With a chronic liver disease, your liver may not work properly. Essential functions that your liver performs can be compromised, placing a strain on the liver, and on other organs and systems within your body. When the liver is diseased, it may not be able to do things like break down saturated fats, make bile for food digestion, and create blood proteins that support the immune system. Liver disease can develop from different causes, including infectious diseases, genetic disorders like autoimmune diseases or metabolic disorders, or from long-term alcohol use.

Early detection increases your chance of recovery. During the early stages of disease, the liver often becomes inflamed; however, there may be no symptoms. This makes early diagnosis difficult.

Unfortunately, most liver conditions are not diagnosed until after they become chronic and potentially life-threatening diseases, like cirrhosis, liver cancer or liver failure.

The specially trained affiliated physicians at Memorial Hermann are experienced in determining the extent of the condition, and can recommend a course of treatment to manage your disease.

What Is the Liver?

Avital organ located on the right side of the upper abdomen, your liver is the largest and most complex solid organ in your body. When the liver does not function well, many of your body systems can be affected.

The normal functions of the liver include:

  • Metabolic Functions: The liver metabolizes nutrients, breaks down toxins and drugs, and generates glucose for energy.
  • Carbohydrates: The liver stores energy in the form of glycogen and generates glucose for energy.
  • Fat: The liver has a key role in the metabolism of fat and cholesterol.
  • Manufacturing of Proteins: The liver makes essential proteins including albumin, blood clotting factors, hormones, enzymes and immune factors.
  • Bile Production: The liver produces bile that aids in digestion of dietary fat and provides clearance of waste products such as bilirubin.

What Are the Types of Chronic Liver Disease?

Chronic liver diseases fall into broad categories, based on how the disease began. They can be infectious (originating from a viral infection like Hepatitis B or Hepatitis C), alcohol-related from long-term abuse, or genetic. Inherited (genetic) liver disease may originate from an underlying autoimmune or metabolic disorder.

Infectious

Chronic hepatitis C is a long-lasting viral infection that occurs when the body is unable to fight off the hepatitis C virus, which is spread through contact with an infected person’s blood. About 75 percent to 85 percent of people with acute (severe and sudden in onset) Hepatitis C will develop chronic hepatitis. Many people who have Hepatitis C do not have symptoms and do not know they have the infection. Without treatment, chronic Hepatitis C can cause chronic liver disease, cirrhosis, liver failure or liver cancer.

Chronic hepatitis B is a long-lasting viral infection that occurs when the body is unable to fight off the hepatitis B virus, causing liver inflammation and damage. Hepatitis B is primarily spread through sexual contact or through injecting illegal drugs. Since doctors began recommending children receive the hepatitis B vaccine in 1991, the rate of new diagnoses in the U.S. has decreased 82 percent, according to the Centers for Disease Control and Prevention.

Alcohol-Related

Alcoholic liver disease (ALD) is damage to the liver that affects its functioning due to long-term alcohol abuse, resulting in scarring and, ultimately, cirrhosis. ALD is more common in people between 40 and 50 years of age. ALD tends to be more prevalent in men, although women may develop it after less exposure to alcohol than men. Some people may have an inherited risk for the disease.

Cirrhosis

Cirrhosis is a condition in which the liver slowly deteriorates and is unable to function normally due to chronic injury. According to the National Institutes of Health, cirrhosis is the 12th leading cause of death in the U.S. and is more prevalent among men than women. Early-stage symptoms may include fatigue, abdominal swelling, tenderness and pain, lack of appetite and weight loss. Later-stage symptoms may include jaundice, darkened urine, bleeding/bruising, enlarged liver and spleen, swelling in the legs and abdomen, vomiting blood, itching, forgetfulness or confusion, tremors and other symptoms. The leading causes of cirrhosis are chronic Hepatitis C, ALD and nonalcoholic steatohepatitis (NASH), which is fat build-up in the liver that is unrelated to alcohol consumption.

Autoimmune

Autoimmune hepatitis occurs when the body’s immune system attacks its own liver cells, resulting in inflammation in the liver and, if left untreated, cirrhosis of the liver. Researchers believe genetics, or inherited genes, may make some people more likely to develop autoimmune diseases. At least 70 percent of those with autoimmune hepatitis are female.

Primary biliary cholangitis (PBC) is an autoimmune disease in which the body’s immune system attacks the small bile ducts of the liver, leading to duct obstruction and bile spilling into the liver tissue. The progression of PBC can be slowed with agents that improve the flow of bile through the bile ducts. In some cases, PBC can lead to cirrhosis. It is more common in women.

Primary sclerosing cholangitis (PSC) is an autoimmune disease in which inflammation (cholangitis) causes scarring (sclerosis) in the bile ducts. Early symptoms may include fatigue and itching. Later symptoms may include upper abdominal pain, fever, chills, night sweats, enlarged liver or spleen, weight loss or jaundice. Although PSC can occur at any age, it is more prevalent in people in their 40s, is more common in men (60 percent) than women (40 percent), and often occurs in the presence of inflammatory bowel disease (IBD).

Metabolic Disorders

Alpha1-antitrypsin deficiency is a genetic (inherited) disorder that can cause liver and lung disease in individuals of any age. Liver-related symptoms include unexplained liver disease or elevated liver enzymes, eyes and skin turning yellow (jaundice), swelling of the abdomen (ascites) or legs, and vomiting blood (from enlarged veins in the esophagus or stomach).

Tyrosinemia (or tyrosinaemia) is a genetic disorder in which the body lacks an enzyme necessary to break down the amino acid tyrosine. As a result, tyrosine and its byproducts reach toxic levels, which can damage and destroy cells in the liver, kidneys, nervous system and other organs. Symptoms typically appear shortly after birth and, depending on the type of the disease (acute or chronic), may include the inability to gain weight, enlarged liver and spleen, abdominal swelling, jaundice, swelling of the legs, increased tendency to bleed, vomiting or diarrhea.

A glycogen storage disease is a metabolic disorder, either genetic or acquired, caused by enzyme deficiencies affecting either glycogen synthesis, glycogen breakdown or glycolysis (glucose breakdown), typically within muscles and/or liver cells. Symptoms can include slow growth, low muscle tone, heat intolerance, bruising, low blood sugar (hypoglycemia), enlarged liver, abdominal swelling and muscle pain, and cramping during exercise.

Maple syrup urine disease (MSUD) is a genetic disorder in which the body is unable to process certain amino acids properly. The disorder’s name is derived from the distinctive sweet odor of affected infants’ urine. It is characterized by poor feeding, vomiting, lack of energy (lethargy), abnormal movements and delayed development. If left untreated, it can lead to seizures, coma and death.

Wilson’s Disease is a genetic disorder in which excessive amounts of copper accumulate in the body, especially in the liver, brain and eyes. Symptoms usually appear between the ages of 6 and 45 (but most often in teenage years) and include a combination of liver disease (especially in affected children and young adults) and neurological and psychiatric problems. Liver-related symptoms include jaundice, fatigue, loss of appetite and abdominal swelling.

Urea cycle deficiency is a genetic disorder that results in a deficiency of one of the six enzymes in the urea cycle that are responsible for removing ammonia from the blood stream. This results in elevated blood ammonia that can cause irreversible brain damage, coma and/or death. Symptoms can occur in infancy, childhood or adulthood and can include lack of appetite, growth failure, vomiting, lethargy, poor muscle tone, respiratory distress, developmental delays and psychiatric problems.

Other Liver Conditions

Acute liver failure (ALF)/Acute hepatic necrosis is a relatively uncommon condition characterized by the abrupt onset of severe liver failure. Symptoms may include malaise, fatigue, nausea, abdominal discomfort or jaundice. Symptoms typically appear within one to 14 days and may include nausea, weakness, fatigue and abdominal pain. Other organ failure, such as lung, kidney or bone marrow, may also be present. Causes can include acetaminophen poisoning (leading cause of AFL), viral infection (hepatitis), blockage of blood vessels to the liver, autoimmune diseases, genetic disorders (most commonly Wilson’s Disease in adults) or unknown causes.

Biliary atresia (BA) is a life-threatening condition affecting newborns characterized by absent or malformed bile ducts. Usually identified shortly after birth, it is the most common cause of liver failure and transplant in children.

What Are the Causes of Chronic Liver Diseases?

An estimated 400,000 Americans are affected by chronic liver disease, and 15 percent to 20 percent of these patients have symptoms of cirrhosis by the time they are diagnosed. Cirrhosis is the 12th leading cause of death in the United States.

The causes of chronic liver disease include:

  • Long-term infection of hepatitis B or C
  • Fatty liver disease (a condition associated with diabetes and obesity)
  • Long-term alcohol abuse
  • Bile duct disorders
  • Metabolic disorders
  • Autoimmune inflammation

What Are the Symptoms of Chronic Liver Diseases?

Symptoms of chronic liver diseases will vary by disease, but may include nausea, fatigue, poor appetite, diarrhea, abdominal pain and swelling, jaundice, weakness or itchy skin.

What Are the Risk Factors of Chronic Liver Diseases? How Can Chronic Liver Diseases Be Prevented?

Certain lifestyle choices and hereditary conditions may put you at a higher risk of developing chronic liver diseases:

  • Moderate to heavy alcohol use, defined as 4 drinks per day for men and 2 drinks per day for women
  • Exposure to other people’s blood and bodily fluids, including unprotected sex
  • Drug use with shared needles
  • Exposure to toxins and chemicals, including pesticides
  • Family history of liver conditions, including hepatitis B, hepatitis C, hemochromatosis or liver cancer
  • Obesity
  • Diabetes
  • High cholesterol

Here are some steps you can take to reduce your risk of developing chronic liver diseases:

  • Limit alcohol use
  • Maintain a healthy weight
  • Get vaccinated for hepatitis A and hepatitis B
  • Use condoms during sex
  • Avoid illicit intravenous drugs; do not share needles
  • Protect yourself from toxin exposure; wear gloves and a mask when working with toxic chemicals like insecticides and paint

How Are Chronic Liver Diseases Diagnosed?

Unfortunately, chronic liver diseases often show few or no symptoms until the disease is fairly advanced. If you suspect you may have a liver condition, your physician may take the following steps to make a diagnosis:

  • Physical exam and health-history evaluation
  • Blood tests, including liver function tests
  • Liver biopsy (a small amount of liver tissue is removed with a needle and examined)
  • Imaging tests, including CT scan, MRI or ultrasound

How Are Chronic Liver Diseases Treated?

If your liver fails, a liver transplant – surgery to replace your diseased liver with a healthy liver from another person – can save your life.

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