Introduction

  • The liver is an organ that sits just under the rib cage on the right side of the abdomen. It can weigh up to 4 pounds (1.8 kilograms).
  • The liver is needed to help digest food, rid the body of waste products and make substances, called clotting factors, that keep the blood flowing well, among other tasks.
  • Liver disease can be passed through families, called inherited. Anything that damages the liver also can cause liver problems, including viruses, alcohol use obesity.
  • Over time, conditions that damage the liver can lead to scarring, called cirrhosis can lead to liver failure, a lifethreatening condition.
  • But early diagnosis is important because the liver has a strong ability to heal itself if damage is caught in time.

Stages of chronic liver disease

Chronic liver disease progresses in roughly four stages:

  1. Hepatitis
  2. Fibrosis
  3. Cirrhosis
  4. Liver failure

Stage 1 : Hepatitis

Hepatitis means inflammation in your liver tissues.Inflammation is your liver’s response to injury or toxicity.It’s an attempt to purge infections and start the healing process. Acute hepatitis (an immediate and temporary response) often accomplishes this. But when the injury or toxicity continues, so does the inflammation. Chronic hepatitis causes hyperactive healing that eventually results in scarring (fibrosis).

Stage 2 : Fibrosis

Fibrosis is a gradual stiffening of your liver as thin bands of scar tissue gradually add up. Scar tissue reduces blood flow through your liver, which reduces its access to oxygen and nutrients. This is how your liver’s vitality begins to gradually decline. Remarkably, some amount of fibrosis is reversible. Your liver cells can regenerate, and scarring can diminish if the damage slows down enough for it to recover.

Stage 3 : Cirrhosis

Cirrhosis is severe, permanent scarring in your liver. This is the stage where fibrosis is no longer reversible. When your liver no longer has enough healthy cells left to work with, its tissues can no longer regenerate. But you can
still slow or stop the damage at this stage. Cirrhosis will begin to affect your liver function, but your body will attempt to compensate for the loss, so you might not notice at first.

Stage 4 : Liver Failure

Liver failure begins when your liver can no longer function adequately for your body’s needs. This is also called “decompensated cirrhosis” — your body can no longer compensate for the losses. As liver functions begin to break down, you’ll begin to feel the effects throughout your body. Chronic liver failure is a gradual process, but it
is eventually fatal without a liver transplant.You need a liver to live.

Causes :

  • Viral infections : Viral hepatitis infections that become chronic can cause chronic hepatitis, including hepatitis B and hepatitis C.
  • Alcohol-induced hepatitis : Heavy alcohol use can cause acute or chronic hepatitis. If it goes on long enough, it can cause cirrhosis and liver failure.
  • Toxic hepatitis : Chronic overexposure to toxins, such as industrial chemicals or drugs, can cause acute or chronic hepatitis.
  • Non-alcohol related fatty liver disease : Metabolic conditions associated with obesity, high blood sugar
    and high blood lipids can cause excess fat storage in your liver, which can cause inflammation (non-alcohol related steatohepatitis).
  • Biliary stasis : Congenital (present at birth) conditions that obstruct the flow of bile through your bile ducts can cause bile to build up and injure your liver, including biliary atresia and cystic fibrosis. Non-congenital causes include biliary stricture and gallstones.
  • Autoimmune diseases : Autoimmune conditions can cause chronic inflammation and scarring in your liver or your bile ducts, including autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis.
  • Inherited metabolic disorders : Disorders that cause toxic products to build up in your blood — such as glycogen storage disease (GSD), Wilson disease, hemochromatosis, and Gaucher disease-can cause chronic liver damage.
  • Cardiovascular disease : Conditions that affect blood flow to and from your liver — including Budd-Chiari syndrome, ischemia, arterial diseases and right sided heart failure — can cause chronic liver damage.

Symptoms:

Liver disease doesn’t always cause symptoms that can be seen or felt. If there are symptoms of liver disease, they may include:

  • Yellowing of the skin and the whites of the eyes, calledjaundice.
  • Belly pain and swelling
  • Swelling in the legs and ankles
  • Swelling in the legs and ankles
  • Itchy skin, but with no visible rash
  • Dark urine
  • Pale stool
  • Musty-smelling breath
  • Digestive difficulties, especially with fats
  • Weight loss and muscle loss
  • Constant tiredness
  • Nausea or vomiting
  • Loss of appetite
  • Bruising easily

Risk Factors :

Factors that can increase the risk of liver disease include:

  • Ongoing moderate or heavy alcohol use
  • Obesity
  • Type 2 diabetes
  • Tattoos or body piercings
  • Shared needles to inject drugs
  • Blood transfusion
  • Contact with other people’s blood and body fluids
  • Sex without protection
  • Contact with chemicals or toxins
  • Family history of liver disease

Complications

Complications of liver disease depend on the cause of the liver problems. Without treatment, liver disease may progress to liver failure. Liver failure can be fatal.

Complications of end stage liver disease :

  • Portal hypertension
  • Ascites
  • Oesophageal varices
  • Hepatic hydrothorax
  • Hepatic encephalopathy
  • Hepatocellular carcinoma
  • Spleenomegaly
  • Respiratory failure
  • kidney failure
  • Liver failure

Diagnosis

A healthcare provider checking for liver disease will begin by physically examining you. They’ll look for visible signs and ask about your symptoms. They may also ask about your diet, lifestyle and health history. Finally, they’ll use
lab tests and imaging scans to check for liver disease. These may include:

  • Blood tests : A panel of liver function tests can showsigns of liver disease, liver disease severity and liver failure. These measure liver products like liver enzymes,proteins and bilirubin levels in your blood. Blood tests may also indicate inflammation, specific diseases or side effects, like reduced blood clotting.
  • Imaging tests : An abdominal ultrasound, CT scan (computed tomography scan) or MRI (magnetic resonance imaging) can show the size, shape and texture of your liver. This can reveal inflammation and swelling, growths and fibrosis.
  • Endoscopy : If your provider needs to see inside your biliary tract, they might need to use a type of endoscopic imaging. Endoscopy involves passing a tiny camera (endoscope) through your upper GI tract. From the endoscope, they can use EUS or ERCP to see your bile ducts.
  • Liver biopsy : A liver biopsy is a minor procedure to take a small tissue sample from your liver to test in a lab. A healthcare provider can usually take the sample through a hollow needle. You might need a liver biopsy to check for cancer or confirm cirrhosis and help determine the cause.
  • Elastography : A special type of imaging test called elastography uses ultrasound or MRI technology to measure the level of stiffness or fibrosis in your liver.
  • Nuclear medicine imaging : A nuclear liver and spleen scan uses a gamma camera to detect a (harmless) radioactive tracer material that’s injected into your body. How your liver absorbs the tracer will highlight the areas that aren’t functioning normally.

Prevention

To prevent liver disease:

  • If you choose to drink alcohol, do so in moderation : For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
  • Avoid risky behavior : Use a condom during sex. If you get tattoos or body piercings, pick a shop that’s clean and safe. Seek help if you shoot illicit drugs. Don’t share needles to shoot drugs.
  • Get vaccinated : If you’re at increased risk of getting hepatitis, talk with your healthcare professional about getting the hepatitis A and hepatitis B vaccines. This also is true if you’ve been infected with any form of the
    hepatitis virus.
  • Be careful when taking medicines : Take prescription and other medicines only when needed. Take only as much as directed. Don’t mix medicines and alcohol. Talk with your healthcare provider before mixing herbal supplements or prescription or other medicines.
  • Stay away from other people’s blood and body fluids : Hepatitis viruses can be spread by accidental needle sticks or poor cleanup of blood or body fluids.
  • Keep your food safe : Wash your hands well before eating or making foods. If traveling in a resource-poor country, use bottled water to drink, wash your hands and brush your teeth.
  • Take care with aerosol sprays : Make sure to use these products in an open area. Wear a mask when spraying insecticides, fungicides, paint and other toxic chemicals. Always follow the maker’s instructions.
  • Protect your skin : When using insecticides and other toxic chemicals, wear gloves, long sleeves, a hat and a mask so that chemicals don’t get on your skin.
  • Maintain a healthy weight : Obesity can cause nonalcoholic fatty liver disease, now called metabolic-associated steatotic liver disease.

Treatment

  • Treatment for liver disease depends on the diagnosis.
  • Some liver problems can be treated with lifestyle changes. These might include losing weight or not drinking alcohol. These changes often are part of a medical program that includes watching liver function.
  • Other liver problems may be treated with medicines or surgery.
  • Liver disease that causes liver failure may need a liver transplant.