Chronic liver disease can be caused by a variety of factors.
Most causes of chronic liver disease are
treatable and if caught early enough, treatment may decrease the risk of
developing permanent liver damage or cirrhosis.
The main causes of chronic
liver disease are:
- Infectious: chronic hepatitis C and chronic hepatitis B
- Metabolic: non-alcoholic fatty liver disease,
hemochromatosis (an inherited iron overload syndrome), or Wilson’s disease
(genetic disorder of excess copper)
- Autoimmune: autoimmune hepatitis, primary biliary
cirrhosis, primary sclerosing cholangitis
Hepatitis C is a virus transmitted by blood which attacks
the liver cells. Most adults who are exposed to the hepatitis C virus develop
chronic (life-long) infection. Due to
hepatitis C being very common in the “baby boomer” generation, both the CDC and
the U.S. Preventive Services Task Force recommend hepatitis C screening for
anyone born between 1945 and 1965.
Chronic hepatitis C can lead to inflammation
in the liver and eventually can cause permanent scarring and nodules throughout
the liver. Hepatitis C is now the #1 cause of liver transplant in the United
States and is a main cause of liver cancer. Hepatitis C can be treated with a
combination of medications and is a potentially curable disease. People with
hepatitis C should avoid alcohol as this can accelerate the progression of
Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) is a condition in
which fat accumulates in the liver and replaces normal liver tissue. Individuals with components of the metabolic
syndrome (obesity, elevated blood sugar, high blood pressure, and/or high
cholesterol) have a higher risk of developing NAFLD versus those without the
The incidence of NAFLD is rising in the United States as obesity and insulin resistance are also rising. In some patients, the liver may have both inflammation (hepatitis) and
steatosis (fat) resulting in a condition called non-alcoholic steatohepatitis
or NASH. This is a more aggressive form of NAFLD which leads to cirrhosis in up
to 20% of cases. Treatments include medications aimed at controlling blood
sugar and cholesterol. Although a number of other treatments have been studies,
the most effective treatment is weight loss by practicing a healthy diet and
getting regular exercise.
Chronic Hepatitis B
Hepatitis B virus is transmitted by blood and body fluids. The
hepatitis B virus either lasts several weeks (acute hepatitis B) or develops
into a life-long liver disease (chronic hepatitis B). Less than 5% of adults
who are exposed to the hepatitis B virus develop chronic infection, but rates
increase if exposed perinatally (prior to or just after birth). The hepatitis B virus attacks the liver, causing
inflammation in the liver. Over time, it can cause cirrhosis and liver cancer.
There is no known cure for hepatitis B at
this time, however, there are medications
that suppress the virus and keep it from damaging the liver. These medications
must be taken indefinitely in most cases. Some people are inactive carriers of
hepatitis B and do not need treatment as they are unlikely to develop liver
damage despite being infected. There is a
vaccination which can help prevent a person from contracting hepatitis B if they
are exposed to the virus.
Alcoholic Liver Disease
There are several types of alcoholic liver disease:
alcoholic steatosis (fatty liver), alcoholic hepatitis (inflammation in the
liver), or alcoholic cirrhosis (nodular liver with scarring). The liver
processes alcohol and helps the body get rid of it. It is well known that
drinking too much alcohol can damage the liver. Alcoholic fatty liver is the
earliest stage of alcoholic liver disease and is easily reversible with discontinuation
of alcohol use.
Alcoholic hepatitis causes inflammation in the liver and can
cause symptoms such as ascites (fluid build-up in the abdomen), hepatic
encephalopathy (elevated ammonia and confusion), and jaundice (yellowing of the
skin). Alcoholic hepatitis can cause liver failure, but is sometimes
reversible. Alcoholic cirrhosis refers to scarring in the liver from years of
heavy alcohol use. Alcoholic cirrhosis can occur with or without alcoholic
steatosis and alcoholic hepatitis.
Autoimmune Liver Disease
There are three major types of autoimmune liver disease:
autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing
Autoimmune hepatitis occurs when the body’s immune system attacks
its own liver cells, resulting in inflammation in the liver and cirrhosis of
the liver if left untreated. Autoimmune
hepatitis is treated with a combination of medications that suppress the immune
system. Some people require these medications
for life, while others achieve remission in two years.
Primary biliary cirrhosis
Primary biliary cirrhosis (PBC) is also an
autoimmune disease in which the body’s immune system attacks the small bile
ducts of the liver, leading to duct obstruction and bile spilling into the
liver tissue. Although the name suggests otherwise, not everyone with PBC has
cirrhosis (a nodular liver). The progression of PBC can be slowed with agents
that improve the flow of bile through the bile ducts. In some cases, PBC can
lead to cirrhosis. Both autoimmune hepatitis and primary biliary cirrhosis are
more common in women.
Primary sclerosing cholangitis
Primary sclerosing cholangitis (PSC) is an
autoimmune disease in which the bile ducts located inside and outside of the
liver get obstructed due to inflammation and scarring of the ducts. About 80%
of people with PSC also have a condition called ulcerative colitis. Treatment
includes medications that improve bile flow and sometimes stenting of the bile
ducts if there is a blockage.
three autoimmune diseases, liver transplant may be a necessary treatment.