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Understanding your liver diseases

The liver is affected by several diseases. Some of the most common diseases that affect the liver include alcoholic liver disease, non-alcoholic fatty liver disease or viral hepatitis. These diseases cause inflammation of the liver, leading to complications such as severe liver scarring or cirrhosis. Liver cirrhosis can further progress to liver cancer or liver failure.

Alcoholic liver disease is a common complication of excessive alcohol intake.1

Clinical Presentation

Individuals who are affected by alcoholic liver disease usually do not have any specific symptoms during the initial stages of the disease. In some cases, certain unspecific symptoms, such as abdominal discomfort, nausea (sensation of vomiting), vomiting or diarrhea may be present. In those with advanced liver disease, specific symptoms such as jaundice, ascites (accumulation of fluid in the stomach), encephalopathy (a brain disorder) or bleeding in the stomach and intestine may be present.1

Who are at Risk?

The following individuals are at high risk of developing alcoholic liver disease:2

  • Individuals consuming more than 25 g of alcohol (ethanol)/day or drink excessive amount of alcohol during each session
  • Binge drinkers
  • Women
  • Obese people, suffering from hepatitis infections, or have increased iron levels in blood

Subtypes of Alcoholic Liver Disease 1

Steatosis1

This condition is also known as "fatty liver". In this condition, there is an abnormal accumulation of fat (lipids) in the liver and occurs in about 80% of all heavy drinkers. Avoiding alcohol consumption can reverse the condition, but continued alcohol consumption can further lead to cirrhosis.

Alcoholic Hepatitis1

In this condition, the cause for inflammation of the liver is prolonged consumption of alcohol. This condition occurs in 10-35% of heavy drinkers. Alcoholic hepatitis usually occurs after 15-20 years of excessive drinking. This condition is more severe in women than men.

Cirrhosis1

This is the most severe form of liver injury owing to alcohol consumption. The risk of cirrhosis is higher in continuous drinkers than in "binge drinkers". Cirrhosis develops in 10% of all heavy drinkers.

Complications of Alcoholic Liver Disease1

Complications of alcoholic liver disease include ascites, which is typically the first complication. Apart from ascites, other complications can include jaundice, variceal bleeding (bleeding due to rupture of blood vessels in the food pipe or oesophagus), infections and hepatic encephalopathy (a brain disorder caused due to failure in liver functions).

Fatty liver can also be noted in individuals who consume little or no alcohol. It can occur in individuals of any age group or any ethnicity, and is prevalent in about 14-30% of the general population.3

Who are at Risk?

Patients with insulin resistance (a condition wherein the body tissues have a low response to insulin) are more prone to non-alcoholic fatty liver disease than others. Hispanics and Asians have a higher risk than African Americans.4 It is common in obese individuals and those suffering from diabetes. Other conditions that lead to non-alcoholic fatty liver disease include high cholesterol levels, high blood pressure levels, malnutrition, hepatitis C infection, exposure to toxins and consumption of certain medications.3

Stages of non-alcoholic fatty liver disease and its complications are similar to that of alcoholic liver disease.

Medications can also cause injury to the liver in certain instances.

Who are at Risk?5

Following people are considered to be at high risk of developing drug-associated liver injury:

  • Elderly individuals and children
  • Women
  • Individuals who consume multiple medications
  • Individuals diagnosed with conditions such as HIV or diabetes

The term "hepatitis" refers to inflammation of the liver. Most often, it is caused by any of the hepatitis virus (hepatitis A, B, C, D or E), wherein hepatitis A, hepatitis B and hepatitis C are the most commonly occurring hepatitis infections. Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.6

Risk factors, symptoms and mode of spread of hepatitis A, B and C are mentioned in Table1:

Hepatitis A7
Risk Factors
  • Travelling to or residing in countries where hepatitis A is common

  • Sexual contact with hepatitis A-positive individual

  • Use of recreational drugs

  • Disorders of blood clotting

Symptoms
  • May not be present in all cases, but can appear 2-6 weeks after infection

  • Fever, vomiting, dark urine, fatigue, abdominal pain, joint pain, loss of appetite, grey-coloured stools, nausea, jaundice

How does it spread?
  • Faecal-oral transmission (ingestion of contaminated food or water and contact with objects contaminated with faeces from an infected individual)

  • Sexual contact

Hepatitis B8
Risk Factors
  • Sexual contact with Hepatitis B-infected individual

  • Living with hepatitis B-infected individual

  • Infants born to mothers with HIV infection

  • Undergoing haemodialysis (procedure for removing metabolic waste products or toxic substances from the blood)

  • Healthcare workers handling blood and tissue samples

Symptoms
  • Usually occur very late in the course of disease

  • Fever, fatigue, abdominal pain and jaundice may occur and are usually associated with advanced liver disease

How does it spread?
  • Individual-individual transmission through blood, semen or other body fluids (e.g. sexual intercourse or sharing needles with a hepatitis B-infected individual, or from infected mother to child during childbirth)

  • It does not spread through touch or through contaminated food/water

Hepatitis C9,10
Risk Factors
  • Drug use through injections

  • Long-term haemodialysis

  • Healthcare workers

  • HIV infection

Symptoms
  • Symptoms may not appear commonly after initial infection

  • Fever, fatigue, reduced appetite, abdominal pain, dark urine, grey-coloured stools, joint pain and jaundice may be seen in acutely symptomatic patients

How does it spread?
  • Exposure to infected blood (contaminated blood transfusion or organ transplantation, sharing infected needles, infected mother to child during child birth)

Liver diseases are also associated with the development of other disorders, which include diseases of the the heart,11 diabetes12 and cancer.13 These diseases have a high prevalence in individuals with liver disease, especially non-alcoholic fatty liver disease11-13

References

1. Walsh K, Alexander G. Alcoholic liver disease. Postgrad Med J. 2000;76:280-286.

2. European Association for the Study of the Liver EASL Clinical Practical Guidelines: Management of Alcoholic Liver Disease. J Hepatol. 2012;57:399-420.

3. Adams LA, Angulo P. Treatment of non-alcoholic fatty liver disease. Postgrad Med J. 2006;82:315-322.

4. Puri P, Sanyal AJ. Nonalcoholic Fatty Liver Disease: Definitions, Risk Factors, and Workup. Clin Liver Dis. 2012; 1(4):99-103.

5. Chalasani N, Bjornsson E. Risk Factors for Idiosyncratic Drug-Induced Liver Injury. Gastroenterology. 2010; 138(7): 2246-2259.

6. information downloaded from http://who.int/topics/hepatitis/en/. Accessed on: 24.05.2013.

7. Hepatitis A. October 2012. Information downloaded from www.cdc.gov/hepatitis.

8. Hepatitis B. June 2012. Information downloaded from www.cdc.gov/hepatitis.

9. Hepatitis C. FAQs for Health Professionals. Information downloaded from www.cdc.gov/hepatitis.

10. Hepatitis C. Information downloaded from http://www.who.int/mediacentre/factsheets/fs164/en/

11. Ahmed MH, Barakat S, Almobarak AO. Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: Has the Time Come for Cardiologists to Be Hepatologists? J Obesity. 012, Article ID 483135.

12. Blendea MC, Thompson MJ, Malkani S. Diabetes and Chronic Liver Disease: Etiology and Pitfalls in Monitoring. Clin Diabetes.2010; 28(4):139-144.

13. Muhidin SO, Magan AA, Osman KA. The relationship between nonalcoholic fatty liver disease and colorectal cancer: The future challenges and outcomes of themetabolic syndrome. J Obesity. 2012;Article ID 637538.

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(*) As shown in experimentally induced-liver cell damage

(**) http://www.liver.ca/liver-health/liver-facts.aspx

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