TYPES OF LIVER DISEASE
ALCOHOL-INDUCED LIVER DISEASE
Alcohol-Induced Liver Disease, as the name implies, is a disease of the liver caused by excessive consumption of alcohol which is a common, but preventable disease. The liver breaks down alcohol so it can be eliminated from your body. If you consume more alcohol than the liver can process, the resulting imbalance can injure the liver by interfering with its normal breakdown of protein, carbohydrates and fats
Women are more susceptible to liver damage than men. They are likely to develop cirrhosis at an earlier age, present at a later stage and have more severe liver disease with more complications. There are three kinds of liver disease related to alcohol consumption:
ALCOHOLIC FATTY LIVER
Fatty Liver is excessive accumulation of fat inside the liver cells and is the most common alcohol-induced liver disorder. Fatty liver occurs in almost all people who drink heavily.
Usually there are no symptoms, although the liver may be enlarged and you may experience discomfort in your upper abdomen on the right side.
ALCOHOLIC HEPATITIS
Alcoholic Hepatitis is inflammation of the liver. Up to 35 percent of heavy drinkers develop alcoholic hepatitis. In its mild form, alcoholic hepatitis can last for years and will cause progressive liver damage. The damage may be reversible if you stop drinking. In its severe form, the disease may occur suddenly, after binge drinking, and it can quickly lead to life-threatening complications.
ALCOHOLIC CIRRHOSIS
 Alcoholic Cirrhosis is the most serious type of alcohol-induced liver disease. Between 10 and 20 percent of heavy drinkers develop cirrhosis, usually after 10 or more years of drinking. The damage from cirrhosis is not reversible and it is a life-threatening disease. Your condition may stabilize if you stop drinking.
Many heavy drinkers will progress from fatty liver to alcoholic hepatitis and finally to alcoholic cirrhosis, though the period varies from patient to patient. The risk of developing cirrhosis is particularly high for people who drink heavily and have another chronic liver disease such as viral hepatitis C.
WHAT ARE THE SYMPTOMS OF ALCOHOL-INDUCED LIVER DISEASE?
It is difficult to detect fatty liver disease. Those who suffer form this disease are either asymptotic or they may show certain non-specific symptoms. Sometimes the liver may appear smooth and slightly enlarged but rarely tender. Fatty liver disease is not caused by alcoholism only. Obesity, insulin resistance and malnutrition may also cause a fatty liver.
Symptoms of alcohol-induced liver diseasedepend on how much and how long a person has been drinking alcohol and each individual may experience symptoms differently.
The most common symptoms of alcohol-induced liver disease are:
- Abdominal pain.
- Ascites - fluid build-up in the abdominal cavity.
- Attention deficit.
- Confusion.
- Dry mouth.
- Enlarged liver and spleen.
- Fatigue.
- Fever.
- Increased white blood cell count.
- Jaundice - yellowing of the skin and eyes.
- Kidney failure.
- Loss of energy.
- Lost of appetite.
- Mental confusion.
- Nausea.
- Portal hypertension.
- Slow lethargic movement and reddishness of the hands or feet.
- Spider-like veins in the skin.
- Vomiting.
More severe symptoms include encephalopathy, which causes general dysfunction in the brain and liver failure. Some individuals suffering from a severe case of alcoholic hepatitis may sometimes also develop acute viral hepatitis. Alcohol induced cirrhosis of the liver is difficult to differentiate from cirrhosis caused due to other reasons.
Some general alcohol induced cirrhosis symptoms are:
- Hypertension.
- Jaundice.
- Some may even suffer from pruritus, an intense scratching sensation.
- Visceral bleeding - a condition in which the blood vessels dilate and bleed and may also burst.
Uncontrolled consumption of alcohol affects the liver and is also bad for health. By the time the signs of alcoholic liver disease surface one may already be in an advanced stage of the disease. It is best to drink in moderation and have a healthy diet, as obesity has been found to increase the risk of alcoholic liver disease among heavy drinkers
The symptoms of alcohol-induced liver disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
HOW IS ALCOHOL-INDUCED LIVER DISEASE DIAGNOSED?
Alcohol-induced liver disease may be suspected based on other medical and lifestyle issues related to alcohol abuse. Blood tests and imaging tests (MRI, CT scan or ultrasound) may help in diagnosis and to rule out other causes of liver disease. Proof is best established by liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.
THE OUTLOOK FOR PEOPLE WITH ALCOHOL-INDUCED LIVER DISEASE
Anyone with alcohol-induced liver disease will improve their health and life expectancy if they stop drinking. For patients who do not stop drinking, the outlook is poor; they are likely to suffer a variety of life-threatening health problems caused by alcohol-related liver damage.
IS THERE A SAFE LEVEL OF DRINKING?
For most people, moderate drinking will not lead to alcohol-induced liver disease. Moderate drinking means no more than one drink a day for women and two drinks a day for men. (A standard drink is one 12-ounce beer, one 5-ounce glass of wine or one 1.5-ounce shot of distilled spirits.) However, for people with chronic liver disease, especially alcohol-induced liver disease, even small amounts of alcohol can make the liver disease worse. Patients with alcohol-induced liver disease and those with cirrhosis from any cause should stop using alcohol completely. Women are more likely to be affected by alcohol-induced liver disease because women can be affected by smaller amounts of alcohol than men.
Even small amounts of alcohol can be dangerous when taken with medications containing acetaminophen, found in many over-the-counter pain relievers. The combination of alcohol and acetaminophen can be very harmful to the liver for anyone who drinks. Never take acetaminophen with alcohol, or immediately after a period of heavy drinking.
IMPORTANT NOTE
THE BEST WAY TO PREVENT ALCOHOL-INDUCED LIVER DISEASE IS TO STAY AWAY FROM ANY ALCOHOL DRINKS.
AUTOIMMUNE HEPATITIS
Autoimmune Hepatitis is a disease in which the body’s own immune system attacks the liver, causing inflammation and cell death. The disease is chronic, meaning it lasts many years and if untreated, it can get worse over time and lead to cirrhosis and liver failure.
Autoimmune hepatitis is typically chronic, meaning it can last for years and can lead to cirrhosis or scarring and hardening of the liver resulting in liver failure. Autoimmune hepatitis usually occurs in women (70 %) between the ages of 15 and 40.
Type 1 - autoimmune hepatitis is the more common form. It mostly affects young women and is
often associated with other autoimmune diseases.
Type 2 - autoimmune hepatitis is less common and generally affects girls between ages of 2 to 14.
WHAT ARE THE SYMPTOMS OF AUTOIMMUNE HEPATITIS?
Symptoms of autoimmune hepatitis range from mild to severe. Because severe viral hepatitis or hepatitis is caused by a drug, for example, certain antibiotics have the same symptoms as autoimmune hepatitis, tests may be needed for an exact diagnosis. Doctors should also review and rule out all medicines a patient is taking before diagnosing autoimmune hepatitis.
The common autoimmune hepatitis symptoms when they occur are:
- Abdominal discomfort.
- Absence of menstruation.
- Aching joints.
- Dark urine.
- Enlarged liver.
- Fatigue.
- Itching.
- Jaundice (yellowing of the skin and whites of the eyes).
- Large abdomen due to enlarged liver and spleen.
- Loss of appetite.
- Nausea.
- Pale or grey colored stools.
- Severe acne.
- Skin rashes.
- Spider angiomas (blood vessels) on the skin (varicose veins).
People in advanced stages of the disease are more likely to have symptoms related to chronic liver disease, such as fluid in the abdomen, also called ascites and mental confusion. Women may stop having menstrual periods.
HOW IS AUTOIMMUNE HEPATITIS DIAGNOSED?
Autoimmune hepatitis often occurs suddenly. Initially, you may feel like you have a mild case of the flu. To confirm a diagnosis of autoimmune hepatitis, your doctor will use blood tests and a liver biopsy, in which a sample of liver tissue is removed with a needle for examination in a laboratory.
WHO IS AT RISK OF AUTOIMMUNE HEPATITIS?
About 70 percent of people with autoimmune hepatitis are women, usually between the ages of 15 and 40. Many people with this disease also have other autoimmune diseases, including:-
- Sjogren’s Syndrome (dry eyes and dry mouth).
- Thyroiditis (inflammation of the thyroid gland)
- Type 1 Diabetes
- Ulcerative Colitis (inflammation of the colon)
- Vitiligo (patchy loss of skin pigmentation)
FATTY LIVER
 
A fatty liver is the result of the accumulation of excess fat in liver cells. It is normal for your liver to contain some fat. But if fat accounts for more than 10% of your liver’s weight, then you have fatty liver and you may develop more serious complications. Fatty liver can be a completely benign condition and usually does not lead to liver damage. However, once there is a buildup of fats, the liver becomes vulnerable to further injury, which may result in inflammation and scarring of the liver or cirrhosis, which is serious and often leads to liver failure.
WHAT ARE THE CAUSES OF FATTY LIVER?
Eating excess calories causes fat to build up in the liver. When the liver does not process and break down fats as it normally should, too much fat will accumulate. People tend to develop fatty liver if they have certain other conditions, such as:
- Alcohol Abuse.
- Diabetes.
- High Triglycerides Level.
- Malnutrition.
- Obesity.
- Rapid Weight Loss.
It is estimated that 75% of obese individuals are at risk of developing a simple fatty liver and up to 23% of obese individuals are at risk of developing fatty liver with inflammation.
WHAT ARE THE SYMPTOMS OF FATTY LIVER?
A fatty liver produces no symptoms on its own, so people often learn about their fatty liver when they have medical tests for other reasons. NASH can damage your liver for years or even decades without causing any symptoms. If the disease gets worse, you may experience:
- Abdominal discomfort
- Confusion.
- Fatigue
- Weakness
HOW COMMON IS FATTY LIVER?
More than 60 % of the regular alcoholics have fatty liver. Although no specific answer can be given to it but obese individuals with a history of diabetes mellitus and high triglycerides are more likely to have fatty liver.
HOW IS FATTY LIVER DIAGNOSED?
Your doctor may see something unusual in your blood test or notice that your liver is slightly enlarged during a routine checkup. These could be signs of a fatty liver. To make sure you don’t have another liver disease, your doctor may ask for more blood tests, an ultrasound, a CT scan or an MRI. If other diseases are ruled out, you may be diagnosed with NASH. The only way to know for sure is to get a liver biopsy. Your doctor will remove a sample of liver tissue with a needle and check it under a microscope.
WHO IS AT RISK FOR FATTY LIVER?
Most (but not all) fatty liver patients are middle-aged and overweight. The risk factors most commonly linked to fatty liver disease are:
- Diabetes
- Elevated Triglyceride Levels
- Obesity (body mass index above 30)
- Overweight (body mass index of 25-30)
HEPATITIS
The five hepatitis viruses can be transmitted in different ways, but they all have one thing in common: They infect the liver and cause it to become inflamed. Generally, the acute phase of the disease lasts from two to three weeks; complete recovery takes about nine weeks. Although most patients recover with a lifelong immunity to the disease, a few hepatitis victims (less than 1%) die in the acute phase. Others may develop chronic hepatitis, in which the liver remains inflamed for six months or more. This condition can lead to cirrhosis and possibly death.
WHAT CAUSES HEPATITIS?
Although their effects on the liver and the symptoms they produce can be similar, the various forms of hepatitis are contracted in different ways. In the case of viral hepatitis, the severity and duration of the disease are largely determined by the organism that caused it.
Hepatitis A (HAV)
HAV is generally contracted orally through fecal contamination of food or water, is considered the least dangerous form of the disease because it almost always resolves on its own. Also, it does not lead to chronic inflammation of the liver. The hepatitis A virus commonly spreads through improper handling of food, contact with household members, sharing toys at day-care centers, and eating raw shellfish taken from polluted waters.
Symptoms of hepatitis A can occur two to seven weeks after infection with the virus. The symptoms are usually mild. Low energy is the most common symptom. Others may include:
- Fatigue.
- Fever.
- Headache.
- Jaundice (a yellowing of the skin and whites of the eyes).
- Loss of appetite.
- Muscle soreness.
- Nausea.
- Pain near the liver.
The symptoms almost always go away within two months. Children may not have any symptoms, even though they can spread the infection to others.
People most likely to get hepatitis A are:
- Day care children and employees, during outbreaks.
- International travelers, particularly those traveling to developing countries.
- Men who have sex with men.
- People living in areas where children are not vaccinated against hepatitis A,
- People who live with or have sex with an infected person.
- Users of illicit drugs.
Hepatitis B (HBV)
HBV can spread through sexual contact, blood transfusions, and needle sharing by intravenous drug users. The virus can pass from mother to child at birth or soon afterward; the virus can also travel between adults and children to infect whole families. In a third of all hepatitis B cases the source cannot be identified. The majority of hepatitis B patients recover completely, but a small percentage of them can't shake the disease and become carriers. Carriers can transmit the disease to others even when their own symptoms have vanished. A smaller percentage of patients who cannot fight off the virus will develop chronic hepatitis B. Like carriers, those with chronic hepatitis B are able to pass on the virus. Up to 25% of chronic hepatitis B patients die prematurely from the disease as a result of cirrhosis or liver cancer.
Many people with acute hepatitis B, and most people with chronic hepatitis B, have no symptoms. When symptoms do occur they are often mild and may include:-
- Fatigue.
- Fever.
- Headache.
- Jaundice (a yellowing of the skin and whites of the eyes).
- Loss of appetite.
- Muscle soreness.
- Nausea.
- Pain near the liver
Because hepatitis B may produce no symptoms, many infected people do not know that they are infected. People most likely to get hepatitis B are:
- Health care workers.
- Hemodialysis patients.
- Immigrants and children of immigrants from areas with high rates of hepatitis B.
- Infants born to infected mothers.
- Injection drug users.
- International travelers.
- Men who have sex with men.
- People who have multiple sex partners.
- People who live with or have sexual contact with an infected person.
- People who received a transfusion of blood or blood products before 1987.
Hepatitis C (HCV)
HCV is usually spread through contact with blood or contaminated needles, including tattoo needles. Although hepatitis C may cause only mild symptoms or none at all, approximately 20% of those infected develop cirrhosis within 20 years. The disease can be passed on through blood transfusions, but screening, which started in the early '90s, has greatly reduced the number of such cases. In a third of all hepatitis C cases, the source of the disease is unknown.
Most people with both acute and chronic hepatitis C have no symptoms from the disease. This is why hepatitis C may persist for years or even decades before it is discovered. When symptoms do occur, they may include:-
- Fatigue.
- Itchy skin.
- Jaundice (a yellowing of the skin and whites of the eyes).
- Joint pain.
- Muscle soreness.
- Stomach pain.
People most likely to be exposed to the hepatitis C virus are:
- Health care workers.
- Hemodialysis patients.
- Infants born to infected women.
- Injection drug users.
- People who have multiple sex partners.
- People who have sex with an infected person.
- People who received a transfusion of blood or blood products before July 1992.
- People who received clotting factors made before 1987.
Hepatitis D (HDV)
HDV occurs only in people infected with hepatitis B and tends to magnify the severity of that disease. It can be transmitted from mother to child and through sexual contact. Although less common, hepatitis D is especially dangerous because it involves two forms of the disease working at once.
For a person with hepatitis D, early symptoms may include one or several of the following:
- Dark urine.
- Diarrhea.
- Excessive tiredness.
- Fatigue.
- Joint pain.
- Light-colored stool.
- Low-grade fever.
- Mild abdominal pain (or stomach pain).
- Muscle pain.
- Nausea.
- No appetite.
- Sore throat.
- Vomiting.
People most likely to be exposed to the hepatitis D virus are:-
- Anyone infected with hepatitis B is at risk for hepatitis D.
- Injection drug users have the highest risk.
- People who live with or have sex with a person infected with hepatitis D.
- People who received a transfusion of blood or blood products before 1987.
Hepatitis E (HEV)
HEV occurs mainly in Asia, Mexico, India, and Africa; only a few cases are reported in the United States, mostly among people who have returned from a country where the disease is widespread. Like hepatitis A, this type is usually spread through fecal contamination, and it does not lead to chronic hepatitis. This form is considered slightly more dangerous than hepatitis A, especially in pregnant women, who may die from this infection.
Alcoholic, toxic and drug-related hepatitis can produce the same symptoms and liver inflammation that result from viral hepatitis. This form is caused not by invading microorganisms but by excessive and chronic consumption of alcohol, ingestion of environmental toxins, or misuse of certain prescription drugs and over-the-counter medications.
Not everyone who is infected with the virus will develop symptoms, however. Some people may also have symptoms that are so mild as to go unnoticed. If symptoms of hepatitis E do occur, they usually appear abruptly. Early symptoms are:
- Dark urine.
- Diarrhea.
- Excessive tiredness.
- Fatigue.
- Jaundice usually occurs several days (up to 2 weeks) after getting Hepatitis E.
- Joint pain.
- Lack of appetite.
- Low-grade fever.
- Muscle pain.
- Nausea.
- Pale-colored stool.
- Sore throat.
- Stomach pain (or abdominal pain) on the right side.
People most likely to be exposed to the hepatitis E virus are
- International travelers, particularly those traveling to developing countries.
- People living in areas where hepatitis E outbreaks are common.
- People who live with or have sex with an infected person.
TOXIC HEPATITIS
Toxic Hepatitis is an inflammation of the liver due to medications and toxic chemicals. Many chemicals that are intentionally or unintentionally inhaled or consumed can have toxic effects on the liver. Among these chemicals are drugs, industrial solvents and pollutants. Virtually every drug imaginable has at one time or another been indicated as a cause of toxic hepatitis. Toxins can occasionally cause chronic liver disease and even cirrhosis if the use of the drug is not stopped.
DO ALL TOXINS AFFECT THE LIVER IN THE SAME MANNER?
Toxins that can damage the liver have been divided into two groups:
Predictable
Toxic chemicals that are known to cause toxic hepatitis and liver damage with sufficient exposure - chemicals found in this group are cleaning solvents.
Unpredictable
Toxins that damage the liver in a very small proportion of individuals exposed to the chemical. Unpredictable injury produced by most drugs is very poorly understood but recent data suggest that a toxic response to a drug probably depends on the kind of enzyme a person inherits to metabolize the drug.
WHAT ARE THE SYMPTOMS OF TOXIC HEPATITIS?
Clinically, toxic hepatitis can resemble any form of acute or chronic liver disease, such as viral hepatitis or bile-duct obstruction.
Mild forms of toxic hepatitis may not cause any noticeable problems and may be detected only by blood tests. When signs and symptoms occur, they're similar to those caused by other types of hepatitis:
- Dark or tea-colored urine.
- Fatigue.
- Jaundice - yellowing of the skin and whites of the eyes.
- Loss of appetite.
- Nausea and vomiting.
- Weight loss.
WHAT ARE THE COMPLICATIONS OF TOXIC HEPATITIS?
Like other types of hepatitis, toxic hepatitis can cause serious complications:
Increased blood pressure in the portal vein. Blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. If damaged liver tissue blocks normal circulation through the liver, the blood backs up, leading to increased pressure within this vein (portal hypertension). This, in turn, causes blood to back up into other blood vessels in your stomach, esophagus and lower intestine.
Enlarged veins (varices). When circulation through the portal vein is blocked, blood may back up into other blood vessels in the stomach, esophagus and lower intestinal tract. These blood vessels are thin-walled and, because they're filled with more blood than they're meant to carry, are likely to leak. Massive bleeding in the upper stomach or esophagus from these blood vessels is a life-threatening emergency that requires immediate medical care.
Jaundice. This occurs when your liver isn't able to remove bilirubin, the residue of old red blood cells from your blood. Eventually, bilirubin builds up and is deposited in your skin and the whites of your eyes, causing a yellow color.
Cirrhosis. This serious condition, irreversible scarring of the liver frequently leads to liver failure, which occurs when the liver is no longer able to function.
IS THE LIVER SUSCEPTIBLE TO INJURY BY CHEMICALS?
The liver is susceptible to injury by chemicals because it plays a fundamental role in chemical metabolism. The liver has the unique job of processing almost all chemicals and drugs that enter the blood stream and removing the chemicals that are difficult for the kidneys to excrete. The liver turns these chemicals into products that can be eliminated from the body through bile or urine. However, during this chemical process in the liver, unstable highly toxic products are sometimes produced; these highly toxic products can attack and injure the liver.
Regular alcohol consumption will likely enhance the chance of drug toxicity especially in the case of acetaminophen. Therefore, alcohol should not be consumed when using medications.
HOW IS TOXIC HEPATITIS DIAGNOSED?
In making a diagnosis of toxic hepatitis, your doctor will ask about your medical history, including detailed information regarding your medications and alcohol consumption. Your doctor also will carry out a thorough physical exam which can be helpful in determining the presence or absence of significant chronic liver disease. The following tests may be performed to assess the presence and severity of liver damage.
WHO IS AT RISK OF TOXIC HEPATITIS?
Your risk for toxic hepatitis increases if you:
- Are an older adult - as you age, the liver breaks down harmful substances more slowly resulting in
toxins and their byproducts staying inside your body longer.
- Are exposed to industrial toxins - working with certain industrial chemicals puts you at risk of toxic
hepatitis.
- Are a female - because women seem to metabolize certain toxins more slowly than men do, their
livers are exposed to higher blood concentrations of harmful substances for longer periods of time.
- Drink alcohol - combining medications with even moderate amounts of alcohol (no more than two
drinks a day for men or one for women), significantly increases the toxic effects of most drugs).
- Have another liver disease – such as cirrhosis or fatty liver disease makes you much more
susceptible to the effects of toxins.
- Have certain gene defects - inheriting certain defects in the liver enzymes that break down toxins
may make you more susceptible to toxic hepatitis.
- Have viral hepatitis - such as hepatitis A, B or C a greatly increased risk of developing toxic
hepatitis.
- Take over-the-counter (OTC) medications - pain relievers or certain prescription drugs for an
extended time or in higher than recommended amounts increases the risk of getting toxic hepatitis.
HEMOCHROMATOSIS
Hemochromatosis is an inherited condition in which the body absorbs and stores too much iron. The extra iron builds up in several organs, especially the liver and can cause serious damage. Without treatment, the disease can cause these organs to fail.
Iron is an essential nutrient found in many foods. Healthy people usually absorb about 10 percent of the iron contained in the food they eat to meet the body’s needs. People with hemochromatosis absorb more than the body needs. The body has no natural way to rid itself of the excess iron, causing the excess to build up in the organs.
WHAT ARE THE SYMPTOMS OF HEMOCHROMATOSIS?
Many people have no symptoms, even in advanced cases. Joint pain is the most common complaint of people with hemochromatosis. Other common symptoms include fatigue, lack of energy, abdominal pain, loss of sex drive, and heart problems. Symptoms tend to occur in men between the ages of 30 and 50 and in women over age 50.
If the disease is not detected early and treated, iron may accumulate in body tissues and may eventually lead to serious problems such as:
- Abnormal pigmentation of the skin, making it look gray or bronze
- Arthritis
- Damage to the adrenal gland
- Damage to the pancreas, possibly causing diabetes
- Early menopause
- Heart abnormalities, such as irregular heart rhythms or congestive heart failure
- Impotence
- Liver disease, including an enlarged liver, cirrhosis, cancer and liver failure
- Pituitary damage
WHAT CAUSES HEMOCHROMATOSIS?
Genetic or hereditary hemochromatosis is connected to a defect in a gene called HFE, which regulates the amount of iron absorbed from food. While hemochromatosis is present at birth, symptoms rarely appear before adulthood. A person who inherits the defective gene from both parents may develop hemochromatosis while a person who inherits the defective gene from only one parent is a carrier for the disease but usually does not develop it.
Juvenile hemochromatosis and neonatal hemochromatosis are two forms of the disease that are not caused by a HFE defect. Their cause is unknown. The juvenile form leads to severe iron overload and liver and heart disease in adolescents and young adults between the ages of 15 and 30, and the neonatal form causes the same problems in newborn infants.
HOW IS HEMOCHROMATOSIS DIAGNOSED?
Blood tests for serum iron and either total iron binding capacity or transferrin are good screening tests. A good additional test is serum ferritin level, which is elevated in patients with hemochromatosis. If these tests are persistently high, a genetic test for the mutations in the HFE gene should be performed.
Depending on whether there is evidence of liver damage, a liver biopsy should be done to assess the damage to the liver. Excess iron is also frequently present in patients with alcoholic liver disease or chronic viral hepatitis. A liver biopsy is the only definitive way to determine if patients with these diseases also have iron overload.
WHO IS AT RISK OF HEMOCHROMATOSIS?
Immediate relatives of people with hemochromatosis should have their blood tested to see if they have the disease or are carriers, this includes parents, siblings and children. People who have joint disease, severe and continuing fatigue, heart disease, elevated liver enzymes, impotence and diabetes should be tested, because these conditions may result from hemochromatosis. Men are five times as likely as women are to develop the condition, and they usually experience symptoms at an earlier age.
PRIMARY BILIARY CIRRHOSIS (PBC)
Primary Biliary Cirrhosis (PBC), is a chronic or long-term disease of the liver that slowly destroys the medium-sized bile ducts within the liver. Bile is a digestive liquid that is made in the liver and travels through the bile ducts to the small intestine, where it helps digest fats and fatty vitamins.
In patients with PBC, the bile ducts are destroyed by inflammation. This causes bile to remain in the liver, where gradual injury damages liver cells and causes cirrhosis, or scarring of the liver. As cirrhosis progresses and the amount of scar tissue in the liver increases, the liver loses its ability to function. Cirrhosis also prevents blood from the intestines from returning to the heart.
PBC advances slowly. Many patients lead active and productive lives for more than 10 to 15 years after diagnosis. Patients who show no symptoms at the time of diagnosis often remain symptom-free for years. Patients who have normal liver tests on treatment may have a normal life expectancy. PBC is a chronic illness and may lead to life-threatening complications, especially after cirrhosis develops.
WHAT ARE THE SIGNS AND SYNPTOMS OF PBC?
Many people with PBC do not have symptoms, especially in the early stages of the disease. When symptoms do occur the most common is pruritus or intense itching of the skin, often in the arms, legs and back. Other symptoms may include:
- Collection of fatty deposits in the skin around the eye.
- Darkening of the skin.
- Fatigue.
- Fluid build-up in the ankles and abdomen.
- Jaundice - an indication of how far the disease has progressed.
Several other disorders often occur with PBC. The most common is problems with the tear and salivary glands, causing dry eyes or mouth. Arthritis and thyroid problems may also be present. Renal stones and gallstones may develop. Bone softening and fragility leading to fractures can occur in late stages of the disease.
WHAT CAUSES PBC?
The cause of this disease is unknown. It may be related to problems in the immune system. Although PBC is technically not a hereditary disease, meaning a disease caused by a specific gene or genetic defect that is passed from parent to child, there appears to be some family link. PBC is more common among siblings and in families where one member has been affected.
HOW IS PBC DIAGNOSED?
Because many PBC patients have no symptoms, the disease is often discovered through abnormal results on routine liver blood tests. Doctors need to do several tests to confirm a diagnosis of primary biliary cirrhosis. One test looks for the presence of antimitochondrial antibodies (AMA) in the blood. This test is positive in nearly all PBC patients. Ultrasound exams and a liver biopsy, in which a small sample of liver tissue is removed with a needle, may also be performed.
WHO IS AT RISK OF PBC?
Women account for about 90 percent of PBC cases. It is most commonly diagnosed in patients between the age of 35 and 60.
PRIMARY SCLEROSING CHOLANGITIS (PSC)
Primary Sclerosing Cholangitis (PSC) is a chronic or long-term disease that slowly damages the bile ducts inside and outside the liver. Bile is a digestive liquid that is made in the liver. It travels through the bile ducts to the gall bladder and the small intestine, where it helps digest fats and fatty vitamins.
In patients with PSC, the bile ducts become blocked due to inflammation and scarring. This causes bile to accumulate in the liver, where it gradually damages liver cells and causes cirrhosis, or scarring of the liver. As cirrhosis progresses and the amount of scar tissue in the liver increases, the liver slowly loses its ability to function. The scar tissue may block drainage of the bile ducts leading to infection of the bile.
PSC advances very slowly. Many patients may have the disease for years before symptoms develop. Symptoms may remain at a stable level, they may come and go, or they may progress gradually. Liver failure may occur 10-15 years after diagnosis, but this may take even longer for some PSC patients. Many people with PSC will ultimately need a liver transplant, typically about 10 years after being diagnosed with the disease. PSC may also lead to bile duct cancer. Endoscopy and MRI tests may be done to monitor the disease.
WHAT ARE THE SYMPTOMS OF PSC?
Many people with PSC do not get symptoms, especially in the early stages of the disease. When symptoms do occur the most common are:
- Fatigue
- Jaundice, a yellowing of the skin and eyes.
- Pruritus, or intense itching of the skin
These symptoms may come and go, but they may worsen over time. As the disease continues, the bile ducts may become infected, which can lead to episodes of fever, chills and abdominal pain.
WHAT CAUSES PSC?
The cause of this disease is not known. About 70 percent of patients are men. It may be related to bacterial or viral infections, as well as problems in the immune system. Genetic factors may also play a role. PSC is considered an uncommon disease, but recent studies suggest that it may be more common than previously thought.
HOW IS PSC DIAGNOSED?
Because many PSC patients have no symptoms, the disease is often discovered through abnormal results on routine liver blood tests. Formal diagnosis is usually made by cholangiography, an X-ray test involving injection of dye into the bile ducts, or by an MRI.
WHO IS AT RISK FOR PSC?
PSC is more common in men than women. It usually affects people between the ages of 30 and 60. As many as 75 percent of patients with PSC also have inflammatory bowel diseases, usually ulcerative colitis.
LIVER CIRRHOSIS
Liver Cirrhosis is a potentially life-threatening condition that causes liver failure. It is always related to other liver diseases. Cirrhosis refers to the replacement of normal liver tissue with non-living scar tissue. The process begins with inflammation that is caused by long-term liver disease. After many months or years of inflammation, healthy tissue is replaced by scar tissue. As cirrhosis continues, the liver is not left with enough functioning tissue to function properly. If the process of cirrhosis is not slowed or stopped, the liver will no longer be able to perform its critically important functions. Life is impossible without a functioning liver.
WHAT CAUSES CIRRHOSIS?
Cirrhosis is caused by long-term liver diseases that damage liver tissue. It can take many years for liver damage to lead to cirrhosis, and then it can take many years for cirrhosis to lead to liver failure. This is because the liver can function adequately with some damage, and it can even repair itself by replacing injured cells. But over time, if the underlying disease is not controlled, cirrhosis begins. Cirrhosis has many causes of which chronic alcoholism and hepatitis C are the most common ones.
Alcoholic Liver Disease
To many people, cirrhosis of the liver is synonymous with chronic alcoholism, but in fact, alcoholism is only one of the causes. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.
Chronic Hepatitis C
The hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.
Chronic Hepatitis B and D
The hepatitis B virus is probably the most common cause of cirrhosis worldwide, but it is less common in the United States and the Western world. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.
Autoimmune Hepatitis
This disease appears to be caused by the immune system attacking the liver and causing inflammation, damage, and eventually scarring and cirrhosis.
Inherited Disease
Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.
NonAlcoholic Steatohepatitis (NASH)
In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.
Blocked Bile Ducts
When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are inadvertently tied off or injured.
Drugs, Toxins and Infections
Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can all lead to cirrhosis.
WHAT ARE THE SYMPTOMS AND COMPLICATIONS OF CIRRHOSIS?
There are usually no symptoms of cirrhosis in its early stages of the disease. However, over the years, as scar tissue replaces healthy cells, liver function starts to fail and a person may experience the following symptoms:
- Abdominal pain.
- Body hair loss.
- Exhaustion.
- Fatigue.
- Loss of appetite.
- Nausea.
- Spider-like blood vessels (spider angiomas) that develop on the skin.
- Weakness.
- Weight loss.
As the disease progresses, loss of liver function affects the body in many ways. Some of the common complications are:
Edema and Ascites
When the liver loses its ability to make the protein albumin, water accumulates in the legs (edema) and abdomen (ascites).
Bleeding
When the liver slows or stops production of the proteins needed for blood clotting, a person will bruise or bleed easily. The palms of the hands may be reddish and blotchy with palmar erythema.
Jaundice
Jaundice is a yellowing of the skin and eyes that occurs when the diseased liver does not absorb enough bilirubin.
Itching
Bile products deposited in the skin may cause intense itching.
Gallstones
If cirrhosis prevents bile from reaching the gallbladder, gallstones may develop.
Toxins in the blood or brain
A damaged liver cannot remove toxins from the blood, causing them to accumulate in the blood and eventually the brain. There, toxins can dull mental functioning and cause personality changes, coma, and even death. Signs of the buildup of toxins in the brain include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.
Sensivity to medications
Cirrhosis slows the liver's ability to filter medications from the blood. Because the liver does not remove drugs from the blood at the usual rate, they act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side effects.
Portal Hypertention
Normally, blood from the intestines and spleen is carried to the liver through the portal vein. But cirrhosis slows the normal flow of blood through the portal vein, which increases the pressure inside it. This condition is called portal hypertension.
Varices
When blood flow through the portal vein slows down, blood from the intestines and spleen backs up into blood vessels in the stomach and esophagus. These blood vessels may become enlarged because they are not meant to carry this much blood. The enlarged blood vessels, called varices, have thin walls and carry high pressure, and are more likely to burst, resulting in serious bleeding problem in the upper stomach or esophagus that requires immediate medical attention.
Insulin resistance and type 2 diabetes
Cirrhosis causes resistance to insulin. This hormone, produced by the pancreas, enables blood glucose to be used as energy by the cells of the body. If you have insulin resistance, your muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulin by producing more. Eventually, the pancreas cannot keep up with the body's need for insulin, and type 2 diabetes develops as excess glucose builds up in the bloodstream.
HOW IS CIRRHOSIS DIAGNOSED?
The doctor may diagnose cirrhosis on the basis of symptoms, laboratory tests, the medical history and a physical examination. For example, during a physical examination, the doctor may notice that the liver feels harder or larger than usual and order blood tests that can show whether liver disease is present.
If looking at the liver is necessary to check for signs of disease, the doctor might order a computerized axial tomography (CAT) scan, magnetic resonance imaging (MRI) or a scan of the liver using a radioisotope (a harmless radioactive substance that highlights the liver), ultrasound or the doctor might look at the liver using a laparoscope, an instrument that is inserted through the abdomen and relays pictures back to a computer screen.
To confirm the diagnosis, your doctor may need to do a liver biopsy, in which a small sample of liver tissue is removed with a needle and examined in a laboratory for scarring or other signs of disease. Your doctor may suspect that you have cirrhosis based on your medical history, since cirrhosis is always linked to other liver diseases. A liver that is harder or larger than usual is a sign of cirrhosis.
HOW IS CIRRHOSIS TREATED?
Liver damage from cirrhosis cannot be reversed, but treatment can stop or delay further progression and reduce complications. Treatment depends on the cause of cirrhosis and any complications a person is experiencing. In all cases, regardless of the cause, following a healthy diet and avoiding alcohol are essential because the body needs all the nutrients it can get, and alcohol will only lead to more liver damage. Light physical activity can help stop or delay cirrhosis as well.
The goals of treatment are to stop or slow the progress of cirrhosis, in order to prevent further liver damage, and address the consequences of cirrhosis, which can be disabling or life-threatening. Specific medicines and surgical procedures may be required to treat the underlying cause of cirrhosis and its complications. In general, if you are diagnosed with cirrhosis you should:
- Completely stop drinking alcohol.
- Reduce salt intake to prevent or reduce fluid buildup.
- Talk to your doctor about your medications, including your use of nonprescription pain relievers.
- Talk to your doctor about getting immunized against Hepatitis A and B.
In cases where cirrhosis cannot be stopped, the liver will ultimately lose its ability to function, and a liver transplant will be necessary. Doctors will look at your overall health to determine whether you are a suitable candidate for a liver transplant, so it is important to stay as healthy as possible from the time you are first diagnosed with cirrhosis.
PROBLEMS IN OTHER ORGANS
Cirrhosis can cause immune system dysfunction, leading to infection. Fluid in the abdomen (ascites) may become infected with bacteria normally present in the intestines. Cirrhosis can also lead to mpotence, kidney dysfunction and failure and osteoporosis.
Talk to your doctor about liver disease. It’s important to catch liver disease early for effective treatment and improve the chance of the liver to heal itself and recover.
Disclaimer: The information provided is for educational and communication purpose only, for use in the maintenance and promotion of good health and should not be construed as personal medical advice or presented with the intention of diagnosing any disease or condition or prescribing any treatment. Bio Healthcare Enterprise shall hold No responsibility or liability on any untoward effects or incidents which may arise as a result of any misinterpretation of this information.
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