liver_disease

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liver disease

Liver disease (also called hepatic disease) is a broad term describing any single 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; normally, the liver removes bilirubin from the blood and excretes it through bile.

Diseases

• Hepatitis, inflammation of the liver, caused mainly by various viruses but also by some poisons (e.g. alcohol), autoimmunity (autoimmune hepatitis) or hereditary conditions.

• Non-alcoholic fatty liver disease, a spectrum in disease, associated with obesity and characterized as an abundance of fat in the liver; may lead to a hepatitis, i.e. steatohepatitis and/or cirrhosis.

• Cirrhosis is the formation of fibrous tissue in the liver, replacing dead liver cells. The death of the liver cells can for example be caused by viral hepatitis, alcoholism or contact with other liver-toxic chemicals.

• Haemochromatosis, a hereditary disease causing the accumulation of iron in the body, eventually leading to liver damage.

• Cancer of the liver (primary hepatocellular carcinoma or cholangiocarcinoma and metastatic cancers, usually from other parts of the gastrointestinal tract).

• Wilson's disease, a hereditary disease which causes the body to retain copper.

• Primary sclerosing cholangitis, an inflammatory disease of the bile duct, likely autoimmune in nature.

• Primary biliary cirrhosis, autoimmune disease of small bile ducts.

• Budd-Chiari syndrome, obstruction of the hepatic vein.

• Gilbert's syndrome, a genetic disorder of bilirubin metabolism, found in about 5% of the population.

• Glycogen storage disease type II, the build-up of glycogen causes progressive muscle weakness (myopathy) throughout the body and affects various body tissues, particularly in the heart, skeletal muscles, liver and nervous system.

There are also many pediatric liver disease, including biliary atresia, alpha-1 antitrypsin deficiency, alagille syndrome, and progressive familial intrahepatic cholestasis, to name but a few.

Symptoms of a diseased liver

The external signs include a coated tongue, bad breath, itchy skin, excessive sweating, offensive body odor, dark circles under the eyes, red swollen and itchy eyes, acne rosacea, brownish spots and blemishes on the skin, flushed facial appearance or excessive facial blood vessels.[http://www.liverdoctor.com/index.php?page=symptoms Dr Sandra Cabot - The Liver Doctor]

Other symptoms include jaundice, dark urine, pale stool, bone loss, easy bleeding, itching, small, spider-like blood vessels visible in the skin, enlarged spleen, fluid in the abdominal cavity, chills, pain from the biliary tract or pancreas, and an enlarged gallbladder.[http://www.umm.edu/liver/common.htm University of Maryland - Symptoms of Liver Disease]

The symptoms related to liver 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.

The malabsorption of fats may lead to symptoms that include indigestion, reflux, deficit of fatsoluble vitamins, hemorrhoids, gall stones, intolerance to fatty foods, intolerance to alcohol, nausea and vomiting attacks, abdominal bloating, and constipation.

Nervous system disorders include depression, mood changes, especially anger and irritability, poor concentration and "foggy brain", overheating of the body, especially the face and torso, and recurrent headaches (including migraine) associated with nausea.

The blood sugar problems include a craving for sugar, hypoglycaemia and unstable blood sugar levels, and the onset of type 2 diabetes.

Abnormalities in the level of fats in the blood stream, whether too high or too low levels of lipids in the organism. Hypercholesterolemia: elevated LDL cholesterol, reduced HDL cholesterol, elevated triglycerides, clogged arteries leading to high blood pressure heart attacks and strokes, build up of fat in other body organs (fatty degeneration of organs), lumps of fat in the skin (lipomas and other fatty tumors), excessive weight gain (which may lead to obesity), inability to lose weight even while dieting, sluggish metabolism, protuberant abdomen (pot belly), cellulite, fatty liver, and a roll of fat around the upper abdomen (liver roll) etc. Or too low levels of lipids: hypocholesterolemia: low total cholesterol, low LDL and VLDL cholesterol, low triglyderides.

Liver function tests

A number of liver function tests are available to test the proper function of the liver. These test for the presence of enzymes in blood that are normally most abundant in liver tissue, metabolites or products.

The liver is the only organ that can completely heal itself.

If alcohol-induced liver disease is suspected, blood tests and imaging tests (MRI, CT scan, or ultrasound) may help in diagnosis and to rule out other causes of liver disease but proof is best established by liver biopsy. American Liver Foundation. [http://www.liverfoundation.org/education/info/alcohol "Alcohol-Induced Liver Disease"] 2010-02-09.

The X-rays are painless procedures which provide images of the organs. They use invisible radioactive waves which are passed through the body in order to obtain an image. There is a specific X-ray known as the hepatic angiography which is used to investigate the veins and arteries that supply blood to the liver. Usually an X-ray is requested only if the CT scan or MRI do not show conclusive information. During a hepatic angiography, a thin and flexible tube is inserted into a blood vessel through a cut into the groin. Then a dye is injected, which lights up the blood vessels for better visualization. This procedure is generally performed under local anesthetic and it is not painful but may be uncomfortable.

Imaging

One of the first tests a patient may be required to take is the ultrasound. This is a routine procedure that is not harmful in any way to the patient since it does not utilize radioactive waves. It normally takes up to 15 minutes to be completed. Before the procedure is performed, a gel is applied on the skin. Its main purposes are to promote easy movements and to make sure that wave sounds are directed through the skin. The solid masses are turned into images that are seen on a monitor by a radiologist. The pictures are recorded and the radiologist will make a report which is to be discussed with the patient's doctor during a specific appointment.

The CT scan or the computed tomography is a painless procedure used in order to obtain pictures of the body organs and tissues. Unlike the ultrasound, the CT scan uses radiation but with minimal risks. The tomograms taken by a CT scanner can show if there are any abnormalities in the lungs, bones, soft tissues and blood vessels. It is mostly used for studying the abdomen and chest and it can take up to 30 minutes. The CT scanner is a large machine, in which the patient is moved forward and backwards. Before the test is taken, the patient gets an iodine dye into a vein which helps visualizing blood vessels and kidneys and also makes it easier to observe differences between normal and abnormal tissue in the liver and other organs.

The magnetic resonance imaging (MRI) is able to get more detailed images than a CT scan. It is a new technology, a kind of a tube scanner used to create magnetic fields by releasing radio frequency energy. The MRI is mostly used to observe and investigate tumors before and after treatment. It is not a painful procedure and a regular scan session does not usually takes more than 30 minutes. However, some patients may feel claustrophobic during the scan. Some of the patients who have specific implants may not have a MRI due to the existence of metal in their bodies.

Treatment of liver diseases

The treatment of liver disease is different depending on the type of condition. Liver diseases affect the proper functioning of the liver. [http://www.liverinfection.net/ Liver Infection symptoms and treatment] 2010-02-09 Treatment for liver diseases is normally directed towards the relief of symptoms and complications. Most of the time is focused on avoiding the risk factors.

All types of hepatitis are taken care of with intravenous therapy fluids due to the dehydration caused by vomiting and diarrhea. Usually, patients whose symptoms are not severe, can treat the disease at home, otherwise, hospitalization may be needed. Medication for nausea and vomiting is also available. Hepatitis B and C may become chronic and unfortunately, there is no medication that can prevent this to happen. Once hepatitis B becomes chronic, it may be treated with antiviral drugs but this type of medication is not effective on all patients. Chronic hepatitis C is treated with the so called pegylated interferon alpha agent (Pegasys or PEG-Intron) that may be combined with an antiviral called ribavirin. The treatment for chronic hepatitis B and C is given based on the results of several tests regarding the functioning of the liver and the type of medication administrated is decided after consulting a gastroenterologist and a liver specialist. However, the usage of interferon in order to treat hepatitis C may be restricted in cases of active alcohol abuse or drug abuse, in cases of depression, autoimmune diseases or low hemoglobin levels.

Treatment for cirrhosis is mainly directed towards the relief of complications. Medication may be used to treat the underlying cause. Some of these include steroids, penicillamine and an anti-inflammatory agent such as colchicine. Their effect is still being studied and at this moment they do not seem to improve the patient's condition. Cirrhosis caused by portal hypertension may be treated with beta blockers that lower the blood pressure.

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