Your liver is a very uncomplaining organ. There is very little evidence that the liver has an ageing problem and without disease it can function fully right into old age. Most liver disease does not show symptoms and, when it does, the symptoms are often vague. There are hundreds of liver disorders but some are quite rare. The most common are:
Hepatitis
Hepatitis literally means inflammation of the liver. Viruses are usually the cause but there are others which are non-viral, such as alcohol excess and the side effects of some drugs and medicines, whether illegal or prescribed. There is also a disease called autoimmune hepatitis.
Viral hepatitis
Your liver can fall prey to an alphabet of viruses, namely hepatitis A, B, C, D, E and possibly G. There isn’t a hepatitis F – it’s been missed out so far! The main difference between the viruses is how they are spread and the effects they have on your health. Hepatitis A, B and C are the most common in the UK.
Hepatitis A
This is spread by eating food or drinking water which is contaminated with the hepatitis A virus (HAV), usually in countries where hygiene standards and sanitation are poor. There is a vaccine for this virus.
Hepatitis B
Is mainly passed on by exposure to infected blood. Globally, infection is usually passed from mother to baby. In developed countries such as the UK the spread is mainly caused by drug use and sexual contact. Approximately two billion people worldwide have been exposed to hepatitis B, with 350 million chronic carriers reported. 75% of the global population currently live in areas of high infection. Hepatitis B is 100 times more more infectious than HIV, yet there is a vaccine to prevent infection.
Hepatitis C
This is also a ‘blood borne’ virus. Before September 1991 it was possible to be infected with hepatitis C (HCV) from contaminated blood transfusions and blood products. Since then all blood donations have been screened for the virus (and HBV). In some people the route of infection is not known but in many others injecting drugs is the cause. Users are thought to become infected by sharing injecting equipment. It takes just a tiny amount of blood from someone carrying the virus to spread the infection if it gets into someone else’s bloodstream. There is no vaccine to prevent HCV.
Most people recover from hepatitis A with no lasting liver damage but B and C can cause long term liver disease, leading to cirrhosis and even liver cancer. In many cases there are no early warning symptoms until liver damage is far advanced.
Autoimmune Hepatitis
This disease mainly affects women, usually just after the onset of puberty or around the time of the menopause. It is thought to be caused by the body’s defence system malfunctioning and attacking the liver. The most common symptoms in the early stages are fatigue and generally feeling unwell. However, the condition can be controlled with drugs which work by dampening down the immune system’s aggressive reaction to the liver.
Cirrhosis
It is a popular misconception that cirrhosis and hence liver disease only affects men who drink too much alcohol over the years. Cirrhosis can affect both men and women. As well as alcohol misuse it can result from long term infection with hepatitis B and C viruses, inherited liver disorders such as haemochromatosis and bile duct diseases such as primary biliary cirrhosis.
The onset of cirrhosis is usually ‘silent’, meaning that it presents few early warning symptoms. Cirrhosis is a result of long term continuous liver damage. If your liver is damaged for a short time some of the cells will die and your liver may re-grow to its original size and shape. However, when the inflammation is severe and continuous, scar tissue (fibrosis) develops. Smooth liver tissue is replaced by irregular nodules and the liver becomes much harder than normal. The combination of nodules and fibrosis is called cirrhosis.
Once cirrhosis has developed it is usually considered irreversible, even when the inflammation which caused it has improved. Recent studies in treating hepatitis C with antiviral therapy such as interferon alpha or pegylated interferon alpha suggest that there can be some reversal in fibrosis and even cirrhosis. More studies are required to determine whether this will also apply to other liver diseases.
Alcoholic Liver Disease
Not everyone who drinks too much alcohol will develop liver damage. It is still unclear why this occurs to certain people but there is some evidence that it could be due in part to a combination of factors including a genetic susceptibility.
Consistent heavy drinking can lead to what is known as a fatty liver in which your liver cells become swollen with excess fat. More seriously it may cause an inflamed liver condition known as alcoholic hepatitis or, ultimately, a permanently scarred and damaged liver – cirrhosis.
Generally the more alcohol you drink, together with an increased frequency of drinking occasions, the more likely you are to develop cirrhosis.
Gallstone and gallbladder disease
Around five million people in the UK or approximately 10 per cent of the population will develop gallstones or gallbladder disease at some time in their lives. Gallstones are lumps of solid material that form in the gallbladder and usually resemble small stones or gravel, although some can be as large as pebbles. Most are the size of a pea and may take many years to grow.
Anyone can get gallstones but middle aged, overweight women have the highest risk.
Inherited liver disease
It is possible for you to be born with a liver disease which may not produce symptoms until adulthood.
Haemochromatosis
This is an inherited metabolic disorder in which the body absorbs and stores more iron from food than it actually needs. It can prove fatal if not recognised and treated early enough. For many years haemochromatosis was thought to be rare. But recent research has discovered that the disease is much more common than first realised. In fact it is one of the most commonly inherited disorders among people of Northern European origin and is estimated to affect one person in 300.
Wilson's disease
Is also inherited and causes excessive amounts of copper to accumulate in the body. Copper, unlike other damaging metals such as lead and mercury, is essential to health. However, in Wilson’s disease the body’s inability to get rid of the excess results in an accumulation of copper in several organs.
The liver is the first organ to store copper. When its storage capacity is exhausted, the overflow passes from the liver to the bloodstream and is carried to other organs, including the brain and the cornea of the eye. In a few cases the copper accumulation can result in psychiatric disorders or physical symptoms such as slurred speech, drooling or tremors.
Primary sclerosing cholangitis
Is a bile duct disease in which the bile ducts inside and outside the liver become narrower because of inflammation and scarring. This causes the bile normally carried away by the ducts to stay within the liver, resulting in damage. It is not known what causes PSC but it often occurs in people with an inflammatory bowel disease, most commonly ulcerative colitis. Men are twice as likely to be affected as women, usually between the ages of 25 and 45, but it can also affect children as young as two years.
Primary biliary cirrhosis
In primary biliary cirrhosis (PBC) your own immune system damages the small bile ducts inside the liver, so that bile cannot be efficiently secreted. The term PBC is misleading because cirrhosis does not always follow, and if it does it can take many years to develop. Middle-aged women are most commonly affected, but the disease can affect anyone.
Paracetamol poisoning
Accidental or deliberate self-poisoning with paracetamol has been a serious cause of liver disease and liver transplantation in the UK. In recent years, however, it has declined. This is possibly due to a reduction in the paracetamol pack sizes on sale to the general public. A useful resource on this issue is the Paracetamol Information Centre.
Cancer of the liver
Cancer of the liver is divided into two main types: primary liver cancer (hepatocellular carcinoma, or HCC) which means cancer that starts in the liver, and secondary liver cancer (or metastatic cancer) meaning cancer that spreads to the liver from another part of the body. There are estimated to be more than 2,500 new cases of primary liver cancer and 70,000 new cases of secondary liver cancer every year in the UK.
In the UK most people who develop primary liver cancer have cirrhosis which may develop from a variety of causes. Primary liver cancer is not easy to diagnose in the early stages because its symptoms are usually vague. Typical symptoms include loss of appetite, weight loss, a general feeling of poor health, jaundice, fever, fatigue and weakness.