CONDITIONS

What Is Chronic Liver Disease

Chronic Liver Disease is comprised of two main diseases: fibrosis and cirrhosis.

         Fibrosis of the liver is a condition in which damage to the liver causes healthy tissue to turn to scar tissue faster               than it can be broken down.

         Cirrhosis is a more advanced stage of fibrosis, and occurs when scar tissue overtakes most of the liver.

Because extensive damage to the liver is required before the development of cirrhosis, the incidence rates of the disease are fairly low. According to the Center for Disease Control, an estimated 101,000 people were newly diagnosed with cirrhosis in 2010, less than 1% of the population. New advancements in research and treatment technologies have made it possible to prevent the progression of fibrosis/cirrhosis in most cases, and possibly reverse liver damage in some people.

What Causes Chronic Liver Disease

Chronic liver disease is caused when damage to the liver causes scar tissue to build up faster than it can be broken down.

According to Johns Hopkins Medical School, the following are the most common causes of liver damage:

  • Alcohol abuse (this is the most common cause)
  • Drug use
  • Hepatitis/other viruses
  • Autoimmune diseases
  • Heart and blood vessel disorders
  • High blood galactose levels
  • High blood tyrosine levels
  • Alpha1-antitrypsin deficiency, an enzyme important in regulating states of inflammation
  • Glycogen storage disease
  • Cystic fibrosis
  • Diabetes
  • Malnutrition
  • Hereditary accumulation of too much copper (Wilson disease) or iron (hemochromatosis)

Risk Factors For Chronic Liver Disease

The following factors can influence your risk of developing chronic liver disease:

  • Age. Chronic liver disease occurs more commonly in adults over the age of 50.
  • Sex Chronic liver disease occurs more commonly in men than in women
  • Alcohol abuse. This is the primary risk factor for chronic liver disease as alcohol abuse is the most common cause of cirrhosis.
  • Hepatitis infection.
  • Liver Cancer
  • Being Overweight
  • Poorly Controlled Diabetes
  • Overconsumption of iron

Diagnosing Chronic Liver Disease

Chronic liver disease can be difficult to diagnose in its early stages, especially because it many times does not cause symptoms early on. The following tests may be used by your doctor in making a chronic liver disease diagnosis:

  • Physical Exam, to look for physical warning signs of chronic liver disease, including jaundiced skin and visible blood vessels.
  • Medical history, both personal and family, to assess your risk of chronic liver disease and other conditions.
  • Liver function tests, which measure the function of the liver by checking for the presence of certain substances in the blood.
  • Liver biopsy, in which a sample of liver tissue is removed and examined in the laboratory.
  • Cholangiography, in which the bile ducts are examined for damage through the use of a contrast die injection.
  • Ultrasound/CT scan, to visualize any damage to internal organs.

Symptoms of Chronic Liver Disease

Chronic liver disease often does not have symptoms, especially in its early stages. Symptoms that do arise depend largely on the stage of the liver disease.

The following may be signs of liver disease:

  • Fatigue
  • Weakness
  • Vomiting blood
  • Fluid buildup in the abdomen, which is known as ascites
  • Loss of appetite
  • Itching
  • Changes to the menstrual cycle
  • Gallstones
  • Hair loss
  • Jaundice, a yellowing of the skin and eyes
  • Appearance of spider vein-like blood vessels on the skin surface
  • Curling of the fingers
  • Muscle loss
  • Red/itchy skin
  • Weight loss
  • Salivary gland enlargement
  • Enlarged breasts in men
  • Loss of body hair
  • Easy bruising

Prognosis

The prognosis of chronic liver disease depends on the stage in which it is detected. Liver failure occurs when 90% of the liver is scarred and unusable. This stage of chronic liver disease can be the result of months, years, or decades of damage of the liver, depending on the degree and extent of the damage.

Living With Chronic Liver Disease

If you have been diagnosed with chronic liver disease, consider the following:

Eat a healthy, low fat diet. Excess fat in the diet can cause a person to become overweight and can put more stress on the liver.

Avoid taking excess supplements, especially iron. The liver has to work especially hard when too many vitamins and minerals are consumed. Though iron in moderation is helpful to liver function, too much of it can cause significant damage

Avoid heavy drinking and drug use. Heavy drinking and drug use can damage the liver, even if substances are only consumed for a short amount of time. Especially if you already have significant liver damage, alcohol and drug use should be avoided entirely.

Do not mix medications with alcohol without first asking your doctor to avoid potentially serious liver damage.

Stay positive. A chronic liver disease diagnosis may be difficult to receive, but know that there are many things you can do to fight its progression.

Talk openly with your doctor. Voice any concerns you may have with your treatment. Communication is key to a successful treatment plan.

Screening

Though chronic liver disease may not be specifically screened for by doctors, some warning signs of chronic liver disease and signs of liver malfunction can be detected by routine tests, so it is important that you visit the doctor for annual checkups. If you have several of the risk factors for chronic liver disease (age, alcohol/drug abuse, diabetes) you may want to consider visiting your doctor more frequently and requesting liver function tests.

Prevention

The following steps can help prevent the development or progression of chronic liver disease:

Don’t abuse alcohol or drugs. Excessive drinking and drug use puts an incredible amount of stress on the liver, leading to the buildup of scar tissue and the breakdown of liver function.

Don’t combine medications and alcohol. Certain medications, including over-the-counter medications such as NSAIDs (acetaminophen), are processed by the liver. When these medications are combined with the consumption of alcohol (even a small amount), the liver can be damaged. Check with your doctor before drinking alcohol while taking medication.

Get vaccinated for Hepatitis A and B.  If contracted, hepatitis can cause significant damage to the liver and even liver failure. Get a vaccination to prevent your risk of contracting the disease. Researchers are working on a vaccine for Hepatitis C that has shown promise in clinical trials—but is likely years away from being available.

Eat a healthy, low-fat diet. This can help keep the body at a healthy weight and decrease stresses put on bile production.

Medication And Treatment

The treatment of chronic liver disease depends largely on the individual patient and the stage of the disease in which it is diagnosed. The liver has the ability to digest scar tissue on its own. The issue at hand in chronic liver disease is that damage is being done to the liver faster than it can repair itself. Therefore, the primary goal of much of chronic liver disease treatments is to eliminate the cause of the liver damage (i.e. fighting a hepatitis infection, stopping the abuse of drugs/alcohol). While damage to the liver may not reverse in all cases, it will stop progressing if the cause of the damage is successfully addressed.

In severe cases, where extensive, irreversible damage to the liver has been done, liver transplantation may be considered. Receiving a liver transplant can be difficult because in order to be on the liver transplant list, you must be at the critical end stages of liver disease, but it can take many months to find a matching donor.  According to the Columbia University Department of Surgery, approximately 17,000 Americans are currently waiting for a liver transplant. The success rate for liver transplants is approximately 85% one year after surgery and 75-80% in the long term.

Complementary and Alternative Treatment

The following treatments may be effective in the treatment of chronic liver disease:

  • Stress reduction practices such as meditation, yoga, tai chi, deep breathing, and guided meditation. Reducing stress helps to decrease the risk of heart attack and can help relieve chronic liver disease-related symptoms.
  • Acupuncture.  Acupuncture is a form of traditional Chinese medicine in which small needles are inserted into the body at specific points designed to restore the flow of bodily energy. Studies have shown that acupuncture treatments are effective at stress and pain relief.

**Warning: patients with chronic liver disease should be cautious about use of herbal and dietary supplements. These may put additional stress on the liver and cause further damage. Speak to your doctor before beginning any herbal or nutritional supplements.

When To Contact A Doctor

If you are experiencing any of the symptoms of chronic liver disease, schedule an appointment with your doctor.

If you are undergoing treatment for chronic liver disease, contact your doctor immediately if you notice any of the following:

  • Persistent nausea/vomiting
  • Vomiting blood
  • Lightheadedness
  • Chest pains**
  • Difficulty breathing**
  • Fever
  • Depression
  • Insomnia

**Call emergency services, these may be signs of a heart attack

Questions For A Doctor

You may want to ask your doctor the following questions:

  • What stage is my disease at?
  • Is there a chance that I can reverse damage done to my liver?
  • What can I do to prevent further damage?
  • What is my prognosis?
  • Should I make changes to my lifestyle/diet?
  • What treatments are available?
  • What are the side effects?
  • Should I consider a liver transplant?