Definition and Overview

Chronic liver disease (CLD) is a term that refers to a number of progressive medical conditions that affect the liver. They are considered chronic if they last for at least six months. These include chronic hepatitis, cirrhosis, and liver cancer.

The liver is the largest abdominal organ that plays a crucial role in the digestive process. It works together with the pancreas, gallbladder, and intestines to digest, absorb, and process food. It also produces blood clotting factors, proteins, cholesterol, triglycerides, and bile. In addition, it rids the body of toxins. A fully functional liver is essential for good health and vitality.

Liver diseases occur when the organ becomes damaged. This damage can be caused by certain environmental, genetic, and lifestyle factors. These include prolonged alcohol abuse and certain types of infections. Other possible causes include abnormal growths and abnormal immune responses.

With very few exceptions, most liver diseases are managed and not cured. This is because damage to the liver is often irreversible. Over the years, this damage can cause scarring, which can prevent the organ from functioning normally.

Causes of Condition

Chronic liver diseases include chronic hepatitis, cirrhosis, and liver cancer.

Hepatitis is a term used to describe an inflamed liver. It can persist for years and even decades. Its most common causes are:

  • Viruses, especially hepatitis B and C viruses.

  • Abnormal immune responses, or when the immune system attacks healthy liver tissue.

  • Long-term alcohol abuse - Many patients with chronic hepatitis have an alcohol dependency problem.

  • Certain medications - These include medications used to treat tuberculosis, seizure disorders, and high blood pressure.

Damage caused by hepatitis can build up over time and increase the risk of cirrhosis. This condition occurs when healthy liver tissue is replaced by scar tissue. Other than chronic hepatitis, it can also occur due to:

  • Certain inherited conditions, including cystic fibrosis and Wilson disease

  • Obstructed bile ducts, which prevents the normal flow of bile from the liver to the intestine.

  • Exposure to certain toxic materials

  • Heart failure, which can cause the blood to build up in the liver

Chronic hepatitis and cirrhosis are the most common causes of liver failure. They are also the main risk factors for liver cancer. Liver failure is the most serious liver disease. A patient is diagnosed with this condition when his or her liver stops working completely.

Key Symptoms

Any damage to the liver results in a number of symptoms. Initially, patients experience nausea and feeling unusually tired all the time (fatigue). They also have a poor appetite that leads to unintentional weight loss. Many symptoms of liver problems are very mild in the early stages. However, as the liver disease continues to worsen, more worrying symptoms start to develop. The most noticeable is the yellowing of the whites of the eyes and skin (jaundice). Patients also have an inflamed abdomen and bruise easily. Other signs are severe abdominal pain and swelling in the lower extremities. The list can also include severe itching, muscle loss, vomiting blood, and spider-like veins in the skin.

Severe cases of CLD can lead to a number of life-threatening complications. If not are treated or managed promptly, patients will experience other serious symptoms. These complications include the following:

  • Ascites - This refers to the build-up of fluid in the abdomen. It can occur when the liver stops working properly. Ascites is a deadly complication because it causes severe damage to various internal organs.

  • Loss of brain function - This occurs when the liver stops removing toxins from the blood. This results in confusion, personality or mood changes, and poor concentration. Severe cases can even lead to coma.

  • Kidney failure - CLD can disrupt normal blood flow to the kidneys. Without enough blood supply, the kidney cells and tissues can die.

Who to See and Types of Treatments Available

People with liver disease undergo a series of tests to determine the extent of damage to their liver. These tests include:

  • Blood tests - Blood tests are useful in measuring liver function. They measure the levels of protein, enzymes, and bilirubin in the blood. When the liver is not working properly, its ability to produce protein and albumin is compromised. It also loses its ability to dispose of bilirubin, causing it to build up in the blood. Such abnormalities can be detected by blood tests.

  • Liver biopsy - This test is carried out if the patient is showing signs of liver disease and results of blood tests suggest abnormality in the organ. In this procedure, a small tissue sample is taken from the liver. This can be done through an open surgery or a needle biopsy. The sample tissue is then studied under a microscope. This test helps determine the extent of damage to the liver. This is crucial in identifying the best treatment option for the patient.

  • Imaging tests - Doctors may also obtain additional details using imaging tests. These include a CT scan, an MRI, and ultrasound. These tests create pictures of the internal organs and the structures that surround them. They can help determine the cause of the problem, such as blockage of blood flow to the liver.

The goal of treatment is not to cure the disease but to prevent it from progressing. Patients with chronic hepatitis B or C are treated with antiviral medications. This helps reduce the swelling of the liver. It can also lower the risk of more serious liver diseases.

There is no treatment for cirrhosis. It is managed by preventing further damage to the liver. This can be done by making healthy lifestyle choices. Patients are advised to stop drinking alcohol immediately. Doctors will also focus on treating the complications of the disease. These include ascites, kidney problems, and reduced mental function. Most of these complications are treated with medications.

In case of liver failure, the patient’s only treatment option is a liver transplant. This involves removing and replacing the diseased liver with a healthy liver from a donor. The procedure is known to be complex but can give patients a new lease on life. It has a 73% five-year survival rate. Without a transplant, patients with end-stage liver failure have only a 5% chance of surviving.

References:

  • Feldman M, et al. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.clinicalkey.com.

  • National Digestive Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases. “Liver.”

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