Download Liver Disease

Alcohol Liaison Service
Liver Disease
Information
Introduction
Most liver diseases do not show symptoms and
when they do, the symptoms are often vague. There
are hundreds of liver disorders and some are quite
rare. The most common are:
Hepatitis
Hepatitis literally means inflammation of the liver.
Viruses are usually the cause but there are others
which are non-viral such as alcohol excess and the
side effects of some drugs and medicines, whether
illegal or prescribed. There is also a disease called
autoimmune hepatitis.
Viral hepatitis
Your liver can be affected by 'an alphabet' of
viruses, namely hepatitis A, B, C, D, E and possibly
G. The main difference between the viruses is how
they are spread and the effects they have on your
health. Hepatitis A, B and C are the most common
in the UK.
• Hepatitis A: This is spread by eating food or
drinking water which is contaminated with the
hepatitis A virus (HAV), usually in countries
where hygiene standards and sanitation are
poor.
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There is a vaccine for this virus.
• Hepatitis B: Is mainly passed on by exposure
to infected blood. In developed countries
such as the UK the spread is mainly due to
drug use and sexual contact.
Approximately 2 billion people worldwide have
been exposed to hepatitis B, with 350 million
chronic carriers reported. Three quarters of
the global population currently live in areas of
high infection.
Hepatitis B is 100 times more infectious than
HIV, yet there is a vaccine to prevent infection.
• Hepatitis C: This is also a ‘blood borne’ virus.
Before September 1991 it was possible to be
infected with hepatitis C (HCV) from
contaminated blood transfusions and blood
products.
Since then all blood donations have been
screened for the virus (and HBV).
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In some people the route of infection is not
known but in many others injecting drugs is the
cause. Users are thought to become infected
by sharing injecting equipment.
It takes just a tiny amount of blood from
someone carrying the virus to spread the
infection into someone else’s bloodstream.
There is no vaccine to prevent HCV.
Most people recover from hepatitis A with no lasting
liver damage, but B and C can cause long term liver
disease, leading to cirrhosis and even liver cancer.
In many cases there are no early warning symptoms
until liver damage is far advanced.
Autoimmune Hepatitis
This disease mainly affects women, usually just
after the onset of puberty or around the time of the
menopause.
It is thought to be caused by the body’s defence
system malfunctioning and attacking the liver.
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The most common symptoms in the early stages are
tiredness and generally feeling unwell. However,
the condition can be controlled with drugs that
dampening down the immune system’s aggressive
reaction to the liver.
Alcoholic Liver Disease
Not everyone who drinks too much alcohol will
develop liver damage.
It is still unclear why this occurs to certain people
but there is some evidence that it could be due
partly to a combination of factors some of which
may be genetic.
Consistent heavy drinking can lead to what is known
as a fatty liver in which your liver cells become
swollen with excess fat.
More seriously it may cause an inflamed liver
condition known as alcoholic hepatitis or ultimately,
a permanently scarred and damaged liver –
cirrhosis.
Generally the more alcohol you drink, together with
an increased frequency of drinking occasions, the
more likely you are to develop cirrhosis.
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It is a commonly believed that cirrhosis and hence
liver disease, only affects men who drink too much
alcohol over the years. However, cirrhosis can
affect both men and women.
As well as alcohol misuse it can result from long
term infection with hepatitis B and C viruses,
inherited liver disorders such as haemochromatosis
and bile duct diseases such as primary biliary
cirrhosis.
The onset of cirrhosis is usually ‘silent’, meaning
that it presents few early warning symptoms.
Cirrhosis is a result of long-term continuous liver
damage. If your liver is damaged for a short time,
some of the cells will die and your liver may
regenerate to its original size and shape.
However, when the inflammation is severe and
continuous, scar tissue (fibrosis) develops. Smooth
liver tissue is replaced by irregular nodules and the
liver becomes much harder than normal.
This combination of nodules and fibrosis is called
cirrhosis.
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Once cirrhosis has developed, it is usually
considered irreversible, even when the inflammation
which caused it has improved. Recent studies in
treating hepatitis C with 'antiviral therapy alpha'
suggest that there can be some reversal in fibrosis
and even cirrhosis but more studies are required to
determine whether this will also apply to other liver
diseases.
Gallstone and gallbladder disease
Around five million people in the UK or
approximately 10 per cent of the population will
develop gallstones or gallbladder disease at some
time in their lives.
Gallstones are lumps of solid material that form in
the gallbladder and usually resemble small stones
or gravel although some can be as large as pebbles.
Most are the size of a pea and may take many years
to grow.
Anyone can get gallstones but middle aged,
overweight women have the highest risk.
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Cancer of the liver
Cancer of the liver is divided into two main types:
primary liver cancer (hepatocellular carcinoma, or
HCC) which means cancer that starts in the liver.
secondary liver cancer (metastatic cancer)
meaning cancer that spreads to the liver from
another part of the body.
There are estimated to be more than 2,500 new
cases of primary liver cancer and 70,000 new cases
of secondary liver cancer every year in the UK.
In the UK most people who develop primary liver
cancer have cirrhosis which may develop from a
variety of causes.
Primary liver cancer is not easy to diagnose in the
early stages because its symptoms are usually
vague.
Typical symptoms include loss of appetite, weight
loss, a general feeling of poor health, jaundice,
fever, fatigue and weakness.
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Inherited liver disease
It is possible for you to be born with a liver disease
which may not produce symptoms until adulthood.
Haemochromatosis
This is an inherited metabolic disorder in which the
body absorbs and stores more iron from food than it
actually needs. It can prove fatal if not recognised
and treated early enough.
For many years haemochromatosis was thought to
be rare. However, recent research has discovered
that the disease is much more common than first
realised. In fact it is one of the most commonly
inherited disorders among people of Northern
European origin and is estimated to affect one
person in 300.
Wilson's disease
Is also inherited and causes excessive amounts of
copper to accumulate in the body. Copper, unlike
other damaging metals such as lead and mercury, is
essential to health. However, in Wilson’s disease,
the body’s inability to get rid of the excess results in
an accumulation of copper in several organs.
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The liver is the first organ to store copper. When it
can store no more, the overflow passes from the
liver to the bloodstream and is carried to other
organs, including the brain and the cornea of the
eye.
In a few cases the copper accumulation can result in
psychiatric disorders or physical symptoms such as
slurred speech, drooling or tremors.
Primary sclerosing cholangitis (PSC)
Is a disease in which the bile ducts inside and
outside the liver become narrower because of
inflammation and scarring.
This causes the bile, which is normally carried away
by the ducts to stay within the liver, resulting in
damage.
It is not known what causes PSC but it often occurs
in people with an inflammatory bowel disease, most
commonly ulcerative colitis.
Men are twice as likely to be affected as women,
usually between the ages of 25 and 45, but it can
also affect children as young as 2 years.
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Primary biliary cirrhosis (PBC)
In primary biliary cirrhosis (PBC) your own immune
system damages the small bile ducts inside the
liver, so that bile cannot be efficiently secreted.
The term PBC is misleading because cirrhosis does
not always follow, and if it does it can take many
years to develop. Middle-aged women are most
commonly affected, but the disease can affect
anyone.
Contacts
For further information and advice, please contact:
The Alcohol Liaison Nurse Service
 01536 491785
Monday to Friday
9am - 5pm
Reference
Information from the British Liver Trust
http://www.britishlivertrust.org.uk
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If you need this information in another format or language
 01536 492510.
Further information about the Trust is available on the
following websites:
KGH - www.kgh.nhs.uk | NHS Choices - www.nhs.uk
Ref: PI.169 April 2014
Review: January 2016