What Causes Liver Disease? (podcast)

Most people understand that the liver is a vital organ in our body, but what it does is somewhat mysterious. Surprisingly, one of the most important functions of the liver is delivering nutrition to the body. So the liver helps not only absorb the nutrition, but stores it in the body.

It’s also critically important for producing proteins that are essential to body function. When patients develop liver disease, the absence of these proteins cause severe muscle loss and weight loss.

On top of that, the liver is also very important for immune function and it allows the body to fight off infections. But the liver can also fill with fat. And that’s one of our main medical conditions that we worry about in patients with liver disease.

Finally, in final stages of liver disease, the liver changes its shape and that’s a sign of cirrhosis.

Fatty liver is the liver manifestation of being overweight. Usually when patients gain about 20 extra pounds, they start to store more fat in their liver than is normal. This can cause a condition called fatty liver disease.

Fatty liver disease in some individuals can eventually lead to permanent scarring of the liver, which eventually can cause stage four scarring, which we call cirrhosis. It causes a change in the liver function. One of the first signs can be changing of the eye colors or jaundice. Many patients will present with that as their first or sentinel symptom of liver disease. It’s really important for the general public to understand that.

But on the other hand, many signs of liver disease are hidden and most patients who have liver disease will have no signs or symptoms, which is why it’s really important to get checked with your primary care doctor. You can ask them to run a simple, comprehensive metabolic panel, and that will include not only the liver enzymes, but also the liver function tests. That can give your doctor an idea of whether you need to see a liver specialist.

These are the ABCs of hepatitis. Almost everybody has heard of hepatitis A. Hepatitis A is an entirely preventable condition with a vaccine. Unfortunately, there are still many people in the United States who have not been vaccinated for hepatitis A. We do see occasional outbreaks, which are primarily driven by food and oral fecal contact. If a person does not get the vaccine and gets infected with hepatitis A, there’s about 5% to 10% chance of death. So it’s a serious condition.

Hepatitis B and C are either controllable or curable conditions. Hepatitis B, if identified early, we can treat patients with simple pills that they have to take for life to control the virus. Hepatitis C is entirely curable now with oral medications that last eight to 12 weeks. After that, you monitor for future infections, but are essentially cured of the virus for life.

The cause of liver damage is the chronic inflammation that occurs from these different types of liver diseases. For example, with hepatitis C, the chronic replication of the virus causes damage to the liver cells. With fatty liver, the abundance of fat in the liver causes inflammation and damage.

The liver is a very good organ in that it is able to recruit stem cells to replace damaged cells. This process occurs throughout our life, as the liver is repairing itself. But eventually those stem cells run dry and there are fewer liver cells to replace the damaged ones. Instead, scar tissue starts to form. That is the framework of liver disease and cirrhosis. It is the scar tissue, the replacement of normal liver function with scar. Eventually this is the final manifestation of cirrhosis.

Some liver diseases are preventable, and some are not. For example, fatty liver disease can be preventable. Patients tend to develop it when they gain about 20 extra pounds. Losing those 20 pounds obviously can improve your liver health. Everybody who has tried to diet understands the difficulties and challenge with weight loss. Sometimes it’s not feasible. Because of that, we’re developing new medications that can help patients with fatty liver.

Another big medical problem in our country right now is use of alcohol. In fact, it’s one of the leading preventable causes of death, and the leading cause of cirrhosis. If patients can reduce or eliminate alcohol, that can also improve their liver health. We see a very severe form of alcoholic liver damage called alcoholic hepatitis. In this syndrome, patients’ livers swell with fat, their eyes turn yellow. It tends to happen in young people, 30 to 50 years old. It can be life-threatening. Between 30% to 80% of patients who develop severe acute alcoholic hepatitis can die.

We’re building a program here at Scripps that allows patients to receive not only the alcohol rehabilitation needed to stay away from alcohol, but potentially even a life-saving liver transplant, should they need it.

Probably the most common symptom I see in my patients is pain in the right upper quadrant. That’s just the lower part of your chest in the right side. Patients may feel a dull, nagging pain there. It’s frequently the most common symptom I hear in my patients.

The next concerning symptom is changing of the color of the eyes to yellow, or the skin. Other very concerning symptoms include vomiting blood or even swelling of the abdomen with fluid called ascites. Any of those happening are signs of end stage liver disease and not just a small liver problem.