Let's learn more about liver disease! Let's talk about this!

The liver is a very important organ in your body. It works like a filter in our body. It filters and removes toxins from the blood. But, there is a limit to what this filter can handle, right? Sometimes, this very job can damage the liver . So today, let's talk about liver diseases.

What is Liver Disease?

When we say 'liver disease', doctors are usually talking about conditions that damage the liver gradually, over time, or that are chronic . These can be caused by viral infections , various toxins, or certain metabolic conditions. The amazing thing is that the liver has an amazing ability to repair itself. But when it is constantly being used, that ability gradually diminishes.

What are the stages of chronic liver disease?

There are usually four main stages of liver disease that have been going on for a long time. Let's take a look at what they are.

Stage 1: Hepatitis

The first stage is hepatitis. Simply put, this is the swelling of the liver tissue. Just like when we get injured somewhere, it swells, when the liver is damaged or poisoned, this swelling occurs in response to that. This happens to eliminate the infection and start the healing process. This can be resolved with a sudden, temporary swelling (acute hepatitis). But if there is ongoing damage or poisoning, the swelling continues. Due to this long-term condition of hepatitis (chronic hepatitis) , as the liver tries to heal itself over time, scarring (fibrosis) eventually begins to form.

Stage 2: Fibrosis

The second stage is fibrosis. This is when scar tissue gradually builds up in the liver, making it stiff and stiff. It's like an old rag. This scar tissue reduces blood flow to the liver, which means less oxygen and nutrients are delivered to the liver. This is how the liver begins to slowly lose function. Surprisingly, some of this fibrosis can be reversed. That is, if the damage is reduced enough, liver cells can regenerate and scar tissue can be reduced.

Stage 3: Cirrhosis

The third stage is cirrhosis, which is severe, irreversible, permanent scarring of the liver.This is where fibrosis becomes irreversible. When the liver loses enough healthy cells to function, the tissue can no longer regenerate. However, even at this stage, there are ways to stop or slow down the damage. As cirrhosis begins to affect liver function, you may not notice much difference at first, as your body tries to compensate for the loss.

Stage 4: Liver failure

The final, or fourth, stage is liver failure. This is when the liver can no longer function to meet the body's needs. This is also called decompensated cirrhosis – which means the body can no longer make up for the loss of the liver. As the liver's functions gradually break down, you start to feel the effects throughout your body. Chronic liver failure is a gradual process, but without a liver transplant, it can eventually lead to death. Remember, we need a liver to survive.

How common are liver diseases?

If we talk about how common this liver disease is, it causes about 2 million deaths per year worldwide. That's about 4% of all deaths. Most deaths are due to complications of cirrhosis. Men are about twice as likely to develop this disease as women.

What are the first signs of liver disease?

Most of the time, these chronic liver diseases don't show any major symptoms in the early stages. But sometimes, it can start as a sudden, acute hepatitis. For example, if you have a viral hepatitis infection, there is an acute phase before it becomes chronic. During that time, you may have a fever, stomach ache, and nausea for a few days. If the immune system can't fight off the infection, it becomes a chronic infection.

Some other causes of liver disease can also cause sudden symptoms like these at first. Early symptoms of liver disease are usually not very obvious. They can include:

• Upper abdominal pain.
• Nausea orFood is tasteless .
• Fatigue and malaise (feeling generally tired and unwell).

What are the later symptoms of liver disease?

As your liver starts to function less, you may start to notice more symptoms. This is when liver disease is at its most advanced stage. One of the first side effects of liver failure is that bile flow becomes blocked. The liver can no longer make bile properly or pump it into the small intestine. Instead, bile starts to leak into the bloodstream. This can cause a number of specific symptoms:

• Jaundice (yellowing of the whites of the eyes and skin).
• Dark urine .
• Passing light-colored stool .
• Difficulty digesting food, especially fatty foods.
• Weight loss and muscle wasting.
• Musty-smelling breath.
• Mild impairment of brain function (hepatic encephalopathy).
• Pruritus (simply itching without any rash on the skin).

As liver disease gets worse, it can affect your blood circulation, hormones, and nutritional status. This can show up in a variety of ways. You may notice symptoms like these on your skin and nails:

• Spoon nails.
• Terry's nails (nails are pale, with only the tips pink).
• Nail clubbing is the swelling and curling of the nail base.
• Spider angiomas.
• Small red dots on the skin ``(petechiae)``.
• Yellow oil deposits on the skin or eyelids, appearing as small bumps.
• Easy bruising and bleeding .
• Redness of the palms.

You may also see signs of fluid leaking from blood vessels and accumulating in various parts of the body:

• Abdominal swelling (ascites).
• Swelling of the ankles, legs, hands, and face (edema).

Gender-specific characteristics

Women may experience symptoms like these due to liver disease:

• Irregular menstrual cycles.
• Difficulty having children (Female infertility).

Men may experience symptoms like:

• Shrunken testicles.
• Enlarged male breast tissue.

Complications of end-stage liver disease

End-stage liver disease is a condition in which the liver is unable to repair itself and gradually becomes dysfunctional, called decompensated cirrhosis and liver failure. Two of the most serious side effects at this stage are portal hypertension and hepatocellular carcinoma . Complications of these two conditions are the leading cause of hospitalization and death in people with cirrhosis and liver failure.

Portal hypertension

Portal hypertension is caused by scarring in the liver, which causes pressure on the portal vein. When the pressure in the portal vein increases, the body diverts blood to other veins that are connected to it. The veins then become enlarged, stretched, and thin. These veins can leak, burst, or bleed. This internal bleeding can be sudden, severe, and life-threatening.

Although rare, other complications may occur:

• Enlargement and hyperactivity of the spleen (hypersplenism).
• Respiratory system dysfunction `(hepatopulmonary syndrome)`.
• Kidney failure (hepatorenal syndrome).

Liver Cancer

Although not everyone with long-term liver disease will develop hepatocellular carcinoma, many people who develop liver cancer have long-term liver disease. The cycle of inflammation, healing, and scarring makes it more likely that liver cells will change and become cancerous. Doctors think that chronic hepatitis viruses, in particular, can also affect the DNA of liver cells.

What are the causes of liver disease?

There are over 100 types of liver disease, but they fall into several main subgroups. Causes include:

• Viral infections: Long-term viral infections such as hepatitis B and hepatitis C can cause chronic hepatitis.
• Alcohol-induced hepatitis: Excessive alcohol consumption can cause acute or chronic hepatitis. If this continues, it can lead to cirrhosis and liver failure. This is a relatively common cause in our country.
• Toxic hepatitis: Acute or chronic hepatitis can be caused by prolonged exposure to toxic substances, such as industrial chemicals or drugs.
• Non-alcohol related fatty liver disease (NAFLD): Metabolic conditions related to obesity, high blood sugar levels, and high blood lipid (fat) levels can cause excess fat to build up in the liver. This can lead to inflammation (non-alcohol related steatohepatitis – NASH). This condition is also seen in many people these days, especially due to poor eating habits.
• Biliary stasis: Some congenital conditions, such as biliary atresia and cystic fibrosis, can cause bile to accumulate and damage the liver by blocking or obstructing the flow of bile through the bile ducts. Causes that occur after birth include biliary stricture and gallstones.
• Autoimmune diseases: Autoimmune conditions such as autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis can cause long-term swelling and scarring of the liver or bile ducts.
• Inherited metabolic disorders: Disorders that cause toxins to accumulate in the blood, such as glycogen storage disease (GSD), Wilson disease, hemochromatosis, and Gaucher disease, can cause long-term damage to the liver.
• Cardiovascular diseases: Conditions that affect the liver and blood flow through it, such as Budd-Chiari syndrome, ischemia, coronary artery disease, and right-sided heart failure, can cause long-term damage to the liver.

What are the risk factors for liver disease?

You may be more likely to develop liver disease if you:

• If you drink too much alcohol.
• If you take drugs through a vein, it is called ``intravenous drugs''.
• If you frequently use painkillers such as aspirin or paracetamol (especially in high doses without medical advice).
• If you have metabolic syndrome (a combination of obesity, high blood pressure, high blood sugar, and unhealthy cholesterol levels).
• If you are frequently exposed to toxic chemicals.
• If you are frequently exposed to the blood or body fluids of others (e.g. healthcare workers, tattoo artists).

How to diagnose liver disease?

A doctor who is checking for liver disease will first examine you physically. They will look for signs and symptoms and ask about your symptoms. They may also ask about your diet, lifestyle, and health history. Then, they will use lab tests and imaging scans to determine if you have liver disease. These may include:

• Blood tests: A series of liver function tests can show symptoms of liver disease, the severity of the disease, and signs of liver failure. These measure things like liver enzymes, protein, and bilirubin levels. Blood tests can also show side effects like swelling, specific diseases, or decreased blood clotting.
• Imaging tests: An abdominal ultrasound, CT scan (computed tomography scan), or MRI (magnetic resonance imaging) scan can show the size, shape, and condition of the liver. This can help detect swelling, nodules, and fibrosis.
• Elastography: This is a special imaging test that uses ultrasound or MRI technology to measure the stiffness, or level of fibrosis, of the liver.
• Endoscopy:If your doctor wants to look inside your bile duct system, they will need to use an imaging procedure called an endoscopy. This involves inserting a small camera (endoscope) through your mouth and passing it down your digestive tract. The bile ducts can then be viewed using either EUS (endoscopic ultrasound) or ERCP (endoscopic retrograde cholangiopancreatography).
• Nuclear medicine imaging: This involves injecting a harmless radioactive substance into the body and using a gamma camera to detect it. Depending on how your liver absorbs the substance, it can show where it is not working properly.
• Liver biopsy: This is a minor procedure. A small sample of tissue is taken from the liver and tested in a laboratory. This sample is usually taken using a hollow needle. A liver biopsy may be done to check for cancer, confirm cirrhosis, and find the cause.

How are liver diseases treated?

Some types of liver disease have specific medical treatments. For example, antivirals are given for viral hepatitis, and corticosteroids and immunosuppressants are given for autoimmune diseases. But in most cases, lifestyle changes are the main treatment for liver disease. Reducing the amount of toxins entering the liver is important for any liver disease. This is especially important for liver disease caused by excess fat, alcohol, or other toxins.

However, early detection is essential to effectively treat liver disease before permanent damage occurs. Unfortunately, not everyone is diagnosed at the time when the disease is reversible. If you already have cirrhosis or liver failure, you may need additional treatment for complications such as portal hypertension or liver cancer. Your liver may not be able to heal, and you may eventually need a liver transplant.

How to reduce the risk of liver disease?

You can do these things to protect yourself from liver disease:

• Getting vaccinated: There are vaccines to protect against viral hepatitis A and B.
• Good hygiene: Things like washing hands after using the toilet, preparing food safely, and using needles safely can help prevent the spread of infections.
• Limit alcohol use and take medications as prescribed: If you have a substance use disorder (e.g., `Substance Use Disorder – SUD`), getting treatment can help prevent hepatitis caused by toxins.
• Controlling metabolic factors such as blood lipids (fats) and blood sugar: You can get help from a doctor for this.

Is liver disease reversible?

Early liver disease can be reversed if the cause is identified and you and your medical team work together to eliminate or control it. This depends on what the cause is and how well it can be treated. If you have cirrhosis, you can't reverse the damage that's already done. But you can prevent further damage or slow it down. Chronic liver failure can't be reversed, but it can take years to get worse.

Can liver disease be cured?

Many types of liver disease can be cured. Liver disease caused by toxins and alcohol usually improves once you stop being exposed to those toxins. Non-alcohol related fatty liver disease can be cured with dietary and lifestyle changes. Some other types of liver disease cannot be cured, but they can be managed with medication. Some hereditary diseases, autoimmune diseases, and viral infections may require lifelong treatment.

What should I do when living with liver disease?

If you have liver disease, do these things to take care of your liver:

• Maintain a healthy diet: Prioritize whole foods, fruits and vegetables, and lean proteins.
• Maintaining a healthy BMI (Body Mass Index): Consult your doctor about this.
• Avoiding alcohol, tobacco, and over-the-counter medications: Ask your doctor for help quitting.
• Take medications only as prescribed: Talk to your doctor about any new medication you take.
• Protecting against infections: Prevent further burden on the liver with good hygiene and safe sex practices.
• Keep up with your doctor's appointments: Get regular checkups and identify complications early.