Overview
In the previous article we reviewed some of the important functions that the liver performs and now have a better understanding of why the liver is considered a vital organ. It makes sense that because the liver does so many things, there are many things that can go wrong. Hepatitis is a general term essentially meaning inflammation of the liver and indicates some type of liver injury. Often the first indication of liver injury will be elevation of the liver enzymes on routine blood testing, as discussed in the previous article. Further testing would then be required to determine if the problem is due to liver cell injury (hepatocellular injury) or due to a problem with bile flow (cholestatic injury). If the liver disorder has been present for less than six months it is considered acute hepatitis and if longer than six months it would be considered chronic hepatitis. Signs and symptoms of liver disease can include general malaise, weight loss, fatigue, nausea, jaundice and pain in the right upper quadrant. Some of the less common liver disorders include:
Autoimmune Hepatitis
Autoimmune hepatitis is a rare condition occurring mostly in females and is caused by the immune cells attacking normal liver cells. It is often associated with other autoimmune diseases like thyroiditis and can lead to cirrhosis. Most patients are asymptomatic, but some may have malaise, rash or arthralgias (joint pains). Severe cases are treated with prednisone.
Metabolic Liver Disease
Fatty Liver Disease describes a condition where fat accumulates in the liver, accompanied by inflammation and fibrosis. This condition has increased in frequency to the point where it is becoming one of the more common forms of liver inflammation. It is more common in individuals with obesity, insulin resistance, hypertension and hyperlipidemia. Treatment consists of controlling these factors.
Wilson Disease is a rare condition characterized by accumulation of copper in the liver. This genetic disorder results in decreased excretion of copper into the bile. Copper accumulates in the liver and also in other tissues such as the brain and the eye, which can lead to neuropsychiatric symptoms. Treatment is based on reducing copper overload. Relatives of patients with Wilson Disease should be screened for this disorder so that intervention can begin before the disease progresses.
Hereditary Hemochromatosis is a fairly common genetic disorder occurring in Caucasians which results in accumulation of iron in the liver, heart, pancreas and other organs. It can lead to cirrhosis, heart disease and diabetes. Treatment is by frequent phlebotomies (withdrawing blood) to remove excess iron.
Cholestatic Liver Disease
Primary Biliary Cirrhosis is another autoimmune disease affecting mostly women. The most common presenting symptoms are fatigue and pruritis (itching). It is a slowing progressing disorder that can lead to malabsorption of vitamins, hyperlipidemia and osteoporosis. While some new medications have been tried, management consists mostly of symptomatic treatment. Some patients may eventually require liver transplantation.
Primary Sclerosing Cholangitis is characterized by bile duct inflammation and eventually destruction of the bile ducts leading to cirrhosis. It is more common in men and occurs in the fourth or fifth decade of life. There is a strong association with ulcerative colitis, which is present in 80% of patients with this disease. Signs and symptoms include fatigue, pruritis and eventually jaundice. This condition can also lead to malabsorption of vitamins. There is no specific treatment and the disease often progresses to cirrhosis. Patients who undergo liver transplantation usually do well.
Coming Next
In the upcoming articles in our series on the liver, we will look at the more common liver diseases, including viral hepatitis and alcohol or toxin induced liver disease and, finally, we’ll review some of the complications of liver disease and take a look at liver transplantation as a treatment for advanced liver disease.