The liver plays an important role in many bodily functions from protein production and blood clotting to cholesterol, glucose (sugar), and ironmetabolism.
A variety of illnesses can affect the liver, for example
- certain drugs like excessive amounts ofacetaminophen, and acetaminophen combination medications like Vicodin, Norco, and statins
- cirrhosis
- alcohol abuse
- hepatitis A, B, C, D, and E
- Epstein Barr virus (infectious mononucleosis)
- non-alcoholic fatty liver disease
- iron overload (hemochromatosis)
Symptoms of liver diseases include
- weakness and fatigue
- weight loss
- nausea
- vomiting
- yellow discoloration of the skin
The treatment of a particular liver disease depends on its specific cause.
What Causes Liver Failure?
The most common causes of chronic liver failure (where the liver fails over months to years) include:
- Hepatitis B
- Hepatitis C
- Long-term alcohol consumption
- Cirrhosis
- Hemochromatosis (an inherited disorder that causes the body to absorb and store too much iron)
- Malnutrition
The causes of acute liver failure, when the liver fails rapidly, however, are often different. These include:
- Acetaminophen (Tylenol) overdose
- Viruses including hepatitis A, B, and C (especially in children)
- Reactions to certain prescription and herbal medications
- Ingestion of poisonous wild mushrooms
What Are the Symptoms of Liver Failure?
The initial symptoms of liver failure are often ones that can be due to any number or conditions. Because of this, liver failure may be initially difficult to diagnose. Early symptoms include:
- Nausea
- Loss of appetite
- Fatigue
- Diarrhea
However, as liver failure progresses, the symptoms become more serious, requiring urgent care. These symptoms include:
- Jaundice
- Bleeding easily
- Swollen abdomen
- Mental disorientation or confusion (known as hepatic encephalopathy)
- Sleepiness
- Coma
How Is Liver Failure Treated?
If detected early enough, acute liver failure caused by an overdose of acetaminophen can sometimes be treated and its effects reversed. Likewise, if a virus causes liver failure, supportive care can be given at a hospital to treat the symptoms until the virus runs its course. In these cases, the liver will sometimes recover on its own.
For liver failure that is the result of long-term deterioration, the initial treatment goal may be to save whatever part of the liver is still functioning. If this is not possible, then a liver transplant is required. Fortunately, liver transplant is a common procedure that is often successful.
Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms.
ARLD doesn't usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms can include:
- feeling sick
- weight loss
- loss of appetite
- yellowing of the eyes and skin (jaundice)
- swelling in the ankles and tummy
- confusion or drowsiness
- vomiting blood or passing blood in your stools
This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage.
If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged.
Alcohol and the liver
With the exception of the brain, the liver is the most complex organ in the body. Its functions include:
- filtering toxins from the blood
- aiding digestion of food
- regulating blood sugar and cholesterol levels
- helping fight infection and disease
The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die.
The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver.
ARLD is very common in the UK – the number of people with the condition has been increasing over the last few decades as a result of increasing levels of alcohol misuse.
Stages of ARLD
There are three main stages of ARLD, although there's often an overlap between each stage. These stages are explained below.
Alcoholic fatty liver disease
Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease, and is the first stage of ARLD.
Fatty liver disease rarely causes any symptoms, but it's an important warning sign that you're drinking at a harmful level.
Fatty liver disease is reversible. If you stop drinking alcohol for two weeks, your liver should return to normal.
Alcoholic hepatitis
Alcoholic hepatitis – which is unrelated to infectious hepatitis – is a potentially serious condition that can be caused by alcohol misuse over a longer period. When this develops, it may be the first time a person is aware they're damaging their liver through alcohol.
Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking).
The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently.
Severe alcoholic hepatitis, however, is a serious and life-threatening illness. Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage.
Cirrhosis
Cirrhosis is a stage of ARLD where the liver has become significantly scarred. Even at this stage, there may not be any obvious symptoms.
It's generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy.
A person who has alcohol-related cirrhosis and doesn't stop drinking has a less than 50% chance of living for at least five more years.
How ARLD is treated
There's currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk of further damage to your liver and gives it the best chance of recovering.
If a person is dependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available through local alcohol support services.
A liver transplant may be required in severe cases where the liver has stopped functioning and doesn't improve when you stop drinking alcohol.
You'll only be considered for a liver transplant if you've developed complications of cirrhosis, despite having stopped drinking. All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest of their life.
Read more about treating ARLD.
Complications
Death rates linked to ARLD have risen considerably over the last few decades. Alcohol is now one of the most common causes of death in the UK, along with smoking and high blood pressure.
Life-threatening complications of ARLD include:
- internal (variceal) bleeding
- build-up of toxins in the brain (encephalopathy)
- fluid accumulation in the abdomen (ascites) with associated kidney failure
- liver cancer
Preventing ARLD
The most effective way to prevent ARLD is to stop drinking alcohol or stick to the recommended limits:
- men and women are advised not to regularly drink more than 14 units a week
- spread your drinking over three days or more if you drink as much as 14 units a week
A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits.
Even if you've been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefits for your liver and overall health.
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