What you should know about liver disease

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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 it 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. In addition, certain types of liver disease primarily affect women.

Here you will find detailed information about your liver, what it does to your body, and what bad things can happen.

Your Liver: What It Is and What It Does

We are very fortunate to have the liver, which is the largest internal organ in the body, weighing about three pounds (technically, the skin is your largest organ).

The liver doesn’t get as much attention as your heart or kidneys, but this reddish-brown, football-shaped organ just beneath your ribs performs many impressive functions every day. Additionally, it is the only internal organ in your body that can heal itself and regrow completely if damaged or removed. Honestly, how great is that?

Here’s a quick overview of some of the functions your liver continually performs:

• Processes nutrients from food
• Produces vital proteins
• Filters toxins from the blood (not only the kidneys have this function!)
• Decomposes dangerous substances
• Stores vitamins and minerals
• Removes old red blood cells
• Generates components necessary for blood clotting

The National Institutes of Health (NIH) describes the liver as “robust” and “resilient.” No matter how strong the liver is, it is not indestructible. An organ capable of self-healing can also be damaged, especially if it is subjected to prolonged overuse.

What are liver diseases?

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

Acute liver disease

Short-term liver disease often results from viral infections such as hepatitis A or, in some cases, from overdoses of acetaminophen, also known as Tylenol (label warnings are there for a reason). Depending on the extent of the damage, acute liver disease can often be treated, especially if detected early enough.

In rare cases, acute liver disease can lead to complete liver failure, and in these cases a liver transplant may be necessary.

Chronic liver diseases

Next: Chronic liver diseases, which are the most common.

One of the liver’s key jobs is to remove toxins from the blood, which makes it particularly vulnerable to disease over time. When the liver is constantly exposed to high levels of toxins and forced to perform at peak performance, even the most resilient organs can deteriorate 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, as the liver deteriorates, healthy tissue is replaced by scar tissue. The liver cannot function normally due to scar tissue. However, scar tissue can heal even at this stage if it is detected early enough. However, if the liver does not have a chance to heal, permanent scarring will occur in the next phase.
3. cirrhosis: Once cirrhosis of the liver occurs, the scars remain, although they can sometimes heal in the early stages if the underlying cause is treated. As liver function deteriorates, symptoms gradually appear in the body. However, your body is very good at compensating when the liver is not functioning normally, so it may take years before noticeable symptoms appear. Even if scarring remains, it may be possible to slow the progression of the disease or prevent further damage if the liver disease is detected relatively early.
4. Liver failure: The final and fourth stage of liver disease is liver failure. The disease still worsens slowly and symptoms may appear after some time, but eventually the full signs of liver failure appear. The only treatment for liver failure is a liver transplant.

Symptoms of liver disease

If you suffer from acute liver problems, you are likely to experience severe pain in the right upper abdomen, nausea and vomiting, and a general feeling of being unwell.

Chronic liver disease may cause similar symptoms, but may also include the following worsening symptoms:

• Jaundice (when the whites and skin turn yellow)
• confusion
• Itchy skin without a rash
• white feces
• Very dark urine
• Bleeding and bruising that occurs easily
• Small, yellow pockets of fat on the skin or eyelids
• weight loss
• Muscle wasting
• Rancid smelling breath
• Difficulty digesting fats
• Swelling of the hands and feet
• Loss of menstrual cycle
• Inflammation of the testicles

Chronic liver disease tends to slowly worsen over time as the body compensates for the damage until the disease is very advanced. For this reason, people may not notice the symptoms of liver disease right away.

What are the causes of liver disease?

Liver disease can result from excessive alcohol consumption and is probably the most common known cause. However, they can also occur without a direct connection to lifestyle. For example, an infection or hereditary disease can cause liver disease.

There are more than 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 in people diagnosed female at birth (AFAB). Autoimmune hepatitis can occur in middle-aged women (type 1) or in girls between the ages of 2 and 14 (type 2).
• Primary biliary cholangitis (PBC): PBC is another form of chronic liver disease that primarily affects women. It is also thought to be related to the immune system and is more common in middle-aged women.
• Hepatitis virus: Viruses can cause acute or chronic liver disease. Hepatitis A, B, C, D, and E are the most common cases of viral hepatitis, but other types, including cytomegalovirus, Epstein-Barr virus, yellow fever, and even herpes simplex virus (HSV), can also attack the liver.
• Hepatic steatosis (SLD): Hepatic steatosis is a condition commonly known as 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 shamed by the stigma of the word. Hepatic steatosis includes three types of diseases, including those associated with alcohol consumption, which can have varying symptoms and degrees of severity:
  • Hepatic steatosis associated with metabolic dysfunction (EADM)Formerly known as nonalcoholic fatty liver disease (NAFLD), it is the most common type of liver disease and is caused by the accumulation of excess fat in the liver.
  • Steatohepatitis associated with metabolic dysfunction (EADM)Formerly known as nonalcoholic steatohepatitis (NAS), it can lead to fat buildup and liver damage.
  • Alcoholic liver disease (HPA)Formerly known as alcohol-associated liver disease (ARLD), it is caused by drinking more alcohol than the liver can process. The amount of alcohol that may pose a risk to a person is not known, but is generally estimated to be more than an average of more than four drinks per day for women and five drinks per day for men over an extended period of time.
  • The alcoholic and metabolic liver disease (HPA + Met) 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 raise levels to those normally seen in classic HPA (two to five drinks per day for women and three to six for men). You may be showing signs and symptoms of EADM or HPA.
• Liver cancer: Almost all types of chronic liver diseases, especially those caused by hepatitis 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 health care providers detect liver disease?

The easiest way to detect early signs of liver disease is through blood tests. If you suspect you are at risk for liver disease, have a history of liver disease, or are experiencing symptoms, you should talk to your healthcare provider about screening.

Liver function tests may not be a traditional part of annual exams, but it is wise to examine the hardest-working organ that is exposed to constant waves of toxins from time to time. So talk to your doctor about your risk.

You can also reduce your overall risk of liver disease or slow or stop the progression of existing liver disease by doing the following:

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

This educational resource was created with support from Merck.

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