The liver is an organ about the size of a football. It sits just under your rib cage on the right side of your abdomen. The liver is essential for digesting food and ridding your body of toxic substances.
Liver disease can be inherited (genetic). Liver problems can also be caused by a variety of factors that damage the liver, such as viruses, alcohol use and obesity.
Over time, conditions that damage the liver can lead to scarring (cirrhosis), which can lead to liver failure, a life-threatening condition. But early treatment may give the liver time to heal.
Liver disease doesn't always cause noticeable signs and symptoms. If signs and symptoms of liver disease do occur, they may 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
• Chronic fatigue
• Nausea or vomiting
• Loss of appetite
• Tendency to bruise easily
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.
Liver disease has many causes.
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
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
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
• Wilson's disease
• Alpha-1 antitrypsin deficiency
Examples include:
• Liver cancer
• Bile duct cancer
• Liver adenoma
Additional, common causes of liver disease include:
• Chronic alcohol abuse
• Fat accumulation in the liver (non-alcoholic fatty liver disease)
• Certain prescription or over-the-counter medications
• Certain herbal compounds
Risk factors
Factors that may increase your risk of liver disease include:
• Heavy alcohol use
• Obesity
• Type 2 diabetes
• Tattoos or body piercings
• Injecting drugs using shared needles
• Blood transfusion before 1992
• Exposure to other people's blood and body fluids
• Unprotected sex
• Exposure to certain chemicals or toxins
• Family history of liver disease
Complications of liver disease vary, depending on the cause of your liver problems. Untreated liver disease may progress to liver failure, a life-threatening condition.
To prevent liver disease:
• Drink alcohol in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men. Heavy or high-risk drinking is defined as more than eight drinks a week for women and more than 15 drinks a week for men. (as such state of Gujarat is having prohibition and ban over drinking alcohol)
• Avoid risky behaviour. Use a condom during sex. If you choose to have tattoos or body piercings, be picky about cleanliness and safety when selecting a shop. Seek help if you use illicit intravenous drugs, and don't share needles to inject drugs.
• Get vaccinated. If you're at increased risk of contracting hepatitis or if you've 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. Don't 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 clean-up of blood or body fluids.
• Keep your food safe. Wash your hands thoroughly before eating or preparing foods. If traveling in a developing 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 a well-ventilated area, 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 so that chemicals aren't absorbed through your skin.
• Maintain a healthy weight. Obesity can cause nonalcoholic fatty liver disease.
Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood.
Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease.
Abnormal liver function test results don't always indicate liver disease. Your doctor will explain your results and what they mean.
Liver function tests can be used to:
• Screen for liver infections, such as hepatitis
• Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working
• Measure the severity of a disease, particularly scarring of the liver (cirrhosis)
• Monitor possible side effects of medications
Liver function tests check the levels of certain enzymes and proteins in your blood. Levels that are higher or lower than normal can indicate liver problems. Some common liver function tests include:
• Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase.
• Aspartate transaminase (AST). AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage.
• Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases.
• Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease.
• Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia.
• Gamma-glutamyl transferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.
• L-lactate dehydrogenase (LD). LD is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders.
• Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may indicate liver damage but can also be elevated if you're taking certain blood-thinning drugs, such as warfarin.
No body organ performs a wider variety of essential jobs than the liver. It:
• Produces essential proteins that help blood to clot
• Removes or neutralizes poisons, drugs and alcohol
• Manufactures bile that helps the body to absorb fats and cholesterol
• Helps to maintain normal blood sugar levels
• Regulates several hormones
Cirrhosis is a disease in which normal liver cells are replaced by scar tissue, which interferes with all of these important functions.Cirrhosis is long-term scarring of the liver. The liver makes enzymes and bile that help digest food and gives your body energy. Cirrhosis is caused by repeated damage to your liver over time. Scar tissue starts to replace healthy liver tissue. The scar tissue prevents the liver from working properly.
Scarring also impedes blood flow and increases pressure in the portal vein, which moves blood from the stomach to the liver. This condition is called portal hypertension. Blood vessels in the stomach and esophagus swell, and the body creates new ones in an attempt to bypass the liver. These vessels, called varices, have thin walls. If one bursts, the resulting hemorrhage (major bleeding) can cause death within hours if not treated.
• Long term diabetes
• Long-term alcohol use
• Hepatitis B or C infection
• Fat or iron build-up in the liver
• A disease such as cystic fibrosis, or a family history of liver cancer
• Damage to the bile ducts that blocks the flow of bile
• Obesity
Rarer causes of cirrhosis include:
• Autoimmune diseases that attack the bile ducts or liver cells
• Severe reactions to prescription drugs
• Prolonged exposure to environmental toxins
• Infections from bacteria and parasites usually found in the tropics or Asia
• Repeated episodes of heart failure with liver congestion.
• Certain inherited diseases, including:
o Hemochromatosis, in which too much iron builds up in the liver and other organs
o Wilson's disease, which produces abnormal concentrations of copper
o Alpha-1-antitrypsin deficiency, which is the absence of a particular enzyme in the liver
You may not have any signs or symptoms until your liver damage is severe. You may have any of the following:
• Fatigue
• Bleeding and bruising easily
• Bool vomiting
• Black stool
• Swelling of your feet, legs, or abdomen
• Nausea, loss of appetite, and weight loss
• Itching
• Jaundice (yellowing of your skin or eyes)
• Black bowel movements or dark urine
• Blood tests may be used to check your liver enzymes.
• An ultrasound may be used to check for damage to your liver or other tissues or organs.
• CT or MRI pictures may be taken of your liver. You may be given IV contrast liquid to help your liver show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything made of metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
• A liver biopsy is a procedure used to take a small piece of your liver to be tested for liver damage.
o Your doctor may recommend a low-sodium diet and diuretics if you are retaining excess fluid in your body.
o Lactulose or other medication will be prescribed if you have confusion caused by hepatic encephalopathy. Lactulose is a laxative that decreases the absorption of certain substances toxic to the brain.
o Medications can be prescribed for itching and infections.
o Blood pressure medicines may help to lower pressure in the portal veins to decrease the risk of internal bleeding.
o Bleeding varices pose an immediate, life threatening hazard. To prevent them from bleeding, doctors called gastroenterologists do endoscopy to find the varices and treat them. The varices can be injected with a solution to shrink them or they can be sealed with bands.
o The same procedure is done when varices are actively bleeding. Intravenous and oral drugs are also given to reduce bleeding.
o The person may also need a procedure called transjugular intrahepatic portosystemic shunt (TIPS). This involves creating a new blood channel in the liver that relieves some of the high portal pressure. With less portal pressure, there is less bulging of the varices. And new varices are less likely to form.
• Surgery-In extreme cases, the damage is so severe that the only solution is a liver transplant.You may need a liver transplant if your liver fails.
• Do not drink alcohol. Alcohol will cause more damage to your liver.
• Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause blood vessel and lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
• Eat a variety of healthy foods. Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat, and fish. Ask if you need to be on a special diet.
• Reach or maintain a healthy weight. You may develop fatty liver disease if you are overweight. Ask your healthcare provider for a healthy weight for you. He can help you create a safe weight loss plan if you are overweight.
• Limit sodium (salt). You may need to decrease the amount of sodium you eat if you have swelling caused by fluid buildup. Sodium is found in table salt and salty foods such as canned foods, frozen foods, and potato chips.
• Drink liquids as directed. Ask how much liquid to drink each day and which liquids are best for you. For most people, good liquids to drink are water, juice, and milk. Liquids can help your liver work better.
• Ask about vaccines. You may have a hard time fighting infection because of cirrhosis. Vaccines help protect you against viruses that can cause diseases such as the flu or hepatitis. Viral hepatitis is caused by a virus that leads to inflammation of the liver. You may need a hepatitis A or B vaccine. You may also need a pneumonia vaccine. Always get a flu vaccine each year as soon as it becomes available.
• Ask about medicines. Some medicines can harm your liver. Acetaminophen is an example. Talk to your healthcare provider about all your medicines. Do not take any over-the-counter medicine or herbal supplements until your healthcare provider says it is okay.
• You have pain during a bowel movement and it is black or contains blood.
• You have a fast heart rate and fast breathing.
• You are dizzy or confused.
• You have severe pain in your abdomen.
• You have trouble breathing.
• Your vomit looks like it has coffee grinds or blood in it.
• You have a fever.
• You have red or itchy skin.
• You are in pain and feel weak.
• You have questions or concerns about your condition or care.
Cirrhosis is usually a progressive disease. Although it usually cannot be reversed, the liver damage can be halted or slowed down with treatment or changes in behaviour in many cases.
Two of the blood tests that indicate a poor prognosis in people with cirrhosis are a low albumin level and a high INR (adjusted Pro-Time). The high INR indicates the person's liver cannot make the normal amount of clotting proteins.
The most important step you can take to prevent cirrhosis is to avoid excessive drinking.It is best to consume an average of no more than two alcoholic drinks a day for men or one drink a day for women. If you have chronic hepatitis or other liver problems, avoid alcohol completely.
Some other causes of cirrhosis can be prevented. To avoid infection with hepatitis B and C, do not inject illegal drugs, snort cocaine, or have unprotected sex, especially with multiple partners. If you are considering body piercing or tattooing, make sure that the equipment is cleaned properly. Health care and emergency workers should follow infection control precautions carefully whenever they are exposed to blood.
Hepatitis B also can be prevented with a vaccine, a series of three shots that is 90% effective.
By preventing non-alcoholic fatty liver disease, you prevent the small risk of developing cirrhosis. This means maintaining a healthy weight and getting plenty of exercise.
Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm, above your stomach and behind right lower rib cage.
Several types of cancer can form in the liver. The most common type of liver cancer is metastasis (Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer), second most common is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte – the original liver cancer). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.
In current era HCC is most commonly found in cirrhosis patients. Cirrhosis is a condition that arises out of many situations namely, fatty liver, alcohol consumption, hepatitis C, Hepatitis B, Diabetes leading to steatohepatitis etc. Liver cancer arising in do novo normal liver is not very common. Most of the time it is associated with other liver diseases.
Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:
• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea
• General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of your skin, urine and the whites of your eyes (jaundice)
• White, chalky stools
Make an appointment with your doctor if you experience any signs or symptoms that worry you. Especially if you are known case of cirrhosis of liver than u must take extra care and follow up should be desired as prescribed by the doctors.
Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell's DNA is the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.
Sometimes the cause of liver cancer is known.
Factors that increase the risk of primary liver cancer include:
• Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
• Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
• Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson's disease.
• Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don't have diabetes.
• Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
• Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops, such as grains and nuts, can become contaminated with aflatoxins, which can end up in foods made of these products. This is very less common in India.
• Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer.
Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you:
• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day.
• Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilograms) each week.
You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.
No vaccine for hepatitis C exists, but you can reduce your risk of infection.
• Know the health status of any sexual partner. Don't engage in unprotected sex unless you're certain your partner isn't infected with HBV, HCV or any other sexually transmitted infection. If you don't know the health status of your partner, use a condom every time you have sexual intercourse.
• Don't use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal drugs. But if that isn't an option for you, make sure any needle you use is sterile, and don't share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
• Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop refuse to answer your questions or don't take your questions seriously, take that as a sign that the facility isn't right for you.
Treatments are available for hepatitis B and hepatitis C infections. Research shows that treatment can reduce the risk of liver cancer.
For the general population, screening for liver cancer hasn't been proved to reduce the risk of dying of liver cancer, and it isn't generally recommended. People with conditions that increase the risk of liver cancer might consider screening, such as people who have:
• Hepatitis B infection
• Hepatitis C infection
• Liver cirrhosis
Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves a blood test and an abdominal ultrasound exam every six months.
Liver biopsy- is not at all primary test. It is only reserved whenever its not possible to diagnosis with other all modalities or testing.
Tests and procedures used to diagnose liver cancer include:
• Blood tests. Blood tests may reveal liver function abnormalities.
• Imaging tests. Your doctor may recommend imaging tests, such as an ultrasound, Triphasic liver CT and Triphasic liver MRI.
• Removing a sample of liver tissue for testing (liver Biopsy). Sometimes it's necessary to remove a piece of liver tissue for laboratory testing in order to make a definitive diagnosis of liver cancer.
During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection.
There are different methods of staging liver cancer. For example, one method uses Roman numerals I through IV, and another uses letters A through D. Your doctor uses your cancer's stage to determine your treatment options and your prognosis.
Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.
Operations used to treat liver cancer include:
• Surgery to remove the tumor. In certain situations, your doctor may recommend an operation to remove the liver cancer and a small portion of healthy liver tissue that surrounds it if your tumor is small and your liver function is good. Whether this is an option for you also depends on the location of your cancer within the liver, how well your liver functions and your overall health.
• Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.
Localized treatments for liver cancer are those that are administered directly to the cancer cells or the area surrounding the cancer cells. Localized treatment options for liver cancer include:
• Heating cancer cells. Radiofrequency ablation uses electric current to heat and destroy cancer cells. Using an imaging test as a guide, such as ultrasound or CT Scan, the doctor inserts one or more thin needles into small incisions in your abdomen. When the needles reach the tumor, they're heated with an electric current, destroying the cancer cells. Other procedures to heat the cancer cells might use microwaves or lasers.
• Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells. This technique is less frequently used.
• Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol causes the tumor cells to die.
• TACE - Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver.
• Placing beads filled with radiation in the liver. Tiny spheres that contain radiation may be placed directly in the liver where they can deliver radiation directly to the tumor.
This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumors. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue.
Radiation therapy might be an option if other treatments aren't possible or if they haven't helped. For advanced liver cancer, radiation therapy might help control symptoms.
During external beam radiation therapy treatment, you lie on a table and a machine directs the energy beams at a precise point on your body.
A specialized type of radiation therapy, called stereotactic body radiotherapy, involves focusing many beams of radiation simultaneously at one point in your body.
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Many targeted drugs are available for treating advanced liver cancer. However, the use is very limited along with the tolerability of the drug is also an issue. Most of the drugs have issue with the efficacy as well.
Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.
Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.
Immunotherapy treatments are generally reserved for people with advanced liver cancer. This therapy is very expensive in Indian settings as compared to its outcomes.
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.
Chemotherapy is hardly used to treat advanced liver cancer.
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.
A liver abscess is a pocket of infected fluid (pus) that forms in the liver. It is caused by infection from germs such as bacteria, parasites, or fungus. It must be treated right away to prevent serious problems.
A liver abscess is a severe infection. It can lead to serious problems and cause death. It can harm tissue in the area where it’s found. It can also cause symptoms such as fever, pain, nausea, diarrhea, and loss of appetite. Treatment is done to cure the abscess, stop symptoms, and prevent death.
The type of treatment you have depends on what caused the abscess. It also depends on how many abscesses you have, and how big they are. Treatment may include:
• Taking medicine. An abscess is first treated with antibiotic or antifungal medicine. You will need to take medicine for a few weeks. You may take it by mouth as a pill or liquid. Or the medicine may be put into a vein through an IV (intravenous) tube.
• Draining the abscess. This may be done in addition to taking medicine. Or it may be done if medicine doesn’t work or the infection causes other problems. There are several ways to drain a liver abscess. The healthcare provider may put a syringe needle through your skin into the abscess. He or she then uses the syringe to drain the fluid. This is called aspiration. Or the provider may put a thin wire may through your skin. The provider uses CT scan or ultrasound to help place the wire in the right spot. A thin, flexible tube (catheter) is then placed over the wire and into the abscess. The tube is left in place for 5 to 7 days to drain the fluid. In some cases, surgery may be done to cut into the liver abscess and drain it.
After treatment, you may have follow-up imaging tests of your liver. This is often done by ultrasound, CT scan, or MRI.
• Bleeding
• A second infection
• Failure to cure the abscess
• Need for more treatment
