Liver diseases
Sources: National Health System, UK. and American Liver Foundation
Viral Hepatitis (Hepatitis A, B, C, E and coinfections)
Hepatitis means "liver inflammation". It is caused by a virus. Around half of all acute cases of hepatitis are due to a viral infection. Several kinds of hepatitis virus can infect the liver, and the most common are hepatitis A and B.
Hepatitis A is caught through the contamination of food and water with faeces (stools) through poor personal hygiene or sanitation. Hepatitis B is spread through the exchange of blood and body fluids.
Hepatitis B can be caught through unprotected sex, unsterilised needles, needlestick injury (accidental puncture of skin by a used needle) or contaminated blood products.
Hepatitis C is also spread through the exchange of blood or blood products. It is spread through sharing needles and needlestick accidents. It was also spread by blood transfusions before September 1992, when screening for hepatitis C was introduced.
There are four other recognised hepatitis viruses, named from C to G. Hepatitis A and E cause only acute infection. Hepatitis B and C cause chronic (ongoing) illness. Hepatitis D is only present in people infected with hepatitis B. The glandular fever virus can be caused by hepatitis. Vaccinations are available for hepatitis A and hepatitis B (singly or combined), and also as a combination of hepatitis A and typhoid.
Liver disease and alcohol
You can damage your liver in different ways. One of the most common ways is by drinking too much alcohol. Because the liver is the main organ that breaks alcohol down into water and carbon dioxide, it is most prone to developing alcohol-related problems.
Drinking excessively (more than around 21 units a week for men and more than around 14 units for women) increases your chances of developing the first stage of alcoholic liver disease, known as fatty liver. Fatty liver will disappear if you stop drinking too much. If you continue, you could progress to the next stages of liver disease.
One of the problems with alcoholic liver disease is that most people have very few early symptoms. Not many people experience pain and if you do feel pain, it will probably be over the right side of your abdomen. Other symptoms include fatigue, loss of appetite, sickness and diarrhea, especially in the mornings. More severe symptoms, such as jaundice (when the eyes and skin turn yellow), don’t appear until you develop alcoholic hepatitis and/or cirrhosis. By this point, the damage caused to your liver can be irreversible.
Alcoholic liver disease has three stages:
- First stage:
- Fatty liver (If caught early, minimal liver damage can be reversed if the person abstains from drinking alcohol).
- Second stage:
- Mild alcoholic hepatitis (high AST/ALT ratio in patients).
- Severe alcoholic hepatitis (it is not frequent, and has a high risk of death).
- Third stage:
- Cirrhosis (is a serious condition that destroys healthy tissue in the liver, leaving scar tissue that blocks the flow of blood through the liver. Cirrhosis progresses slowly, gradually causing the liver to stop functioning).
Non alcoholic liver disease (Fatty liver)
Non alcoholic steatohepatitis or NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.
E.g. NASH affects 2 to 5 percent of Americans. An additional 10 to 20 percent of Americans have fat in their liver, but no inflammation or liver damage, a condition called “fatty liver.” Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver.
Both NASH and NAFLD are becoming more common, possibly because of the greater number of persons with obesity.
Hereditary diseases
(Hereditary Haemochromatosis, Wilson’s disease and alpha-1-antitrypsin deficiency).
Hereditary Haemochromatosis (HH) is an inherited metabolic disorder in which the body absorbs and stores more iron from food than it needs. It can prove fatal if not recognised and treated early enough. Abdominal pain, weakness, lethargy, and weight loss are early symptoms. Without therapy, males may develop symptoms between age 40 and 60 years and females after menopause. Hepatic fibrosis or cirrhosis may occur in untreated individuals after age 40 years. Other findings in untreated individuals may include progressive increase in skin pigmentation, diabetes mellitus, congestive heart failure and/or arrhythmias, arthritis, and hypogonadism.
Wilson’s Disease is a genetic disorder that prevents the body from getting rid of extra copper. A small amount of copper obtained from food is needed to stay healthy, but too much copper is poisonous. In Wilson disease, copper builds up in the liver, brain, eyes, and other organs. Over time, high copper levels can cause life-threatening organ damage.
Alpha-1-antitrypsin deficiency is one of the most common inherited disorders among white persons. Its primary manifestation is early-onset panacinar emphysema. About 1-3% of patients with diagnosed chronic obstructive pulmonary disease (COPD) are predicted to have alpha1-antitrypsin deficiency. Slowly progressive dyspnea is the primary symptom, though many patients initially have symptoms of cough, sputum production, or wheezing.
Treatment involves smoking cessation, bronchodilation, and physical rehabilitation in a program similar to that designed for patients with smoking-related COPD. In addition, intravenous (IV) augmentation therapy with alpha1-antitrypsin benefits some patients. Alpha1-antitrypsin deficiency is also an unusual cause of hepatic cirrhosis in children and adults.
Hepatic Cirrhosis
Cirrhosis is a condition in which the liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver. Scarring also impairs the liver’s ability to control infections, remove bacteria and toxins from the blood, process nutrients, hormones, and drugs, make proteins that regulate blood clotting and produce bile to help absorb fats—including cholesterol—and fat-soluble vitamins.
A healthy liver is able to regenerate most of its own cells when they become damaged. With end-stage cirrhosis, the liver can no longer effectively replace damaged cells.
Cirrhosis has various causes; heavy alcohol consumption and chronic hepatitis C have been the most common causes of cirrhosis. Obesity is becoming a common cause of cirrhosis, either as the sole cause or in combination with alcohol, hepatitis C, or both. Many people with cirrhosis have more than one cause of liver damage. Cirrhosis is not caused by trauma to the liver or other acute, or short-term, causes of damage. Usually years of chronic injury are required to cause cirrhosis.
Icterus / Jaundice
Jaundice is a term that is used to describe a yellow coloured tinge to the skin, and a yellowing of the whites of the eyes. The body fluids of someone who is affected by jaundice can also become yellow in colour. The medical name for jaundice is icterus.
Jaundice is caused by the build up of bilirubin in the blood. Bilirubin is a yellow coloured substance that is produced when red blood cells are broken down.
Normally, the liver ‘picks up’ bilirubin and it is filtered by the kidneys before being excreted (passed out) of the body in urine. If there is something wrong with the liver, or the biliary system (which produces a waste substance called bile), an excess amount of bilirubin is produced.
Autoimmune Diseases
(Autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC), Primary sclerosing cholangitis (PSC))
Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the body really attacks its own cells the body’s immune system attacks liver cells. This immune response causes inflammation of the liver, also called hepatitis (AIH), the bile ducts in the liver to become inflamed and damaged and, ultimately, disappear (PBC) and damages and blocks bile ducts inside and outside the liver (PSC).
Ascites
Ascites is an accumulation of fluid in the peritoneal cavity. Although most commonly due to cirrhosis and severe liver disease, its presence can portend other significant medical problems. Ascites is caused by high pressure in the blood vessels of the liver (portal hypertension) and low albumin levels. Diagnosis of the cause is usually with blood tests, an ultrasound scan of the abdomen and direct removal of the fluid by needle or paracentesis (which may also be therapeutic). Treatment may be with medication (diuretics), paracentesis or other treatments directed at the cause.
Hepatic Encephalopathy
It is a potentially-reversible neuropsychiatric abnormality in the setting of liver failure, whether chronic (as in cirrhosis), or acutely. It can be diagnosed only after exclusion of other neurological, psychiatric, infectious, and metabolic etiologies. Hepatic encephalopathy may occur suddenly in people who previously had no liver problems when damage occurs to the liver. More often, the condition is seen in people with chronic liver disease.
With severe liver impairment, toxic substances normally removed by the liver accumulate in the blood and impair the function of brain cells. If there is also portal hypertension, and subsequent bypassing of the liver filtration system of blood flowing in from the intestines, these toxic substances can travel directly to the brain, without being modified or purified. Signs can include impaired cognition, a flapping tremor (asterixis), and a decreased level of consciousness including coma (hepatic coma or coma hepaticum), cerebral edema, and, ultimately, death.
Liver cancer
Liver cancer (hepatocellular carcinoma) is a cancer arising from the liver. It is also known as primary liver cancer or hepatoma. The liver is made up of different cell types (for example, bile ducts, blood vessels, and fat-storing cells). However, liver cells (hepatocytes) make up 80% of the liver tissue. Thus, the majority of primary liver cancers (over 90 to 95%) arises from liver cells and is called hepatocellular cancer or carcinoma.
When patients or physicians speak of liver cancer, however, they are often referring to cancer that has spread to the liver, having originated in other organs (such as the colon, stomach, pancreas, breast, and lung). More specifically, this type of liver cancer is called metastatic liver disease (cancer) or secondary liver cancer.
The most common diseases associated with liver cancer are chronic viral hepatitis, alcoholism, and cirrhosis. Moreover, chronic viral hepatitis is common in alcoholism, and both viral hepatitis and alcoholism cause cirrhosis which usually precedes the development of cancer.
Liver cancer is a bad cancer. It has frequently spread beyond the liver by the time it is discovered, and only 5% of patients with liver cancer that has begun to cause symptoms survive even five years without treatment. The only hope for patients who are at risk for liver cancer is regular surveillance so that the cancers can be found early. Early cancers can be treated by surgical removal (resection), destruction of the individual tumors, or liver transplantation.