Liver Disease (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Bhupinder Anand, MD
In this Article
What are the causes of liver disease?
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The liver can be damaged in a variety of ways.
Alcohol abuse is the most common cause of liver disease in North America. Alcohol is directly toxic to liver cells and can cause liver inflammation, referred to as alcoholic hepatitis. In chronic alcohol abuse, fat accumulation
Cirrhosis is a late-stage of liver disease. Scarring of the liver and loss of functioning liver cells cause the liver to fail.
Drug-induced liver disease
Liver cells may become temporarily inflamed or permanently damaged by exposure to medications or drugs. Some medications or drugs require an overdose to cause liver injury while others may cause the damage even when taken in the appropriately prescribed dosage.
Taking excess amounts of acetaminophen (Tylenol, Panadol) can cause liver failure. This is the reason that warning labels exist on many over-the-counter medications that contain acetaminophen and why prescription narcotic-acetaminophen combination medications (for example, Vicodin, Lortab, Norco, Tylenol #3) limit the numbers of tablets to be taken in a day. For patients with underlying liver disease or those who abuse alcohol, that daily limit is lower and acetaminophen may be contra-indicated in those individuals.
Statin medications are commonly prescribed to control elevated blood levels of cholesterol. Even when taken in the appropriately prescribed dose, liver inflammation may occur. This inflammation can be detected by blood tests that measure liver enzymes. Stopping the medication usually results in return of the liver function to normal.
Niacin is another medication used to control elevated blood levels of cholesterol, but liver inflammation for this medication is related to the dose taken. Similarly, patients with underlying liver disease may be at higher risk of developing liver disease due to medications such as niacin. Recent studies have found that niacin may not be as effective as previously thought in controlling high cholesterol. Patients who take niacin may want to see their health care professional to determine if other treatment options may be appropriate.
There are numerous other medications that may cause liver inflammation, most of which will resolve when the medication is stopped. These include antibiotics such as nitrofurantoin (Macrodantin, Furadantin, Macrobid), amoxicillin and clavulanic acid (Augmentin, Augmentin XR), tetracycline (Sumycin), and isoniazid (INH, Nydrazid, Laniazid). Methotrexate (Rheumatrex, Trexall), a drug used to treat autoimmune disorders and cancers, has a variety of side effects including liver inflammation that can lead to cirrhosis. Disulfiram (Antabuse) is used to treat alcoholics and can cause liver inflammation.
Many mushrooms are poisonous to the liver and eating unidentified mushrooms gathered in the wild can be lethal.
The term "hepatitis" means inflammation, and liver cells can become inflamed because of infection.
Hepatitis A is a viral infection that is spread primarily through the fecal-oral route when small amounts of infected fecal matter are inadvertently ingested. Hepatitis A causes an acute inflammation of the liver which generally resolves spontaneously. The hepatitis A vaccine can prevent this infection. Thorough handwashing, especially when preparing food is the best way to prevent the spread of hepatitis A.
Hepatitis B is spread by exposure to body fluids (needles from drug abusers, contaminated blood, and sexual contact) and can cause an acute infection, but can also progress to cause chronic inflammation (chronic hepatitis) that can lead to cirrhosis and liver cancer. The hepatitis B vaccine can prevent this infection.
Hepatitis C causes chronic hepatitis. An infected individual may not recall any acute illness. Hepatitis C is spread by exposure to body fluids (needles from drug abusers, contaminated blood, and sexual contact). Chronic hepatitis C may lead to cirrhosis and liver cancer. At present, there is no vaccine against this virus.
Hepatitis D is a virus that requires concomitant infection with hepatitis B to survive, and is spread via body fluid exposure (needles from drug abusers, contaminated blood, and sexual contact).
Hepatitis E is a virus that is spread via exposure to contaminated food and water.
Other viruses can also cause liver inflammation or hepatitis as part of the cluster of symptoms. Viral infections with infectious mononucleosis (Epstein Barr virus), adenovirus, and cytomegalovirus can inflame the liver. Non-viral infections such as toxoplasmosis and Rocky Mountain spotted fever are less common causes.
Non-Alcoholic fatty liver disease
NASH or non-alcoholic steatohepatitis (also referred to as "fatty liver") describes the accumulation of fat within the liver that can cause inflammation of the liver and a gradual decrease in liver function.
Hemachromatosis (iron overload) is a metabolic disorder that leads to abnormally elevated iron stores in the body. The excess iron may accumulate in the tissues of the liver, pancreas, and heart and can lead to inflammation, cirrhosis, liver cancer, and liver failure. Hemachromatosis is an inherited disease.
Wilson's disease is another inherited disease that affects the body's ability to metabolize copper. Wilson's disease may lead to cirrhosis and liver failure.
In Gilbert's disease, there is an abnormality in bilirubin metabolism in the liver. It is a common disease that affects up to 7% of the North American population. There are no symptoms and it is usually diagnosed incidentally when an elevated bilirubin level is found on routine blood tests. Gilbert's disease is a benign condition and requires no treatment.
Primary cancers of the liver arise from liver structures and cells. Two examples include hepatocellular carcinoma and cholangiocarcinoma.
Metastatic cancer (secondary cancer of the liver) begins in another organ and spreads to the liver, usually through the blood stream. Common cancers that spread to the liver begin in the lung, breast, large intestine, stomach, and pancreas. Leukemia and Hodgkin's lymphoma may also involve the liver.
Blood flow abnormalities
Budd Chiari syndrome is a disease in which blood clots form in the hepatic vein and prevent blood from leaving the liver. This can increase pressure within the blood vessels of th eliver, especially the portal vein. This pressure can cause liver cells to die and lead to cirrhosis and liver failure. Causes of Budd Chiari syndrome include polycythemia (abnormallyelevated red blood cell count), inflammatory bowel disease, sickle cell disease, and pregnancy.
Congestive heart failure, where poor heart function causes fluid and blood to back up in the large veins of the body can cause liver swelling and inflammation.
Normally, bile flows from the liver into the gallbladder and ultimately into the intestine to help with the digestion of food. If bile flow is obstructed, it can cause inflammation within the liver. Most commonly, gallstones can cause an obstruction of the ducts that drains bile from the liver.
Abnormalities of the opening of the bile duct into the small intestine (sphincter of Oddi) can lead to abnormalities of bile flow. The sphincter of Oddi acts as a "valve" that allows bile to flow from the common bile duct into the intestine.
Primary biliary cirrhosis and primary sclerosing cholangitis can lead to progressive scarring of the bile ducts, causing them to become narrow, which results in reduced bile flow through the liver. Eventually, damage and scarring of the liver architecture occurs resulting in liver failure.
Other diseases and conditions
Since the liver is responsible for the functions that affect so many other organs in the body, liver disease and failure may cause complications. Examples include:
Medically Reviewed by a Doctor on 6/22/2012
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