Liver Diseases

The liver lies on the right side of the abdominal cavity beneath the diaphragm. It has many functions, including the metabolism of fats, conversion of glucose to glycogen, production of urea, amino acid synthesis, storage of vitamins and minerals, filtration of harmful substances from the blood, and maintenance of the proper level of glucose in the blood. The liver is also responsible for producing about 80 percent of the cholesterol in the human body. Liver disease is a broad term describing any number of diseases affecting the liver. Many are accompanied by jaundice, caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; the liver normally removes bilirubin from the blood and excretes it through bile.

There are many different kinds of liver diseases that require clinical care by a physician or other healthcare professional. Some of the more common liver diseases are listed below with a brief description of each for general information, bearing in mind that a diagnosis should always be made in person by a physician or healthcare professional:

• Amebic liver abscess is a type of liver abscess caused by amebiasis. The parasite enters the gastrointestinal tract and, once it reaches the bloodstream, it can spread throughout the body, most frequently ending up in the liver, causing liver abscess. Most patients show symptoms of weight loss, earthy complexion, profuse sweating, fever, and pain in right hypochondrium. Patients also show signs of pallor, tenderness and rigidity in right hypochondrium, palpable liver, intercostals tenderness, and basal lung signs. Infections can be prevented by good sanitary practices.
• Autoimmune hepatitis is a cell-mediated immune response to the body's own liver, due to a genetic predisposition or acute liver infection, which has a presentation of human leukocyte antigen class II on the surface of hepatocytes. Diagnosis is best achieved when clinical, laboratory, and histological findings are employed. Treatment is done with glucocorticoids and immunosuppressive drugs.
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• Biliary atresia is a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. Cause of the condition is currently unknown, and the only effective treatments are certain surgeries or liver transplantation. Initially, symptoms are indistinguishable from neonatal jaundice. Symptoms, usually evident between one and six weeks after birth, include clay-colored stools, dark urine, swollen abdominal region, and large hardened liver.
• Cirrhosis is characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules, leading to progressive loss of liver function. Ascites, fluid retention in the abdominal cavity, is the most common complication of cirrhosis, and is associated with a poor quality of life, increased risk of infection, and poor long-term outcome. Cirrhosis is generally irreversible and treatment focuses on preventing progression and complication.
• Hemochromatosis is a hereditary disease that causes the accumulation of iron in the body, eventually leading to liver disease. It is associated to the iron accumulation associated with the HFE gene (hemochromatosis type 1). Hemochromatosis less often refers to the condition of iron overload as a consequence of multiple transfusions. Causes can be primary (generally genetic) and secondary (due to other conditions).
• Hepatitis A is an acute infectious disease of the liver caused by the hepatitis A virus, which is most commonly transmitted by the fecal-oral route via contaminated food or drinking water. Symptoms include fatigue, fever, abdominal pain, nausea, diarrhea, appetite loss, depression, and jaundice. Hepatitis A does not have a chronic stage, it is not progressive, and it does not cause permanent liver damage. Following infection, the immune system makes antibodies against the virus that confer immunity against future infection. The disease can be prevented by vaccination.
• Hepatitis B is a disease caused by the hepatitis B virus, which infects the liver and causes inflammation. The acute illness causes liver inflammation, vomiting, jaundice, and, rarely, death. Symptoms include nausea, loss of appetite, body aches, vomiting, mild fever, dark urine, and jaundice. Hepatitis B is transmitted through body fluids, against which prevention should be taken. Infants may be vaccinated at birth.
• Hepatitis C is an infectious disease affecting the liver caused by the hepatitis C virus. The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver, fibrosis, and cirrhosis. Hepatitis C is spread by blood-to-blood contact. Hepatitis C may be suspected based on medical history, unexplained symptoms, and abnormal liver enzymes or liver function test found during routine blood testing. There is currently no vaccine that protects against hepatitis C.
• Liver cancer: multiple types of tumors can develop in the liver because the liver is made of up many various cells. Liver cancer is often characterized by the presence of malignant hepatic tumors. Hemangiomas are the most common type of benign liver tumor that begins in blood vessels. Hepatic adenomas are benign epithelial liver tumors that develop in the liver and are also an uncommon occurrence. Focal nodular hyperplasia is the second-most-common tumor in the liver, and is a result of congenital artiovenous malformation hepatocyte response. There are many cancers that begin in the liver, including hepatocellular carcinoma, hepatoblastoma, cholangiocarcinomas, angiosarcomas, and hemangiosarcomas.
• Primary biliary cirrhosis is an autoimmune disease of the liver, marked by the slow, progressive destruction of the small bile ducts within the liver. When these ducts are damaged, bile builds up in the liver and over time damages the tissue. Patients show signs and symptoms of fatigue, itchy skin, jaundice, xanthoma, and complications of cirrhosis and portal hypertension. Liver function tests, ultrasound, and CT scan aid in diagnosis.
• Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to the liver as well as many other organs including the brain. The cause is currently unknown. Reye's progresses through five stages. The first-stage signs and symptoms include heavy vomiting, lethargy, nightmares, and mental symptoms (such as confusions). Stage two signs and symptoms include stupor, hyperventilation, fatty liver, and hyperactive reflexes. Stage [Page 259]three is a continuation of stages one and two, with a possible coma and possible cerebral edema. Stage four is a deepening coma, large pupils with minimal response to light, minimal but still present hepatic dysfunction. Stage five has a very rapid onset following stage four and includes a deep coma, seizures, multiple organ failure, flaccidity, extremely high blood ammonia, and death; thus early diagnosis is vital.
• Wilson's disease, also known as hepatolenticular degeneration, is an autosomal-recessive genetic disorder in which copper accumulates in tissues. This manifests in liver disease as well as neurological and psychiatric symptoms. The liver disease may present as tiredness, increased bleeding tendency, or confusion and portal hypertension. Wilson's disease is caused due to mutations in the Wilson's disease protein gene. A liver biopsy is the most ideal test for a diagnosis of Wilson's disease. A low copper diet is highly recommended for patients, and liver transplantation may be necessary.
• Primary sclerosing cholangitis is a chronic liver disease caused by progressive inflammation and scarring of the bile ducts of the liver. The inflammation impedes the flow of bile to the gut, which can ultimately lead to liver cirrhosis and liver failure. The underlying cause of the inflammation is believed to be autoimmunity. Symptoms include fatigue, severe jaundice, signs of cirrhosis, dark urine, pale stools, malabsorption and steatorrhea, and ascending cholangitis. Imaging of the bile duct makes diagnosis. The definitive treatment is liver transplant.

The symptoms related to liver disease and dysfunction include both physical signs and a variety of symptoms related to digestive problems, blood sugar problems, immune disorders, abnormal absorption of fats, and metabolism problems.

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