Liver Diseases

Overview

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.

Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

The liver damage done by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.

Symptoms

Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

• Fatigue
• Easily bleeding or bruising
• Loss of appetite
• Nausea
• Swelling in your legs, feet or ankles (edema)
• Weight loss
• Itchy skin
• Yellow discoloration in the skin and eyes (jaundice)
• Fluid accumulation in your abdomen (ascites)
• Spiderlike blood vessels on your skin
• Redness in the palms of the hands
• For women, absent or loss of periods not related to menopause
• For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)

When to see a doctor

Make an appointment with your doctor if you have any of the signs or symptoms listed above.

Causes

A wide range of diseases and conditions can damage the liver and lead to cirrhosis.

Some of the causes include:

• Chronic alcohol abuse
• Chronic viral hepatitis (hepatitis B, C and D)
• Fat accumulating in the liver (nonalcoholic fatty liver disease)
• Iron buildup in the body (hemochromatosis)
• Cystic fibrosis
• Copper accumulated in the liver (Wilson’s disease)
• Poorly formed bile ducts (biliary atresia)
• Alpha-1 antitrypsin deficiency
• Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)
• Genetic digestive disorder (Alagille syndrome)
• Liver disease caused by your body’s immune system (autoimmune hepatitis)
• Destruction of the bile ducts (primary biliary cirrhosis)
• Hardening and scarring of the bile ducts (primary sclerosing cholangitis
• Infection, such as syphilis or brucellosis
• Medications, including methotrexate or isoniazid

Complications

• High blood pressure in the veins that supply the liver (portal hypertension).
• Swelling in the legs and abdomen.
• Enlargement of the spleen (splenomegaly).
• Bleeding.
• Infections.
• Malnutrition.
• Buildup of toxins in the brain (hepatic encephalopathy).
• Jaundice.
• Bone disease.
• Increased risk of liver cancer.
• Acute-on-chronic cirrhosis.

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Overview

Alcohol Related Liver Disease is inflammation of the liver caused by drinking alcohol.

Alcohol Related Liver Disease is most likely to occur in people who drink heavily over many years. However, the relationship between drinking and alcoholic liver diseases is complex. Not all heavy drinkers develop Alcohol Related Liver Disease, and the disease can occur in people who drink only moderately.

If you’re diagnosed with Alcohol Related Liver Disease, you must stop drinking alcohol. People who continue to drink alcohol face a high risk of serious liver damage and death.

Symptoms

The most common sign of alcoholic Liver Diseases is yellowing of the skin and whites of the eyes (jaundice).

Other signs and symptoms include:

• Loss of appetite
• Nausea and vomiting
• Abdominal tenderness
• Fever, often low grade
• Fatigue and weakness

Malnutrition is common in people with alcoholic Liver Diseases. Drinking large amounts of alcohol suppresses the appetite, and heavy drinkers get most of their calories from alcohol.

Additional signs and symptoms that occur with severe alcoholic Liver Diseases include:

• Fluid accumulation in your abdomen (ascites)
• Confusion and behavior changes due to a buildup of toxins normally broken down and eliminated by the liver
• Kidney and liver failure

When to see a doctor

alcoholic Liver Diseases is a serious, often deadly disease.

See your doctor if you:

• Have signs or symptoms of alcoholic Liver Diseases
• Can’t control your drinking
• Would like help cutting back on your drinking

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Overview

Fatty liver disease (FLD) is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of FLD is too much fat stored in liver cells.

FLD is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting about one-quarter of the population.

Some individuals with FLD can develop nonalcoholic steatohepatitis (NASH), an aggressive form of fatty liver disease, which is marked by liver inflammation and may progress to advanced scarring (cirrhosis) and liver failure. This damage is similar to the damage caused by heavy alcohol use.

Symptoms

• Fatigue
• Pain or discomfort in the upper right abdomen

Possible signs and symptoms of NASH and advanced scarring (cirrhosis) include:

• Abdominal swelling (ascites)
• Enlarged blood vessels just beneath the skin’s surface
• Enlarged spleen
• Red palms
• Yellowing of the skin and eyes (jaundice)

When to see a doctor

Make an appointment with your doctor if you have persistent signs and symptoms that cause you concern.

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Overview

Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood.

Until recently, hepatitis C treatment required weekly injections and oral medications that many HCV-infected people couldn’t take because of other health problems or unacceptable side effects.

That’s changing. Today, chronic HCV is usually curable with oral medications taken every day for two to six months.

Still, about half of people with HCV don’t know they’re infected, mainly because they have no symptoms, which can take decades to appear. For that reason, the U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C, even those without symptoms or known liver disease. The largest group at risk includes everyone born between 1945 and 1965 — a population five times more likely to be infected than those born in other years.

Symptoms

Long-term infection with the hepatitis C virus is known as chronic hepatitis C. Chronic hepatitis C is usually a “silent” infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease.

Signs and symptoms include:

• Bleeding easily
• Bruising easily
• Fatigue
• Poor appetite
• Yellow discoloration of the skin and eyes (jaundice)
• Dark-colored urine
• Itchy skin
• Fluid buildup in your abdomen (ascites)
• Swelling in your legs
• Weight loss
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)
• Spiderlike blood vessels on your skin (spider angiomas)

Every chronic hepatitis C infection starts with an acute phase. Acute hepatitis C usually goes undiagnosed because it rarely causes symptoms. When signs and symptoms are present, they may include jaundice, along with fatigue, nausea, fever and muscle aches. Acute symptoms appear one to three months after exposure to the virus and last two weeks to three months.

Acute hepatitis C infection doesn’t always become chronic. Some people clear HCVfrom their bodies after the acute phase, an outcome known as spontaneous viral clearance. In studies of people diagnosed with acute HCV, rates of spontaneous viral clearance have varied from 15% to 25%. Acute hepatitis C also responds well to antiviral therapy.

Causes

Hepatitis C infection is caused by the hepatitis C virus (HCV). The infection spreads when blood contaminated with the virus enters the bloodstream of an uninfected person.

Globally, HCVexists in several distinct forms, known as genotypes. Seven distinct HCV genotypes and more than 67 subtypes have been identified. The most common HCVgenotype in the United States is type 1.

Although chronic hepatitis C follows a similar course regardless of the genotype of the infecting virus, treatment recommendations vary depending on viral genotype.

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Overview

The term “hepatitis” refers to syndromes or diseases causing liver inflammation, including inflammation due to viruses and chronic alcohol abuse. Viruses causing hepatitis include Hepatitis A, B, C, E, and the delta factor. Each virus causes a distinct syndrome, though they share some symptoms and consequences.

Most people who become infected with hepatitis B get rid of the virus within 6 months. A short infection is known as an “acute” case of hepatitis B.

Causes

Hepatitis B is transmitted via blood and other body fluids. Infection can occur through:

• Contact with blood in healthcare settings — this puts physicians, nurses, dentists, and other healthcare personnel at risk
• Unsafe sex with an infected person
• Blood transfusions
• Sharing needles during drug use
• Receiving a tattoo or acupuncture with contaminated instruments
• Birth — an infected mother can transmit the virus to the baby during delivery or shortly thereafter

People who are at higher risk, including healthcare workers and those who live with someone with hepatitis B, should get the hepatitis B vaccine.

In acute hepatitis, it takes about 1-6 months from the time of infection until symptoms appear. Early symptoms may include nausea and vomiting, loss of appetite, fatigue, and muscle and joint aches. Jaundice, together with dark urine and light stools, follows. About 1% of patients infected with hepatitis B die due to liver damage in this early stage.

The risk of becoming chronically infected depends on the person’s age at the time of infection. More than 90% of newborns, about 50% of children, and less than 5% of adults infected with hepatitis B develop chronic hepatitis.

Most damage from hepatitis B virus is caused by the body’s response to the infection. The body’s immune response against the infected liver cells (hepatocytes) damages the cells, causing liver inflammation (hepatitis). As a result, liver enzymes (transaminases) leak out of the liver into the blood, causing transaminase blood levels to be elevated. The virus impairs the liver’s ability to produce the clotting factor prothrombin, increasing the time required for blood clot formation (prothrombin time).

Liver damage also impairs the body’s ability to rid itself of bilirubin (a breakdown product of old red blood cells), causing jaundice (yellow discoloration of the eyes and body) and dark urine.

Symptoms

• Fatigue, malaise, joint aches, and low-grade fever
• Nausea, vomiting, loss of appetite, and abdominal pain
• Jaundice and dark urine due to increased bilirubin

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Overview

Jaundice is yellow discoloration of a newborn baby’s skin and eyes. Infant jaundice occurs because the baby’s blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow pigment of red blood cells.

Infant jaundice is a common condition, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breast-fed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice.

Most infants born between 35 weeks’ gestation and full term need no treatment for jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice.

Symptoms

Yellowing of the skin and the whites of the eyes — the main sign of infant jaundice — usually appears between the second and fourth day after birth.

To check for infant jaundice, press gently on your baby’s forehead or nose. If the skin looks yellow where you pressed, it’s likely your baby has mild jaundice. If your baby doesn’t have jaundice, the skin color should simply look slightly lighter than its normal color for a moment.

Examine your baby in good lighting conditions, preferably in natural daylight.

When to see a doctor

Most hospitals have a policy of examining babies for jaundice before discharge. The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to 12 hours while in the hospital.

Your baby should be examined for jaundice between the third and seventh day after birth, when bilirubin levels usually peak. If your baby is discharged earlier than 72 hours after birth, make a follow-up appointment to look for jaundice within two days of discharge.

The following signs or symptoms may indicate severe jaundice or complications from excess bilirubin. Call your doctor if:

• Your baby’s skin becomes more yellow
• The skin on your baby’s the abdomen, arms or legs looks yellow
• The whites of your baby’s eyes look yellow
• Your baby seems listless or sick or is difficult to awaken
• Your baby isn’t gaining weight or is feeding poorly
• Your baby makes high-pitched cries
• Your baby develops any other signs or symptoms that concern you

Causes

Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. Bilirubin, which is responsible for the yellow color of jaundice, is a normal part of the pigment released from the breakdown of “used” red blood cells.

Newborns produce more bilirubin than adults do because of greater production and faster breakdown of red blood cells in the first few days of life. Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. A newborn’s immature liver often can’t remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day of life.

Other causes

An underlying disorder may cause infant jaundice. In these cases, jaundice often appears much earlier or much later than does the more common form of infant jaundice. Diseases or conditions that can cause jaundice include:

• Internal bleeding (hemorrhage)
• An infection in your baby’s blood (sepsis)
• Other viral or bacterial infections
• An incompatibility between the mother’s blood and the baby’s blood
• A liver malfunction
• Biliary atresia, a condition in which the baby’s bile ducts are blocked or scarred
• An enzyme deficiency
• An abnormality of your baby’s red blood cells that causes them to break down rapidly.

Risk factors

Major risk factors for jaundice, particularly severe jaundice that can cause complications, include:

• Premature birth.
  A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do. Premature babies also may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool.
• Significant bruising during birth.
  Newborns who become bruised during delivery gets bruises from the delivery may have higher levels of bilirubin from the breakdown of more red blood cells.
• Blood type. If the mother’s blood type is different from her baby’s, the baby may have received antibodies through the placenta that cause abnormally rapid breakdown of red blood cells.
• Breast-feeding.
  Breast-fed babies, particularly those who have difficulty nursing or getting enough nutrition from breast-feeding, are at higher risk of jaundice. Dehydration or a low caloric intake may contribute to the onset of jaundice. However, because of the benefits of breast-feeding, experts still recommend it. It’s important to make sure your baby gets enough to eat and is adequately hydrated.
• Race.
  Studies show that babies of East Asian ancestry have an increased risk of developing jaundice.

Complications

High levels of bilirubin that cause severe jaundice can result in serious complications if not treated.

Acute bilirubin encephalopathy

Bilirubin is toxic to cells of the brain. If a baby has severe jaundice, there’s a risk of bilirubin passing into the brain, a condition called acute bilirubin encephalopathy. Prompt treatment may prevent significant lasting damage.

Signs of acute bilirubin encephalopathy in a baby with jaundice include:

• Listlessness
• Difficulty waking
• High-pitched crying
• Poor sucking or feeding
• Backward arching of the neck and body
• Fever

Kernicterus

Kernicterus is the syndrome that occurs if acute bilirubin encephalopathy causes permanent damage to the brain. Kernicterus may result in:

• Involuntary and uncontrolled movements (athetoid cerebral palsy)
• Permanent upward gaze
• Hearing loss
• Improper development of tooth enamel

Prevention

The best preventive of infant jaundice is adequate feeding. Breast-fed infants should have eight to 12 feedings a day for the first several days of life. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week

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