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Liver Disease

Overview, Causes, & Risk Factors

Liver disease is a term for a collection of conditions, diseases, and infections that affect the cells, tissues, structures, or functions of the liver.

What is going on in the body?

The liver is an important organ in the body located in the upper right quadrant of the abdomen. It is responsible for:

filtering the blood

making bile, a substance that aids in digestion and helps rid the body of harmful substances

processing fats and sugars, helping the body store energy for later use

making important proteins, such as those involved in blood clotting

metabolizing many medications, such as barbiturates, sedatives, and amphetamines

the storage of vitamins A, B1\ \B2\ \B6\ \pantothenic acid\ \folic acid\ \niacin\ \biotin\ Cobalamin is the general name for vitamin B12. ',CAPTION,'Vitamin B12');" onmouseout="return nd();">B12, D, and several of the B-complex vitamins. The liver also stores iron and copper.

If the liver becomes inflamed or infected, its ability to perform these functions may be impaired. Liver disease and infections are caused by a variety of conditions including viral infections, bacterial invasion, and chemical or physical changes within the body. The most common cause of liver damage is malnutrition, especially that which occurs with alcoholism.

Symptoms of liver disease may be acute, occurring suddenly, or chronic, developing slowly over a long period of time. Chronic liver disease is much more common than acute. The rates of chronic liver disease for men are two times higher than for women. Liver disease may range from mild to severe depending on the type of disease present.

What are the causes and risks of the disease?

Liver disease can be caused by a variety of factors. Causes include:

congenital birth defects, or abnormalities of the liver present at birth

metabolic disorders, or defects in basic body processes

viral or bacterial infections

alcohol or poisoning by toxins

certain medications that are toxic to the liver

nutritional deficiencies

trauma, or injury

Common liver diseases in children include:

galactosemia, an inherited disease in which the body can not tolerate certain sugars in milk. These sugars can build up, causing serious damage to the liver and other organs of the body.

alagille syndrome, a condition in which the bile ducts narrow and deteriorate, especially during the first year of life

alpha 1- antitrypsin deficiency, a genetic liver disease in children that can lead to hepatitis and cirrhosis of the liver

neonatal hepatitis, which is hepatitis that occurs in a newborn during the first few months of life

tyrosinemia, a disorder that causes serious problems with liver metabolism

hemorrhagic telangiectasia, a condition in which thin blood vessels allow frequent and easy bleeding of the skin and digestive tract

Reye's syndrome, a condition that causes a buildup of fat in the liver

Wilson's disease, an inherited condition that causes a buildup of the mineral copper in the liver

thalassemia, a group of hereditary anemias, or low red blood cell counts

biliary atresia, a condition in which the bile ducts extending from the liver to the intestine are too small in diameter or are missing

chronic active hepatitis, an inflammation of the liver that causes severe scarring and interference with liver function

cancer of the liver, which may result from cancer in other parts of the body that have spread to the liver

Common liver diseases seen in adults include:

cirrhosis, which is a serious condition that causes tissues and cells in the liver to be replaced by scar tissue. This results in serious complications throughout the liver and other organs of the body.

type I glycogen storage disease, which causes problems in controlling blood sugars when a person fasts

porphyria, a condition that causes a malfunction in how the body uses porphyrins. Porphyrins are important in making the red blood cells and carrying oxygen throughout the body.

hemochromatosis, a condition which causes the body to absorb and store too much iron. The iron buildup causes damage to the liver and other organs.

primary sclerosing cholangitis, a condition that causes the bile ducts of the liver to narrow due to inflammation and scarring

sarcoidosis, a disease that causes a buildup of lesions within the liver and other organs of the body

gallstones, which may block the bile duct

hepatitis, an inflammation and infection of the liver caused by a number of viruses

cystic disease of the liver, which causes lesions and fluid-filled masses in the liver

Alcohol-related liver diseases include:

fatty liver disease, which causes an enlarged liver

alcoholic hepatitis

alcoholic cirrhosis

Symptoms & Signs

What are the signs and symptoms of the disease?

Symptoms partly depend on the type and the extent of liver disease. In many cases, there may be no symptoms. Signs and symptoms that may occur include:

jaundice, or yellowing of the skin

darkened urine

nausea

loss of appetite

unusual weight loss or weight gain

vomiting

diarrhea

light-colored stools

abdominal pain in the upper right part of the stomach

malaise, or a vague feeling of illness

generalized itching

varicose veins, or enlarged blood vessels

fatigue

hypoglycemia, or low blood sugar

mild low grade fever

muscle aches and pains

loss of sex drive

depression

A rare but severe form of the liver infection called acute fulminant hepatitis causes liver failure. Symptoms of liver failure include:

an enlarged and tender liver

enlarged spleen

susceptibility to bleeding

encephalopathy, which is a disorder that affects how the brain functions

changes in mental status or level of consciousness

ascites, which is an accumulation of fluid inside the abdomen

edema or swelling under the skin

aplastic anemia, a condition in which the bone marrow cannot make blood cells

Diagnosis & Tests

How is the disease diagnosed?

A healthcare provider can determine whether a person's symptoms, medical history, and physical exam are consistent with liver disease. Splenomegaly, or an enlarged, firm liver, and other signs of liver disease may be found on examination. Many further tests may also be used to support the diagnosis. These include blood tests, such as:

liver function tests, which are blood tests that check a wide variety of liver enzymes and byproducts

a complete blood count, or CBC, which looks at the type and number of blood cells in the body

abdominal X-rays

ultrasounds, to show size of abdominal organs and the presence of masses

an upper GI study, which can detect abnormalities in the esophagus caused by liver disease

liver scans with radiotagged substances to show changes in the liver structure

ERCP, or endoscopic retrograde cholangiopancreatography. A thin tube called an endoscope is used to view various structures in and around the liver.

abdominal CT scan and abdominal MRI, which provide more information about the liver structure and function

In some cases, the only way to definitively diagnosis the presence of certain liver diseases is by a liver biopsy. This procedure involves the removal of a small piece of liver tissue for examination under a microscope. Liver biopsies may have to be done repeatedly to see how the disease is progressing or responding to treatment.

Prevention & Expectations

What can be done to prevent the disease?

Some liver diseases can be prevented, while others cannot. For example, hepatitis A and hepatitis B can be prevented with vaccines. Other ways to decrease the risk of infectious liver disease include:

practicing good hygiene, such as washing hands well after using the restroom or changing diapers

avoiding drinking or using tap water when traveling internationally

avoiding behaviors like sharing drug needles

practicing safer sex

avoiding the sharing of personal hygiene items, such as razors or nail clippers

avoiding toxic substances and excess alcohol consumption

avoiding improper combinations or use of medications

using caution around industrial chemicals

eating a well balanced diet following the food guide pyramid

getting an injection of immune globulin after exposure to hepatitis A or hepatitis B. This may prevent the hepatitis A or B infection from developing.

the use of safety precautions by healthcare and day care workers

Some forms of liver disease, such as liver disease a person is born with, cannot be prevented.

What are the long-term effects of the disease?

Long- term effects depend on the type of liver disease present. For example, chronic hepatitis can lead to:

cirrhosis of the liver

liver failure

illnesses in other parts of the body, such as kidney damage or low blood counts

Other long-term effects of liver disease may include:

gastrointestinal bleeding. This includes bleeding esophageal varices, the life-threatening bleeding in the esophagus and/or the stomach.

encephalopathy, which is deteriorating brain function that may progress to a coma

peptic ulcers, which erode the stomach lining

liver cancer

What are the risks to others?

Some liver diseases are highly contagious and pose a risk to others. For example, different forms of hepatitis are highly contagious through sexual contact or contamination of food and water. Other liver diseases are not contagious, such as biliary atresia.

Treatment & Monitoring

What are the treatments for the disease?

Treatment for liver disease will include:

bed rest

drinking extra fluids to prevent dehydration

avoiding unnecessary medications

avoiding alcohol

eating a well balanced diet for liver disease

taking antinausea medications as needed

Further treatment will depend on the type and the extent of disease. For example, treating hepatitis B, hepatitis C, and hepatitis D may involve the use of medications such as the antiviral medication alpha interferon. Other medications used to treat liver disease may include ribavirin, lamivudine, steroids, and antibiotics.

To treat Wilson's disease, the healthcare provider may prescribe trientine or penicillamine. If these medications cannot be tolerated, the person may be asked to take zinc acetate.

Hemochromatosis is treated by removing a pint of blood once a week for 1 to 2 years. This will effectively deplete the excess iron.

Vitamin and mineral supplements are given to prevent complications from primary biliary cirrhosis. These include vitamin A, vitamin D, vitamin E, phylloquinone, which is found in food\ \menadione, which is man-made\ \menaquinone, which is produced by the body\ ',CAPTION,'Vitamin K');" onmouseout="return nd();">vitamin K, and calcium. Cholestyramine may be given to help relieve itching.

Biliary atresia may be treated with a procedure called the Kasai surgery, a procedure in which the surgeon replaces the bile ducts with part of the baby's intestine.

Acute fulminant hepatitis can cause life-threatening liver failure. This requires a hospital stay and treatment for the bleeding disorder, encephalopathy, and nutritional problems. Sometimes, the only effective treatment for certain liver diseases is a liver transplant.

What are the side effects of the treatments?

Side effects will depend on the treatments used for the liver disease. Antibiotics may cause stomach upset or allergic reactions. Side effects of interferon include a flu-like illness, with fever, and body aches. A liver transplant can cause many problems, including failure or rejection of the new liver. After a liver transplant, a person will need to take powerful antirejection medications for the rest of his or her life. Side effects of these medications increase the person's risk for infections, certain cancers, and other problems.

What happens after treatment for the disease?

What occurs after treatment will depend on the type of liver disease and the response to treatment. For example, people with hepatitis A will not usually need medication after the disease has been resolved. They can return to a normal lifestyle when symptoms are gone, even if they still have some jaundice. A person with hepatitis B, hepatitis C, or hepatitis D will be monitored for side effects and benefits during and after interferon treatment. Alpha interferon treatment might be repeated if the disease flares up again. A person who has received a liver transplant is checked for further disease, as well as for function of the new liver.

How is the disease monitored?

Monitoring will depend on the type of liver disease. Periodic visits to the healthcare provider and liver function tests may be used to monitor the disease and to see how the liver is working. Any new or worsening symptoms should be reported to the healthcare provider. The status of the liver may require repeated liver biopsies. Decisions for further treatment or liver transplantation are frequently made based on these tests.

Attribution

Author:Eileen McLaughlin, RN, BSN
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:01/31/01
Reviewer:Barbara Mallari, RN, BSN, PHN
Date Reviewed:07/13/01

Sources

http://www.liverfoundation.org/html/livheal.dir/livheal.htm/ http://www.niddk.nih.gov/health/digest/pubs/hep/index.htm/ Harrison's Principles of Internal Medicine, fauci et al, 1998

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