Liver disease

What is liver disease?

Liver disease is a broad term for any condition that damages your liver and stops it working as it should. Your liver is the largest internal organ in your body, and it plays a vital role in digesting food, storing energy, and clearing toxins from your blood. There are more than 100 different types of liver disease, ranging from mild to life-threatening.

Symptoms of liver disease

Liver disease often causes no symptoms in its early stages. By the time symptoms appear, your liver is usually already damaged and scarred, a stage known as cirrhosis. Symptoms can include:

• feeling very tired and weak all the time
• loss of appetite, which may lead to weight loss
• yellowing of your skin or the whites of your eyes (jaundice)
• itchy skin
• feeling or being sick
• dark-coloured urine and pale, light-coloured stools
• swelling in your abdomen or legs
• a loss of sex drive.

More severe signs, such as vomiting blood, black or bloody stools, or confusion and changes in your mood or sleep, suggest advanced liver damage and need urgent medical attention.

Causes of liver disease and who is at risk

The 3 main causes of liver disease are obesity, an undiagnosed hepatitis infection, and drinking too much alcohol; all 3 are largely preventable. Other causes include:

• viral infections, such as hepatitis A, B or C
• autoimmune conditions, where your immune system mistakenly attacks your liver or bile ducts
• inherited conditions, such as haemochromatosis (a build-up of iron) or Wilson's disease (a build-up of copper)
• long-term use of certain medications, supplements or herbal remedies
• exposure to toxins, such as some pesticides or industrial chemicals.

You may be more at risk if you have obesity or type 2 diabetes, drink alcohol regularly or heavily, have a history of hepatitis, or have a family history of liver disease. You don't need to drink excessively to damage your liver; regularly drinking just over the recommended limits can also be harmful.

Are there different types of liver disease?

Yes, there are more than 100 types of liver disease, but the most common include:

• alcohol-related liver disease, where the liver is damaged after years of drinking too much alcohol
• non-alcoholic fatty liver disease, a build-up of fat in the liver cells, usually linked to being overweight or obese
• hepatitis, inflammation of the liver caused by a viral infection or by alcohol
• haemochromatosis, an inherited condition causing a build-up of iron in the liver
• primary biliary cholangitis, a rare condition where the immune system damages the liver's bile ducts.

Many types of liver disease can lead to cirrhosis, or scarring of the liver, if the underlying cause isn't treated.

How liver disease is diagnosed

Your doctor will ask about your symptoms, your medical and family history, and your eating, drinking and exercise habits. They'll also ask about any medications, vitamins or supplements you take.

You'll usually have blood tests to check how well your liver is working, and you may need imaging, such as an ultrasound, CT scan or MRI, to look for signs of damage. Occasionally, a liver biopsy, where a small tissue sample is taken and examined, is needed to confirm the diagnosis or see how advanced the condition is.

How liver disease is treated

Non-surgical treatment

Treatment depends on the type and cause of your liver disease, and how advanced it is. In earlier stages, healthy lifestyle changes can sometimes treat, or even reverse, liver damage. These include:

• eating a nutritious, balanced diet
• getting regular physical activity
• reaching and maintaining a healthy weight
• cutting down or stopping drinking alcohol.

Some types of liver disease need medicine as well, such as antiviral drugs for certain types of hepatitis, steroids to reduce inflammation, or medicines to relieve specific symptoms such as itchy skin.

Surgical treatment

If your liver is severely damaged and scarred (cirrhosis), a liver transplant may be needed, where your diseased liver is replaced with a healthy donor liver. This is usually only considered once other treatments haven't been able to control the condition.

Occasionally, surgery to remove all or part of the liver is used to treat certain conditions, such as liver cancer.

When to see a doctor

See a GP if you think you might have liver disease or cirrhosis. Contact your doctor if you notice yellowing of your skin or eyes, ongoing fatigue or weakness, swelling in your belly or legs, or unexplained weight loss.