What You Need to Know About Liver Disease

What is liver disease?

Liver disease can be acute (short-term) or chronic (long-term). Acute liver disease is rarer than chronic liver disease. In both cases, the liver is too overwhelmed to function, but they usually have different causes.

Acute liver disease

Short-term liver disease is typically caused by a viral infection, such as hepatitis A, or in some cases, an overdose of acetaminophen, also known as Tylenol. (Those label warnings on the bottle are there for a reason.) Depending on the extent of the damage, acute liver disease is often treatable, especially if caught early enough.

In rare cases, acute liver disease can cause complete liver failure, and in that case, a liver transplant may be needed.

Chronic liver disease

Next up: Chronic liver disease, which is the more common condition.

One of the key roles the liver plays is filtering toxins out of the blood, which makes it especially vulnerable to disease over time. If the liver is constantly exposed to high levels of toxins and forced to work at higher-than-normal loads, even the toughest of organs can wear down over time.

There are four stages of chronic liver disease, which progress by severity:

1. Hepatitis: This is the inflammation stage, when the liver is responding to injury or trauma. If no intervention occurs to stop the inflammation, it will progress to the next stage of fibrosis.
2. Fibrosis: In this stage, as the liver is damaged, healthy tissue is replaced by scar tissue. The liver cannot function normally with bands of scarred tissue. However, even at this stage, if caught early enough, the scar tissue can be reversed. If the liver is not given the chance to heal, however, the next stage is permanent scarring.
3. Cirrhosis: Once cirrhosis of the liver occurs, the scarring in the liver is usually permanent, although sometimes it can be reversible in its early stages if the underlying cause is treated. As liver function gets worse, symptoms in the body will gradually appear. However, your body is quite good at compensating when your liver isn’t working the way it should, so it can be years before noticeable symptoms appear. Even with permanent scarring, if the liver disease is caught fairly early on, it's possible to slow down or stop further damage.
4. Liver failure: The fourth and final stage of liver disease is liver failure. The disease still gets worse slowly, and symptoms can take some time to show, but eventually, full signs of liver failure will be apparent. The only treatment for liver failure is a liver transplant.

Symptoms of liver disease

If you have something acutely wrong with your liver, you're more likely to experience extreme upper right abdominal pain, nausea and vomiting, and general feelings of being unwell.

With chronic liver disease, you can have similar symptoms, but you can also experience worsening symptoms of:

• Jaundice (when the whites of your eyes and skin appear yellow)
• Confusion
• Itchy skin without a rash
• White poop
• Very dark urine
• Easy bruising and bleeding
• Small, yellow fat bumps on your skin or eyelids
• Weight loss
• Muscle loss
• Musty-smelling breath
• Difficulty digesting fats
• Swelling in your hands and feet
• Loss of menstrual cycle
• Swelling of the testes

Chronic liver disease tends to get worse slowly over time, with the body making up for a lot of damage until the disease is very advanced. So people may not notice symptoms of liver disease right away.

What causes liver disease?

Liver disease can occur from excessive alcohol usage — and that’s probably the most commonly known reason. However, it can also occur without any direct lifestyle link. For instance, an infection or hereditary condition can lead to liver disease.

There are over 100 different types of liver disease, but some of the most commonly seen include:

• Autoimmune liver disease: Autoimmune hepatitis, like other types of autoimmune diseases, can happen randomly when the body mistakes healthy liver cells as foreign cells and attacks them. This type of liver disease is more common in women and people assigned female at birth (AFAB). Autoimmune hepatitis can occur in middle-aged women (Type 1) or girls ages 2–14 (Type 2).
• Primary biliary cholangitis (PBC): PBC is another type of chronic liver disease that occurs mostly in women. It's also thought to be related to the immune system and is most common in middle-aged women.
• Viral hepatitis: Viruses can cause acute or chronic liver disease. Hepatitis A, B, C, D and E are the most common causes of viral hepatitis, but other types, including cytomegalovirus, Epstein-Barr virus, yellow fever and even herpes simplex virus (HSV), can attack the liver.
• Steatotic liver disease (SLD): SLD refers to a condition you may have heard called fatty liver disease. The name was changed because patients often heard the term "fatty" and mistakenly thought the disease was their fault, believed that it was not serious, or felt shame from the stigmatizing language. Now, SLD includes three types of liver conditions, including those associated with alcohol use, that can have varying degrees of symptoms and severity:
  • Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD), is the most common type of liver disease and is caused by a buildup of excess fat in the liver.
  • Metabolically associated steatohepatitis (MASH), previously known as nonalcoholic steatohepatitis (NASH), can include fat buildup and liver damage.
  • Alcohol-associated liver disease (ALD), previously called alcohol-related liver disease (ARLD), is linked to drinking more alcohol than the liver can process. The amount of alcohol that places a person at risk is not known, but it generally exceeds an average of four drinks/day in women and five/day in men for an extended period of time.
  • Metabolic with alcohol-associated liver disease (Met + ALD) is a new category of liver disease that includes cardiometabolic risk factors like obesity, diabetes or high cholesterol along with enough consumption of alcohol to be a contributing factor but not enough to rise to the levels usually seen with classic ALD (between two to five drinks/day for women and three to six/day for men). It can have signs and symptoms of MASLD and/or ALD.
• Liver cancer: Nearly every type of chronic liver disease, especially those caused by hepatitis infections or heavy drinking, can increase the risk of liver cancer. Liver cancer can also occur in people with no other liver diseases, much like any other type of cancer.

How do healthcare providers find liver disease?

The easiest way to spot early signs of liver disease is through bloodwork. If you suspect you’re at risk for liver disease, have a family history of liver disease or are experiencing symptoms, you should ask your healthcare provider (HCP) about testing.

Liver function testing may not be a traditional part of annual workups, but the hardest-working organ in the body facing a constant onslaught of toxins deserves to be assessed now and then, so talk to your HCP about your risk.

You can also work to reduce your overall risk of liver disease or work to slow or stop the progression if you have liver disease by:

• Reducing alcohol intake
• Maintaining a healthy diet
• Exercising regularly
• Avoiding saturated fats
• Reducing sugar intake
• Incorporating healthy fats into your diet, such as olive oil, nuts and fish
• Achieving a healthy weight