Liver Disease Overview

What is Liver Disease? 

The liver is the centre of metabolism, glycogen storage, energy conversion and detoxification. Liver disease comprises a range of disorders and conditions affecting the liver. These disorders vary in presentation and symptoms, however, they have the same generalized effect on the liver: they can damage liver cells and subsequently deteriorate their physiological functions, possibly leading to liver failure.

On a more positive note, liver failure can often be prevented and the damage to liver cells reversed if the symptoms are noticed and managed early enough.

What are the causes of Liver Disease? 

The classification of liver diseases is predominantly made based on their underlying causes:

1. Cancer and Tumors 

Cancer in the liver can be spread from other organs in which it originated including the lungs, breast, colon and more. They are referred to as secondary liver cancers. The cancers that first develop in the liver are usually a result of poor and unhealthy lifestyle choices, including excessive alcohol consumption, lack of exercise, imbalance of dietary substances, as well as predisposing conditions of hepatitis, age and genetics. These types of cancers include:

- Hepatocellular Carcinoma 

- Bile Duct Cancer 

- Liver Cell Adenoma 

2. Genetic Conditions 

Genetic conditions are inherited from one’s biological parents. An abnormal gene inherited from one or more parents can affect the regulatory functions of the liver causing a buildup of certain substances  (e.g: iron buildup - hemochromatosis, the buildup of oxalate – Hyperoxaluria,  copper buildup - Wilson’s Disease). These conditions often prevent the liver from performing detoxification. These genetic conditions include:

- Alpha-1-antitrypsin deficiency 

- Hemochromatosis

- Hyperoxaluria 

- Wilson’s Disease 

3. Infections  

Parasites, bacteria and viruses can cause infections of the liver. They cause inflammation and affect regular liver functions. These pathogens can be passed on via blood, semen, needles, contaminated food and water. The most common liver diseases caused by pathogens are: 

- Hepatitis A 

- Hepatitis B 

- Hepatitis C 

4. Immune System  

Certain disorders can cause the immune system to attack healthy cells within the body. These immune cells can attack the cells in the liver causing bile acid build ups, inflammation and liver cirrhosis, leading to liver failure if left untreated. These conditions include: 

- Autoimmune Hepatitis 

- Primary Biliary Cirrhosis 

- Primary Sclerosing Cholangitis 

5. Other Conditions  

Liver Disease can also be caused by excess alcohol consumption, drug overuse, excess herbal supplement consumption, and fat buildups (Non-Alcoholic-Fatty Liver Disease). They can cause an inflammatory immune-mediated response leading to liver cirrhosis and /or liver failure if left untreated¹.

What are the symptoms of Liver Disease? 

Symptoms of liver disease are highly subjective and vary from person to  person. Some symptoms may not manifest clinically. However, if they do  occur, some of the common symptoms include: 

• Abdominal swelling 
• Abdominal pain
• Swelling of the limbs (hands and legs) 
• Alterations in stool and/or urine 
• Yellowish pallor of the eyes and skin (jaundice)
• Chronic fatigue 
• Vomiting and/or nausea 
• Loss of appetite 
• Easy bruising 
• Itchy skin 

What are the complications of Liver Disease? 

The primary complications of liver disease are cirrhosis and liver failure. Cirrhosis is the outcome of chronic diseases of the liver. This can lead to  hypertension, hepatic encephalopathy (brain damage), ascites (abdominal fluid build ups), hepatic carcinomas, hepatopulmonary syndrome and disorders affecting blood clotting. Liver disease can also increase the risk for urinary tract infections, pneumonia and kidney damage.

What are the risk factors for Liver Disease? 

Risk factors for liver disease include:  

• Blood transfusions prior to 1992 
• Chronic alcohol abuse 
• Exposure to certain toxins and/or chemicals 
• Family history of liver disease 
• High cholesterol  
• Obesity
• Tattoos and/or body piercings conducted in unsanitary environments
• Type 2 diabetes 
• Having unprotected intercourse

What are the diagnostic tests used for Liver Disease? 

Treating liver diseases at an early stage can help tailor a treatment plan and improve the prognostic outcome. The diagnostic tests used for these purposes include: 

1. Abdominal Ultrasound

Noninvasive sound-wave imaging using a technical device (ultrasound) for detection of structural abnormalities in the liver.

2. Chloride Blood Test

A section of the blood test studies the electrolyte levels in the body. Changes in the serum chloride levels are indicative of liver disease.

3. Computed Tomography (CT) Scan

Diagnostic imaging tests can be used to scan the liver and nearby tissue and organs, in order to detect and understand the extent and scope of progression of liver disease.

4. Elastography

This includes Ultrasound elastography and Magnetic Resonance Elastography (ultrasound and magnetic resonance imaging).  It is a non-invasive alternative to liver biopsies, primarily for the diagnosis of fatty liver disease and fibrosis by using sound waves.

5. Liver Function Tests

These blood test panels measure a variety of bio compounds in the body, in addition to the serum metabolites, enzymes and proteins of the liver. They are: albumin, total protein,  prothrombin (protein involved with blood clotting) time, alkaline phosphatase, alanine transaminase, gamma glutamyl transferase,  lactate dehydrogenase and bilirubin².

6. Needle Biopsy

A needle biopsy is a procedure involving extracting tissue or fluid samples of the liver for further investigation and diagnostics. It is painless, as it is performed under anaesthesia.

What is the treatment for Liver Disease? 

The treatment for liver disease is discussed by hepatologists, in consultation  with a multidisciplinary team, depending on the severity, progression and type of liver disease.  

The treatment plan for chronic liver disease largely involves lifestyle changes to reduce its effect. These may include:

1. Avoiding alcohol consumption 

2. Avoiding the use of medications that can induce liver damage 

3. Avoiding recreational drug usage 

4. Managing metabolic factors such as obesity and Diabetes 

5. Reducing salt intake  

6. Complete protection from harmful chemical substances, unsanitary food  and living conditions and contact with external fluids (other individuals’ blood and bodily fluids)³

Doctors may also prescribe immunosuppressants and steroids in cases of  autoimmune liver disease, alcohol abuse treatments in case of alcohol-related liver disease (naltrexone and acamprosate), diuretics for swelling (oedema, ascites) acetylcysteine for drug-induced liver disease and other treatments for the management of liver disease symptoms and prevention of further liver damage. If the damage to the liver is severe and irreversible, the doctor may suggest a liver transplant.