Liver disease is disease that affects the liver. This vital organ is the body's largest internal organ. Liver disease can lead to serious complications, such as portal hypertension, fluid retention, jaundice and liver failure.

There are many types of liver disease, including cirrhosis, fatty liver, hepatitis and liver cancer.

The cause of some types of liver disease, particularly those present at birth, is not known. Other types, such as hemochromatosis, are caused by genes inherited from parents. In the United States, the most common causes of cirrhosis are alcoholism and hepatitis B and C.

Patients in the early stages of liver disease often do not experience symptoms. Others may experience symptoms such as fatigue, unexplained weight loss and loss of appetite. In the later stages of liver disease, patients may experience signs and symptoms such as enlarged liver, itching, spiderlike blood vessels and anemia.

Diagnosis of liver disease typically begins with a physical examination and medical history. Tests that may be performed include liver function tests, ultrasound and liver biopsy.

Treatment for liver disease varies according to the type of disease. It may include lifestyle changes (e.g., avoiding alcohol), medications (e.g., corticosteroids) or surgery (e.g., a shunt procedure). In advanced cases of liver failure, the only treatment option is liver transplantation.

Liver disease may be prevented in a variety of ways, including drinking alcohol in moderation, taking medications as directed and avoiding illegal drugs. Patients should eat a well-balanced diet and restrict intake of foods that are high in fat and cholesterol. Patients are encouraged to also exercise regularly and practice safe sex, such as using a condom.

There are many types of liver disease, including:

• Bile duct disorders. Several conditions can affect the bile ducts (tubes connecting the gallbladder and liver to the small intestine). Some babies are born with bile duct disorders. Other types of disorders develop in adulthood, such as primary biliary cirrhosis or sclerosing cholangitis. Gallstones can pass into the biliary system and cause inflammation and scarring.
  
  
• Budd Chiari syndrome. Disorder that causes narrowing and clotting in the hepatic vein, the major vein that leaves the liver.
  
  
• Cirrhosis. Scarring of the liver, resulting in tissue and cell damage. Advanced cases may lead to death.
  

  

• Cystic disease of the liver. Cysts can develop in the liver or in the bile ducts as a result of birth defects or disease.
  
  
• Fatty liver. The buildup of fat cells in the liver. There are two types of fatty liver, alcoholic and nonalcoholic. Fatty liver not associated with alcohol use is called nonalcoholic steatohepatitis (NASH).
  
  
• Gilbert syndrome. Common and benign (harmless) or mild condition involving genetically inherited deficiency in an enzyme that conjugates bilirubin (substance formed from the breakdown of red blood cells that give bile its color).
  
  
• Glycogen storage diseases. Birth defects that change the way the liver breaks down glycogen, the stored form of glucose (blood sugar) contained in the liver that the body can use for energy.
  
  
• Hemochromatosis. Genetic condition in which the body absorbs too much iron and stores it in the liver and other organs.
  
  
• Hepatitis. Inflammation of the liver. There are two main types of hepatitis, viral and nonviral. Autoimmune hepatitis is a progressive inflammation of the liver associated with an abnormality of the immune system. Advanced cases may lead to death.
  
  
• Intrahepatic cholestasis of pregnancy (ICP). A temporary liver disorder that can develop in pregnant women. ICP is marked by intense itching and sometimes jaundice. It can complicate the pregnancy but is rare in the United States.
  
  
• Liver cancer. The growth of malignant cells in the liver. This form of cancer is often fatal, but survival rates have doubled in recent decades.
  
  
• Porphyrias. A group of diseases that affect the production of heme, the chemical that colors blood. Some types are inherited conditions.
  
  
• Reye's syndrome. A systemic disease, most common in children, that increases pressure within the brain and causes a buildup of fat in the liver. A viral infection typically precedes Reye's syndrome. There is no known cure, but recovery can occur if early diagnosis prevents or limits brain damage and other complications.
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• Wilson's disease. Inherited disorder that causes too much copper to accumulate in the liver and other vital organs.

The cause of liver disease depends on the type of disease. In many cases, particularly with diseases that are present at birth, the cause is unknown. Causes and risk factors for specific types of liver disease may include:

• Budd Chiari syndrome. In most cases, the cause of Budd Chiari syndrome is unknown. Some patients with this condition also have polycythemia vera (an abnormal increase in blood cells that results from excess production by the bone marrow). Pregnancy, chronic infections, certain diseases, tumors and the use of birth control pills may cause the condition in some people. Most people with this condition are between ages 20 and 40.
  
  
• Cirrhosis. In the United States, the most common causes of cirrhosis are alcoholism and hepatitis B and C. People who drink excessive amounts of alcohol, engage in unsafe sexual practices and share needles for intravenous drug use have a higher risk for developing cirrhosis.
  
  
• Fatty liver. All the causes of fatty liver have not yet been identified. In the United States and other Western countries, the most common causes of fatty liver include alcohol abuse, obesity and diabetes (a disorder in the body’s ability to use blood sugar [glucose]). Nonalcoholic fatty liver disease, also called nonalcoholic steatohepatitis (NASH) is strongly associated with obesity, high blood pressure, high cholesterol levels and diabetes.
  
  
• Gilbert syndrome. Patients with this condition have an inherited genetic abnormality that causes reduced levels of an enzyme in bilirubin to be produced. As a result, a type of bilirubin (called unconjugated bilirubin) accumulates in the blood. However, patients do not have acute or chronic liver disease.
  
  
• Glycogen storage disease. Most patients with this disease inherited certain types of genes from their parents that lead to development of the condition.
  
  
• Hemochromatosis. In the United States, a large percentage of patients with this condition inherit a certain type of gene from their parents. However, not everybody who inherits these genes develops the condition.
  
  
• Hepatitis. Viral hepatitis is caused by exposure to the hepatitis A, B, C, D or E viruses. The viruses live in blood, body fluids and feces. They can be spread through food or water that is contaminated by feces, through sexual contact with an infected person, from mother to child during childbirth and through shared needles during intravenous drug use.
  
  
• Liver cancer. It is not clear what causes liver cancer, but risk factors for developing the disease may include exposure to the hepatitis B and C viruses, cirrhosis and excessive alcohol consumption.
  
  
• Liver failure. Acetaminophen is one of the most popular over-the-counter painkillers. Researchers have found a growing incidence of acute liver failure in recent years. Much of this increase is attributed to unintentional and sometimes intentional overdose of acetaminophen. Liver failure can also result from late stages of diseases such as cirrhosis or hepatitis.
  
  
• Wilson's disease. Most patients with this disease inherited certain type of genes from their parents that results in development of the disease.

Signs and symptoms of liver disease vary according to the type of disease. In the early stages of some types of diseases, patients may experience no symptoms. In the early stages of others, symptoms may be mild and may include:

• Fatigue
• Weakness
• Unexplained weight loss
• Loss of appetite
• Nausea or vomiting
• Fever
• Bruising

In the later stages of liver disease, signs and symptoms may include:

• Jaundice (yellowing of the skin and whites of the eyes)
  
  
• Enlarged liver
  
  
• Ascites (fluid buildup in the abdomen)
  
  
• Encephalopathy (confusion that results from deterioration of brain function)
  
  
• Cholestasis (reduction or stoppage of bile flow)
  
  
• Varices (stretched veins) that can lead to gastrointestinal bleeding
  
  
• Portal hypertension (high blood pressure in the portal vein)
  
  
• Itching
  
  
• Spiderlike blood vessels, red palms or bright red complexion of the skin
  
  
• Anemia (decreased number of red blood cells)
  
  
• Leukopenia (decreased number of white blood cells)
  
  
• Thrombocytopenia (decreased number of platelets)
  
  
• Coagulopathy (tendency to bleed)
  
  
• High glucose (blood sugar) levels
  
  
• Cessation of menstrual cycle and decreased fertility in women
  
  
• Erectile dysfunction (impotence) in men
  
  
• Increased heart rate and amount of blood pumped
  
  
• Hypotension (low blood pressure)
  
  
• Liver failure

Diagnosis of liver disease typically begins with a physical examination and a medical history that includes a review of medications.

During the examination, a physician may gently press against the abdomen to determine whether the liver is enlarged. A physician may also ask a patient about practices that can lead to liver disease, such as alcohol use, drug use or sexual habits.

A physician may conduct a blood test (test that determines the amount of a substance in the blood and identifies abnormally high or low levels). The presence of certain types of substances in the blood often indicates whether liver damage has occurred. Substances studied during blood tests may include:

• Blood cells. A complete blood count (CBC) measures the amount of the three types of blood cells to detect conditions such as anemia (decreased number of red blood cells), leukopenia (decreased number of white blood cells), leukocytosis (increased number of white blood cells, often due to infection) or thrombocytopenia (decreased number of platelets).
  
  
• Enzymes (complex proteins found in body cells). This is sometimes called a liver function test. Enzymes identified may include alanine aminotransferase (enzyme found mainly in the liver), alkaline phosphatase (enzyme related to the bile ducts) and aspartate aminotransferase (enzyme found in the liver and a few other tissues, such as the heart and muscles).
  
  
• Bilirubin. A substance formed from the breakdown of red blood cells that gives bile its color. A total bilirubin test measures all the bilirubin in the blood and a direct bilirubin test measures a form made in the liver.
  
  
• Proteins. Protein is produced in the liver. Two tests for protein include an albumin test (measures albumin, the main protein made by the liver) and a total protein test (measures albumin and all other proteins in the blood). There are also coagulation tests, which can reveal the insufficient amount of clotting protein that is common in liver disease.

When all tests related to enzymes, bilirubin and proteins are performed, it is called a liver panel.

A physician may also perform imaging tests to identify blockages and other damage to the liver. They may include:

• Ultrasound. An imaging technology that uses sound waves to produce images of the shape and outline of various tissues and organs in the body.
  
  
• Endoscopic ultrasound. A procedure in which a probe that emits sound waves is inserted through the mouth into the gastrointestinal tract to produce images of body tissues.
  
  
• Computed axial tomography (CAT scan). A test that allows for multiple x-rays to be taken from different angles around the patient. It creates images of organs and bones within the body. It may be performed alone or with the use of a special dye (contrast medium).
  
  
• Magnetic resonance imaging (MRI). A safe and noninvasive or minimally invasive imaging test that can help physicians diagnose diseases of numerous organs and vessels. It uses powerful magnets to produce images on a computer screen and film. There may be some concern with recent implanted devices when patients have MRI exams.
  
  
• Endoscopic retrograde cholangiopancreatography (ERCP). A contrast x-ray of the gallbladder, pancreas and liver ducts and other related portions of the biliary system. An endoscope (lighted tube) is inserted through the mouth into the small intestine.
  
  
• Cholangiography. A series of x-rays of the gallbladder and bile ducts using a contrast medium to help detect blockages.
  
  
• Radionuclide imaging. Tests that use small amounts of radioactive material to determine how much bile is flowing through the liver.

Although blood tests and imaging tests provide useful information in the diagnosis of liver disease, a physician may also perform a liver biopsy to confirm a diagnosis. This involves removing a small sample of tissue from the liver and studying it under a microscope. There are several techniques that may be used to remove the tissue. A numbing agent may be applied to the skin and a sedative may be administered before the procedure.

The treatment of liver disease varies, depending on the type of disease. In some cases, treatment involves minimizing or treating complications that may arise due to liver disease.

Liver diseases may be treated with lifestyle changes, such as:

• Avoiding or limiting alcohol. Alcohol can damage the liver, so abstaining from or minimizing consumption is very important.
  
  
• Avoiding medications that may damage the liver, such as acetaminophen.
  
  
• Eating a well-balanced diet. Liver disease can sometimes impact the body’s ability to absorb nutrients, so patients must take special care to eat foods high in vitamins and minerals.
  
  
• Following special diets. Patients with ascites and edema, two common complications of liver disease, may follow a low-sodium diet to reduce fluid buildup. Patients with Wilson's disease may be required to avoid foods that are high in copper, such as liver, shellfish, mushrooms and nuts.
  
  
• Exercising regularly. This can help patients maintain a healthy weight.

Liver diseases may also be treated with medications, including:

• Corticosteroids. A group of anti-inflammatory drugs used to provide relief for inflamed areas of the body by reducing swelling, redness, itching and allergic reactions. They are used to treat conditions such as autoimmune hepatitis and some cases of Budd Chiari syndrome.
  
  
• Interferon. Naturally produced proteins in the immune response that attack viruses and other foreign agents. Interferon is used to treat viral hepatitis.
  
  
• Beta blockers. Medication to treat high blood pressure. A common complication of liver disease is portal hypertension (increased blood pressure in the portal vein).
  
  
• Chelating agent. Medication that binds to copper and helps eliminate it from the body. It is used to treat Wilson’s disease.
  
  
• Chemotherapy. This involves using powerful medications to kill cancer cells. Liver cancer is treated with chemotherapy.

Liver diseases may be treated with medical procedures, including:

• Removing blood from the body (phlebotomy). Hemochromatosis is treated with the regular removal of blood from the body to reduce iron levels in the blood.
  
  
• Removing abdominal fluid. Some patients require fluid to be removed from the abdominal cavity with a needle using local anesthetic. Patients may require antibiotics to lessen the possibility of bacterial peritonitis.
  
  
• Radiation therapy. This involves using high-dose x-rays to kill cancer cells and shrink tumors. It is a treatment technique for liver cancer.

Liver diseases may also be treated with surgical procedures, including:

• Shunt surgical procedures. Technique to improve the flow of blood in the veins leading to the liver. It may be used to treat portal hypertension. One common type of shunt procedure is the transjugular intrahepatic portosystemic shunt (TIPS). This involves placing a stent (tubular device) in the middle of the liver to redirect blood flow.
  
  
• Liver transplantation. This is the only treatment option for patients with liver failure. It involves removing a damaged liver and replacing it with a liver from a donor. Though liver transplantation is successful in a large number of patients, the number of patients that need a new liver is much larger than the number of donated organs. Living-donor transplants are an option for some patients, and involve the transplantation of part of a liver from a donor into a patient.

Researchers are studying many potential advances in treating liver disease, including gene therapy, stem cells and experimental medications.

Not all liver diseases can be prevented, but there are many ways people can reduce their risk of developing liver disease. These strategies include:

• Drinking alcohol in moderation or avoiding alcohol. Excessive alcohol consumption over many years is a leading cause of liver disease. Do not take other drugs, such as acetaminophen, while consuming alcohol because the combination can be toxic to the liver.
  
  
• Avoiding illegal drugs and using care with supplements. Take only recommended dosages of prescription and over-the-counter medications, and only when necessary. Avoid herbal supplements that may be toxic to the liver including kava, comfrey, chaparral, jin bu huan, kombucha tea, pennyroyal and skullcap. High dosages of vitamins A, D, E and K can also be toxic.
  
  
• Exercising caution when using chemicals such as aerosol sprays, insecticides, fungicides and paint. Cover the skin with gloves, long sleeves, a hat and a face mask.
  
  
• Eating a well-balanced and nutritious diet. Restrict intake of foods with high amounts of fat and cholesterol. Increase the amount of fiber in the diet.
  
  
• Maintaining a healthy weight. Obesity is a risk factor in several liver diseases.
  
  
• Exercising regularly. This helps to maintain a healthy weight and also keeps the liver healthy. It is recommended that patients perform at least 30 minutes of aerobic exercise on most days of the week.
  
  
• Practicing safe sex. Certain types of the hepatitis virus are spread through sexual contact. Therefore it can often be prevented by using a condom during sexual intercourse. Hepatitis can also be spread by infected needles used in tattooing, body piercing or intravenous (I.V.) drug use.
  
  
• Receiving a vaccination for hepatitis B if at risk for contracting the virus. People at a higher risk of being exposed to hepatitis B include people with multiple sexual partners, people who use I.V. drugs, healthcare workers, staff of institutions for people with developmental disabilities, firefighters, police officers, mortuary attendants and daycare workers.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to liver disease:

1. What function does the liver serve in my body?
   
   
2. Why do you suspect I may have liver disease?
   
   
3. What diagnostic tests do you recommend for me?
   
   
4. Do I have one of the more common types of liver disease?
   
   
5. Aside from alcohol use, can you tell me some of the most common causes of liver disease?
   
   
6. Are the symptoms I am experiencing typical?
   
   
7. Is it possible for me to have liver disease and not experience symptoms?
   
   
8. How should my liver disease be treated?
   
   
9. Are there any lifestyle changes I can make to prevent my liver disease from becoming worse?
   
   
10. Will I need a liver transplant at some point in my life?