What You Need to Know About Liver Disease

Your liver is one of your body’s largest organs. It has the important job of turning nutrients from the food you eat into substances that your body can use for energy. It can store these substances and release them when your body needs it. In addition, the liver helps your body safely release potentially harmful toxins.

As you can see, your liver is a very important part of your whole health, but there are several things that you should be aware of to protect your liver health. In fact, the most common liver disease, alcohol related liver disease, is 100% preventable by adopting healthy lifestyle habits.

AdventHealth gastroenterologist Abu Hurairah, MD explains more about the most common liver diseases, their causes, symptoms and how to keep your liver in tip-top health.

The Most Common Liver Diseases

“Among many causes of liver disease, the most prevalent that we see today are alcohol related liver disease due to chronic alcohol use, Chronic hepatitis infection caused by hepatitis B or hepatitis C viruses and non-alcoholic steatohepatitis (NASH), also called fatty liver disease, due to increasing prevalence of obesity,” says Dr. Hurairah.

Alcohol Related Liver Disease

Dr. Hurairah explains, “Alcohol has a direct toxic effect on the liver cells (called hepatocytes) causing inflammation which is termed alcoholic hepatitis. In the advanced stages, there is ballooning of the liver cells due to fat accumulation. This renders the liver cells unable to perform their normal functions. Alcohol abuse is the most common cause of liver disease in the United States.”

Preventing alcohol related liver disease is within your control. Avoiding alcohol is the best way to protect your liver from it.

Viral Hepatitis

“Viral hepatitis is the most common cause of both acute and chronic liver injury worldwide. The hepatitis viruses A, B, C, D and E are responsible for the majority of cases of acute viral hepatitis,” says Dr. Hurairah.

He continues, “However, only the B and C hepatitis viruses can advance to chronic infection, cause chronic liver injury, progressive fibrosis and lead to cirrhosis and a type of cancer called hepatocellular carcinoma (HCC).”

While most fully recover from acute hepatitis, chronic hepatitis can be a lifelong challenge.

Unlike hepatitis B, there is no vaccine to prevent hepatitis C infection. However, Dr. Hurairah explains, “Newer medications have shown promising results in treating and potentially curing hepatitis C infection. People born between 1945 and 1965 should be tested for hepatitis C antibody in the blood.”

Hepatitis Rates in the U.S.

Some forms of hepatitis continue to significantly affect many in the United States, while others are affecting specific populations more than others.

Dr. Hurairah states, “Despite the fact that a highly effective vaccine for hepatitis B virus has been available since the 1970s, HBV remains the most common cause of acute hepatitis in the USA. The rate of acute HBV, about 2,000 cases/100,000 annually, has been stable for more than a decade. The incidence of hepatitis A virus has also been stable for decades and represents 1,500 cases/100,000.”

However, hepatitis C rates have declined.

“The incidence of acute hepatitis C virus had been on the decline since this virus was identified in the 1990s. However, this has more than doubled from 800 to 2,000 cases/100,000 between 2010 and 2016.”

The primary reason for this is the opioid epidemic, primarily affecting young adults between the ages of 20 and 40 years.

Non-alcoholic Steatohepatitis (NASH)

Incidence of NASH or fatty liver disease has been on the rise in the United States and is strongly associated with obesity and metabolic syndrome.

“This occurs due to fat accumulation within the liver cells, which can lead to liver enlargement and inflammation. The liver cells ultimately lose the ability to perform their functions,” says Dr. Hurairah.

Prevention of NASH is focused on weight loss and maintaining a healthy weight with a healthy lifestyle that includes a balanced calorie diet and regular exercise.

Other Causes of Liver Disease

We’ve reviewed some of the most common causes of liver disease, but there are other things that can affect your liver health.

Dr. Hurairah notes that liver disease can also be caused by the following:

• Autoimmune diseases, including autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis
• Hereditary causes such as Wilson’s disease, hemochromatosis and alpha 1 anti-trypsin deficiency
• Acetaminophen (Tylenol) overdose
• Certain herbal medications and supplements

Risk Factors for Liver Disease

Dr. Hurairah notes that the risk factors associated with liver disease are as follows.

Alcohol Abuse

This is one of the modifiable risk factors and is the most common cause of preventable liver disease. In the early stages, liver disease may be stopped from progression and even reversed if the person practices abstinence from heavy alcohol use. Heavy alcohol drinking is defined as more than seven drinks per week for women and more than 14 drinks per week for men.

Viral Hepatitis

Hepatitis C is the most common cause of liver cirrhosis in the United States. Risk factors for viral hepatitis are unsafe sexual practices, sharing used needles and syringes, use of non-sterile equipment for tattoos or body piercings and un-screened blood transfusions.

Obesity

Obesity is the most common cause of non-alcohol related fatty liver disease. This is also a modifiable risk factor by making lifestyle changes, for example, weight loss and dietary modifications.

Medications

Acetaminophen overdose can lead to liver failure. It is important to ask your doctor or the pharmacist for correct dosage for all the over-the-counter medications. People with pre-existing liver disease are at increased risk of acetaminophen toxicity.

Chemicals

Certain chemicals like carbon tetrachloride (a dry-cleaning solution), vinyl chloride (used to make plastic) and paraquat (weed killer) can cause liver cancers. Anabolic steroids have also been associated with liver disease. Some herbal medications and supplements can also cause liver disease, such as kava kava, black cohosh and comfrey.

Harmful Supplements

Drug induced liver injury (DILI) is one of the most frequent causes of abnormal liver chemistries. DILI occurs in those taking prescription or over-the-counter medications, including health and nutritional supplements. Just because a supplement is labeled as “natural” doesn’t mean it’s good for you — many herbs and supplements have been associated with liver damage, with 20% of liver injury in the U.S. being caused by herbs.

Tips to Prevent Liver Disease

Prevention depends on reducing your risk factors. Overall, here are some things that Dr. Hurairah recommends in keeping your liver healthy and functioning at its peak.

• Abstaining from alcohol
• Implementing safe strategies to prevent sexual transmission of hepatitis B
• Avoiding used or non-sterile needles or equipment for IV injections and for tattoo and body piercings
• Eating a healthy balanced diet
• Exercising regularly
• Maintaining a healthy weight to prevent NASH
• Avoiding the unnecessary use of over-the-counter medications
• Using personal protective equipment around chemicals, such as proper clothing, masks, glasses and gloves
• Washing eyes and skin immediately if directly exposed to chemicals

Signs and Symptoms of Liver Disease

Signs and symptoms may vary depending upon the exact type of the liver disease; however, Dr. Hurairah notes a few general symptoms, such as:

• Nausea and Vomiting
• Abdominal pain (right side or generalized) and swelling
• Malaise
• Fatigue
• Loss of appetite
• Jaundice (yellowing of skin and sclera of the eyes)
• Itchy skin
• Dark urine
• Pale stools
• Bloody or tarry stools
• Bloody vomiting
• Easy bruising
• Weight loss

Diagnosing Liver Disease

Dr. Hurairah explains, “Precise diagnosis of the liver disease starts with a detailed history and physical examination by a health-care provider. Identifying and understanding the individual risk factors plays the pivotal role in the diagnosis of liver disease and selecting the appropriate testing modalities. Complete physical examination is also essential since liver disease may have effects on all other body systems.”

Some tests that can help diagnose liver disease include:

Complete Blood Count (CBC)

CBC shows hemoglobin levels, which may be decreased in liver disease. Other cells may be low since the bone marrow may be affected in advanced stages of liver diseases.

Liver Function Tests (LFTs)

ALT and AST are the enzymes released by liver cells. They may be increased in acute liver injury. GGT, alkaline phosphatase, and bilirubin levels may also be increased. Protein and albumin levels might decrease since the liver in not able to produce protein. INR (blood clotting function) is an additionally important measure of liver function.

Other Lab Tests

Checking lipase levels can help rule out pancreatitis.

Imaging Tests

Ultrasound can show liver texture and also show problems with the gall bladder or bile duct. A CT scan and Magnetic Resonance Imaging (MRI) can give detailed pictures of the liver, too.

Liver Biopsy

A biopsy involves taking a small piece of liver with the help of a long needle and observing it under microscope. This is an invasive test which is usually reserved as the last resort to confirm a specific diagnosis.

Dr. Hurairah’s Message to You

“Know about the various risk factors for liver disease and to talk to your physician about them,” advises Dr. Hurairah.

If you and your doctor identify risk factors within your control, work together to develop a plan to reduce them, which can include eliminating alcohol from your diet, regular exercise, weight loss and proper nutrition.

It’s also important to be aware of some over-the-counter medications.

Dr. Hurairah recommends, “It is essential to ask your physician about the correct dosage of medications. Some medication may have direct toxic effect on the liver whereas, other may cause liver injury through interactions with other over the counter or prescribed medications.”

Learn more about Dr. Hurairah or schedule an appointment today.