About liver disease
What is liver disease?
Drug-induced liver diseases are diseases of the liver that are caused by physician-prescribed medications, over-the-counter medications, vitamins, hormones, herbs, illicit ("recreational") drugs, and environmental toxins.
What is the liver?
The liver is an organ that is located in the upper right hand side of the abdomen, mostly behind the rib cage. The liver of an adult normally weighs close to three pounds and has many functions.
- The liver produces and secretes bile into the intestine where the bile assists with the digestion of dietary fat.
- The liver helps purify the blood by changing potentially harmful chemicals into harmless ones. The sources of these chemicals can be outside the body (for example, medications or alcohol), or inside the body (for example, ammonia, which is produced from the break-up of proteins; or bilirubin, which is produced from the break-up of hemoglobin).
- The liver removes chemicals from the blood (usually changing them into harmless chemicals) and then either secretes them with the bile for elimination in the stool, or secretes them back into the blood where they then are removed by the kidneys and eliminated in the urine.
- The liver produces many important substances, especially proteins that are necessary for good health. For example, it produces proteins like albumin (a protein that carries other molecules through the blood stream), as well as the proteins that cause blood to clot properly.
When drugs injure the liver and disrupt its normal function, symptoms, signs, and abnormal blood tests of liver disease develop. Abnormalities of drug-induced liver diseases are similar to those of liver diseases caused by other agents such as viruses and immunologic diseases. For example, drug-induced hepatitis (inflammation of the liver cells) is similar to viral hepatitis; they both can cause elevations in blood levels of aspartate amino transferase (AST) and alanine aminotransferase (ALT) (enzymes that leak from the injured liver and into the blood) as well as anorexia (loss of appetite), fatigue, and nausea. Drug-induced cholestasis (interference with the flow of bile that is caused by injury to the bile ducts) can mimic the cholestasis of autoimmune liver disease (e.g., primary biliary cirrhosis or PBC) and can lead to elevations in blood levels of bilirubin (causing jaundice), alkaline phosphatase (an enzyme that is leaked from injured bile ducts), and itching.
What are the symptoms for liver disease?
Signs and symptoms of liver disease include:
- Skin and eyes that appear yellowish (jaundice)
- Abdominal Pain and swelling
- Swelling in the legs and ankles
- Itchy skin
- Dark urine color
- Pale stool color, or bloody or tar-colored stool
- Chronic fatigue
- Nausea or vomiting
- Loss of appetite
- Tendency to bruise easily
When to see a doctor
Make an appointment with your doctor if you have any persistent signs or symptoms that worry you. Seek immediate medical attention if you have Abdominal Pain that is so severe that you can't stay still.
What are the causes for liver disease?
Liver disease has many causes.
Infection
Parasites and viruses can infect the liver, causing inflammation that reduces liver function. The viruses that cause liver damage can be spread through blood or semen, contaminated food or water, or close contact with a person who is infected. The most common types of liver infection are hepatitis viruses, including:
- Hepatitis A
- Hepatitis B
- Hepatitis C
Immune system abnormality
Diseases in which your immune system attacks certain parts of your body (autoimmune) can affect your liver. Examples of autoimmune liver diseases include:
- Autoimmune hepatitis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
Genetics
An abnormal gene inherited from one or both of your parents can cause various substances to build up in your liver, resulting in liver damage. Genetic liver diseases include:
- Hemochromatosis
- Hyperoxaluria and oxalosis
- Wilson's disease
- Alpha-1 antitrypsin deficiency
Cancer and other growths
Examples include:
- Liver cancer
- Bile duct cancer
- Liver adenoma
Other
Additional, common causes of liver disease include:
- Chronic alcohol abuse
- Fat accumulating in the liver (nonalcoholic fatty liver disease)
What are the treatments for liver disease?
Treatment for liver disease depends on your diagnosis. Some liver problems can be treated with lifestyle modifications, such as stopping alcohol use or losing weight, typically as part of a medical program that includes careful monitoring of liver function. Other liver problems may be treated with medications or may require surgery.
Treatment for liver disease that causes or has led to liver failure may ultimately require a liver transplant.
What are the risk factors for liver disease?
Factors that may increase your risk of liver disease include:
- Heavy alcohol use
- Injecting drugs using shared needles
- Tattoos or body piercings
- Blood transfusion before 1992
- Exposure to other people's blood and body fluids
- Unprotected sex
- Exposure to certain chemicals or toxins
- Diabetes
- Obesity
Is there a cure/medications for liver disease?
Liver disease is also called chronic liver disease. It is a progressive crippling of liver functions that include synthesis of clotting factors, detoxification of harmful metabolites and various drugs, and excretion of bile.
Treatment/management
- Treatment is aimed at the correction of underlying causes, portal hypertension management, and specific treatment based on individual disease.
- Ascites: Sodium restriction and diuretics such as furosemide and spironolactone are effective options. Therapeutic paracentesis and albumin infusion are the options for tense ascites.
- Esophageal varices: Aggressive fluid resuscitation, endoscopy, and vasopressors including octreotide and terlipressin are the treatment options. In emergencies, endoscopic band ligation and injection sclerotherapy help stop the bleeding.
- Hepatic encephalopathy: Correction of precipitating factors improves the complication. However, lactulose and rifaximin are incorporated to reduce the levels of ammonia in the body.
- Hepatorenal syndrome: The goal is to reverse the acute renal injury. Norepinephrine, midodrine, octreotide, or terlipressin with albumin infusion are the treatment modalities. A transjugular intrahepatic portosystemic shunt helps some patients. Liver transplantation is the last resort when there is no response to other treatments.
- Hepatocellular carcinoma: Treatment modality depends on the stages- initial stage: resection and ablation and intermediate stage: transarterial chemoembolization and radio-embolization.
- Viral hepatitis: Nucleoside and nucleotide analogs, direct-acting antivirals and interferon-alfa.
- Autoimmune hepatitis: Corticosteroids and other immunosuppressive drugs
- Hereditary hemochromatosis: Phlebotomy and iron chelators
- Copper overload: Copper chelators
- Drugs and toxins: Identification and abstinence of the factors
- Primary biliary cholangitis: Ursodeoxycholic acid
Symptoms
Fatigue,Anorexia,Weight loss are some of the nonspecific symptoms,Other symptoms depend on complications and include fever, abdominal pain, GI tract bleeding, ascites, and jaundice
Conditions
Jaundice,Yellowing of the skin, can be one sign of liver disease
Drugs
Furosemide and spironolactone for ascites,Vasopressors including octreotide and terlipressin for esophageal varices,Lactulose and rifaximin for hepatic encephalopathy,Norepinephrine, midodrine, octreotide, or terlipressin for hepatorenal syndrome,Nucleoside and nucleotide analogs, Direct-acting antivirals, Interferon-alfa for viral hepatitis,Corticosteroids and other immunosuppressive drugs for autoimmune hepatitis,Ursodeoxycholic acid for primary biliary cholangitis,Copper chelator for copper overload