Liver Disease – an Overview

Liver disease can become critical if not detected and treated early. The liver is a solid organ that sits on the right upper side of the body. It is a large organ responsible for the breakdown of drugs and other metabolites. Almost all proteins found in blood are produced in the liver. These proteins are necessary for normal daily function (e.g., blood clotting), and it also makes chemical compounds necessary for digestion. Because of all these functions, the liver is metabolically a very active organ which is prone to damage from many angles.

Liver disease or hepatic disease occurs when any of the above functions of the liver are disturbed and leads to illness. The manifestation of disease implies significant damage to liver cells since the liver can replace damaged cells reasonably quickly and disease implies that more than 75% of cells have been affected.

There are many categories and causes of liver disease. Most ongoing damage to the liver leads to scarring of the liver, also known as cirrhosis. Cirrhosis increases the risk of malignant transformation and developing hepatocellular carcinoma or liver cancer. Different causes of liver cells damage are:

  • Alcohol
  • Hepatitis viruses
  • Obesity and diabetes
  • Obstruction of bile
  • Drugs and other toxins
  • Metal storage disorders, like hemochromatosis

The non-alcoholic fatty liver disease (NAFLD) is the name of the condition in which fat accumulates around liver cells.  Typically the fat accumulates by excessive alcohol intake, but NAFLD is a fatty liver that occurs in people with little to no alcohol intake. The liver is the most important place for the elimination of fat from the blood. When liver cells are damaged, they are unable to metabolize and get rid of fat and therefore it simply accumulates in the liver.

NAFLD is the most common disease and sometimes can trigger serious conditions like cirrhosis, which eventually leads to liver failure and cancer. In the United States, NAFLD is one of the most common liver diseases diagnosed, with a prevalence of as high as 30% in the general population and approximately 10% of these people develop significant scarring (fibrosis). There are an estimated 4 million people living in the USA with fibrosis due to NAFLD.

While the causes of non-alcoholic fatty liver disease are not well understood, it is a multifactorial disease that results from a combination of disorders. It has been demonstrated that there is a higher prevalence of NAFLD in people who are obese or have diabetes. Therefore, NAFLD is considered to be one of the many manifestations of the so-called metabolic syndrome, in addition to renal dysfunction and cardiovascular complications.

Other causes that have been thought to contribute to the development of NAFLD include:

  • Corticosteroids
  • Starvation
  • Intravenous nutrition
  • Wilson’s disease

It is untypical to have symptoms of fatty liver disease unless the liver disease is very advanced. Typically it is picked up during blood testing, or imaging that is for something else, for example, ultrasound scan for gallstones. Infrequently, there is liver enlargement, but this is not a common finding.

Typically, the symptoms occur from advanced disease and liver cirrhosis. These include jaundice, portal hypertension, and mental changes.

The fatty liver disease is diagnosed on imagining like CT or MRI.

Treatment of NAFLD include lifestyle changes such as exercise, weight loss, diet and antioxidant medications. Patients need to improve diet by reducing the number of unsaturated fats. Other treatment includes management of patient’s diabetes and other cardiovascular complications.

Alcoholic Fatty Liver Disease (AFLD) is another common condition in alcohol abusers. AFLD is a bit more aggressive than NAFLD, leading to scarring, cirrhosis and cancer if the problem of alcoholism is not resolved.

The above mentioned conditions are the most common liver diseases. Besides those, infective and autoimmune hepatitis affect a significant percentage of “liver patients”.

The symptoms of liver disease include fatigue, swellings, jaundice, pain below the ribs on the right side, and malaise. The symptoms are not specific to the liver disease, meaning they can be caused by many other conditions, so for a timely diagnosis, it is essential to perform blood work in time.

Liver blood testing can help you identify the problem in the early stages, before the disease advances too much to complicate successful treatment. Typical tests performed are ALT/ AST, bilirubin (direct and total) and total protein. If you think you may be at risk of viral B or C hepatitis (unprotected sex, contact with blood of infected person), then Hepatitis B Panel and Hepatitis C Antibodies may clear any doubts about infection.