Diseases of the liver

Disease of the liver (also called hepatic disease) is a type of disease of the liver. This can be inherited (genetic) or caused by a
variety of factors that damage the liver, such as viruses and alcohol use.
Obesity is also associated with liver damage. Over time, damage to the liver
results in scarring (cirrhosis), which can lead to liver failure.

Causes of liver diseases
Liver disease has many causes which include the
following:
1.   
Infection
Parasites and viruses can infect the liver, causing
inflammation and 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
2.   
Immune system abnormality
Diseases in which the immune system attacks certain
parts of the body (autoimmune) can affect your liver. Examples of autoimmune
liver diseases include:
  • Autoimmune
    hepatitis
  • Primary
    biliary cirrhosis
  • Primary
    sclerosing cholangitis
3.   
Genetics
An abnormal gene inherited from one or both of
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
4.   
Cancer and other growths
Examples of cancer and other growth than can cause
liver disease include:
  • Liver
    cancer
  • Bile
    duct cancer
  • Liver
    adenoma
5.   
Other causes
Additional, common causes of liver disease include:
  • Chronic
    alcohol abuse
  • Fat
    accumulating in the liver (non-alcoholic fatty liver disease)
Types of liver diseases
There are more than a hundred kinds of liver
disease. The most widely spread disease of the liver are as follows:
·        
Fascioliasis: A parasitic infection of the
liver caused by a
Liver fluke of the Fasciola genus, mostly the Fasciola hepatica.
·        
Hepatitis: Inflammation
of the liver, is caused mainly by various viruses (
viral hepatitis) but
also by some
liver toxins (e.g. alcoholic hepatitis), autoimmunity (autoimmune hepatitis) or hereditary conditions.
·        
Alcoholic liver disease is any
hepatic manifestation of
alcohol over-consumption,
including
fatty liver disease,
alcoholic hepatitis, and
cirrhosis.
Analogous terms such as “drug-induced” or “toxic” liver
disease are also used to refer to the range of disorders caused by various
drugs and environmental chemicals.
·        
Fatty liver disease (hepatic steatosis) is a
reversible condition where large vacuoles of
triglyceride fat
accumulate in liver cells.
Non-alcoholic fatty liver disease is a
spectrum of disease associated with obesity and
metabolic syndrome, among other causes. Fatty liver
may lead to inflammatory disease (i.e.
steatohepatitis) and,
eventually, cirrhosis.
·        
Cirrhosis is the
formation of fibrous tissue (
fibrosis) in the
place of liver cells that have died due to a variety of causes, including viral
hepatitis, alcohol over-consumption, and other forms of liver toxicity.
Cirrhosis causes chronic
liver failure.
·        
Primary biliary cirrhosis is a
serious
autoimmune disease
of the
bile capillaries.
·        
Primary sclerosing cholangitis is a
serious chronic
inflammatory disease
of the
bile duct, which
is believed to be autoimmune in origin.
·        
Centrilobular necrosis of liver
can be caused by leakage of enteric toxins into circulation. Salmonella toxins
in ileum have been shown to cause severe damage to liver hepatic cells
·        
Budd–Chiari syndrome is the clinical picture caused
by
occlusion of the hepatic vein, which
in some cases may lead to cirrhosis.
·        
Hereditary diseases that cause damage to the liver
include
hemochromatosis,
involving accumulation of
iron in the
body, and
Wilson’s disease, which
causes the body to retain
copper.
·        
Gilbert’s syndrome, a genetic disorder of bilirubin
metabolism found in about 5% of the population, can cause mild
jaundice.
Signs and symptoms of diseases of the liver
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 colour
  • Pale
    stool colour, or bloody stool
  • Chronic
    fatigue
  • Nausea
    or vomiting
  • Loss
    of appetite
  • Tendency
    to bruise easily
Test and diagnosis of disease of
the liver
Test and diagnosis of
disease of the liver include:
·        
Blood tests. A group of blood tests called liver function tests
can be used to diagnose liver disease. Other blood tests can be done to look
for specific liver problems or genetic conditions.
·        
Imaging tests. CT scan, MRI and ultrasound can show liver damage.
·        
Tissue analysis. Removing a tissue sample (biopsy) from the liver may
help diagnose liver disease. Liver biopsy is most often done using a long
needle inserted through the skin to extract a tissue sample. It is then
analyzed in a laboratory.

 

Prevention of diseases of the
liver

The
following are measures to prevent diseases of the liver:
·        
Use alcohol beverages in moderation: For healthy adults, that means up to one drink a
day for women of all ages and men older than age 65, and up to two drinks a day
for men age 65 and younger. Heavy or high-risk drinking is defined as more than
three drinks on any day or more than seven drinks a week for women and for men
older than age 65, and more than four drinks on any day or more than 14 drinks
a week for men age 65 and younger.
·        
Avoid risky behaviour: Get help if you use illicit intravenous drugs, and do on share needles
used to inject drugs. Use a condom during sex. If you choose to have tattoos or
body piercing, be picky about cleanliness and safety when selecting a shop.
·        
Get vaccinated: If you are at increased risk of contracting hepatitis or if you have
already been infected with any form of the hepatitis virus, talk to your doctor
about getting the hepatitis A and hepatitis B vaccines.
·        
Use medications wisely: Take prescription and non-prescription drugs only
when needed and only in recommended doses. Do not mix medications and alcohol.
Talk to your doctor before mixing herbal supplements or prescription or non-prescription
drugs.
·        
Avoid contact with other people’s blood and body fluids: Hepatitis viruses can be spread by accidental
needle sticks or improper cleanup of blood or body fluids.
·        
Take care with aerosol sprays: Make sure the room is ventilated, and wear a mask
when spraying insecticides, fungicides, paint and other toxic chemicals. Always
follow the manufacturer’s instructions.
·        
Protect your skin: When using insecticides and other toxic chemicals, wear gloves, long
sleeves, a hat and a mask.
·        
Maintain a healthy weight: Obesity can cause non-alcoholic fatty liver
disease.
Dietary management of disease of the liver
It
is vitally important that patients with liver disease maintain a balanced diet,
one which ensures adequate calories, carbohydrates, fats and
proteins. Such a diet will aid the liver in the regeneration of liver
cells. Nutrition that supports this regeneration is a means of treatment
of some liver disorders.
Liver diseases
may change the way the body uses nutrients from food. Some people with liver
disease may not get enough nutrients and lose weight. A liver disease diet
provides the right amount of calories, nutrients, and liquids you need to
manage symptoms of liver disease.

Recommended food

It
is important to eat a variety of foods from all the food groups each day to
stay at a healthy weight. You may not feel hungry, or you may feel full right
away after you eat. Eat 4 to 6 small meals throughout the day to make sure you
eat enough calories. The following nutrients are recommended for patient with
liver diseases each day:
  • Protein: It is important to eat the right amount of
    protein when you have liver disease. The following foods are good sources
    of protein. The amount of protein (in grams) follows each food listed
    below.
    • 3
      ounces of meat, pork, turkey, chicken, or fish (21 grams)
    • 1
      cup of milk or yogurt (8 grams)
    • 1
      large egg (7 grams)
    • 2
      tablespoons of peanut butter (7 grams)
    • ½
      cup of tofu (7 grams)
    • ¼
      cup of cottage cheese (7 grams)
    • 1
      ounce of cheese (7 grams)
    • ½
      cup of cooked pinto, kidney, or navy beans (3 grams)
  • Fat: Some people with liver disease have problems
    digesting and absorbing fat so patients should stick to a low-fat diet.
  • Carbohydrates: Carbohydrates are found in bread, pasta,
    rice, cereal, grains (rice, oats), and starchy vegetables (potatoes, corn,
    peas). Liver disease may cause blood sugar levels to be too high or too
    low in some people. Patient may need to control the amount of carbohydrate
    you eat to help control your blood sugar levels.

 

What foods should I limit or
avoid?

Ask your dietitian if you need to limit or avoid
some foods. This will depend on the type of liver disease and other health
problems you have.
  • Sodium: You may need to decrease the amount of sodium
    in your diet if your body is retaining fluids. When you retain fluids, you
    will have swelling in your body. Ask your caregiver for more information
    about a low-sodium diet. Some foods that contain high amounts of sodium
    are:
    • Table
      salt
    • Bacon,
      sausage, and deli meats
    • Canned
      vegetables and vegetable juice
    • Frozen
      dinners and packaged snack foods, such as potato chips and pretzels
    • Soy,
      barbecue, and teriyaki sauces
    • Soups
  • Liquids: You may also have to drink fewer liquids if
    you have swelling. Liquids include water, milk, juice, soda, and other
    beverages. Some foods contain liquid, such as soup. Foods that are liquid
    at room temperature, such as gelatin or popsicles, must also be counted as
    a liquid. Ask your dietitian how much liquid you may drink each day.
  • Alcohol: Avoid alcohol because it may make your liver
    disease worse. Talk to your caregiver if you have questions about alcohol
    in your diet.
  • You
    gain or lose a lot of weight within a short amount of time.
  • You
    have questions or concerns about the liver disease diet.
References
Chang, C.Y. & Schiano, T.D. (2007). Drug hepatotoxicity. Aliment Pharmacol Ther. 25(10):1135-51.
Drake,  M. (2007). Coagulopathy in liver
disease”. Current Treat Options Gastroenterol 10 (6): 464–73.
Jalan, R. & Rose, C. (2004). Hypothermia in acute liver failure. Metab Brain Dis. 19(3-4):215-21.
Mannucci, P.M. & Tripodi, A. (2013). Liver disease, coagulopathies and transfusion
therapy. Blood Transfus. 11(1):32-6.
Shawcross, D. & Jalan. R. (2005). Dispelling myths in the treatment of hepatic
encephalopathy. Lancet. 4;365(9457):431-3.
Stickel, F., Egerer, G. & Seitz, H.K. (2000). Hepatotoxicity of botanicals. Public Health Nutr. 3(2):113-24.
YashRoy, R.C. (2000).
Toxicity in ileum and liver by light and electron microscopy. Indian Journal of Pathology and Microbiology
43(1):
17-22
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(Dr) Rajesh YashRoy
(Dr) Rajesh YashRoy
12 April 2023 1:50 PM

Informative, useful, well-written, brief, lab-to-land and socially relevant health advisory note.

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