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Liver Disease

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.

Causes of Liver Disease

  • 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)
  • Alcohol
  • Autoimmune: autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis

Hepatitis C

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 treatment is possible 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 liver damage. 

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 metabolic syndrome.

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. Non-alcoholic fatty liver disease treatments include medications aimed at controlling blood sugar and cholesterol. Although a number of other treatments have been studied, the most effective NAFLD 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 and do not need hepatitis B 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 cholangitis.

Autoimmune Hepatitis

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 treatments consists of 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 symptoms of a condition called ulcerative colitis. Primary sclerosing cholangitis treatment includes medications that improve bile flow and sometimes stenting of the bile ducts if there is a blockage.

In all three autoimmune diseases, liver transplant may be a necessary treatment.