Liver Diseases Symptoms, Risk Factors, Diagnosis and Treatment

1.

Anatomy of the Liver

The liver is the second largest organ in the human body which is present on the right side of the abdomen. It is a reddish-brown organ with a rubbery texture and weighs around 3 pounds. The liver is protected against external injuries by a bony rib cage. It is in the shape of a triangle and consists of 2 lobes. The right lobe is larger than the left lobe and both lobes are separated by a band of tissue that keeps it connected to the diaphragm.

A system of tubes called the biliary tree that runs through the liver collects bile and drains it into the gallbladder or the intestine. Bile is an important digestive juice secreted by the liver. Other important components of the liver include the intrahepatic ducts that are located inside the liver and extrahepatic ducts that are on the outside.

Anatomically, the liver is positioned below the gallbladder along with parts of the pancreas and intestines. All these organs work in complete coordination to digest, absorb and process food. The liver also filters the blood from the digestive tract before it is passed to the rest of the body.

2.

Functions of the liver

The liver plays a key role in digestion and detoxification. It produces chemicals that are important for the digestion of various foods ingested through the mouth. It also breaks down unwanted compounds and detoxes the body. The liver also acts as a storage unit by storing fats that can be utilized during the phases of starvation.

Some of the key functions of the liver are as follows:

Liver produces bile to initiate the process of digestion. Bile is an important digestive juice that is necessary for digestion.Liver converts glucose into glycogen which is stored in the liver and muscle cells
Hepatocytes in the liver are responsible for protein synthesis which is central for many body functions including the maintenance of circulatory system
Liver produces cholesterol and triglycerides which are essential as energy reserves.
Liver detoxifies the body by converting ammonia into urea which is excreted through the urine
It breaks down drugs to simple elements that can be tolerated by the body while treating diseases
Alcohol in its original form is toxic to the human body. Liver breaks it down to a form that can be tolerated by the body
Liver also breaks down insulin and other hormones to facilitate certain functions like blood glucose management
Certain vitamins and minerals like B12, folic acid, iron, vitamin A, D, and K are stored in the liver. They are important for certain functions like the production of red blood cells, calcium absorption, vision and clotting of blood.

3.

Liver disease and possible causes

A healthy liver is important to support certain functions like digestion and detoxification. The liver can be damaged due to excessive alcohol consumption or an unhealthy lifestyle. Fatty liver, cirrhosis, and hepatitis are some of the most common liver diseases that need medical treatment.

Fatty liver disease:

Excessive alcohol consumption increases the risk of cholesterol and triglycerides. Fatty liver disease is the accumulation of these compounds in the liver but is not related to alcohol abuse. Fatty liver disease is also known as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).

Cirrhosis:

Regular consumption of alcohol can result in scarring of the liver. The liver tissues can harden and lose their function over a period. The damage is irreversible and is considered fatal as it can result in liver failure.

Hepatitis:

Hepatitis is an inflammation of the liver which can be caused by various reasons like infections or viruses. There are various types of hepatitis as shown below:

Hepatitis A: This condition is spread by poor sanitary habits and poor handling of food. Not washing hands regularly and poor sanitation is considered one of the main reasons for the spread of hepatitis A.
Hepatitis B and C: This spreads through the contact of infected body fluids especially with contaminated needles or unprotected sex.
Hepatitis D: Hepatitis B and Hepatitis are spread concurrently.
Hepatitis E: This is a water or foodborne infection.

Liver diseases due to genetic conditions:

Some genetic conditions can cause some liver problems as follows:

Hereditary hemochromatosis promotes the storage of excess iron in the organs.
Wilson’s disease promotes the storage of copper instead of releasing it from the body.
Alpha-1 antitrypsin is mostly produced in the liver. Alpha-1 antitrypsin deficiency is caused by a genetic condition where the body is unable to make a sufficient amount of it.

Autoimmune Liver Disease:

The human body is supported by an immune system that defends against foreign bodies including bacteria and viruses. In some rare cases, the body’s immune system attacks healthy cells due to various reasons. The attack on healthy liver tissue can result in inflammation and scarring of the tissue. Autoimmune liver condition includes primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis.

Infections:

Some infections can cause liver disease. Some of the most common infections are caused by toxoplasmosis, cytomegalovirus, adenovirus and Epstein Barr virus.

4.

Signs and symptoms of liver diseases

The liver is a vital organ of the body as it supports several important functions like digestion and conversion of food to energy. It is also crucial to store energy as a fuel to be used during starvation or excessive demand for energy. The liver also acts as a massive filter removing toxic substances from the body. Liver disease or damage to the liver can influence all these functions and can result in serious health issues. Hence it is important to identify the damage early so that necessary steps can be taken to treat the damage. The damage caused by some conditions like cirrhosis is irreversible if it is not identified early but most of the conditions can be managed with early diagnosis.

Signs and symptoms of liver disease are as follows:

Skin develops a yellow tinge, also called as Jaundice
Nausea
Vomiting
Urine develops a dark yellow colouration
Stools look pale, bloody or black (tarlike)
Ankles, legs, or abdomen being swollen
Decrease in appetite
Persistent fatigue
Itchy skin
Unusual bruising

Signs and symptoms of Hepatitis

The symptoms may not be visible for years as the hepatitis virus may stay dormant in the body. It may manifest as flu-like symptoms initially which can gradually emerge with the following signs:

Yellow coloration of the skin also called jaundice
Nausea
Vomiting
General weakness along with tiredness
Aches in muscles and joints
Abdominal pain
Loss of appetite
Dark urine
Stools look pale

Signs and symptoms of Fatty liver disease:

There will be no signs in the early stages of fatty liver disease but some patients may complain of pain on the right side of the abdomen. As the disease progresses, the disease can cause fever, jaundice along with nausea and vomiting.

Signs and symptoms of and Non-alcoholic fatty liver disease:

Patients with non-alcoholic fatty liver disease do not show any symptoms in the early stages. As the disease progresses they may show the following symptoms:

Yellow coloration of the skin also called jaundice
General weakness and fatigue
Inexplicable weight loss
Reduced appetite
Itchy skin
Swollen legs and abdomen

Signs and symptoms of liver diseases due to genetic conditions:

Yellow coloration of the skin also called jaundice
Fatigue and low energy
Pain in joints
Pain in the abdomen
Reduced appetite
Swelling in legs and abdomen

Signs and symptoms of Autoimmune Hepatitis:

Early symptoms of this condition include fatigue and itchy skin but as the disease progresses it may cause the following:

Pain in right abdomen
Jaundice
Leg and abdominal swelling
Enlarged liver, spleen, or abdomen
Unexplained weight loss

In the final stages the symptoms of an autoimmune disease will be as follows:

Jaundice
Fatigue and decreased energy
Pain in joints and abdomen
Itchy skin
Urine looking dark and pale stools
Nausea
Reduced appetite

Signs and symptoms of Cirrhosis:

Yellow coloration of the skin also called jaundice
Fatigue and weakness
Reduced appetite
Unexplained weight loss
Very itchy skin
Nausea
Leg and abdominal pain and swelling
Unusual bruising or bleeding

5.

How to keep your liver healthy

The liver breaks down all the food that passes through the body. It acts like a giant filter removing toxins from the body and protecting healthy human cells from the damage. It performs this task through the following mechanism:

The toxins, especially the fatty one, are metabolized with liver enzymes and oxygen
The toxins are combined with amino acids and are further eliminated through urine

In extreme cases of liver injury or liver damage, the system gets loaded with toxins resulting in health issues. The liver has the responsibility to break down or convert drugs, alcohol to components suitable for the food. Overloading the liver with large quantities of alcohol, fried foods, drugs, etc., impacts the cleaning process.

Food sources to enhance the detoxification process:

Several natural food sources are available to detoxify the liver. They stimulate the liver to expel toxins from the body. Some ideal food sources are provided below:

Garlic: This is a common ingredient in our diet and when taken with food can activate liver enzymes that can flush out toxins from the system. Garlic has a component called selenium which helps in the detoxification process.
Citrus Fruits: Oranges, grapefruit, limes, and lemons are well known to enhance the detoxification process. When taken in moderation, they promote the release of enzymes from the liver to flush out toxins.
Vegetables: Broccoli and cauliflower possess a compound called glucosinolate which can promote the liver to produce detoxifying enzymes. They also possess sulfur which can enhance the health of the liver. Leafy vegetables are rich in chlorophyll, a compound that can leach toxins out of the bloodstream. Chlorophyll can also neutralize heavy metals from the body.
Turmeric: It contains antioxidants that can repair liver cells and can also promote the enzymes to flush out toxins. Turmeric can also detoxify metals while boosting bile production.
Walnuts: Walnuts are known to enhance the cleaning of the liver and assist in detoxifying ammonia.
Beets: They cleanse the blood and help in the quick break down of toxic waste thereby facilitating their excretion. They are also known to stimulate blood flow and boost enzymatic activity.
Carrots: Carrots are rich in flavonoids and beta-carotene which support the overall function of the liver. Carrots are rich in vitamin A which can prevent liver disease.
Green Tea: Green Tea is rich in antioxidants which are proven to improve liver function.
Apples: They are rich in pectin that helps the body in detoxification.
Avocado: This fruit helps the body to produce glutathione that helps to cleanse itself of toxins.

Recommendations to keep the liver healthy

Maintain a healthy diet: Eating healthy food can reduce the burden on the liver. Simple adjustments to diet and lifestyle can help in maintaining a healthy liver. A balanced combination of carbohydrates, fat, and protein is recommended.
Eat food in moderation: Overeating can increase the load on the liver which is already working hard to digest the food while getting rid of toxins. It can also influence the liver capacity to function properly. Maintain good control and what you eat and keep a check on the quantity. Consuming too many calories, especially in the form of fat and alcohol results in excess storage of fat in the liver.
Eat raw fruits and vegetables
Increase fiber content in the diet which can further help in the absorption of fat and cleansing the bowel
Eat a diet with good fats in moderation. This helps the body and liver to function effectively.
Maintain healthy hygiene. Clean your hands regularly to avoid hepatitis.
Avoid sharing needles with others. It can cause hepatitis.
Limit alcohol intake to prevent cirrhosis or other liver problems
Drink plenty of fluids to facilitate the excretion of toxins. This can prevent liver injury by toxins and also reduce the load on the liver.

6.

Importance of Liver Function Tests

Understanding the health of the liver regularly is important to prevent liver problems or avoid irreversible damage. Your doctor may recommend certain liver function tests or blood tests to understand the health of the liver. These tests evaluate the level of enzymes and proteins in the blood. The objective is to understand the liver’s capability of producing protein and clearing bilirubin or test the levels of enzymes in the blood. Liver function tests are used to measure the following:

Alanine transaminase (ALT)
Aspartate transaminase (AST)
Alkaline phosphatase (ALP)
Albumin and total protein
Bilirubin
Gamma-glutamyltransferase (GGT)
L-lactate dehydrogenase (LD)
Prothrombin time (PT)

Objectives of the liver function tests:

These tests help in screening liver infections
Liver diseases like cirrhosis is progressive. Liver function tests help in monitoring the progress of the disease and the extent of damage. They also help in understanding the effectiveness of the treatment in managing the condition
Tests help in measuring the severity of the condition like the extent scarring of the liver in cirrhosis
Tests can help in monitoring the possible side effects of medication

7.

Treatment of liver disease

If left untreated liver diseases can cause deterioration of liver function and permanent damage. Non-surgical treatment may not be able to reverse the underlying liver damage but may offer pain relief and reduce discomfort.

You doctor may recommend some lifestyle changes and diet modification to manage your cholesterol levels. You may be asked to reduce alcohol intake and maintain a healthy weight. You should also cut back on fat and sugar consumption and switch to fiber diet.

Your doctor may recommend some of the following medicines based on the severity of the condition.

Anti-inflammatory medications – to reduce inflammation
Medications to treat hepatitis – Drugs against hepatitis viruses
Medication to treat inflammation of the liver
Medication to treat blood pressure
Supplements – vitamins and minerals

In extreme cases, your doctor may recommend surgery like liver transplantation surgery.

8.

Understanding liver failure

Liver failure is a life-threatening condition and will need immediate medical attention. The most common symptoms of liver failure include nausea, loss of appetite, fatigue, and diarrhea. Severe symptoms may include bleeding, yellow discoloration of skin and eyes (jaundice), swelling of the abdomen with associated pain and discomfort, and confused state of mind (hepatic encephalopathy).

The two types of liver failure are “acute liver failure” and “chronic liver failure”. Acute liver failure is usually asymptomatic and may be caused due to drug overdose. Chronic liver failure is characterized by inflammation and scarring of the liver and is usually a long-term disease caused by heavy alcohol consumption.

Causes of liver failure:

Overdose with drugs
Viral infections - hepatitis A, hepatitis B, hepatitis E, EBV (Epstein-Barr virus), CMV (Cytomegalovirus), HSV (herpes simplex virus)
Herbal supplements
Industrial toxins
Autoimmune disease
Excess consumption of alcohol – leads to cirrhosis

Liver failure is diagnosed based on the symptoms, physical examination findings, and diagnostic tests including blood tests, radiological studies, and liver biopsy.

Treatment varies depending on the severity of the disease and underlying medical conditions.

Medications may be prescribed to help alleviate pain and discomfort.
Liver transplant to restore liver function

Tips to prevent hepatic failure:

Limiting alcohol intake
Vaccinations for hepatitis A and hepatitis B
Diet and proper hygiene
Avoiding drugs and sharing needles
Exercise and maintaining a healthy weight.

9.

Stages and prognosis

It’s hard to diagnose liver failure and the condition requires urgent medical care. Understanding the various stages of liver disease helps to make better and early treatment choices.

Inflammation

Liver inflammation is an early sign of liver disease and is usually asymptomatic. If untreated, the inflamed liver may become hard and cause health problems.

Fibrosis

Fibrosis refers to the scarring of the inflamed liver. In this stage, the normal functioning of the liver is impaired. Fibrosis causes no symptoms and may progress to cirrhosis if left untreated.

Cirrhosis

In this stage, the liver becomes inflamed, scarred and damaged and loses its ability to function due to the reduced blood supply. Patients with cirrhosis may experience symptoms of liver disease.

End-Stage Liver Disease

End-stage liver disease (ESLD) is an advanced case of cirrhosis in which the liver fails to function normally. The condition is irreversible and will need treatment. Complications include ascites and hepatic encephalopathy. A liver transplant may be needed in severe cases of ESLD.

Liver cancer

In some cases, the liver cells may become abnormal and grow out of control causing cancer. Risk factors of liver cancer include cirrhosis, hepatitis B, and can occur in any stage of liver disease. Signs and symptoms associated with liver cancer include:

Nausea
Vomiting
Weight loss, unexplained
Abdominal pain and swelling
Loss of appetite
Jaundice – yellowish discoloration of skin and eyes
White chalky stools

Treatment of liver cancer varies depending on the tumor size/location, scar tissue, liver function and may include hepatectomy, liver transplant, ablation, chemotherapy, radiation therapy, targeted therapy, embolization, and chemoembolization.

10.

Liver Health FAQs: All your concerns addressed.

Q. Which foods can boost liver health?

The following can boost your liver health and can help you maintain good health.

Hot beverages such as tea and coffee – lowers the risk of developing liver cancer
Fruits rich in antioxidants like grapefruit – helps to protect the liver
Berries like blueberries and cranberries - rich in antioxidants and inhibits the growth of liver cancer cells
Grapes – prevents liver damage and fights inflammation
Prickly pear – The juice of the fruit help reduce inflammation
Beetroots – These vegetables are packed with antioxidants and nitrates. Beetroot juice reduces oxidative damage and inflammation.
High fiber plant food protects the liver from damage.
Nuts – Nuts top the list of foods that boost liver health. Nuts are a rich source of fats and nutrients including antioxidant vitamin E. Nut intake is associated with improved liver enzyme levels.
Fatty fish are an excellent source of omega-3 fatty acids that fights inflammation.

Q. How can I identify the symptoms of liver disease?

There will no clear symptoms in the early stages of liver disease. As the disease progresses you may see symptoms such as nausea, vomiting, unexplained weight loss, abdominal pain and swelling, white chalky stools, mental confusion, yellow discoloration of skin and eyes, and sometimes itchy skin. Talk to your doctor to know more about liver diseases and the associated signs/symptoms. Early diagnosis can help prevent the progression of the disease.

Q. Is liver damage reversible?

Alcoholic liver disease is reversible. It is the condition of liver damage caused by excessive alcohol consumption for a prolonged time. The disease progression can be slowed down by stopping alcohol consumption. Liver damage in cases of acetaminophen overdose is also reversible once the drug usage is stopped. The liver will sometimes recover on its own with improvement in lifestyle and diet. In the worst cases, you may need liver transplantation when the liver loses all the functions.

Q. What are the early signs of liver damage?

Liver disease doesn't always cause noticeable signs and symptoms. Few noticeable body changes or pain can be a warning for your liver:
- Jaundice, (a condition where the skin and eyes appear yellowish)
- Abdominal pain and swelling
- Leg Swelling
- Itchy skin
- Dark urine colour
- Pale stool colour
- Chronic fatigue
- Nausea or vomiting
- Loss of appetite
- A tendency to bruise easily

Q. How do you detect liver problems?

To find the cause and extent of liver damage, your doctor might recommend the following tests:
- Blood tests to detect genetic conditions or liver dysfunctioning.
- Imaging tests like CT scan, ultrasound and MRI can show liver damage.
- Biopsy where your tissue sample is checked to diagnose liver disease and to look for signs of liver damage.

Q. What are the 4 stages of liver diseases?

There are many different types of liver disease. It is important to know what happens to your liver at each stage of the progression before complete liver failure. Understanding the progression of liver disease may help you make better health choices. Here are the four stages of liver disease.
Stage 1: The first sign of liver damage is Inflammation
Inflammation in the liver is a sign that it in no longer efficient in detoxifying your blood of toxins found in the food you eat.
Stage 2: Fibrosis is the start of Liver Scarring
If you do not treat the inflammation, it will start to cause the liver to scar. It is the process of Fibrosis when the scar tissues replace the healthy liver tissue and thus reduces the liver function.
Stage 3: More severe scarring leads to Cirrhosis
When you don't treat the fibrosis medically, you are at risk of the next stage called cirrhosis, which is severe scarring of the liver.
Stage 4: Liver failure
It's the final stage where your liver completely fails to heal and loses all its ability to function.

Q. Is itching a sign of liver disease?

Itching (pruritus) is one symptom of chronic liver disease, though not everyone with liver disease develops it. Some people get itching sensation is one particular area like the soles of their feet, limbs or the palms of their hands, while others experience an all-over itch. When itching persists, it can contribute to Insomnia, Fatigue, Anxiety, Depression, and impaired quality of life.

Q. How should I change my diet if I have liver problems?

Dieting is one of the main ways to treat fatty liver disease, regardless of what type of liver disease it is. Here are a few food items you should avoid or limit if you have fatty liver disease.
- Alcohol: It is a major cause of fatty liver disease.
- Added sugar: Avoid sugary foods such as cookies, candy, sodas, and packaged fruit juices.
- Fried foods: These are the powerhouses of fat and calories, which increases the amount of fat buildup in the liver.
- Salt: Limit your Sodium intake. Eating too much salt can make your body hold on to excess water.
- White bread and Rice: White usually means the flour is highly processed, which can raise your sugar level more than whole grains due to a lack of fibre.
- Red meat: Avoid red meat as they are high in saturated fat.

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NH cares Your guide to Liver Health:

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