Liver disease
Overview
The liver is an organ about the
size of a football. It sits just under your rib cage on the right side of your
abdomen. The liver is essential for digesting food and ridding your body of
toxic substances.
Liver disease can be inherited
(genetic). Liver problems can also be caused by a variety of factors that
damage the liver, such as viruses, alcohol use and obesity.
Over time, conditions that damage
the liver can lead to scarring (cirrhosis), which can lead to liver failure, a
life-threatening condition. But early treatment may give the liver time to
heal.
Liver problems
Liver problems that can occur
include fatty liver disease and cirrhosis. The liver and its cells — as seen
through a microscope — change dramatically when a normal liver becomes fatty or
cirrhotic.
Symptoms
Liver disease doesn't always
cause noticeable signs and symptoms. If signs and symptoms of liver disease do
occur, the may 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
Chronic fatigue
Nausea or vomiting
Loss of appetite
Tendency to bruise easily
When to see a doctor
Make an appointment with your
doctor if you have any persistent signs or symptoms that worry you. Seek
immediate medical attention if you have abdominal pain that is so severe that
you can't stay still.
The liver
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.
Causes
Liver disease has many causes.
Infection
Parasites and viruses can infect
the liver, causing inflammation that reduces liver function. The viruses that
cause liver damage can be spread through blood or semen, contaminated food or
water, or close contact with a person who is infected. The most common types of
liver infection are hepatitis viruses, including:
Hepatitis A
Hepatitis B
Hepatitis C
Immune system abnormality
Diseases in which your immune
system attacks certain parts of your body (autoimmune) can affect your liver.
Examples of autoimmune liver diseases include:
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis
Genetics
An abnormal gene inherited from
one or both of your parents can cause various substances to build up in your
liver, resulting in liver damage. Genetic liver diseases include:
Hemochromatosis
Wilson's disease
Alpha-1 antitrypsin deficiency
Cancer and other growths
Examples include:
Liver cancer
Bile duct cancer
Liver adenoma
Other
Additional, common causes of
liver disease include:
Chronic alcohol abuse
Fat accumulation in the liver
(nonalcoholic fatty liver disease)
Certain prescription or
over-the-counter medications
Certain herbal compounds
Risk factors
Factors that may increase your
risk of liver disease include:
Heavy alcohol use
Obesity
Type 2 diabetes
Tattoos or body piercings
Injecting drugs using shared
needles
Blood transfusion before 1992
Exposure to other people's blood
and body fluids
Unprotected sex
Exposure to certain chemicals or
toxins
Family history of liver disease
Complications
Complications of liver disease
vary, depending on the cause of your liver problems. Untreated liver disease
may progress to liver failure, a life-threatening condition.
Prevention
To prevent liver disease:
Drink alcohol in moderation. For
healthy adults, that means up to one drink a day for women and up to two drinks
a day for men. Heavy or high-risk drinking is defined as more than eight drinks
a week for women and more than 15 drinks a week for men.
Avoid risky behavior. Use a
condom during sex. If you choose to have tattoos or body piercings, be picky
about cleanliness and safety when selecting a shop. Seek help if you use
illicit intravenous drugs, and don't share needles to inject drugs.
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. Hepatitis viruses can be spread by accidental
needle sticks or improper cleanup of blood or body fluids.
Keep your food safe. Wash
your hands thoroughly before eating or preparing foods. If traveling in a
developing country, use bottled water to drink, wash your hands and brush your
teeth.
Take care with aerosol sprays. Make
sure to use these products in a well-ventilated area, and wear a mask when
spraying insecticides, fungicides, paint and other toxic chemicals. Always
follow the manufacturer's instructions.
Protect your skin. When
using insecticides and other toxic chemicals, wear gloves, long sleeves, a hat
and a mask so that chemicals aren't absorbed through your skin.
Maintain a healthy weight. Obesity
can cause nonalcoholic fatty liver disease.
Diagnosis
Finding the cause and extent of
liver damage is important in guiding treatment. Your doctor is likely to start
with a health 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. An
ultrasound, CT scan and MRI can show liver damage.
Checking a tissue sample. Removing
a tissue sample (biopsy) from your liver may help diagnose liver disease and
look for signs of liver damage. A liver biopsy is most often done using a long
needle inserted through the skin to extract a tissue sample that's sent to a
lab for testing.
Ultrasound of liver tumor
An ultrasound uses sound waves to
create an image. This ultrasound shows a liver tumor.
Liver biopsy
A liver biopsy is a procedure to
remove a small sample of liver tissue for laboratory testing. Liver biopsy is
commonly performed by inserting a thin needle through your skin and into your
liver.
Treatment
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, typically 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 or has led to liver failure may ultimately require a liver transplant.
Lifestyle and home remedies
Changing certain lifestyle habits
can often help improve your liver health. If you've been diagnosed with liver
disease, your doctor may recommend that you:
Drink alcohol sparingly, if at
all.
Avoid red meat, trans fats, processed
carbohydrates and foods with high-fructose corn syrup.
Exercise 30 to 60 minutes around
three to four times a week at a moderate intensity.
Cut calories by 500 to 1,000
calories daily, if you're overweight.
Alternative medicine
No alternative medicine therapies
have been proved to treat liver disease. Some studies have indicated possible
benefits, but further research is needed.
On the other hand, some dietary
and herbal supplements can harm your liver. More than a thousand medications
and herbal products have been associated with liver damage, including:
Vitamin A
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.
Preparing for an appointment
You may be referred to a doctor
who specializes in the liver (hepatologist).
What you can do
Be aware of any pre-appointment
restrictions, such as not eating solid food on the day before your
appointment.
Write down your symptoms, including
any that may seem unrelated to the reason why you scheduled the appointment.
Make a list of all your
medications, vitamins and supplements.
Write down your key medical
information, including other conditions.
Write down key personal
information, including any recent changes or stressors in your life.
Ask a relative or friend to
accompany you, to help you remember what the doctor says.
Write down a list of questions to
ask your doctor.
Questions to ask your doctor
What's the most likely cause of
my symptoms?
What kinds of tests do I need? Do
these tests require any special preparation?
Are my liver problems likely
temporary or long lasting?
What treatments are available?
Should I stop taking certain
medications or supplements?
Do I need to stop drinking
alcohol?
I have other health conditions.
How can I best manage these conditions together?
Are my children at risk for liver
disease?
In addition to the questions that
you've prepared to ask your doctor, don't hesitate to ask other questions
during your appointment.
What to expect from your doctor
Your doctor is likely to ask you
a number of questions. Being ready to answer them may leave time to go over
points you want to spend more time on. You may be asked:
When did you first begin
experiencing symptoms, and how severe are they? Have your symptoms been
continuous or occasional?
Does anything seem to improve
your symptoms, or make them worse?
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?
