Chronic Liver Disease/Cirrhosis

Chronic Liver Disease/Cirrhosis

Chronic Liver Disease/Cirrhosis | Johns Hopkins Medicine

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Cirrhosis is when scar tissue replaces healthy liver tissue. This stops the liver from working normally.

Cirrhosis is a long-term (chronic) liver disease. The damage to your liver builds up over time.

The liver is your body’s largest internal organ. It lies up under your ribs on the right side of your belly.

The liver does many important things including:

  • Removes waste from the body, such as toxins and medicines
  • Makes bile to help digest food
  • Stores sugar that the body uses for energy
  • Makes new proteins

When you have cirrhosis, scar tissue slows the flow of blood through the liver. Over time, the liver can’t work the way it should.

In severe cases, the liver gets so badly damaged that it stops working. This is called liver failure.

What causes cirrhosis?

The most common causes of cirrhosis are:

  • Hepatitis and other viruses
  • Alcohol abuse
  • Nonalcoholic fatty liver disease (this happens from metabolic syndrome and is caused by conditions such as obesity, high cholesterol and triglycerides, and high blood pressure)

Other less common causes of cirrhosis may include:

  • Autoimmune disorders, where the body’s infection-fighting system (immune system) attacks healthy tissue
  • Blocked or damaged tubes (bile ducts) that carry bile from the liver to the intestine
  • Use of certain medicines
  • Exposure to certain toxic chemicals
  • Repeated episodes of heart failure with blood buildup in the liver
  • Parasite infections

Some diseases passed from parent to child (inherited diseases) may also cause cirrhosis. These may include:

  • Alpha1-antitrypsin deficiency
  • High blood galactose levels
  • Glycogen storage diseases
  • Cystic fibrosis
  • Porphyria (a disorder in which certain chemicals build up in the blood)
  • Hereditary buildup of too much copper (Wilson disease) or iron (hemochromatosis) in the body

What are the symptoms of cirrhosis?

Your symptoms may vary, depending on how severe your cirrhosis is. Mild cirrhosis may not cause any symptoms at all.

Symptoms may include:

  • Fluid buildup in the belly (ascites)
  • Vomiting blood, often from bleeding in the blood vessels in the food pipe (esophagus)
  • Gallstones
  • Itching
  • Yellowing of the skin and eyes (jaundice)
  • Kidney failure
  • Muscle loss
  • Loss of appetite
  • Easy bruising
  • Spider- veins in the skin
  • Low energy and weakness (fatigue)
  • Weight loss
  • Confusion as toxins build up in the blood

The symptoms of cirrhosis may look other health problems. Always see your healthcare provider to be sure.

How is cirrhosis diagnosed?

Your healthcare provider will look at your past health. He or she will give you a physical exam.

You may also have tests including:

  • Blood tests. These will include liver function tests to see if the liver is working the way it should. You may also have tests to see if your blood is able to clot.
  • Liver biopsy. Small tissue samples are taken from the liver with a needle or during surgery. The samples are checked under a microscope to find out the type of liver disease.

Your healthcare provider may want you to have imaging tests including:

  • CT scan (computed tomography). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs.
  • MRI (magnetic resonance imaging). This test makes detailed pictures of organs and structures inside your body. It uses a magnetic field and pulses of radio wave energy. A dye may be shot (injected) into your vein. The dye helps the liver and other organs to be seen more clearly on the scan.
  • Ultrasound. This shows your internal organs as they work. It checks how blood is flowing through different blood vessels. It uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.

You may also have an upper endoscopy (EGD). A lighted flexible camera is placed through your mouth into your upper digestive tract to look for enlarged blood vessels that are at risk of bleeding because of your cirrhosis. 

If you have fluid in the belly (ascites), you may need a low sodium diet, water pills (diuretics), and removal of the fluid with a needle (paracentesis).

How is cirrhosis treated?

Cirrhosis is a progressive liver disease that happens over time. The damage to your liver can sometimes reverse or improve if the trigger is gone, such as stop drinking alcohol or if the virus is treated.

The goal of treatment is to slow down the buildup of scar tissue and prevent or treat other health problems.

In many cases, you may be able to delay or stop any more liver damage. If you have hepatitis, it may be treated to delay worsening of your liver disease.

Your treatment may include:

  • Eating a healthy diet, low in sodium
  • Not having alcohol or illegal drugs
  • Managing any health problems that happen because of cirrhosis  

Talk to your healthcare provider before taking prescription medicines, over-the-counter medicines, or vitamins.

If you have severe cirrhosis, treatment can’t control other problems. A liver transplant may be needed.

Other treatments may be specific to your cause of cirrhosis, such as controlling excessive iron or copper levels, or using immune suppressing medicines.

Be sure to ask your healthcare provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.

What are the complications of cirrhosis?

Cirrhosis can cause other health problems such as:

  • Portal hypertension. The portal vein carries blood from your intestines and spleen to your liver. Cirrhosis slows the normal flow of blood. That raises the pressure in the portal vein. This is called portal hypertension.
  • Enlarged blood vessels. Portal hypertension may cause abnormal blood vessels in the stomach (called portal gastropathy and vascular ectasia) or enlarged veins in the stomach and the food pipe or esophagus (called varices). These blood vessels are more ly to burst due to thin walls and higher pressure. If they burst, severe bleeding can happen. Seek medical attention right away.
  • Ascites. Fluid collecting in your belly. This can become infected. 
  • Kidney disease or failure
  • Easy bruising and severe bleeding. This happens when the liver stops making proteins that are needed for your blood to clot.
  • Type 2 diabetes. When you have cirrhosis, your body does not use insulin properly (insulin resistance). The pancreas tries to keep up with the need for insulin by making more, but blood sugar (glucose) builds up. This causes type 2 diabetes.
  • Liver cancer

Key points about cirrhosis

  • Cirrhosis is when scar tissue replaces healthy liver tissue. This stops the liver from working normally.
  • Cirrhosis is a long-term (chronic) liver disease.
  • The most common causes are hepatitis and other viruses, and alcohol abuse. Other medical problems can also cause it.
  • The damage to the liver usually can’t be reversed.
  • The goal of treatment is to slow down the buildup of scar tissue and prevent or treat any problems that happen.
  • In severe cases, you may need a liver transplant.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.


Liver function

Chronic Liver Disease/Cirrhosis | Johns Hopkins Medicine

  • Multiple serum chemistries assayed to assess hepatic function and/or injury.
  • Tests indicative of: 1) liver inflammation: ALT (alanine aminotransferase) and AST (aspartate aminotransferase); 2) cholestasis or biliary obstruction: bilirubin (total includes both direct and indirect bilirubin), ALP (alkaline phosphatase) and GGT (gamma-glutamyltransferase); and 3) synthetic function: albumin and PT (prothrombin time).
  • Abnormal liver function due to non-alcoholic fatty liver disease (NAFLD) is common in diabetes.
  • Recently, combined patented algorithms (Fibrotest [FibroSURE in the U.S.]) have been made commercially available. Used to assess the presence of liver fibrosis.
  • Serum ALT, AST, ALP and bilirubin (total and direct) are measured indirectly by using a spectrophotometer.
  • PT, reported as the INR, measured from citrated whole blood: 1 full blue top, mixed gently. The vacutainer must be filled to the tube’s drawing capacity to achieve the proper blood to anticoagulant ratio.
  • Symptoms suggestive of liver disease: jaundice, dark urine, or light-colored bowel movements, loss of appetite, fatigue, vomiting of blood, bloody or black bowel movements, swelling or pain in the abdomen, unusual weight changes.
  • Signs suggestive of liver disease: hepatomegaly, ascites
  • Exposure to medications associated with liver damage (e.g. HMG Co-A reductase inhibitors, thiazolidinediones), contact with people that have viral hepatitis, excessive alcohol consumption.
  • Presence of additional comorbid conditions associated with liver disease among persons with diabetes: extreme obesity, hypertriglyceridemia, alcohol use
  • To monitor response to treatment or track course of disease in patients with liver disease.
  • Increased AST: primary liver disease, acute myocardial infarction, muscle trauma and diseases, pancreatitis, intestinal surgery, burns, renal infarction, pulmonary embolism.
  • Increased ALT: primary liver disease, biliary obstruction, pancreatitis. ALT > AST viral hepatitis, AST> ALT alcoholic liver disease.
  • Increased ALP: biliary obstruction, primary liver disease (changes parallel GGT), infiltrative liver disease, bone diseases, hyperparathyroidism, hyperthyroidism.
  • Increased GGT: biliary obstruction, primary liver disease (changes parallel ALP), alcohol consumption, pancreatitis
  • Increased bilirubin: biliary obstruction, primary liver disease, hemolytic anemias, hypothyroidism
  • Medications: may cause increases in one or more liver chemistry tests because of direct hepatotoxicity or cholestasis (See American Gastroenterological Association (AGA) Technical Review[1] for full list of medications).
  • ALT and AST are abundant liver enzymes. AST is also present in heart, muscle. ALP is present in nearly all tissues, primarily bone and liver. GGT is abundant in liver, kidney, pancreas and intestine.
  • ALT and AST normal ranges vary depending on lab, in general: ≤ 40 U/L.
  • Mild ALT and AST elevations (ALT and AST less than 5 times the upper limit of normal (ULN)) should be rechecked before extensive work-up is undertaken. Possible causes: chronic hepatitis C or B, acute viral hepatitis, NAFLD, hemachromatosis, autoimmune hepatitis, medications, alcohol-related liver injury, Wilson’s disease.
  • Moderately elevated ALT and AST (ALT and AST 5-15 times the ULN) should be investigated without waiting to confirm the persistence of abnormal ALT, possible causes: entire spectrum of liver diseases that may cause either mild or severe elevations.
  • Severe ALT and AST elevations (ALT and AST greater than 15 times the ULN) suggest severe acute liver cell injury: acute viral hepatitis, ischemic hepatitis or other vascular disorder, toxin-mediated hepatitis, acute autoimmune hepatitis.
  • Bilirubin is a heme degradation product excreted in the bile, it requires conjugation in the liver before its secretion.
  • Hyperbilirubinemia: Investigate if caused by direct (conjugated) or indirect (unconjugated) fraction of bilirubin. Pre-hepatic causes (increased production, decreased liver uptake) cause increase of indirect. Intra-hepatic or post-hepatic causes (decreased hepatic excretion), increase of direct. Increased production: hemolysis. Decreased liver uptake: Gilbert Syndrome, found in 5% population, benign. Decreased hepatic excretion: bile duct obstruction, primary biliar cirrhosis, primary sclerosing cholangitis, benign recurrent cholestasis, hepatitis, cirrhosis, medications, sepsis, total parenteral nutrition, Dubin-Johnson Syndrome, medications (See AGA Technical Review[1] for full list of medications).
  • Increased GGT: Alcohol consumption
  • Increased ALP and GGT: bile duct obstruction, primary biliary cirrhosis, primary sclerosing cholangitis, benign recurrent cholestasis, infiltrative disease of the liver (sarcoidosis, lymphoma, metastasic disease)
  • Isolated elevated ALP (extra-hepatic disease): bone disease, pregnancy, chronic renal failure, lymphoma, congestive heart failure.
  • Abnormal PT (expressed in seconds or as INR) and albumin levels: indicate severe hepatic synthetic dysfunction and indicates progression to cirrhosis or impending hepatic failure.
  • Other commonly used tests to assess potential causes of hepatic diseases include: viral markers (IgM Hepatitis A Virus, HBsAg, Total Anti-HBc, IgM anti-HBc, anti-hepatitis C antibody), immunologic markers (ANA, SMA, anti-LKM-1, AMA), genetic diseases (hereditary hemochromatosis: transferrin saturation, ferritin, hepatic iron index; Wilson’s disease: serum ceruloplasmin, urinary copper; a1-antitrypsin deficiency: serum electrophoresis), hepatocellular carcinoma marker (AFP: alfa-Fetoprotein) and imaging studies (ultrasound, CT, MRI).
  • Poor correlation between ALT and AST levels and hepatic fibrosis. Patients with cirrhosis may have normal or only mildly elevated ALT.
  • For ALT, AST, ALP and bilirubin samples, hemolysis can cause significant increases. Samples need to be stable at 0 to 4 ° C over 1 to 3 days.
  • ALT and AST: increase with strenuous exercise and muscle injury. Meals have no effect. ALT is increased with higher BMI.
  • ALP levels increase with food intake, pregnancy and smoking.
  • Bilirubin levels increase with fasting. Light exposure decrease bilirubin.
  • Among people with type 2 diabetes (T2DM), liver disease is one of the leading causes of death.
  • In addition, patients with T2DM have have a higher incidence and prevalence not only of NAFLD, but of hepatitis C and hepatocellular carcinoma compared to the general population.
  • Liver tests are not always specific for the liver because there are extra-hepatic sources.
  • Normal levels of liver chemistry tests (including ALT) do not exclude the presence of disease.
  1. Green RM, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology. 2002;123(4):1367-84.  [PMID:12360498]

    Comment: Formal recommendations on how to interpret liver function tests and comprehensive list of medications that may cause liver toxicity or injury.

  1. Dufour DR, Lott JA, Nolte FS, et al. Diagnosis and monitoring of hepatic injury. I. Performance characteristics of laboratory tests. Clin Chem. 2000;46(12):2027-49.


    Comment: Very detailed review of the characteristics of all liver tests, reference values, individual factors influencing their levels.

    An approved guideline not only by the National Academy of Clinical Biochemistry but also by the American Association for the Study of Liver Diseases.

  2. Dufour DR, Lott JA, Nolte FS, et al. Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clin Chem. 2000;46(12):2050-68.  [PMID:11106350]

    Comment: Detailed review of the different patterns of liver injuries and their laboratory findings. An approved guideline by the National Academy of Clinical Biochemistry

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Johns Hopkins Pathology

Chronic Liver Disease/Cirrhosis | Johns Hopkins Medicine

Understanding Liver Cancer

Introduction +

In the United States approximately 10,000 new patients are diagnosed with primary liver cancer (hepatocellular carcinoma) each year. This is the most common type of cancer to arise in the liver. The number of liver cancers diagnosed in the US and throughout the world is increasing at an alarming rate. The number of liver cancers will continue to increase over the next few decades.

Most of the increase in liver cancer is attributable to patients who became infected with hepatitis B and C viruses. Hepatitis B and hepatitis C viral infections peaked in the 1950's to 1980's. Approximately 4 million (that is about 2% of the US population!) Americans are infected with Hepatitis C virus.

People become infected with hepatitis viruses by coming in contact with infected person's blood. After 2 to 3 decades patients infected with these viruses can develop complications of long-standing (chronic) viral infection. The complications of long-standing (chronic) viral infection include liver scarring (cirrhosis) and liver cancer.

Liver cancer is a lethal cancer with untreated patients rarely surviving more than one year. The Johns Hopkins Medical Institution is a leader in the treatment and investigative study of liver cancer.

We have created this Web site as a resource for patients and physicians to access the latest clinical and research developments as well as to the multidisciplinary team assembled here to treat liver cancer.

We have also included a chat room so that users of the web page can directly support each other.

Diagnosis +

Masses that occur in the liver can be determined to be harmless (benign) or malignant (cancerous) in various ways. The first, involves the use of imaging techniques such as Computed Axial Tomography (CT) scan / Magnetic Resonance Imaging (MRI) or the injection of a dye into the blood vessels (angiography).

The larger the liver cancer the more ly these imaging techniques will be able to diagnose it. Liver cancer has special features, such as a rich blood supply or tendency to increase in size, which these imaging techniques can detect.

If imaging can not determine if a tumor is benign or malignant, a fine needle biopsy may be performed. In this procedure, a fine (very thin) needle is passed through the skin, into the liver and directed toward the tumor using an exterior ultrasound to guide the needle.

If a needle biopsy is performed, Johns Hopkins' pathologists, Drs. Robert Anders, Michael Torbenson, John Boitnott all have focused interest on interpreting these biopsies. The normal liver cells grow in columns that are one or two cells thick.

In liver cancer, the columns of liver cells become wider than one or two cells. The wide columns of liver cells can be seen on microscopic examination and are one helpful feature of liver cancer.

Screening +

Screening tests are used to detect liver cancer at the earliest possible stage. There are no good screening tools for liver cancer. Current screening methods include a blood test, Computed Axial Tomography (CT) scan / Magnetic Resonance Imaging (MRI) or angiography (the injection of a dye into the blood vessels).

There are currently no reliable blood test to diagnose liver cancer. A test for alpha fetal protein (AFP) may be slightly elevated in 2/3 of patients with liver cancer, but may also be slightly elevated in patients with chronic liver disease. Very high levels of serum AFP is a good indication of liver cancer, but is only seen in a few patients.

At risk individuals can also be screened using imaging techniques such as Computed Axial Tomography (CT) scan / Magnetic Resonance Imaging (MRI) or angiography (the injection of a dye into the blood vessels).

At Johns Hopkins, the Department of Gastroenterology and Hepatology are actively involved in day to day screening of patients at high risk for developing liver cancer.

Prevention +

Since most liver cancer develops in patients with long standing (chronic) hepatitis viral infection, prevention of infection is vital.

Avoiding contact with an infected person's blood can prevent the transmission of hepatitis viruses. In addition, there is an effective vaccine for hepatitis B.

To learn more about this vaccine click here. However, there is no vaccine for hepatitis C virus.

Once patients develop chronic infection with hepatitis viruses, the goal is to preserve liver tissue and prevent scarring (cirrhosis). This requires a multi-disciplinary approach involving the patient, a hepatologist and pathologist.

Once it is established that a patient is chronically infected with a hepatitis virus, the patient will need to enter into a treatment program to minimize liver damage. This program involves regular visits to a hepatologist who will monitor the relative health of the liver.

This monitoring may involve simple blood tests or occasionally a liver needle biopsy. A pathologist experienced in interpreting liver biopsies will determine the amount of liver damage and scarring.

Patients need to learn to avoid activities with can further damage the liver, such as consuming alcohol or taking certain medications. In addition, patients can engage in liver healthy activities such as maintaining an ideal body weight and a liver healthy diet.

Treatment +

Treatment of liver injury
Most liver cancers develop in patients with chronic liver disease. Chronic liver injury and liver scarring (cirrhosis) are fertile environments for the development of liver cancer.

Current treatments are aimed at reducing chronic injury and attempt to prevent cirrhosis. These treatments include interferons, ribavirin and lamivudine.

These medications are given as an injection or a pill and require supervision of a doctor.

Treatment of liver cancer Once liver cancer develops there are 3 main treatment options. First, surgery that involves the removal of the tumor or even liver transplant in which the entire liver is surgically removed and replaced with a new liver from a donor, offers the best hope of a cure.

The size and location of the tumor, the health of the remaining liver, if the tumor has spread and the overall health of the patient determines if this is an option.

Second, tumor ablation in which the cancer cells in the tumor are directly killed by radiofrequency, freezing or chemical injection are relatively new treatment options.

Tumor ablation techniques involve placing a fine probe into the center of the tumor and injecting cold or toxic chemical that destroy the tumor cells. Third, radiation and chemotherapy have been used. Radiation can shrink a tumor but is not a curative procedure.

Similarly, chemotherapy has been shown to shrink liver cancers, but it is unclear if this increases patient survival.

Although most cancers develop in patients with liver scarring (cirrhosis), some patients develop liver cancer without first developing cirrhosis. Johns Hopkins researchers have a particular interest in this type of liver cancer.

Cancer Types +

As the largest internal organ, the liver performs a variety of vital functions. Different cell types are responsible for these diverse functions. The basic liver cells (known as hepatocytes) produce blood clotting factors, synthesize bile, metabolize proteins and remove toxins from the blood.

The liver has a rich network of blood vessels carrying nutrients and toxins from the intestine to the liver and back to the circulation. The liver also has a system of bile ducts which carry bile (a green fluid that helps digestion of food) from the liver and gall bladder into the intestine.

Tumors may arise from any of these types of cells and thus there is a wide variety in types of liver cancer.

Tumors can be generally thought of as benign or malignant. Benign tumors are unly to metastasize (spread throughout the body) while malignant tumors are cancerous and are ly to spread to other organs.

Liver Cancer types listed by cell of origin
List of benign tumors and cell of origin List of malignant (cancerous) tumors and cell of origin
  • – Hepatocytes
    • Adenoma
    • Focal nodular hyperplasia
  • – Vessels
  • – Bile duct
    • Adenoma
    • Hamartoma (Von Myenberg Complex)
  • – Hepatocytes
    • Hepatocellular carcinoma
    • Hepatoblastoma
    • Fibrolamellar carcinoma
  • – Vessels
  • – Bile duct


Liver: Function, Failure & Disease

Chronic Liver Disease/Cirrhosis | Johns Hopkins Medicine

The liver is an abdominal glandular organ in the digestive system. It is located in the right upper quadrant of the abdomen, under the diaphragm and on top of the stomach. The liver is a vital organ that supports nearly every other organ to some capacity. 

The liver is the body's second-largest organ (skin is the largest organ), according to the American Liver Foundation (ALF), weighing about 3 lbs. (1.4 kilograms). At any given moment, the liver holds about 1 pint (half a liter) of blood — about 13 percent of the body's blood supply, according to Johns Hopkins Medicine. 

The liver is shaped a football, or a cone, and consists of two main lobes. Each lobe has eight segments that consist of 1,000 small lobes, or lobules, according to Johns Hopkins. The lobules are connected to ducts that transport bile to the gallbladder and small intestine.


“The liver has a complex role in the function of the body,” said Jordan Knowlton, an advanced registered nurse practitioner at the University of Florida Health Shands Hospital. “Detoxification, metabolism (including regulation of glycogen storage), hormone regulation, protein synthesis, digestion, and decomposition of red blood cells, to name a few.” 

In fact, more than 500 vital functions have been identified with the liver, according to Johns Hopkins, including:

  • Production of bile, which helps carry away waste and break down fats in the small intestine during digestion.
  • Production of certain proteins for blood plasma. 
  • Production of cholesterol and special proteins to help carry fats through the body
  • Conversion of excess glucose into glycogen for storage (glycogen can later be converted back to glucose for energy) and to balance and make glucose as needed 
  • Regulation of blood levels of amino acids, which form the building blocks of proteins
  • Processing of hemoglobin for use of its iron content (the liver stores iron)
  • Conversion of poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine)
  • Clearing the blood of drugs and other poisonous substances
  • Regulating blood clotting
  • Resisting infections by making immune factors and removing bacteria from the bloodstream
  • Clearance of bilirubin, also from red blood cells. If there is an accumulation of bilirubin, the skin and eyes turn yellow.  


One of the best-known roles of the liver is as a detoxification system. It removes toxic substances from blood, such as alcohol and drugs, according to the Canadian Liver Foundation. It also breaks down hemoglobin, insulin and excessive hormones to keep hormone levels in balance. Additionally, it destroys old blood cells. 

The liver is vital for healthy metabolic function.

It metabolizes carbohydrates, lipids and proteins into useful substances, such as glucose, cholesterol, phospholipids and lipoproteins that are used in various cells throughout the body, according to Colorado State University's Department of Biomedical Sciences' Hypertexts for Pathophysiology: Metabolic Functions of the Liver. The liver breaks down the unusable parts of proteins and converts them into ammonia, and eventually urea.

Liver disease

According to the Canadian Liver Foundation, there are more than 100 types of liver disease, and they are caused by a variety of factors, such as viruses, toxins, genetics, alcohol and unknown causes. The following are among the most common types of liver disease: 

  • Alagille syndrome
  • Alpha 1 anti-trypsin deficiency
  • Autoimmune hepatitis
  • Biliary atresia
  • Cirrhosis
  • Cystic disease of the liver
  • Fatty liver disease
  • Galactosemia
  • Gallstones
  • Gilbert's syndrome
  • Hemochromatosis
  • Liver cancer
  • Liver disease in pregnancy
  • Neonatal hepatitis
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Porphyria
  • Reye's syndrome
  • Sarcoidosis
  • Toxic hepatitis
  • Type 1 glycogen storage disease
  • Tyrosinemia
  • Viral hepatitis A, B, C
  • Wilson disease

According to the National Institutes of Health (NIH), one symptom of liver disease is jaundice — yellowish skin and eyes. Other symptoms include abdominal pain and swelling, persistent itchy skin, dark urine, pale stools, bloody or black stools, exhaustion, bruising easily, nausea and loss of appetite.

Fatty liver

There are two types of fatty liver, according to the Cleveland Clinic: that caused by excessive alcohol consumption (fatty liver) and that which is not (non-alcoholic fatty liver or non-alcoholic steatohepatitis). 

Speaking of both conditions, Knowlton said, “Some fat on the liver is normal, but when it starts to accumulate to greater than 5-10 percent, it can lead to permanent liver damage and cirrhosis.

” It also increases the chance of liver failure or liver cancer. Fatty liver “can be caused by genetics, obesity, diet, hepatitis, or alcohol abuse,” said Knowlton.

Other risk factors include rapid weight loss, diabetes, high cholesterol, or high trigycerides, according to the ALF. 

Some people may get fatty liver even if they don't have any risk factors. Up to 25 percent of the U.S.

population suffers from fatty liver disease, according to the University of Michigan Health System.

There are no medical treatments for fatty liver disease, though avoiding alcohol, eating a healthy diet, and exercising can help prevent or reverse fatty liver disease in its early stages.

Enlarged liver

According to the Mayo Clinic, an enlarged liver (or hepatomegaly) isn't a disease itself, but a sign of an underlying serious problem, such as liver disease, cancer or congestive heart failure.

There may be no symptoms of an enlarged liver, though if they are they are the same as the symptoms for liver disease. Normally, the liver cannot be felt unless you take a deep breath, but if it is enlarged, your doctor may be able to feel it, according to the NIH.

The doctor may then do scans, MRIs, or ultrasounds of the abdomen to determine if you have an enlarged liver. Treatment will involve addressing the underlying problem.

Liver pain

Liver pain is felt in the upper right area of the abdomen, just below the ribs. Usually, it is a dull, vague pain though it can sometimes be quite severe and may cause a backache. Sometimes people perceive it as pain in the right shoulder.

It is often confused with general abdominal pain, back pain or kidney pain, according to New Health Guide. It can be hard to pinpoint the exact location or cause of such pains, so it is important to see a doctor.

Doctors may do blood tests, ultrasounds or biopsies to determine the cause of pain.

Liver pain can be the result of a variety of causes. Some common causes are: ascites (fluid in the abdomen), cirrhosis, hepatitis, liver failure, enlarged liver, liver abscess, and liver tumors. 

Liver failure

Liver failure is an urgent, life-threatening medical condition. It means that the liver has lost or is losing all of its function. “Livers typically fail gradually,” said Knowlton, “but sometimes [it] can be rapid.

” Early symptoms of liver failure are general, making it difficult to know that the liver is failing. Knowlton said, “Symptoms of liver failure may include nausea, appetite changes, fatigue, diarrhea, jaundice, easy bleeding.

” As the condition worsens, she said symptoms might include “mental confusion and coma.”

“Typical causes of liver failure include Tylenol overdose, viruses, hepatitis B & C, cirrhosis, alcoholism, and some medications,” said Knowlton. Georgia's Emory Healthcare stated that there are two types of liver failure: chronic and acute.

Chronic liver failure is the most common type of liver failure. It is the result of malnutrition, disease and cirrhosis, and it can develop slowly over years. Acute liver failure is rarer, and it can come on suddenly.

Acute liver failure is usually the result of poisoning or a drug overdose.

Liver failure treatments depend on the case. Knowlton said, “Treatment options are mostly supportive (hospitalization and treatment until the liver recovers), but ultimately may require liver transplantation.”

Liver transplant

Donated livers can come from cadavers or living donors. In the case of living donors, the donor donates part of his or her liver to another person, according to the American College of Gastroenterology.

The liver can regrow itself, so both people should end up with healthy, functional livers.

According to the National Institute of Diabetes and Digestive and Kidney Diseases the most common reason adults get liver transplants is cirrhosis, though transplants can also be done for patients with various liver diseases or early stage liver cancer.

A liver transplant is a very serious surgery that may take up to 12 hours. According to the Mayo Clinic, there are several risks involved with liver transplants, including:

  • Bile duct complications, including leaks or shrinking
  • Bleeding
  • Blood clots
  • Failure of donated liver
  • Infection
  • Memory and thinking problems
  • Rejection of donated liver

If you have a liver transplant, you can expect to stay in the hospital for at least a week after the surgery, to get regular checkups for at least three months, and to take anti-rejection and other medications for the rest of your life. It will take six months to a year to feel fully healed from the surgery.

Liver transplant success depends on the individual case. Transplants from cadavers have a 72 percent success rate, meaning that 72 percent of liver transplant recipients lived for at least five years after the surgery. Transplants from living donors had a slightly higher success rate, at 78 percent, according to the Mayo Clinic.

Things that can harm the liver

While some liver diseases are genetic, others are caused by viruses or toxins, such as drugs and poisons.

Some risk factors, according to the Mayo Clinic, include drug or heavy alcohol consumption, having a blood transfusion before 1992, high levels of triglycerides in the blood, diabetes, obesity and being exposed to other people's blood and bodily fluids. This can happen from shared drug needles, unsanitary tattoo or body piercing needles, and unprotected sex.

Alcohol is big player in liver damage. It is believed that alcohol could possibly change the type of fungi living in the liver, leading to disease, according to a small study published May 22, 2017, in the Journal of Clinical Investigation. If this is true, it could lead to new treatment options.

The findings suggest that “we might be able to slow the progression of alcoholic liver disease by manipulating the balance of fungal species living in a patient's intestine,” study co-author Dr. Bernd Schnabl, an associate professor of gastroenterology at the University of California, San Diego School of Medicine, said in a statement.

[How Alcohol & Gut Fungus Team Up to Damage Your Liver]

Additional reporting by Alina Bradford, Live Science contributor.

Additional Resources


Liver Health

Chronic Liver Disease/Cirrhosis | Johns Hopkins Medicine

Linkedin Pinterest Liver Gallbladder and Pancreas What You Need to Know

  • The liver is the largest organ in the human body. It performs over 500 functions, including digestion of proteins, mineral storage, bile production and blood filtration.
  • The liver is about 3 pounds (the weight of a football) and can be found in the upper right abdomen, below the diaphragm.
  • There are many disorders of the liver, including liver disease, hepatitis, liver cancer and cirrhosis.
  • Liver disease has many causes, including genetics, infection and autoimmune diseases.

The liver performs many functions essential for good health and long life. Among its most important jobs are:

  • Producing important substances. Your liver continually produces bile. This is a chemical that helps turn fats into energy that your body uses. Bile is necessary for the digestive process. Your liver also creates albumin. This is a blood protein that helps carry hormones, drugs and fatty acids throughout your body. Your liver also creates most of the substances that help your blood clot after injury.
  • Processing bilirubin. The liver helps your body get rid of bilirubin, a substance found in bile. This happens from the breakdown of your red blood cells. Too much bilirubin in your body can cause jaundice. This is a yellowing of the skin and eyes.
  • Removing waste products. When you take in a potentially toxic substance, alcohol or medicine, your liver helps alter it and remove it from your body.
  • Controlling immune responses. When bacteria, viruses and other harmful organisms enter your body, specialized cells in your liver can find and destroy these organisms.
  • Maintaining glucose. The liver helps your body maintain a healthy level of blood sugar. Your liver supplies glucose to your blood when it’s needed. It also removes glucose from your blood when there’s too much.

There are many steps you can take to keep your liver functioning well and reduce your risk for liver disease:

  • Stay up to date on your shots.
  • Wash your hands often, especially after using the bathroom, touching pets and before eating.
  • Limit your exposure to toxins, such as cleaning supplies, chemicals and tobacco products.
  • Keep your cholesterol within a normal range.
  • If you have diabetes, keep your sugars in a normal range.
  • Do not share needles, razors, toothbrushes or other personal items.
  • Do not smoke or use other tobacco products.
  • Eat a healthy, well-balanced diet and maintain a healthy weight.
  • Limit how much alcohol you drink.
  • Be careful about using medicine. Always talk with your health care provider about the medicines you’re taking, including over-the-counter products, such as pain relievers.
  • Practice safe sex to reduce the risk of contracting hepatitis or other health problems.

Many health problems can keep your liver from functioning properly and cause disease. There are several common symptoms of liver disease, including jaundice, liver failure and liver enlargement.

The types of liver disease include:

  • Alcoholic Liver Disease. Alcoholic liver disease is a result of alcohol abuse. A large percentage of Americans drink alcohol, and most do not develop liver disease as a result. However, those who continue to consume alcohol excessively may cause injury to their liver.
  • Cholestasis. This happens when the flow of bile from your liver is limited or blocked. Cholestasis can be caused by certain drugs, genetic factors or even pregnancy. It can also happen from a blockage caused by a tumor or a gallstone stuck in the body’s digestive system.
  • Cirrhosis. This is a hardening of your liver due to scar tissue. Heavy alcohol use and viruses hepatitis are common causes of cirrhosis. Diabetes, immune problems and genetic diseases can also cause the disease.
  • Hepatitis. This is the name for any condition involving inflammation of your liver. There are many different types. Sometimes, excessive alcohol use, drugs or toxins cause hepatitis. Hepatitis can lead to liver failure, liver cancer and other life-threatening conditions.
  • Nonalcoholic Fatty Liver Disease. This happens when there are fat deposits in the liver. The deposits prevent your liver from functioning properly and removing toxins from your body.


There are a number of tests that can determine how well the liver is functioning. Your doctor will assess your symptoms and determine the best approach. Your doctor may request:


Depending on the severity of the liver disease, treatment may be an option. Treatments vary depending on the specific disease but may include prescribed medication, a restrictive diet or surgery. If the liver damage is irreversible, a liver transplant may be necessary.