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Liver Health And Liver Failure

Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Dec 19, 2018
Last Modified Date: Dec 19, 2018
Published Date: Aug 03, 2017

TABLE OF CONTENTS

Chapter 1: Liver Health: The Basics Chapter 2: Global Burden of Liver Problems Chapter 3: Main Liver Tests Chapter 4: Other Tests Help to Understand Liver Function Chapter 5: Liver Failure Chapter 6: Commonly Asked Questions about the Liver


Liver Health: The Basics

Damage caused by Hepatitis

The human body is made of several organ systems, interconnected and interrelated. Each organ has its own set of functions. The liver is a relatively large one that is meaty and located on the upper right side. It is a spongy red brownish organ that is protected by our rib cage. It is made of two lobes and has sitting behind it the gallbladder. The liver gets the help of the gallbladder, pancreas and intestines to digest what we are eating, absorb the nutrients and process the whole ingested food.

What the liver is responsible for is filtering your blood that is coming from the digestive tract, before it goes everywhere in your body. This large organ is also in charge of detoxifying chemicals and metabolizing the drugs you take.

The liver controls many functions that impact every part of our system, including digestion and metabolism. It destroys toxins that include bacteria, damaged cells and some harmful substances including alcohol.

We can’t survive without a liver; so, it’s critically important to take care of this major organ. It is also the only organ in the body that can regenerate its own damaged tissue; but it must receive proper nutritional support to do so. Many believe in the power of following a detox diet, every once in a while, to refresh the health of their liver. The American liver Foundation explains that the best way to fight off liver disease is to avoid it.

The health of the liver also helps determining your overall personal health. In addition to continuously detoxifying our body, internally, the liver manufactures bile, then regulates, converts, stores, and processes the many substances we take in from food, air and skin absorption. So, the liver serves as a filter to our body before certain blood components are sent to nourish it. About the size of an American football and reddish-brown in color, the liver is located to the right of the stomach just below the diaphragm.

So, to recapitulate everything, the liver is critical to the function of the human body. It processes all of the blood from the stomach and intestines; and, produces a substance called "bile" that carries away the waste products. It is essentially a filter for your body. It neutralizes toxins. The liver also converts the nutrients in the food that we eat, into elements that our bodies can use, then stores them until we need them. It is responsible for over 500 functions important to keeping you healthy and running smoothly.

Global Burden of Liver Problems

When the liver is being neglected and not well-taken care of, problems start surfacing up. While some issues may be relatively manageable; others could be life threatening. According to the CDC, the United States has been witnessing an increase in the numbers of those who are dying due to liver problems. By jumping from year 2000 to years 2015, death rates related to chronic liver diseases and cirrhosis have increased by 31%. These death rates were 20.1 per 100,000 people in 2000. They reached 26.4 per 100,000. These rates were observed in people between the ages of 45 ad 65 years and were more common among women (57%) than men (21%). Findings were even more surprising when comparing bother genders between ages 25 and 44. For this age group, death rates decreased by 10% for men while they increased by 18% for women. But, for bother genders, death rates due to liver issues do increase with age.

The CDC also explains that these rates do change according to the geographical location of the person. In the USA, rates are the highest if you live in the states of New Mexico, South Dakota and Alaska while they are the lowest in New York, Maryland and Hawaii.

From another angle, statistics related to viral hepatitis fall as follows, according to the U.S. Department of Health and Human Services’ reports in 2016:

  • 3.5 million Americans live with Hepatitis C; but, due to underreporting, the actual number could be as high as 4.7 million.
  • 850,000 Americans have Hepatitis B with a possible range between 730,000 and 2.2 million cases.
  • It is assumed that more than half of those infected with Hepatitis do not know they have the virus. About 67% of those infected with Hepatitis B and 51% of those infected with Hepatitis C, do not knowing their status. This could lead to higher rates of liver failure, and cancer. Also, they are most likely spreading the virus to their partners.
  • For acute hepatitis C, there was an increase of 250% between years from 2010 and 2014.

Liver disease causes from CDC

Main Liver Tests

Liver function is usually determined by an increase or decrease in certain elements in the blood. These elements are proteins and enzymes, as well as bilirubin, which is a product resulting from the breakdown of red blood cells. Enzymes are proteins that act as catalysts. This means that they speed up chemical reactions in the body. The presence of higher than normal, or lower than normal, amounts of these elements is generally determined by various blood tests. Bilirubin levels can also be tested from a urine sample. Often, using these tests together can give your doctor a clearer picture of what is happening in your body and liver.

What to test in your blood to understand how well your liver functions?

There are several tests that assist in determining liver function and efficacy. These are:

  • Alanine transaminase (ALT)
  • Aspartate transaminase (AST)
  • Alkaline phosphatase (ALP)
  • Albumin
  • Total protein
  • Bilirubin
  • Globulin
  • Gamma-glutamyltranpeptidase (GGT)
  • L-lactate dehydrogenase (LD)
  • Prothrombin time (PT)

You have to keep in mind that these tests are often performed together, all part of what is called a "liver panel." This panel is normally recommended to be done for numerous reasons. One is if you are showing symptoms of a disease or damage to your liver. For instance, jaundice is an indication that your bilirubin levels are too high, which could indicate that your liver is not doing well. Other symptoms include:

  • Dark-colored urine
  • Light-colored stool
  • Continued nausea or vomiting
  • Unusual loss of appetite or weight
  • Experiencing fatigue (weakness or tiredness)
  • Experiencing pruritus (itching) of the skin
  • Swelling and/or pain in abdomen area

Also, certain medications that you may be taking could have part of their side effects to affect your liver function. If you are taking such medicines, then, it is required that your liver be monitored regularly. Further, you may be at risk for liver damage or disease due to family history, being an alcoholic, being quite overweight (especially if you are also diabetic or have high blood pressure) or if you have been exposed to the hepatitis virus. These tests are used to monitor the progression of any possible liver disease as well. Your doctor will choose the right panel of tests for your case.

What Do each of These Blood Tests do for you?

Alanine transaminase (ALT) test

Alanine transaminase is an enzyme that is found naturally in your liver. It is important to your metabolism as it works on converting the food you eat into energy. If you have high levels of this enzyme in your blood, it could indicate that your liver may be damaged. This damage or disease could include hepatitis, other infection, liver cancer, or cirrhosis. The ALT blood test is one of the screening tests for liver function that can detect problems before you even experience any symptom.

Aspartate transaminase (AST) test

This substance is also an enzyme found in abundance in your liver, naturally; but, only in small amounts in your blood. However, if your test shows high levels in the blood, this could indicate liver damage or disease. You may have this test done if you are experiencing certain symptoms. Your doctor may even ask you for it if you are at risk; for example, if you have liver issues in your family history, you are a heavy drinker, have diabetes, or take medications which may cause liver damage.

Alkaline phosphatase (ALP) test

Alkaline phosphatase is another enzyme found in the liver, but it is also found in your bile ducts, and bones. High levels in your blood could indicate that you may have liver disease: that your bile ducts are blocked; or, that you may have some kind of bone illness. What you need to keep remembering is that waste products, in your body, are normally carried away in the bile that is produced by the liver. So, imagine what would possibly happen if this bile, along all its waste products in, backs-up in the liver.

Albumin test

Albumin is a protein that is produced by the liver. When testing its levels in your blood, it can show your liver's capacity in producing it. Albumin is needed by your body to fight off infections, among other things. If your albumin levels are low, this may indicate liver damage or disease, such as hepatitis or cirrhosis.

Globulin test

Globulins are another group of proteins made in the liver. Globulins aid your immune system to fight off infections. If you have low levels of globulin in your blood, you could have liver damage, or other problems. High globulin levels, on the other hand, may suggest infection, inflammatory disease, immune disorder, or some cancers.

Total protein test

Your liver manufactures two primary proteins. These are albumin and globulin as discussed above. The total protein test checks the levels of all proteins in your blood. Low levels of total protein in the blood could mean liver damage or disease, such as celiac disease, a digestive disorder. High levels of total protein could indicate an ongoing infection or inflammation, such as what might be experienced with HIV, AIDS or viral hepatitis. They may also be the first sign to indicate a problem with your bone marrow.

Bilirubin test

Bilirubin is the result of red cells breaking down of red blood cells. If there are high levels of bilirubin in your blood, a condition called "jaundice" can occur. This causes yellowed eyes and skin. It may also indicate liver damage or disease, such as cirrhosis, gall stones and hepatitis. Higher levels of bilirubin in your blood can also alert your doctor to the possibility of sickle cell anemia or other types of anemia, caused by red blood cells breaking down faster than normal.

Gamma-glutamyltranpeptidase (GGT) test

You naturally have a lot of this kind enzyme in your liver, bile ducts, pancreas, kidney, heart and brain. The GGT test looks at how much of the enzyme is in your blood. High levels could indicate bile duct issues or liver damage. Used with other tests, like the ALT, AST, ALP and bilirubin tests, it can be used to differentiate between liver,bile duct diseases and bone diseases.

If your GGT levels are high, it could mean any of the following:

  • You may have drank a lot of alcohol
  • You are possibly diabetic
  • You have Cholestasis (bile flow is blocked)
  • Possibly have Heart failure
  • Hepatitis
  • Your liver not getting sufficient blood flow
  • Some of the liver's tissue have died
  • You might have a tumor or cancer of the liver
  • Lung disease is also a possibility
  • Disease of the pancreas
  • You may have liver cirrhosis (scarring of the liver)
  • You possibly have used some drugs that are toxic to the liver

L-lactate dehydrogenase (LD) test

High levels of this liver enzyme in the blood could be an indicator of liver disease. However, numerous other conditions can cause the LD levels to rise as well. Levels of LD are not as high when compared to the levels of AST and ALT when there is a liver disease.

Prothrombin time (PT) test

This test measures the time it takes for your blood to clot. If you are taking a blood thinner, such as warfarin, it will take longer than normal. But, if you are not, and your clotting time is longer than normal, it could indicate liver damage or disease.

Liver problems can be caused by alcohol

Other Tests Help to Understand Liver Function

Depending on your case, your primary health care giver might ask you to do additional tests to clearly understand the functioning of your liver. There are numerous imaging tests, which can also be done to help understand how well your liver is functioning. These are often done as a follow-up routine to the blood tests described above. Imaging tests may include ultrasounds, CT scans, as well as liver and spleen scans. Such assessments can help confirm what the liver function blood tests may have suggested. Finally, if necessary, your doctor may order a liver biopsy to be performed, where a sample of tissue is taken to examine under the microscope for signs of injury and/or disease. Not everyone has to do all these testing and imaging routines. It all depends on every case and how the results of the primary test came.

The liver is susceptible to several injuries, conditions and diseases, including: hepatitis, cirrhosis, cancer, liver failure, gall stones (which get stuck in bile ducts and cause infection) and hemochromatosis (where iron deposits in the liver and causes damage to it). Screening tests are critical to detecting problems with the liver early, so treatment can be sought. And, many conditions can be prevented by you. Remember that the liver is your filter for all toxins that go into your body.

Hepatitis

Hepatitis A

Hepatitis A is a communicable disease that is caused by a virus: the hepatitis A virus. It is highly preventable when one takes its vaccine. HAV can be transmitted from a person to another by contact with contaminated food or water. This contamination is an oral fecal one. The good thing about this type of Hepatitis is that it is self-limited. This means that it does not turn into a chronic illness with life-threatening risks.

Is Hepatitis A a serious condition?

Unlike the other kinds of Hepatitis viruses, HAV is not a scary illness. When you contract this viral infection, you will have the symptoms for couple of weeks; after which, you will be back on your feet with no symptoms or side effects lingering past the infection period. So, in other words, the HAV will not scar your liver and pose a possible death sentence on your life. This viral infection could possibly, rarely, cause liver failures if you were older than 50 years of age and have liver problems.

Who is at risk of contracting the HAV?

This viral infection can be contracted in many ways. But, normally, it occurs when you take in the virus through contaminated food, objects or drinks. These could become contaminated when they contain a very small amount, even an undetectable one, of the stool of a person who has Hepatitis A. You could even contract it by having sex with an infected person; or, even, being the care giver of one.

As for food, it could become contaminated at any stage: growing, harvesting, processing, handling, and even cooking. But such a contamination is most probable in nations that have unsanitary conditions. In our country, the USA, they chlorinate the water which kills the Hepatitis A virus. In addition, the Food and Drug Administration does monitor our irritation water regularly. So, unless you visited a developing country who is among those who have high risks of Hepatitis A infections, you should not worry about contracting the virus from your produce.

While you could catch the Hepatitis A virus at any time, some people are at higher risks of this infection than others. So, if you are one of the below groups or think you could have been exposed, you have to call your doctor and get tested. High risks groups include:

1- Those who are taking care of individuals who have Hepatitis A

2- Those who have traveled to nations that are at high risk for Hepatitis A

3- Men who have sex with men

4- Those who use injection and non-injection drugs

5- Those who work with nonhuman primates

If you have contracted Hepatitis A, your body would build antibodies against this virus. These will protect you from getting sick as they would attack and destroy any future Hepatitis A virus you may get exposed to.

Hepatitis A Symptoms

While children, who are younger than six years of age, would not develop any symptom when they get infected with Hepatitis A; older kids and adults would develop some. Such symptoms will appear suddenly and include fever, fatigue, losing your appetite, feeling nauseous and vomiting, having abdominal pain, diarrhea or even joint pains. You can also have clay-colored stools and yellowing of the skin and eyes.

Symptoms normally appear about four weeks after being exposed to the virus and last about to months, more or less. A minority (10-15% of infected people) have their symptoms lasting for up to six months.

Since it takes some times for the symptoms to start appearing, one can be highly infectious for this virus two weeks before starting to witness some indicators. So, people at high risk or those who are witnessing some symptoms similar to a Hepatitis A infection need to get tested!

Hepatitis A Diagnosis and Treatment

If you suspect having or being exposed to the Hepatitis A virus, you’d better visit your doctor and get examined. You will also need to have a specific blood test done. For those who are not vaccinated against Hepatitis A, and knew about their exposure as early as two weeks post, taking a Hepatitis A vaccine or a shot of immune globulin would be the best way to prevent severe illness. You will also need to have good rest, drink plenty of fluids, and eat a well-balanced diet. The essence for this illness, just like for any other condition is to detect any faulty behavior or sign. This way, you will need to directly get tested and talk to your doctor.

Hepatitis A Prevention

The best way you could prevent Hepatitis A is by getting vaccinated. Getting more than one shot would give better results. Normally, there should be a six months separation between ach dose. For those who are older than 18 years of age, there is the combination hepatitis A&B vaccine available for them. In that case, three shots would be recommended, six months or more apart. The vaccine is safe and does offer protection. If you have severe allergies, you may want to inform your doctor before taking the vaccine. The Advisory Committee on Immunization Practices (ACIP) does recommend the following to get vaccinated:

1- Children who are younger than one year of age

2- Those who frequently travel to countries prevalent in Hepatitis A.

3- Men who have sex with men

4- Drug users and those who have a clotting factor disorder

5- Anyone who wants to get immunity to the virus

You may want to keep in mind that getting vaccinated against Hepatitis A will not offer you any kind of protection against the other types of Hepatitis. Also, for those who are immunocompromised, the vaccine is still administered as it is in its inactive form. If you have taken the first dose of the vaccine and have lasted longer than six months before taking the second one, you can take it as soon as possible. You will not have to repeat the first dose.

Treatment options for Hep B

Hepatitis B

Hepatitis B is a liver disease, caused by the hepatitis B virus (HBV). According to the Hepatitis B Foundation, up to 100,000 new HBV infections occur in the U.S. each year; and, more than a million people have chronic hepatitis B infections. Many infected individuals show no noticeable symptoms, with some studies indicate that as many as two -thirds of people with chronic infections are not aware of their illness. For this reason, blood testing is an important tool in the detection of the disease.

Hepatitis B is a contagious viral infection that causes inflammation leading to an impaired liver function. Primarily, getting infected with HBV means that you will deal with an acute type of hepatitis B. This means that it is a short-term infection of the liver, taking its course until the immune system gains control of the infection, and clears the virus from the system. Such a process generally needs up to six months.

However, for some individuals, hepatitis B could become a chronic condition. This means that the immune system will be unable to rid the body of the virus during the acute phase of the disease. As a result, the virus will continue to replicate in the liver for several months or even years. Individuals with chronic hepatitis B are at high risk of complications, which can include liver damage, failure, cancer, or cirrhosis. They will also be like a time bomb as they will remain capable of transmitting the virus to others.

According to the Hepatitis B Foundation, about 90 percent of, otherwise healthy, adults infected with HBV will clear the infection during the acute phase and develop the necessary antibodies to protect them against future hepatitis B infections. The odds of chronic infection are much greater in immune-compromised adults, infants and children who contract the disease, with about 90 percent of infants and up to half of all children, who are infected before age 5, developing chronic hepatitis B.

When you understand the real progression of this type of Hepatitis, you will surely understand the necessity of getting tested at the right time. Delaying a proper diagnosis will possibly advance the illness and transform it into a chronic and more severe kind. If you think you contacted Hepatitis B by a possible exposure, get tested! If you are exacerbating symptoms of this type of Hepatitis, get tested!

Hepatitis B Symptoms

Approximately 30 percent of individuals newly infected with HBV will display some hepatitis B symptoms that start appearing three months post to contracting the virus. This phase is known as acute hepatitis B; and, its symptoms can range from mild to severe. Patients who have mild symptoms often do not recognize them as hepatitis B symptoms, misidentifying them as cold or flu symptoms. They tend to be undiagnosed increasing their risks of advancing the illness or spreading the virus to others.

Common signs of Hepatitis B include:

  • Flu like symptoms, including fever, weakness, fatigue and muscle or joint pain
  • Dark urine
  • light or clay-colored stool
  • Decreased appetite
  • Nausea and/or vomiting

Severe symptoms of Hepatitis B are less common, but require immediate medical help. These may include:

  • Severe nausea and vomiting
  • Abdominal pain
  • Abdominal bloating or swelling
  • Jaundice, which presents as yellowing of the white of the eyes and/or the skin

How Hepatitis B Virus (HBV) Spreads

The hepatitis B virus is spread through contact with the blood or body fluids of an infected person. These include the semen, vaginal fluids, saliva or fluids secreted by open wounds. In the United States, the HBV infection, in adults, is most commonly contracted through sexual contact with an infected individual, accounting for nearly two thirds of acute hepatitis B cases. Other ways a person can become infected include:

  • Birth – Infants can contract the virus from an infected mother during the birthing process
  • Direct contact with blood or open wounds of an infected person
  • Sharing of needles or syringes used to inject drugs, or accidental needle sticks
  • Sharing of personal care items, such as toothbrushes or razors, with an infected individual

People who may be at increased risk of contracting HBV include:

  • People who have unprotected sex with an infected partner
  • Get a blood transfusion
  • People with sexually transmitted diseases
  • Homosexual men
  • IV drug users
  • People who get a tattoo from an unclean establishment
  • Health care workers
  • People who live with an infected individual and/or share personal items with them
  • Individuals who travel to countries with high rates of Hepatitis B
  • Dialysis patients

Testing and Diagnosis

Blood tests are used to screen for or diagnose hepatitis B. They work by detecting antibodies in the bloodstream that are produced by the immune system in response to a possible HBV infection. With a series of blood tests, medical professionals can determine whether a person is newly exposed to HBV, has been exposed in the past; has become immune to HBV infection through previous infection or immunization; or, has developed chronic hepatitis B, as well as an infected individual's viral load. They could also detect the amount of HBV virus that he or she carries.

Health care professionals may order these tests for individuals who display potential symptoms of hepatitis B. Such a protocol is also followed for those who have a known or suspected exposure; or, for people who are subject to one or more of the above-mentioned risk factors. Additionally, since hepatitis B is most commonly spread through sexual contact, HBV testing should be done as part of a person’s annual STD screening, in sexually active individuals.

Hepatitis C

Since it is one of the three most common forms of Hepatitis, knowing how to recognize Hepatitis C symptoms is very important. It is a contagious disease that results from being infected with the Hepatitis C virus (HCV). This viral infection can present as either an acute infection or a chronic, lifelong disease that, if left undiagnosed and untreated, can eventually result in liver damage, liver failure, liver cancer or even death. Symptoms of Hepatitis C are often very subtle; but, the disease can be confirmed or detected through blood tests.

Hepatitis C: What it is and How it Spreads

Hepatitis is a general term that means the inflammation of the liver, a condition that can stem from a variety of causes including an exposure to: toxins, certain prescription and over the counter drugs, heavy alcohol consumption, and a number of bacterial/viral infections. However, the more familiar use of the term is to refer to a family of viral infections affecting the liver. The three most common forms of Hepatitis are Hepatitis A, Hepatitis B and Hepatitis C. Of these three viruses, Hepatitis C is the only one for which no vaccine has been developed to protect against its infection. According to the CDC, Hepatitis C is the most common blood-borne infection in the United States, with an estimated 3.2 million individuals infected nationwide. According to studies, here are some interesting statistics about this virus:

  • Around 15-25% of infected people will be able to clear their body from the virus without following a treatment regimen. For those, Hepatitis C will remain a simple short-termed infection.
  • In 2016, the CDC estimates around 41,200 cases of Hepatitis C in the United States.
  • 75 to 85% of Hepatitis C infected people end up with a chronic condition.
  • About 10 to 20% of Hepatitis C infected people will end up having a liver cirrhosis 20 to 30 years down the road.
  • Among those who had a liver cirrhosis due to Hepatitis C, 3 to 6 % will end up with liver failure and 1 to 5% with liver cancer.

The Hepatitis C Virus (HCV), which causes the infection, is transmitted through the blood and other bodily fluids of infected individuals. Before 1992, when modern screening methods were not a common use, blood transfusions and organ transplants were among the most common sources of Hepatitis C infection. Today, the most common means of contracting the virus is through infected needles and/or syringes. This usually happens in one of the following ways.

  • Sharing of needles or syringes among drug users.
  • Accidental needle-stick injuries in health care settings.
  • Body piercings or tattoos done with unsterilized, reused equipment.

Other, less common means of Hepatitis C infection include:

  • Direct, through the skin contact with the blood of an infected individual, through an open cut, for example.
  • Sexual contact with an infected individual; while fairly uncommon, this form of transmission is a greater risk for people with multiple sex partners, HIV positive individuals or those infected with other sexually transmitted diseases.
  • Transmission from an infected mother to an unborn child.
  • Very rarely, blood transfusions – although individuals who had transfusions or organ transplants prior to 1992 are at greater risk than patients undergoing these procedures today.

Symptoms of Hepatitis C: Acute Infections

In 15 to 25 percent of individuals who become infected with HCV, the disease will present itself as a short-term condition called acute Hepatitis C infection. Typically, acute hepatitis C is cleared from the body by the immune system without treatment, generally within a few months. In an acute Hepatitis C infection, symptoms occur within 6 to 7 weeks after exposure; but, can appear as late as 6 months. Some of the most common Hepatitis C symptoms are:

  • Fever
  • Fatigue
  • Nausea
  • Vomiting
  • Loss of appetite
  • Abdominal pain
  • Jaundice (yellowing of the skin and/or the whites of the eyes)
  • Dark, concentrated urine
  • Pale or clay-colored stool
  • Joint pain

Among the majority of infected individuals and according to the CDC, approximately 75 to 80 percent of Hepatitis C cases becomes a chronic, lifelong conditions. Chronic Hepatitis C infections, in most cases, present no symptoms or very mild ones. The lack of definitive symptoms often leads to the disease remaining undetected for years, often until affected individuals develop liver damage, cirrhosis, or liver cancer. This can occur as a result of the severe liver scarring that characterizes cirrhosis. So, to prevent such an advancement of this viral infection, it is always a good idea to include Hepatitis C part of your yearly routine STD’s tests. But, if you think you may have been exposed to the virus, you may want to check with your primary care giver straight ahead and get tested to be on the safe side.

Diagnosis and Treatment

Patients who have any of the Hepatitis C symptoms or risk factors for exposure listed above should be tested for Hep C infection. Several blood tests are commonly used to detect Hepatitis C, including tests that check for Hep C antibodies and liver function tests. Treatment is not necessary in all cases, but when it is, typically consists of a combination of medications called interferon and ribavirin. All Hepatitis C patients are carefully monitored for signs of liver disease.

The difference between the three forms of Hepatitis is that each is caused by a different kind of virus. So, three kinds of viruses lead to three distinctive illnesses. While their symptoms may, somehow, be similar, they are contracted in different routes and exert different forms of damages to the liver. Hepatitis A is normally a short-term infection; while the B and C types start up as short term but could last longer and longer in the body for a very long time. When this is the case, chronic illnesses arise. Finally, while vaccination is a great way for preventing Hepatitis A and B; up until now, there is still no vaccine for Hepatitis C.

Diagram of alcohol related liver damage

Liver Failure

Liver failure occurs when a large portion of the liver becomes damaged, which will impair its normal functions. The most common form of this condition is the chronic liver failure, in which the liver functions degrade gradually, over many years. In this case, the damage to the organ would be slowly accumulating over the years. A less common form is the acute liver failure that happens when a damage and/or impairment of the liver functions occurs rapidly, often in as little as 48 hours. Both conditions are life-threatening, require urgent medical care and can be difficult to detect if you are only relying on the related symptoms. Since the signs of liver failure are similar to those of many other health problems, liver-function testing is necessary to end up with a certain diagnosis of the condition.

What Causes Liver Failure?

Chronic liver failure, which generally involves slow, progressive damage to the liver over a number of years, has a variety of causes. Amongst the most common of these are viral infections, such as hepatitis B or C. Also, heavy and long-term alcohol consumption can end up messing your liver dramatically. Regular exposure to certain toxins, such as cleaning solvents, aerosolized paints, paint thinners and many other chemicals can cause liver inflammation, which can lead in its turn to more pronounced damages and a liver failure. This can also be the result of certain inherited diseases and malnutrition.

Overusing acetaminophen, a common over-the-counter pain medication, is damaging to the liver; and, is considered a leading cause of liver failure. Other prescription medications can, as well, cause liver damages. These include statins, anticonvulsants, some herbal remedies (such as kava, ephedra, skullcap and pennyroyal), some anti-seizure medications, antibiotic drugs used for the treatment of tuberculosis, and some medications used for the treatment of heart disease.

In many cases of acute liver failure, underlying causes are unable to be determined. Hepatitis A, B and C can cause acute liver failure, as can auto-immune diseases, metabolic diseases, vascular disorders and liver cancer.

Signs of Liver Failure

The liver is one of the body's most important organs, performing a long list of life-sustaining functions. The truth is that liver problems are more common than most people realize. CDC reports state that 101,000 people were hospitalized due to liver dysfunction in 2010 and 31,903 died of liver disease.

According to the American Liver Foundation, liver failure occurs when liver damage has caused the organ to lose half its functional capacity. There are two basic types of liver failure, chronic and acute, both of which are life-threatening if left untreated. However, when caught and treated in its early stages, liver failure can be reversible. Since liver failure symptoms can be difficult to distinguish from many other common maladies, the condition is typically discovered and/or confirmed through diagnostic testing.

Chronic Liver Failure

Chronic liver failure, the most common form of liver failure, is a condition that develops slowly over a period of months or years. It is caused by incremental damage to the liver, which slowly degrades liver function.

Among the most common causes of chronic liver failure are various forms of viral Hepatitis, the most common of these being Hepatitis A, Hepatitis B and Hepatitis C. Other common causes include long-term heavy daily alcohol consumption, everyday exposure to a number of toxins and chemicals, genetic disorders, autoimmune diseases and liver cancer.

Regular use of some drugs can cause liver deterioration as well, including prescription drugs, such as statins, tuberculosis drugs, some anti-seizure medications and several medications used to treat heart disease. Overuse of acetaminophen can cause liver damage and is one of the leading causes of drug-induced liver failure in the U.S.

All of these factors can lead to liver inflammation, which can damage the organ. Among the consequences of sporadic or chronic liver inflammation are fibrosis, which is mild to moderate scarring of the liver, and cirrhosis, or severe liver scarring. In both these conditions, healthy, functioning liver cells are replaced with scar tissue over time, reducing liver function.

Acute Liver Failure

Acute liver failure is a much quicker process, with extensive liver damage and impairment of liver functions occurring in as little as 48 hours. Common causes of acute liver failure include medication overdoses, particularly acetaminophen, as well as some antibiotics, anti-inflammatory medications or anticonvulsants. Overuse of some herbal supplements has also been linked with acute liver failure, and in some cases, viral Hepatitis can lead to acute liver damage and failure.

Signs of Liver Failure

While the acute and chronic forms of liver failure are different in terms of the ‘incubation period’ they go through to become critical health conditions, the basic symptoms of the two are very similar. Early signs of liver failure may include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Abdominal swelling, tenderness and/or pain
  • Weakness
  • Fatigue
  • Dark colored, concentrated urine
  • Diarrhea
  • Pale, bloody or tar colored feces
  • Persistent skin itching
  • Achy muscles or joints

If liver failure is allowed to progress untreated, more serious symptoms will typically begin to emerge. Among the most common later-stage signs of liver failure are:

  • Jaundice, or yellowing of the skin and/or whites of the eyes
  • Bleeding and/or bruising easily
  • Fluid accumulation in the legs and/or abdomen
  • Mental confusion
  • Extreme fatigue
  • Coma

How Liver Failure is Diagnosed

The liver is unique among the organs of the body in that it has the ability to regenerate, or heal damaged cells. However, there is a point at which the damage becomes irreversible, making the early diagnosis of any liver disease or failure essential to end up with a successful treatment.

Immediate liver function testing is necessary in anyone who has noticed any of the typical signs of liver failure or has risk factors for liver disease, such as:

  • A family history of liver disease
  • Current or past heavy alcohol consumption
  • Use of medications known to affect the liver
  • Current or past viral Hepatitis infection
  • Diabetes
  • Elevated Cholesterol or triglyceride levels
  • Regular workplace chemical exposure

Depending upon the particular risk factors or symptoms present, a physician may order blood tests that measure specific proteins and liver enzymes, detect antibodies to various types of viral Hepatitis, and evaluate ammonia levels in the blood, among others, checking for abnormalities that can indicate liver dysfunction, disease or failure.

Unfortunately, the signs of liver failure and/or liver disease are very similar to an array of other health concerns, and in the case of chronic live failure especially, can be very subtle. For this reason, routine screening is recommended by many physicians as a component of annual health exams, especially in patients over the age of 40.

Diagnosis and Treatment

In many cases, with treatment, liver failure and the damage that causes it can be reversed, since the liver is the only organ in the body that is able to regenerate, replacing damaged tissues with new cells. However, successful recovery depends upon early intervention, before damage becomes too severe for regeneration to occur. Once that line is crossed, a liver transplant is the only effective option to restore live function and sustain life, so detecting liver failure in its earliest stages is important. For this reason, individuals who display any combination of the signs of liver failure listed above should have liver function testing done as quickly as possible. Liver function testing is a series of blood tests that measure specific enzymes and proteins in the blood that are related to liver function, allowing an accurate assessment of how efficiently this vital organ is functioning.

Individuals who are at higher risks for liver disease should also be monitored for early signs of liver failure. Regular testing in that instance is necessary. Testing is generally recommended annually in such cases; but, monitoring may be more or less frequent, according to a person's level of risk. Risk factors that can merit such observation include:

  • A family history of liver disease
  • Current heavy drinking or a history of alcoholism
  • A history of any form of Hepatitis
  • Regular use of prescription, non-prescription or herbal medications known to affect the liver
  • Diabetes
  • Occupations that involve regular chemical exposure
  • Elevated triglyceride levels in the blood
  • Past or present use or abuse of illegal drugs

Individuals, with any combination of these risk factors, and who have not undergone any proper liver function testing should raise the issue with their health care provider; or, have testing done on their own resorting to an independent medical testing service. Health Testing Centers offer patients the opportunity to order the same high-quality liver function tests, prescribed by physicians, directly within a few clicks. Also, testing will be conducted by LabCorp that is a respected national laboratory chain with more than 1400 convenient locations. Results will be delivered directly to the patient; and, the process is typically quicker, more convenient, and less expensive than having it done through a physician.

Commonly Asked Questions about the Liver.

Viral structure of Hep B

What is the most frequent cause of liver disease?

In Western societies, it is alcohol abuse and hepatitis. Of the two, hepatitis is the most well-known. Excessive alcohol causes damage to the liver by preventing the organ from doing its job of purging toxins from the body over time. Over the short haul, the liver is adept at dealing with alcohol but over a long period of time, cellular damage occurs. Large amounts of alcohol (binge drinking, for example) can permanently alter the liver’s cell structure, impairing its ability to metabolize.

If left untreated, many liver disorders, including those that stem from alcoholism or hepatitis can progress to cirrhosis, or scarring of the liver. Excessive alcohol consumption can lead to fatty liver disease.

What is cirrhosis of the liver?

Cirrhosis, or scarring of the liver, is a condition in which scar tissue begins to replace the soft healthy tissue of the liver. It is also the most serious type of liver disease related to excessive alcohol consumption and is not reversible. However, if a person stops drinking altogether, further damage can be avoided.

According to the Centers for Disease Control (CDC) and Prevention, “safe” drinking is up to two drinks a day for men and one drink a day for women. Five or more drinks for men and four or more drinks for women at one sitting are generally considered binge drinking. Regular binge drinking, over a period of years, creates the highest risk for permanent liver damage.

Among the complications that can occur from alcohol-related liver disease are:

  • Enlarged spleen
  • Malnutrition
  • Frequent infection
  • High blood pressure within the liver
  • Kidney failure
  • Fluid build-up in the abdomen
  • A higher risk of liver cancer

Treatment for alcohol-related disease includes abstinence from alcohol, a healthy diet and medications. In severe cases of alcoholic cirrhosis, a liver transplant may be required.

What is fatty liver?

Also called steatosis, fatty liver usually occurs as the result of either alcoholism or obesity. A leading cause of cirrhosis in both alcoholic and non-alcoholic patients, it is also associated with a metabolic disorder characterized by diabetes, high pressure, obesity and high cholesterol combined. The excess fat within the liver can damage cells and lead to cirrhosis. Early diagnosis is essential in preventing serious liver disease.

What are the different types of hepatitis and how do they differ?

In simple terms, hepatitis is an inflammation of the liver. Most cases are the result of a group of viral infections affecting the liver that, if left untreated, can cause liver cancer. More than 4 million Americans have chronic hepatitis, yet many don’t know they have it.

The three most common types are:

Hepatitis A – caused by the Hepatitis A virus (HAV) – spread through contaminated food and drink; normally short-lived and not a cause of chronic hepatitis; a vaccine is available and recommended when traveling to developing countries.

Hepatitis B – caused by the Hepatitis B virus (HBV) – spread through sexual contact, and sharing needles for injection drug use, prevalent worldwide; can lead to chronic hepatitis and cirrhosis; remains a major cause of liver cancer. A vaccine is available to prevent Hepatitis B.

Hepatitis C – caused by the Hepatitis C virus (HCV) – the most common type of hepatitis found in the U.S.; generally, spread through contaminated blood and needles; can become chronic and lead to cirrhosis.

There is no vaccine presently available for Hepatitis C. It is also one of the main reasons for a liver transplant. Symptoms are similar for all types of viral hepatitis and can, if left untreated, include:

  • Fatigue
  • Fever
  • Poor appetite
  • Nausea and vomiting
  • Gray-colored bowel movements
  • Upper-right abdomen tenderness
  • Muscle and joint pain
  • Jaundice

Other types of hepatitis:

Hepatitis B with D – most often found in drug users; many cases will progress to cirrhosis. A vaccination for Type B will prevent Type D.

Hepatitis E – found in countries with poor sanitation; can be a major complication among pregnant women. No vaccine is currently available.

Non-viral Hepatitis – includes toxic hepatitis; usually drug or alcohol-induced and autoimmune hepatitis; when the body’s own immune system attacks liver cells and causes inflammation.

What is the general treatment for hepatitis?

Treatment varies, depends upon the type of hepatitis involved. The first step is to determine what type is present through a blood test. Preventive vaccinations are recommended for A and B types. There is no vaccine for hepatitis C. For Hepatitis A treatment, there is no specific medication prescribed; treatment is generally supportive until the virus subsides.

In chronic Hepatitis B, treatment may include regular monitoring for signs of liver disease; some patients also receive antiviral drugs. Hepatitis C, if chronic requires monitoring for liver disease progression and antiviral drugs are often prescribed.

What about liver diseases that are not related to hepatitis or substance abuse?

Some liver disorders are genetic in nature, including iron overload, or hemochromatosis, which results in an iron buildup in the body. The excess iron is stored in the liver, heart and pancreas where it can cause damage and life-threatening illnesses. Men are afflicted more often than women and people of Caucasian ethnicity (northern Europe background) are at higher risk.

Other metabolic liver diseases include copper overload, also known as Wilson’s disease, in which too much copper is released into the bloodstream due to a defective gene, causing damage to kidneys, brain and eyes.

What is jaundice?

Jaundice, also known as icterus, is characterized by the yellowing of the skin and mucous membrane of the eyes. It is caused by an excess of bilirubin (a pigment derived from hemoglobin). Jaundice can come from liver, bile duct, pancreas or blood diseases. It usually disappears after cause is found and treatment is administered.

What are the causes of liver cancer?

It’s estimated that a majority of primary liver cancer is the result of cirrhosis. Chronic hepatitis or alcohol abuse account for most cases of cirrhosis. But what is more common is secondary liver cancer, in which cancer has spread to the liver from other organs.

How can I keep my liver healthy?

Knowing that the liver is an essential organ for the proper functioning of the entire body, one has to keep am eye on his or her liver. What you eat, drink, inhale and even medicate yourself with has an effect on your liver. According to a leading doctor from the MedStar Georgetown Transplant Institute, the liver is the organ that can easily be wrecked. And once messed up, it becomes nearly impossible to put it back together.

While some might be neglecting towards their bodies, others like to prevent anything bad from happening, as much as possible. When it comes to the liver, it is not that tricky: it is all about the lifestyle choices you are taking.

1- Unlike other organs where it could be possible to eat and drink what is right to eradicate the risks of eating the bad things; when it comes to the liver, the formula is different. Keeping your liver healthy means that you have to only eat what is good for you and stay away from wat is bad. This means that you should not drink a lot of alcohol. This means that you should not have more than two drinks a day if you are a man; and, two drinks a day if you are a woman. From another angle, you should eat in such a way to lower your intake of fried food and keeping your weight at the right BMI. Working our regularly is also essential.

2- Watch out for some medicines that have damaging side effects on the liver. For example, those who take a lot of acetaminophen can possibly damage their livers. Keep your doses within the safe zones. You may want to note that acetaminophen is not only found in Tylenol and in its pure forms. It is also an ingredient of many painkillers and cold meds. So, make sure you are not overdosing on it. Also, the Kava Kava herbal supplement that is being used to manage, naturally, menopause symptoms has been shown to prevent a normal functioning of the liver.

3- If you are a sexually active person, you have to get tested regularly for Hepatitis, among all other STD’s. If you have done a tattoo in a not-so-reputable shop, you need to be tested. If you got in close contact with someone who might have the virus, you should be tested. Finally, if you traveled recently to a country prevalent in Hepatitis, you should be tested a couple of weeks after your arrival back home. The reason for all this testing fuss, is to detect the possibility of the virus at its earliest stage in order to treat/manage it easily and prevent its progression into a more chronic and impactful stage.

4- Make sure you do not have sex with many partners, which ca increase your risks for viral hepatitis as well as many STD’s.

5- Never share your personal items like your toothbrush, razor, or needles.

6- Always use a condom when having sex.

7- Get vaccinated if you think you might be one of those high-risk groups (for Hepatitis A and B).

8- Do not smoke. Cigarettes do contain certain additives that could damage the liver.

9- Avoid direct contact with cleaning products and aerosol products, as well as insecticides.

10- Try to control your intake of refines sugar. Studies have lined a high intake of this kind of sugar and high corn syrups to a fatty build up on the liver leading to liver disease. So, try to consume moderately sodas, pastries, candies and other similar products.

11- While Vitamin A can be very good for good for your body. It is one that can be easily gotten from red, orange and yellow fruits and vegetables. However, supplements that are high in this vitamin might be problematic to your liver.

12- Trans fats can be your liver’s worst enemy. These can be read in food labels as ‘hydrogenated fats’ and can cause fatty livers, which in turn could lead to liver damages. You may even want to watch out for food that have ‘0 trans-fat’ on their labels as these do not mean a full zero. They may still have some small amounts that could build up over time.

Finally, your liver is your jewel. While it can be damaged easily, it also has the power of forgiving quickly. Watch out to stay within its limits of forgiveness. Make sure you live a healthy lifestyle by eating well, limiting your alcohol consumption, and not smoking. Also, make sure you listen to your body and its warning signs by noticing anything unusual in your body. Also, make it a date to get regularly tested so you can be on top of the game. Having a routine liver functions test is the best way to detect any abnormality at a very early stage, which will prevent any possible disease or viral infection from progressing in your body.

References

Alcohol and public health: Frequently asked questions. (2018). Retrieved from: www.cdc.gov/alcohol/faqs.htm

The U.S. Department of Health and Human Services. (2016). Hepatitis C Basic Information. Retrieved from: www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-c-basics/index.html

CDC, Viral Hepatitis – Statistics & Surveillance. (2016) Surveillance for Viral Hepatitis – United States 2014. Retrieved from www.cdc.gov/hepatitis/statistics/2014surveillance/commentary.htm#bkgrndC

The U.S. Department of Health and Human Services. (2016). Hepatitis B Basic Information. Retrieved from: www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-b-basics/index.html

John Hopkins Medicine. Gastroenterology and Hepatology. FAQs about Alcoholic Liver Disease. Retrieved from: www.hopkinsmedicine.org/gastroenterology_hepatology/diseases_conditions/faqs/alcoholic_liver_disease.html

Becker U, Deis A, Sørensen TI, Grønbaek M, Borch-Johnsen K, Müller CF, et al. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology 1996; 23: 1025-1029.

Center for Disease Control and Prevention. (2016). Liver Cancer. Retrieved from: https://www.cdc.gov/cancer/liver/

Center for Disease Control and Prevention. (2018). Hepatitis A Questions and Answers for the Public. Retrieved from: https://www.cdc.gov/hepatitis/hav/afaq.htm#overview

Center for Disease Control and Prevention. (2018). Hepatitis C Questions and Answers for the Public. Retrieved from: https://www.cdc.gov/hepatitis/hcv/cfaq.htm