Liver Disease

What is liver disease?

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 percent or three quarters of liver tissue needs to be affected before a decrease in function occurs.

What causes liver disease?

A variety of illnesses can affect the liver:

• Certain drugs like excessive amounts of acetaminophen, and acetaminophen combination medications like Vicodin, Norco, and statins.
• Cirrhosis.
• Alcohol abuse.
• Hepatitis A, B, C, D, and E.
• Epstein Barr virus (infectious mononucleosis).
• Non-alcoholic fatty liver disease.
• Iron overload (hemochromatosis).

What are the risk factors for acquiring 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.
• Hepatitis B is a viral infection most often spread through the exchange of bodily fluids (for example, unprotected sexual intercourse, sharing unsterilized drug injecting equipment, using non-sterilized equipment for tattoos or body piercing).
• Hereditary liver disease can be passed genetically from generation to generation. Examples include Wilson’s disease (copper metabolism abnormalities) and hemochromatosis (iron overload).
• Chemical exposure may damage the liver by irritating the liver cells resulting in inflammation (hepatitis), reducing bile flow through the liver (cholestasis) and accumulation of triglycerides (steatosis). Chemicals such as anabolic steroids, vinyl chloride, and carbon tetrachloride can cause liver cancers.
• Acetaminophen (Tylenol) overdose is a common cause of liver failure. It is important to review the dosing guidelines for all over-the-counter medications and to ask for guidance from your health care professional or pharmacist as to how much of any medication may be taken safely. While over the counter medications are relatively safe, they may cause complications directly or as an interaction with a prescription medication.
• Medications may irritate the liver blood vessels causing narrowing or the formation of blood clots (thrombosis). Birth control pills may cause hepatic vein thrombosis, especially in smokers.

What are the symptoms of liver disease?

• Weakness and fatigue.
• Weight loss.
• Nausea.
• Vomiting.
• Yellow discoloration of the skin (jaundice).

How is liver disease treated?

Each liver disease will have its own 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

For people with cirrhosis and end-stage liver disease, medications may be required to control the amount of protein absorbed in the diet. A 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). Low sodium diet and water pills (diuretics) may be required to minimize water retention.

In those patients 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 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 looking for infection.

Operations 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.

What you can expect at your appointment

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

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 are helpful in assessing 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 the following:

• Complete blood count (CBC), patients with end stage liver disease may have bone marrow suppression and low red blood cells, white blood cells and platelets. As a result, people with cirrhosis may have bleeding;
• INR blood clotting function may be impaired due to poor protein production and is a sensitive measure of liver function;
• Lipase to check for pancreas inflammation;
• Electrolytes, BUN and creatinine to assess kidney function; and
• Ammonia blood level assessment is helpful in patients with mental confusion to determine whether liver failure is a potential cause.
• Imaging studies may be used to visualize, not only the liver, but other nearby organs that may be diseased. Examples of imaging studies include:
  • CT scan (computerized axial tomography),
  • MRI (magnetic resonance imaging), and
  • Ultrasound (sound wave imaging, which is especially helpful in assessing the gallbladder and bile ducts.
  • Liver biopsy may be considered to confirm a specific diagnosis of liver disease. Under local anesthetic, a long thin needle is inserted through the chest wall into the liver, where a small sample of liver tissue is obtained for examination under a microscope.