What you need to know about liver disease

May is Hepatitis Awareness Month.

Approximately 4.5 million adults in the United States live with chronic liver disease – and women are more likely to develop chronic liver disease than men.

Some people may associate liver disease with alcohol consumption, but the truth is that many different factors, such as obesity, autoimmune diseases, and even viruses, can cause liver disease. Certain types of liver disease also primarily affect women.

Here’s a closer look at your liver, what it does in your body, and what can go wrong.

Your Liver: What It Is and What It Does

Everyone praises the liver, which is the largest organ in the body at around three pounds. (Skin is technically your largest organ.)

The liver may not get as much attention as, say, your heart or kidneys, but the football-shaped, reddish-brown organ located just beneath your ribs accomplishes hundreds of impressive feats every day. Additionally, it is the only organ in your body that can heal and regrow itself if any part of it is damaged or removed. Honestly, how cool is that?

Here’s a quick overview of some of the functions your liver performs on a regular basis:

• Processes nutrients from food
• Produces vital proteins
• Filters toxins from the blood (this job doesn’t just affect the kidneys!)
• Decomposes pollutants
• Stores vitamins and minerals
• Removes old red blood cells
• Produces the necessary components for blood clotting

The National Institutes of Health (NIH) describes the liver as “robust” and “resilient.” As strong as the liver may be, it is not indestructible. Even an organ that is capable of healing can be damaged, especially if it is permanently overloaded.

What is Liver Disease?

Liver disease can be acute (short-term) or chronic (long-term). Acute liver disease is less common than chronic liver disease. In both cases the liver is too overloaded to function, but they usually have different causes.

Acute liver disease

Short-term liver disease is typically caused by a viral infection such as hepatitis A or, in some cases, an overdose of acetaminophen, also known as Tylenol. (Those bottle warnings are there for a reason.) Depending on the extent of the damage, acute liver disease is often treatable, especially if caught early enough.

In rare cases, acute liver disease can lead to complete liver failure. In this case, a liver transplant may be necessary.

Chronic liver disease

Next: Chronic liver disease, the more common condition.

One of the liver’s key jobs is to filter toxins from the blood, which makes it particularly vulnerable to disease over time. If the liver is constantly exposed to high levels of toxins and has to perform above-average workloads, even the toughest organs can wear out over time.

There are four stages of chronic liver disease, depending on the severity:

1. hepatitis: This is the inflammatory stage in which the liver responds to injury or trauma. If no intervention is made to stop the inflammation, it progresses to the next stage of fibrosis.
2. Fibrosis: At this stage, when the liver is damaged, healthy tissue is replaced by scar tissue. The liver cannot function normally due to scarred strips of tissue. However, the scar tissue can also recede at this stage if it is detected early enough. However, if the liver is not given a chance to heal, permanent scarring will occur in the next stage.
3. cirrhosis: Once cirrhosis of the liver occurs, the scarring of the liver is usually permanent, although it can sometimes be reversible in the early stages if the underlying cause is treated. As liver function deteriorates, symptoms gradually appear in the body. However, your body is quite good at compensating when your liver isn’t functioning as it should, so it may take years before noticeable symptoms appear. Even if scarring remains, it is possible to slow or stop further damage if the liver disease is detected relatively early.
4. Liver failure: The fourth and final stage of liver disease is liver failure. The disease still slowly worsens and it may take some time for symptoms to appear, but eventually the full signs of liver failure will become apparent. The only treatment for liver failure is a liver transplant.

Symptoms of liver disease

If you have acute liver disease, you are more likely to experience extreme right upper abdominal pain, nausea and vomiting, and a general feeling of being unwell.

Chronic liver disease can cause similar symptoms, but symptoms can also worsen:

• Jaundice (when the whites of your eyes and skin appear yellow)
• confusion
• Itchy skin without a rash
• White poop
• Very dark urine
• Minor bruising and bleeding
• Small, yellow pockets of fat on the skin or eyelids
• weight loss
• Muscle loss
• Musty smelling breath
• Difficulty digesting fats
• Swelling of hands and feet
• Loss of menstrual cycle
• Swelling of the testicles

Chronic liver disease tends to worsen slowly over time, with the body compensating for major damage until the disease is very advanced. Therefore, people may not notice the symptoms of liver disease right away.

What causes liver disease?

Excessive alcohol consumption can lead to liver disease – and this is probably the most common known cause. However, it can also occur without a direct connection to lifestyle. For example, an infection or a hereditary disease can lead to liver disease.

There are over 100 different types of liver disease, but some of the most common include:

• Autoimmune liver disease: Autoimmune hepatitis, like other types of autoimmune diseases, can occur randomly when the body mistakes healthy liver cells for foreign cells and attacks them. This type of liver disease is more common in women and people who were assigned female at birth (AFAB). Autoimmune hepatitis can occur in middle-aged women (type 1) or girls aged 2-14 years (type 2).
• Primary biliary cholangitis (PBC): PBC is another type of chronic liver disease that occurs primarily in women. It is also thought to be related to the immune system and is most common in middle-aged women.
• Viral hepatitis: Viruses can cause acute or chronic liver disease. Hepatitis A, B, C, D, and E are the most common causes of viral hepatitis, but other types, including cytomegalovirus, Epstein-Barr virus, yellow fever, and even herpes simplex virus (HSV), can also attack the liver.
• Steatotic liver disease (SLD): SLD refers to a condition you may have heard called fatty liver disease. The name was changed because patients often heard the term “fat” and mistakenly thought the disease was their fault, believed it was not serious, or felt ashamed because of the stigmatizing language. SLD now includes three types of liver disease, including those associated with alcohol consumption, which can have varying degrees of severity and symptoms:
  • Metabolic dysfunction-associated steatotic liver disease (MASLD)formerly known as nonalcoholic fatty liver disease (NAFLD), is the most common type of liver disease and is caused by the accumulation of excess fat in the liver.
  • Metabolism-associated steatohepatitis (MASH)Formerly known as nonalcoholic steatohepatitis (NASH), it can lead to fat buildup and liver damage.
  • Alcohol-associated liver disease (ALD)Formerly called alcohol-related liver disease (ARLD), it is associated with drinking more alcohol than the liver can process. The amount of alcohol that puts a person at risk is not known, but it is generally more than an average of four drinks per day for women and five drinks per day for men over an extended period of time.
  • Metabolism with alcoholic liver disease (Met + ALD) is a new category of liver disease that includes cardiometabolic risk factors such as obesity, diabetes or high cholesterol, as well as alcohol consumption sufficient to be a contributing factor but not sufficient to reach the levels normally seen in classic ALD (between two and five drinks per day for women and three to six drinks per day for men). It may present with signs and symptoms of MASLD and/or ALD.
• Liver cancer: Almost any type of chronic liver disease, especially those caused by hepatitis infections or excessive alcohol consumption, can increase the risk of liver cancer. Liver cancer, like any other type of cancer, can occur in people without other liver diseases.

How do healthcare providers recognize liver disease?

The easiest way to detect early signs of liver disease is with a blood test. If you suspect you are at risk for liver disease, have a family history of liver disease, or are experiencing symptoms, you should ask your healthcare provider (HCP) about an evaluation.

Liver function tests may not be a traditional part of annual exams, but the hardest-working organ in the body, subject to a constant onslaught of toxins, deserves to be evaluated every now and then. So talk to your doctor about your risk.

You can also work to reduce your overall risk of liver disease or slow or stop its progression if you have liver disease by:

• Reducing alcohol consumption
• Maintaining a healthy diet
• Exercise regularly
• Avoid saturated fats
• Reducing sugar intake
• Incorporate healthy fats like olive oil, nuts and fish into your diet
• Achieve a healthy weight

This educational resource was created with support from Merck.

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