrypsin Deficiency

Hemochromatosis

Gierke's Disease - Type I Glycogen Storage Disease (GSD I)

Galactosemia

Gilbert Syndrome

Lysosomal Acid Lipase Deficiency (LALD)

Wilson's Disease


Cancer and other growths

Examples include:

Liver cancers

Liver Cysts

Bile duct cancer

Liver adenomas


Other

Additional, types of liver disease include:

Chronic alcohol abuse (Cirrhosis)

Nonalcoholic Steatohepatitis (NASH)

Fat accumulation in the liver (Nonalcoholic Fatty Liver Disease (NAFLD))


Symptoms

Signs and symptoms of liver disease include:

Skin and eyes that appear yellowish (jaundice)

Abdominal pain and swelling

Swelling in the legs and ankles

Itchy skin

Dark urine color

Pale stool color, or bloody or tar-colored stool

Chronic fatigue

Nausea or vomiting

Loss of appetite

Tendency to bruise easily

Hepatic Encephalopathy


Risk Factors for Liver Damage

Factors that may increase your risk of liver disease include:

Heavy alcohol use

Injecting drugs and using sharing needles

Tattoos or body piercings

Blood transfusions received before 1992

Exposure to other people's blood and body fluids

Unprotected sex

Exposure to certain chemicals or toxins

Diabetes

Obesity

High levels of triglycerides in your blood


Complications of Liver Disease

Complications of liver disease vary depending on the etiology of the liver problem. Untreated liver disease may progress to liver failure which can be a life-threatening condition.


Your Office Visit

What should you expect during your consultation

Your doctor is likely to ask you a number of questions. You may be asked:

When did you first begin experiencing symptoms? How severe are they?

Have your symptoms been continuous or occasional?

What, if anything, seems to improve or worsen your symptoms?

Have you had a fever?

Have you ever had your skin or eyes turn yellow?

What medications and supplements do you take?

How many days of the week do you drink alcohol? 

Do you have any tattoos?

Does your job involve exposure to chemicals, blood or body fluids?

Have you ever had a blood transfusion?

Have you been told that you have had liver problems before?

Has anyone in your family ever been diagnosed with liver disease?


Testing and Diagnosis

Finding the cause and extent of liver damage is important in guiding treatment.
Your doctor is likely to start with a history and thorough physical examination. Your doctor may then recommend:

Blood tests:  A group of blood tests called liver function tests can be used to diagnose liver disease. Other blood tests can be done to look for specific liver problems or genetic conditions.

Imaging tests: CT scan, MRI and ultrasound can show liver damage.

FibroScan / Transient Elastography: an FDA approved, non-invasive test to measure liver inflammation and fibrosis - comparable to a Liver Biopsy

Tissue analysis via Liver Biopsy: Removing a tissue sample (biopsy) from your liver may help diagnose liver disease. Liver biopsy is most often done using a needle inserted through the skin to extract a tissue sample. It is then analyzed in a laboratory.

Treatments and Medications

Treatment for liver disease depends on your diagnosis. Some liver problems can be treated with lifestyle modifications, such as stopping alcohol use or losing weight. Weight loss is best completed as part of a medical program that includes careful monitoring of liver function. Other liver problems may be treated with medications or may require surgery.Treatment for liver disease that causes liver failure may ultimately require a liver transplant.


Prevention of Liver Disease

Abstinence of alcohol: For healthy adults up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger has been considered acceptable. Heavy or high-risk drinking is defined as more than three drinks on any day or more than seven drinks a week for women and for men older than age 65, and more than four drinks on any day or more than 14 drinks a week for men age 65 and younger.


Avoid risky behavior: Get help if you use illicit intravenous drugs, and don't share needles used to inject drugs. Use a condom during sex. If you choose to have tattoos or body piercings, be picky about cleanliness and safety when selecting a shop.


Get vaccinated: If you're at increased risk of contracting hepatitis or if you've already been infected with any form of the hepatitis virus, talk to your doctor about getting the hepatitis A and hepatitis B vaccines.


Use medications wisely: Take prescription and nonprescription drugs only when needed and only in recommended doses. Don't mix medications and alcohol. Talk to your doctor before mixing herbal supplements or prescription or nonprescription drugs.


Avoid contact with other people's blood and body fluids: The Hepatitis viruses are spread by accidental needle sticks or improper cleanup of blood and body fluids.


Maintain a healthy weight: Obesity can cause nonalcoholic fatty liver disease.


Herbal Medications and Liver Disease

Some herbal supplements used as alternative treatments can harm your liver. 

More than a thousand medications and herbal products have been associated with liver damage, including:

Jin bu huan

Ma-huang

Germander

Valerian

Mistletoe

Skullcap

Chaparral

Comfrey

Kava

Pennyroyal oil


To protect your liver, it's important to talk to your doctor about the potential risks before you take any complementary or alternative medicines.

Cirrhosis

The liver weighs about 3 pounds and is the largest solid organ in the body. It performs many important functions, such as:

  • Manufacturing blood proteins that aid in clotting, oxygen transport, and immune system function
  • Storing excess nutrients and returning some of the nutrients to the bloodstream
  • Manufacturing bile, a substance needed to help digest food
  • Helping the body store sugar (glucose) in the form of glycogen
  • Ridding the body of harmful substances in the bloodstream, including drugs and alcohol
  • Breaking down saturated fat and producing cholesterol


Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

According to the National Institutes of Health, cirrhosis is the 12th leading cause of death by disease.


What Causes Cirrhosis of the Liver?

Hepatitis C, fatty liver, and alcohol abuse are the most common causes of cirrhosis of the liver in the U.S., but anything that damages the liver can cause cirrhosis, including:

  • Fatty liver associated with obesity and diabetes
  • Chronic viral infections of the liver (hepatitis types B, C, and D; Hepatitis D is extremely rare)
  • Blockage of the bile duct, which carries bile formed in the liver to the intestines, where it helps in the digestion of fats; in babies, this can be caused by biliary atresia in which bile ducts are absent or damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked, or scarred, due to another liver disease called primary biliary cholangitis.
  • Repeated bouts of heart failure with fluid backing up into the liver
  • Certain inherited diseases such as:
    • Cystic fibrosis
    • Glycogen storage diseases, in which the body is unable to process glycogen, a form of sugar that is converted to glucose and serves as a source of energy for the body
    • Alpha 1 antitrypsin deficiency, an absence of a specific enzyme in the liver
    • Diseases caused by abnormal liver function, such as hemochromatosis, a condition in which excessive iron is absorbed and deposited into the liver and other organs, and Wilson's disease, caused by the abnormal storage of copper in the liver


Although less likely, other causes of cirrhosis include reactions to prescription drugs, prolonged exposure to environmental toxins, or parasitic infections.


What Are the Symptoms of Cirrhosis of the Liver?

The symptoms of cirrhosis of the liver vary with the stage of the illness. In the beginning stages, there may not be any symptoms. As the disease worsens, symptoms may include:


  • Loss of appetite
  • Lack of energy (fatigue), which may be debilitating
  • Weight loss or sudden weight gain
  • Bruises
  • Yellowing of skin or the whites of eyes (jaundice)
  • Itchy skin
  • Fluid retention (edema) and swelling in the ankles, legs, and abdomen (often an early sign)
  • A brownish or orange tint to the urine
  • Light colored stools
  • Confusion, disorientation, personality changes
  • Blood in the stool
  • Fever

Hepatitis A, B & C

The liver, the body's largest organ weighing about three pounds, is located on the right side of the abdomen, protected by the lower rib cage. It is responsible for over 5,000 life-sustaining functions, produces most of the building blocks used by the rest of the body and removes harmful chemicals. The liver produces bile that is transported to the small intestine to aid in the digestive process. The liver also produces proteins, hormones and enzymes that keep the body functioning normally, as well as materials that help in normal clotting of the blood, and to cleanse the body of substances that would otherwise be poisonous. It has a role in the processing of cholesterol, maintenance of blood sugars levels, and the processing of drugs.

When the liver becomes diseased, it may have many serious consequences. Viral infections are the most common diseases to affect the liver. When a virus damages a liver cell, the cell can no longer function. With fewer healthy cells to carry on their important work, many body functions can be affected.


Hepatitis means inflammation of the liver. There are many reasons for the liver to be inflamed, and not all of them are due to viruses. Certain toxic drugs and immune disorders may cause liver inflammation. The most common cause for liver inflammation is viral hepatitis. When liver inflammation is present for more than 6 months, the condition is referred to as chronic hepatitis. In the United States: There will be 500,000 new cases of viral hepatitis this year. More than 4.5 million Americans have chronic viral hepatitis. That is nearly 2 percent of the United States population. Chronic viral hepatitis, well tolerated in many, may result in premature death from cirrhosis or liver cell cancer and is a leading indication for liver transplantation.


Symptoms produced by viral hepatitis are varied and differ depending upon whether the hepatitis is acute or chronic. Many cases of acute hepatitis are so mild that there may be no symptoms or only non-specific "flu-like"symptoms for a few days or weeks. Symptoms of Viral Hepatitis Acute hepatitis refers to inflammation of the liver and symptoms which are more short-term and sporadic. Acute hepatitis is less likely than chronic hepatitis to result in permanent damage to liver function.


Acute Hepatitis    Chronic Hepatitis   Severe Fatigue    Fatigue

   Yellow Eyes     Yellow Skin     Joint Aches     Skin Rashes   

Dark Urine    Loss of Memory    Low Grade Fevers    GI Upset


Note: many patients with either acute or chronic hepatitis have NO SYMPTOMS, and symptoms are not a reliable means of knowing if progressive liver damage is occurring.


There are currently seven viruses known which cause liver inflammation. They are called hepatitis A, B, C, D, E, F and G. Because of this terminology, they are commonly referred to as an "alphabet soup" of names.


Hepatocellular Carcinoma (HCC) - Liver Cancer

Hepatocellular carcinoma is a cancer that arises in the liver. It is also known as hepatoma or primary liver cancer.


HCC is the fifth most common cancer in the world. Recent data shows that HCC is becoming more common in the US. This rise is thought to be because of chronic hepatitis C, an infection that can cause HCC.


What are the symptoms of HCC?

Abdominal pain is the most common symptom of HCC and usually is present when the tumor is very large or has spread. Unexplained weight loss or unexplained fevers are warning signs in patients with cirrhosis. Sudden appearance of abdominal swelling (ascites), yellow discoloration of the eyes and skin (jaundice), or muscle wasting suggests the possibility of HCC.


What are the treatment options for HCC?

Chemotherapy :

This may include injection of anti-cancer chemicals into the body through a vein or through chemoembolization.

The technique of chemoembolization is a procedure where chemotherapeutic drugs are given directly into the blood vessels that supply the tumor and small blood vessels are blocked so that the drug stays within the area of the tumor. Chemotherapy can provide some relief of symptoms and possibly decrease tumor size (in 50% of patients) but it is not curative.


Ablation:

Ablation (tissue destruction) therapy in the form of using radiofrequency waves, alcohol injection into the tumor or proton beam radiation to the tumor site are other options for treatment. There is no data to indicate that any one of these treatment is better than another.


Surgery:

Surgery is only available to patients with excellent liver function who have tumors less than 3-5 cm that are confined to the liver. If the patient is able to undergo surgery successfully, the five year survival is 30-40%. Many patients may have recurrence of HCC in another part of the liver.


Liver transplantation is a treatment option for patients with end-stage liver disease and small HCC. There is however a severe shortage of donors in the USA.



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