Understanding Liver Disease
The liver is the largest internal organ in the human body. It is a complex biochemical “factory” where many substances are produced, stored, processed, and filtered. The liver plays a central role in almost every major function of the body. When liver function becomes impaired, other body functions also begin to suffer. In severe cases, this can progress to liver failure, which can be life-threatening.
One of the surprising things about liver disease is that many liver diseases cause few or no symptoms, especially in the early stages. This is why diseases such as hepatitis B and hepatitis C are sometimes called “silent killers.” In addition, fatty liver disease including NAFLD/MASLD and NASH and long-term heavy alcohol use can silently cause serious liver damage. Everyone should therefore have appropriate liver tests when recommended, find out whether they have any liver disease, and seek proper treatment if a condition is diagnosed. Preventive measures should also be taken whenever possible. The good news is that many liver diseases (about 60%) can be prevented.
Knowing about liver disease is one of the most important steps toward living safely and well with a liver condition.
Major Liver Diseases
You may have liver disease without knowing it. The first step is to find out whether your liver has been affected by any disease. If you have a liver condition, it is also important to understand how to live safely with it.
Major liver diseases include:
- Viral hepatitis, including hepatitis A, B, C, D, and E.
- Alcohol-related hepatitis and alcohol-related liver disease.
- Nonalcoholic steatohepatitis (NASH).
- Autoimmune hepatitis.
- Liver cirrhosis caused by different conditions.
- Liver tumors, which may be benign (noncancerous) or malignant (cancerous).
- Liver cancer that begins in the liver (primary liver cancer) or cancer that spreads to the liver from another organ (metastatic cancer).
- Liver cysts.
- Liver or bile duct stones.
- Narrowing or blockage of the bile ducts.
- Sclerosing cholangitis, a disease that causes inflammation and scarring of the bile ducts.
Diagnosis and Symptoms
Liver disease may remain silent for a long time, with no noticeable symptoms.
When symptoms do occur, they may include:
- Fever.
- Jaundice.
- Itchy skin.
- Dark-colored urine.
- Pale or clay-colored stools.
- Loss of appetite.
- Unexplained weight loss.
- Extreme tiredness or weakness.
- Swelling or fluid buildup in the abdomen (ascites).
In advanced liver cirrhosis, a person may become confused, lose consciousness, or even become comatose because of severe liver dysfunction.
When living with liver disease, two broad stages are commonly described.
1. Compensated Liver Disease
In this stage, the healthy part of the liver can increase its activity and compensate for the damaged part, allowing the liver to continue performing many of its normal functions, hence being known as ‘compensated liver condition’. However, this compensation may not continue indefinitely. The disease may progress over time, especially if the underlying cause is not treated.
2. Decompensated Liver Disease
In this stage, the liver can no longer maintain its normal functions adequately. The patient may develop signs of advanced liver failure, including:
- Fluid buildup in the abdomen (ascites).
- Jaundice.
- Vomiting blood.
- Blood in the stool or black, tarry stools.
- Confusion, loss of consciousness, or coma due to hepatic encephalopathy.
Other abnormalities may also occur, including:
- Low levels of certain blood components.
- Low albumin levels.
- Prolonged prothrombin time (PT/INR).
- An increased tendency to bleed.
- Increased ammonia levels.
- Electrolyte imbalances.
- Increased creatinine levels.
Precautions for People With Liver Disease
If you have liver disease, the following precautions are important:
- Avoid alcohol.
- Avoid smoking.
- Avoid unscientific medicines and folk remedies.
- Avoid unproven treatments that claim to make hepatitis B or C “negative.”
- If you are diagnosed with fatty liver, take appropriate measures to prevent progression of NAFLD/MAFLD, NASH, fibrosis, and cirrhosis.
- Avoid excessive use of pain relievers and sleeping pills.
- Never take Paracetamol or Acetaminophen while suffering from hepatitis or jaundice.
- Do not use excessive amounts of diuretics.
- Women should not take birth-control pills (contraceptive pills) or hormone therapy continuously for long periods without appropriate medical advice and follow-up.
- Limit salt and follow fluid recommendations in cirrhosis.
- If a liver tumor is found, its type and cause should be properly evaluated so that the most appropriate treatment can be provided.
- Be careful when driving or operating machinery. Liver disease can sometimes cause confusion, excessive sleepiness, or sudden changes in mental alertness. If you have advanced or complicated liver disease, do not drive a vehicle or operate machinery unless your doctor confirms that it is safe to do so.
- Take medicines only as advised by your liver specialist. Do not buy and take medicines on your own from a pharmacy without medical advice.
- If you have hepatitis B or another transmissible hepatitis infection, inform your spouse or sexual partner and family members who may have been exposed. They can then receive appropriate testing, vaccination when available, and other preventive measures.
- If you have viral hepatitis and need dental treatment, surgery, or another medical procedure, tell your doctor or dentist. This allows the healthcare team to take appropriate infection-control precautions and provide you with proper care.
- Control other health conditions. Keep conditions such as diabetes, dyslipidemia, hypothyroidism, heart disease and kidney disease under proper medical control.
- Do not donate blood or organs if you have hepatitis B or C.
- A pregnant woman diagnosed with hepatitis B should have appropriate testing to determine the level of infection, including HBsAg and HBV-DNA testing when indicated, and should receive treatment according to the advice of a liver specialist. The newborn should receive:
- The first dose of hepatitis B vaccine as soon as possible after birth, preferably within 24 hours.
- Hepatitis B immune globulin (HBIG) when indicated.
- The remaining recommended doses of hepatitis B vaccine according to the appropriate schedule.
- If you have cirrhosis from any cause, you should remain under regular medical follow-up. In many patients with cirrhosis, liver cancer surveillance is performed about every 6 months, usually with ultrasound and other tests when appropriate. Regular monitoring can help detect tumors or liver cancer at an earlier stage, when more treatment options may be available.
If you have liver disease, regular medical follow-up and appropriate treatment are essential. If you have hepatitis B or hepatitis C, take appropriate steps to protect your spouse, sexual partner, and family members from infection. Preventing complications, treating the underlying disease, following medical advice, and attending regular follow-up appointments can help you live longer and healthier with liver disease.