An Introductory Guide to Liver Disease

What is Liver Disease?

Liver disease is an umbrella term used to refer to various conditions that affect the liver's structure, function, or both. Liver disease can manifest in different forms, ranging from mild inflammation to severe conditions such cirrhosis or liver cancer which can be life-threatening if not addressed in time. The progression of liver disease can lead to scarring (fibrosis) of the liver tissue, impacting its ability to function properly. Early detection and appropriate management are crucial to prevent further liver damage and complications.

What are the Types of Liver Diseases?

There are different diseases of the liver which can be recognised from its manifestation. The common liver disease that poses challenges are: Viral Hepatitis, the commonest cause of jaundice in India. It is due to different types of viral infections such as Hepatitis A, E, B and C. Other types of liver disease include:

• Alcoholic hepatitis: Acute inflammation in the liver resulting from overindulgence in alcohol can result in acute liver failure.
• Cirrhosis of liver: This results from chronic hepatitis B and hepatitis C infection and alcohol abuse and obesity. 

Also, Check: Liver Cirrhosis Symptoms

• Non-alcoholic fatty liver disease: It is due to an unhealthy diet resulting in too much fat in the Liver. Left untreated this can lead to cirrhosis of the liver, heart attack or stroke.
• Liver cancer: It can manifest with abdominal pain, jaundice, rapidly feeling ascites and weight loss.
• Liver cysts: The problem arises when the deceased liver produces fluid filled centres such as cysts. There are no warning signs until the cysts become large and can cause pain and discomfort.
• Jaundice: The issue is caused due to obstruction of the biliary system caused by stones, cancer of the bile duct and pancreatic cancer. The condition is treatable if diagnosed at an early stage.
• Autoimmune liver disease: Autoimmune Hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis are diseases that are when the immune system attacks certain parts of the body which eventually affects the liver.

What are the Stages of Liver Disease?

Liver disease progression is often characterised by stages, each reflecting the severity of liver damage and the extent of scarring (fibrosis). The stages are commonly categorised into several phases, with the most widely used classification being the Metavir system:

• Stage 0 - No Fibrosis: The liver is healthy without any signs of fibrosis or scarring.
• Stage 1 -Mild Fibrosis: Minimal fibrosis is present, indicating the beginning of liver damage. Inflammation might be present, but the liver is still largely functioning normally.
• Stage 2 - Moderate Fibrosis: Fibrosis has progressed, indicating a more significant level of liver damage. Inflammation continues to contribute to the scarring process.
• Stage 3 - Severe Fibrosis: Advanced fibrosis is present, indicating substantial liver damage. This stage may be referred to as bridging fibrosis, as fibrous bands extend and connect adjacent portal areas.
• Stage 4 - Cirrhosis: Cirrhosis is the most advanced stage, characterised by extensive scarring and nodules, impacting liver function. Cirrhosis can lead to complications such as portal hypertension, liver failure, and an increased risk of liver cancer.

It's important to note that liver disease progression can vary between individuals, and not everyone with liver disease will progress through all these stages.

What are the Causes and Risk Factors of Liver Diseases? 

Liver disease can be inherited (genetic) or caused by a variety of factors that damage the liver. The causes and risk factors of liver diseases include:

• Excessive alcohol consumption: Chronic and heavy alcohol consumption over an extended period can lead to alcoholic liver disease, which includes conditions such as fatty liver, alcoholic hepatitis, and cirrhosis.
• Hepatitis viruses: Viral hepatitis, particularly hepatitis B (HBV) and hepatitis C (HCV), can lead to acute or chronic liver inflammation. These infections are commonly transmitted through contaminated blood, unprotected sex, or from an infected mother to her baby during childbirth.
• Metabolic syndrome: Conditions such as obesity, insulin resistance, and type-2 diabetes are associated with non-alcoholic fatty liver disease. This condition involves the accumulation of fat in the liver, which can progress to inflammation and liver damage.
• Immune system dysfunction: In autoimmune hepatitis, the body's immune system mistakenly attacks and damages the liver tissue. The exact cause of autoimmune hepatitis is not well understood.
• Genetic disorders: Certain genetic disorders can also lead to liver disease. These disorders include:

○ Hemochromatosis: A genetic disorder leading to excessive iron absorption and deposition in the liver.

○ Wilson's disease: An inherited disorder causing copper buildup in the liver and other organs.

○ Alpha-1 antitrypsin deficiency: A genetic condition that can lead to liver and lung problems.

• Medications: Long-term use of certain medications, including some antibiotics, antifungal drugs, and nonsteroidal anti-inflammatory drugs (NSAIDs), can contribute to liver damage.
• Environmental toxins: Exposure to certain environmental toxins, chemicals, or contaminated substances can harm the liver.
• Biliary atresia: Biliary atresia is a rare condition in which the bile ducts outside and inside the liver are scarred and blocked.
• Budd-Chiari syndrome: A rare condition where blood clots obstruct the veins that carry blood from the liver.
• Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC): PBC and PSC are autoimmune conditions affecting the bile ducts.

What are the Signs And Symptoms of Liver Disease?

The warning signs of liver diseases include:

• Skin and eyes that appear yellowish (Jaundice)
• Abdominal pain and swelling
• Swelling the legs/and ankle
• Itching skin
• Dark urine colour
• Pale stool colour, or bloody or tar coloured stool
• Chronic fatigue
• Nausea or vomiting
• Loss of appetite
• Tendency to bruise easily

What are the Complications of Liver Disease?

Liver disease can lead to various complications, and the severity of these complications depends on factors such as the underlying cause of the liver disease, its stage, and how well it is managed. Common complications of liver disease include:

• Portal hypertension: Liver disease can cause increased pressure in the portal vein, leading to portal hypertension. This can result in the development of varices (enlarged veins) in the oesophagus or stomach, which can be prone to bleeding.
• Ascites: Accumulation of fluid in the abdominal cavity (ascites) is a common complication of advanced liver disease, particularly cirrhosis.
• Hepatic encephalopathy: Buildup of toxins in the blood, due to the liver's impaired ability to detoxify, can lead to cognitive dysfunction, confusion, and hepatic encephalopathy.
• Liver cancer (Hepatocellular Carcinoma): Chronic liver disease, especially cirrhosis, increases the risk of developing liver cancer.
• Coagulopathy: Liver disease can affect the production of blood-clotting proteins, leading to coagulopathy and an increased risk of bleeding.
• Jaundice: Impaired liver function can result in the buildup of bilirubin, causing yellowing of the skin and eyes (jaundice).
• Gastrointestinal bleeding: Portal hypertension and varices can lead to gastrointestinal bleeding, a serious and potentially life-threatening complication.
• Malnutrition: Liver disease can impact the body's ability to process nutrients, leading to malnutrition and weight loss.
• Fluid and electrolyte imbalance: Complications such as ascites and kidney dysfunction can disrupt fluid and electrolyte balance in the body.
• Increased infection risk: Liver disease can weaken the immune system, making individuals more susceptible to infections.
• Kidney dysfunction: Liver disease can lead to complications affecting the kidneys, known as hepatorenal syndrome.
• Bone disorders: Impaired liver function may result in decreased bone density and an increased risk of fractures.

How are Liver Diseases Diagnosed?

The doctor will recommend the patient to go through some of the tests to be sure about the disease. Here are some of the tests that can diagnose liver diseases:

1. Liver function tests which may reflect the healthy or diseased state of the Liver.
2. Serology test for Hepatitis A, E, B and C detects the cause of jaundice in a case of Viral Hepatitis. They also rule out any evidence of chronic Hepatitis B and C infection.
3. Quantitative assessment of AFP is helpful in the diagnosis of hepatocellular cancer.
4. Autoimmune factors - ANF, anti-smooth muscles antibody if detected favours the presence of autoimmune Liver disease.
5. Imaging techniques like USG, CT scan and MRI gives a complete picture of the liver and biliary tract and helps to diagnose the presence or absence of liver disease.
6. Liver biopsy - in certain diseases liver biopsy is necessary to confirm the nature of the liver diseases, help in initiating therapy.

How are Liver Diseases Treated? 

Most liver diseases can be treated with medical treatment. However, in case of primary liver cancer, certain therapeutic interventions that can cure the disease, such as chemotherapy, Transarterial chemoembolization and Radiofrequency ablation, are necessary.

The exact approach to treatment of liver diseases depends on the specific type of liver disease, its underlying cause, and the stage of the condition. Here are common approaches to the treatment of liver diseases:

• Addressing the underlying cause: Treatment often begins with identifying and addressing the underlying cause of liver disease. For example, antiviral medications may be prescribed for hepatitis infections, and lifestyle modifications are essential for alcohol-related liver disease.
• Medications: Medications may be prescribed to manage symptoms, control inflammation, or slow the progression of certain liver diseases. For instance, corticosteroids or immunosuppressive drugs may be used in autoimmune hepatitis.
• Antiviral therapy: Antiviral medications are often used to treat viral hepatitis, aiming to reduce viral replication and prevent further liver damage.
• Lifestyle modifications: Lifestyle changes, such as maintaining a healthy diet, exercising, and abstaining from alcohol or illicit substances, are crucial in managing liver diseases.
• Nutritional support: In cases of malnutrition or severe weight loss, nutritional support may be provided to ensure adequate nutrient intake.
• Managing complications: Complications of liver disease, such as ascites or hepatic encephalopathy, are managed individually. Diuretics may be prescribed for ascites, and dietary restrictions may be recommended for hepatic encephalopathy.
• Liver transplantation: In cases of advanced liver disease or liver failure, liver transplantation may be considered. This involves replacing the damaged liver with a healthy liver from a deceased or living donor.
• Regular medical monitoring: Individuals with liver disease require regular medical monitoring to assess liver function, detect complications early, and adjust treatment plans as needed.
• Supportive therapies: Supportive therapies, such as blood transfusions or clotting factor infusions, may be administered to address coagulopathy associated with liver disease.
• Alcohol and substance abuse treatment: For individuals with alcohol-related liver disease, treatment often involves addressing alcohol dependence through counselling, support groups, or rehabilitation programs.

It's important for individuals with liver disease to work closely with healthcare professionals to develop a comprehensive treatment plan tailored to their specific condition. Early detection, lifestyle modifications, and appropriate medical management are extremely important to better outcomes and an improved quality of life for individuals with liver diseases.

Note: It must be remembered in case of acute liver disease and in patients who are suffering from terminal liver diseases, the disease can progress to chronic liver failure - and the only cure available is liver transplantation.

How can Liver Disease be Prevented?

Preventing liver disease involves adopting a combination of healthy lifestyle practices, vaccinations, and avoiding risk factors associated with liver damage. Here are key strategies for liver disease prevention:

• Hepatitis vaccines: Hepatitis A and B vaccines are available and recommended for individuals to protect against these viral infections. Vaccination can prevent the development of hepatitis-related liver disease.
• Practise safe sex and avoid risky behaviours: Use protection during sexual activity to reduce the risk of sexually transmitted infections, including hepatitis B and C.
• Limit alcohol intake: Moderation or abstinence from alcohol is crucial in preventing alcohol-related liver disease. For adults, moderate alcohol consumption is generally defined as up to one drink per day for women and up to two drinks per day for men.
• Eat a balanced diet: Consuming a diet rich in fruits, vegetables, whole grains, and lean proteins supports overall health and helps prevent obesity and related liver conditions.
• Maintain a healthy weight: Adopting a balanced and healthy diet, along with regular physical activity, can help prevent non-alcoholic fatty liver disease (NAFLD) associated with obesity and metabolic syndrome.
• Maintain personal hygiene: Proper handwashing and hygiene practices can reduce the risk of infections, including those that may affect the liver.
• Be cautious with medications: Follow healthcare provider recommendations regarding the use of medications, especially over-the-counter drugs. Some medications can cause liver damage when taken in excess or over a prolonged period.
• Avoid sharing personal items: Avoid sharing personal items such as razors or toothbrushes that may come into contact with blood or bodily fluids.
• Get regular health check-ups: Regular health check-ups and screenings can help detect liver diseases at an early stage, allowing for timely intervention and management.
• Maintain blood sugar levels: Individuals with diabetes should work to manage and control blood sugar levels, as uncontrolled diabetes can contribute to liver disease.
• Limit exposure to toxins: Minimise exposure to environmental toxins and chemicals that can harm the liver. Follow safety guidelines in workplaces where exposure to toxins may occur.

Final Words

If you have any concerns about your or a loved one’s liver health or suspect the presence of a liver disease, seeking specialised care is paramount. That’s when you can count on the expertise of the dedicated liver specialists at Max Hospitals. With a commitment to comprehensive care and a patient-centric approach, the liver specialist doctors at Max Hospitals stand ready to guide you through every step of your liver health journey. Don't wait for symptoms to escalate - consult with one of the experienced liver specialists at Max Hospitals, where your well-being is our top priority.