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Disorders of the Liver
There are many disorders of the liver that require clinical care by a physician or other healthcare professional. Listed in the directory below are some, for which we have provided a brief overview.

- Alcohol-Induced Liver Disease
- Chronic Liver Disease /Cirrhosis
- Congenital Defects
- Hepatitis
- Liver Tumors
- Other Liver Disorders
- Liver Transplantation

Alcohol-Induced Liver Disease

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What is alcohol-induced liver disease?

Alcohol-induced liver disease, as the name implies, is caused by excessive consumption of alcohol and is a common, but preventable, disease.

There are three primary types of alcohol-induced liver disease, including the following:

  • fatty liver
    Fatty liver is excessive accumulation of fat inside the liver cells.
    Fatty liver is the most common alcohol-induced liver disorder. The liver is enlarged, causing upper abdominal discomfort on the right side.

  • alcoholic hepatitis
    Alcoholic hepatitis is an acute inflammation of the liver, accompanied by the destruction of individual liver cells and scarring. Symptoms may include fever, jaundice, an increased white blood cell count, an enlarged, tender liver, and spider-like veins in the skin.

  • alcoholic cirrhosis
    Alcoholic cirrhosis is the destruction of normal liver tissue, leaving non-functioning scar tissue. Symptoms may include those of alcoholic hepatitis, in addition to portal hypertension, enlarged spleen, ascites, kidney failure, confusion, or liver cancer.

What are the symptoms of alcohol-induced liver disease?

Symptoms of alcohol-induced liver disease depend on how much and how long a person has been drinking alcohol. The following are the most common symptoms of alcohol-induced liver disease. However, each individual may experience symptoms differently. Symptoms may include:

  • enlarged liver

  • fever

  • nausea

  • vomiting

  • jaundice - yellowing of the skin and eyes

  • increased white blood cell count

  • spider-like veins in the skin

  • portal hypertension

  • enlarged spleen

  • ascites - fluid build-up in the abdominal cavity

  • kidney failure

  • confusion

The symptoms of alcohol-induced liver disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is alcohol-induced liver disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for alcohol-induced liver disease may include the following:

  • laboratory tests

  • liver function tests - a series of special blood tests that can determine if the liver is functioning properly.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

  • computed tomography scan (CT or CAT scan) - This diagnostic imaging procedure uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

  • magnetic resonance imaging (MRI) - MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. The patient lies on a bed that moves into the cylindrical MRI machine. The machine takes a series of pictures of the inside of the body using a magnetic field and radio waves. The computer enhances the pictures produced. The test is painless, and does not involve exposure to radiation. Because the MRI machine is like a tunnel, some people are claustrophobic or unable to hold still during the test, and may be given a sedative to help them relax. Metal objects cannot be present in the MRI room, so persons with pacemakers or metal clips or rods inside the body cannot have this test done. All jewelry must be removed before the procedure.

Treatment for alcohol-induced liver disease:

Specific treatment for alcohol-induced liver disease will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

The goal of treatment is to restore some or all normal functioning to the liver. Treatment usually begins with abstinence from alcohol. The liver has great restorative power and is often able to repair some of the damage caused by alcohol. In most cases, the only damage it cannot reverse is scarring from cirrhosis.

Chronic Liver Disease /Cirrhosis

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What is chronic liver disease?

Chronic liver disease is marked by the gradual destruction of liver tissue over time. Several liver diseases fall under this category, including the following:

  • cirrhosis of the liver

  • fibrosis of the liver

What is cirrhosis of the liver?

Cirrhosis is the 12th leading cause of death in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Because of chronic damage to the liver, scar tissue slowly replaces normal functioning liver tissue, progressively diminishing blood flow through the liver. As the normal liver tissue is lost, nutrients, hormones, drugs, and poisons are not processed effectively by the liver. In addition, protein production and other substances produced by the liver are inhibited.

What are the symptoms of cirrhosis?

Symptoms of cirrhosis vary, depending on severity of the condition. Mild cirrhosis may not exhibit any symptoms at all. The following are the most common symptoms of cirrhosis. However, each individual may experience symptoms differently. Symptoms may include:

  • abnormal nerve function

  • ascites - fluid build-up in the abdominal cavity.

  • breast enlargement in men

  • coughing up or vomiting blood

  • curling of fingers (Dupuytren's contracture of the palms)

  • gallstones

  • hair loss

  • itching

  • jaundice - yellowing of the skin and eyes.

  • kidney failure

  • liver encephalopathy

  • muscle loss

  • poor appetite

  • portal hypertension

  • redness of palms

  • salivary gland enlargement in cheeks

  • shrinking of testes

  • spider-like veins in the skin

  • weakness

  • weight loss

The symptoms of cirrhosis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

What causes cirrhosis?

The most common cause of cirrhosis is alcohol abuse. Other causes include the following:

  • hepatitis and other viruses

  • use of certain drugs

  • chemical exposure

  • bile duct obstruction

  • autoimmune diseases

  • obstruction of outflow of blood from the liver (i.e., Budd-Chiari syndrome)

  • heart and blood vessel disturbances

  • alpha1-antitrypsin deficiency

  • high blood galactose levels

  • high blood tyrosine levels at birth

  • glycogen storage disease

  • cystic fibrosis

  • diabetes

  • malnutrition

  • hereditary accumulation of too much copper (Wilson's Disease) or iron (hemochromatosis)

How is cirrhosis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for cirrhosis may include the following:

  • laboratory tests

  • liver function tests - a series of special blood tests that can determine if the liver is functioning properly.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

  • cholangiography - x-ray examination of the bile ducts using an intravenous (IV) dye (contrast).

  • computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

  • ultrasound (Also called sonography.) - a diagnostic imaging technique, which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen, and kidneys and to assess blood flow through various vessels.

Treatment for cirrhosis:

Specific treatment for cirrhosis will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Cirrhosis is a progressive liver disease, and damage sustained to the liver is irreversible. However, with proper nutrition, avoidance of certain toxins (such as alcohol), vitamin supplementation, and management of cirrhosis complications, further liver damage can often be delayed or stopped. In severe cases of cirrhosis, liver transplantation may be considered.

What is fibrosis?

Fibrosis is the growth of scar tissue due to infection, inflammation, injury, or even healing. The overgrowth of scar tissue can occur in almost any organ. Fibrosis in the liver can inhibit the organ's proper functioning. Liver fibrosis is usually the result of cirrhosis.

Congenital Liver Defects

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What are congenital liver defects?

Defects of the liver at birth usually affect the bile ducts. Though rare, some congenital liver defects include the following:

  • biliary atresia - a condition in which the bile ducts are blocked or have developed abnormally to obstruct flow of bile in infants.

  • choledochal cyst - a malformation of the hepatic duct that can obstruct flow of bile in infants.

What are the indicators that a congenital liver defect may be present?

Congenital liver defects that affect the flow of bile share some common symptoms. The following are the most common symptoms of congenital liver defect. However, each individual may experience symptoms differently. Symptoms may include:

  • jaundice - yellowing of the skin and eyes.

  • dark urine

  • pale, white or gray-colored stools

The symptoms of congenital liver defects may resemble other medical conditions or problems. Always consult your child's physician for a diagnosis.

How are congenital liver defects diagnosed?

Congenital liver defects that affect the flow of bile are usually diagnosed at birth or shortly afterward. In addition to a complete medical history and physical examination, diagnostic procedures for a congenital liver defect may include the following:

  • laboratory tests (blood, urine and stool)

  • liver function tests - a series of special blood tests that can determine if the liver is functioning properly.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

  • computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

  • ultrasound (also called sonography) - a diagnostic imaging technique, which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen, and kidneys and to assess blood flow through various vessels.

Treatment for congenital liver defects:

Specific treatment for congenital liver defects will be determined by your child's physician based on:

  • your child's age, overall health, and medical history

  • extent of the disease

  • your child's tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Treatment may include surgery to reconstruct or bypass the bile ducts. Sometimes, a liver transplant may be necessary.

Hepatitis

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There are several types of hepatitis that require clinical care by a physician or other healthcare professional. Listed in the directory below are some, for which we have provided a brief overview.

Autoimmune Hepatitis

Viral Hepatitis Overview

Hepatitis A

Hepatitis B

Hepatitis C

Drug-Induced Hepatitis

Alcoholic Hepatitis

Autoimmune Hepatitis

Back to Hepatitis

What is autoimmune hepatitis?

Hepatitis is the inflammation of the liver, resulting in liver cell damage and destruction. In autoimmune hepatitis, the body's own immune system destroys the cells of the liver. It is a chronic inflammatory liver disease with no known cause. It is associated with a disorder called hypergammaglobulinemia. Hypergammaglobulinemia is a disorder where there are too any circulating protein antibodies in the blood. A chronic infection or certain malignant blood diseases may cause hypergammaglobulinemia. Autoimmune hepatitis may resolve without treatment in some individuals, but, for the majority of individuals, it is chronic and can lead to cirrhosis and liver failure.

Autoimmune hepatitis may be classified as type 1 or type 2. Type 1 (classic) is the most common form. It may occur at any age but usually affects young women more than men. Also, other autoimmune disorders can be associated with type 1 such as thyroiditis, Grave's disease, and ulcerative colitis. Type 2 generally affects girls between the ages of two and 14, but does occur in adults.

What are the symptoms of autoimmune hepatitis?

The following are the most common symptoms of autoimmune hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

  • jaundice - yellowing of the skin and eyes.

  • fatigue

  • abdominal pain

  • severe acne

  • joint pain

  • joint swelling

  • cessation of menses

  • chest pain

  • diarrhea

  • fever

  • large abdomen due to large liver and spleen

  • spider-like blood vessels in the skin

  • dark urine

  • pale or gray-colored stools

  • ascites - fluid build-up in the abdominal cavity.

The symptoms of autoimmune hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is autoimmune hepatitis diagnosed?

In addition to complete medical history and physical examination, diagnostic procedures for autoimmune hepatitis may include the following:

  • specific laboratory blood tests, such as the following:

    • liver function studies

    • cellular blood counts

    • bleeding times

    • electrolyte tests

    • tests for other chemicals in the body

    • autoimmune antibodies

  • computed tomography scan (CT or CAT scan) - This diagnostic imaging procedure uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

  • magnetic resonance imaging (MRI) - MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. The patient lies on a bed that moves into the cylindrical MRI machine. The machine takes a series of pictures of the inside of the body using a magnetic field and radio waves. The computer enhances the pictures produced. The test is painless, and does not involve exposure to radiation. Because the MRI machine is like a tunnel, some people are claustrophobic or unable to hold still during the test, and may be given a sedative to help them relax. Metal objects cannot be present in the MRI room, so persons with pacemakers or metal clips or rods inside the body cannot have this test done. All jewelry must be removed before the procedure.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

Treatment for autoimmune hepatitis:

Specific treatment for autoimmune hepatitis will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

The goal of treatment for autoimmune hepatitis is to drive the disease into remission (complete or partial absence of symptoms). This is done by taking corticosteroids and immunosuppressive medications. Remission may take six months to a year or longer to occur. If an individual develops liver failure, a liver transplant may be considered.

Viral Hepatitis Overview

Back to Hepatitis

What is hepatitis?

Hepatitis is the inflammation of the liver, resulting in liver cell damage and destruction.

Illustration of the  anatomy  of the biliary system
Click Image to Enlarge

Hepatitis can be categorized in two groups:

  • acute hepatitis

  • chronic hepatitis

There are six main types of the hepatitis virus that have been identified, including the following:

  • Hepatitis A
    This type of hepatitis is usually spread by fecal-oral contact, or fecal-infected food and water, and may also be spread by blood-borne infection (which is rare). The following is a list of modes of transmission for hepatitis A:

    • consuming food made by someone who touched infected feces

    • drinking water that is contaminated by infected feces (a problem in developing countries with poor sewage removal)

    • touching an infected person's feces, which may occur with poor hand washing

    • outbreaks may occur in large childcare centers, especially when there are children in diapers

    • residents of American Indian reservations or Native Alaskan villages where hepatitis A may be more common

    • sexual contact with an infected person A vaccine for hepatitis A has been developed and is now available.

  • Hepatitis B
    Hepatitis B (HBV) has a wide range of clinical presentations. It can be mild, without symptoms, or it may cause chronic hepatitis and, in some cases, can lead to full-blown liver failure and death. Transmission of hepatitis B virus occurs through blood and body fluid exposure such as blood, semen, vaginal secretions, or saliva. Needle sticks, sharp instruments, sharing items (razors, toothbrushes) and sex with an infected person are primary modes of transmission. Infants may also develop the disease if they are born to a mother who has the virus. Infected children often spread the virus to other children if there is frequent contact or a child has many scrapes or cuts. The following describes persons who are at risk for developing hepatitis B:

    • children born to mothers who have hepatitis B (the illness may present up to five years after the child is born)

    • children who are born to mothers who have immigrated from a country where hepatitis B is widespread such as southeast Asia and China

    • persons who live in long-term care facilities or who are disabled

    • persons who live in households where another member is infected with the virus

    • persons who have a blood clotting disorder such as hemophilia

    • persons who require dialysis for kidney failure

    • persons who may participate in high-risk activities such as intravenous (IV) drug use and/or unprotected heterosexual or homosexual sexual contact

    • persons who have a job that involves contact with human blood

    • persons who received blood transfusions or blood products before the early 1990s

    A vaccine for hepatitis B does exist and is now widely used for routine childhood immunization. The Centers for Disease Control and Prevention (CDC) now recommend that universal infant hepatitis B vaccination should begin at birth except in rare circumstances.

  • Hepatitis C
    The symptoms of hepatitis C are usually mild and gradual. Children often show no symptoms at all. Transmission of hepatitis C occurs primarily from contact with infected blood, but can also occur from sexual contact, or from an infected mother to her baby. Although hepatitis C has milder symptoms initially, it leads to chronic liver disease in a majority of people who are infected. According to the Centers for Disease Control and Prevention (CDC), hepatitis C is the leading indication for liver transplantation. With some cases of hepatitis C, no mode of transmission can be identified. In addition, people with alcoholic liver disease also tend to develop hepatitis C.

    The following describes persons who may be at risk for contracting hepatitis C:

    • children born to mothers who are infected with the virus

    • persons who have a blood clotting disorder such as hemophilia and received clotting factors before 1987

    • persons who require dialysis for kidney failure

    • individuals who received a blood transfusion before 1992

    • persons who may participate in high-risk activities such as intravenous drug use and/or unprotected heterosexual or homosexual sexual contact.

    There is no vaccine for hepatitis C. Persons who are at risk should be checked regularly for hepatitis C. Persons who have hepatitis C should be monitored closely for signs of chronic hepatitis and liver failure.

  • Hepatitis D
    This form of hepatitis can only occur in the presence of hepatitis B. If an individual has hepatitis B and does not show symptoms, or shows very mild symptoms, infection with D can put that person at risk for full-blown liver failure that progresses rapidly. Hepatitis D can occur at the same time as the initial infection with B, or it may show up much later. Transmission of hepatitis D occurs the same way as hepatitis B, except the transmission from mother to baby is less common.

  • Hepatitis E
    This form of hepatitis is similar to hepatitis A. Transmission occurs through fecal-oral contamination. It is less common than hepatitis A. Hepatitis E is most common in poorly developed countries and rarely seen in the United States. There is no vaccine for hepatitis E at this time.

  • Hepatitis G
    This is the newest strain of hepatitis and very little is known about it. Transmission is believed to occur through blood and is most commonly seen in IV drug users, individuals with clotting disorders such as hemophilia, and individuals who require hemodialysis for renal failure. Often, hepatitis G shows no clinical symptoms and has not been found to be a cause of acute or chronic hepatitis.

How often does hepatitis occur?

According to the CDC, in the US:

  • hepatitis A rates have declined by 92 percent since the hepatitis A vaccine first became available in 1995 .

  • an estimated 800,000 to 1.4 million people have hepatitis B infections.

  • an estimated 3.2 million people have chronic hepatitis C infections.

What is acute hepatitis?

What is chronic hepatitis?

Acute hepatitis is quite common in the US.

Causes:
Common causes of acute hepatitis may include:

  • infection with a virus (viral hepatitis A, B, C, D, or E)

  • overdose of drugs (such as acetaminophen)

  • chemical exposure (such as dry cleaning chemicals)

Symptoms:
Acute hepatitis usually starts with flu-like symptoms. The following are the most common symptoms of acute hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

  • jaundice (yellow color in the skin and/or eyes)

  • nausea

  • vomiting

  • loss of appetite

  • fever

  • tenderness in the right, upper abdomen

  • sore muscles

  • joint pain

  • clay-colored bowel movements

  • itchy red hives on skin

The symptoms of acute hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnosis:
In addition to a complete medical history and medical examination, diagnostic procedures for acute hepatitis may include the following:

  • specific laboratory tests

  • liver function tests

Treatment:
Specific treatment for acute hepatitis will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Treatment varies, depending on the type of acute hepatitis (viral versus non-viral). Severe, acute hepatitis may require hospitalization.

People who have had acute viral hepatitis may become chronic carriers of the disease. Proper precautions need to be taken to prevent the spread of the disease.

Some people do not recover fully from acute hepatitis and develop chronic hepatitis, as the liver continues to sustain more damage and inflammation. Hepatitis is considered chronic if symptoms persist longer than six months. Chronic hepatitis can last years.

Type of chronic hepatitis:

  • alcohol-induced chronic hepatitis - continued liver damage throughout the liver from heavy alcohol consumption.

  • chronic active hepatitis - an aggressive inflammation and destroyer of liver cells, which usually leads to cirrhosis.

  • chronic persistent hepatitis - a milder inflammation of the liver, which usually does not lead to cirrhosis.

Causes:
Certain viruses and drugs may cause chronic hepatitis in some people, but not in others. Some common causes include the following:

  • viral hepatitis

  • heavy alcohol consumption

  • autoimmune disorder (when the body attacks its own tissues)

  • reaction to certain medications

  • metabolic disorder (such as hemochromatosis or Wilson's Disease)

Symptoms:
Symptoms for chronic hepatitis are usually mild. Although the liver damage continues, its progression is usually slow. The following are the most common symptoms of chronic hepatitis. However, each individual may experience symptoms differently. Some individuals may experience no symptoms, while others may experience the following:

  • feeling ill

  • poor appetite

  • fatigue

  • low fever

  • upper abdominal pain

  • jaundice

  • symptoms of chronic liver disease (such as enlarged spleen, spider-like blood vessels in the skin, and fluid retention)

The symptoms of chronic hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnosis:
In addition to a complete medical history and medical examination, diagnostic procedures for chronic hepatitis may include the following:

  • specific laboratory tests

  • liver function tests

  • liver biopsy (to determine severity of inflammation, scarring, cirrhosis, and underlying cause)

Treatment:
Specific treatment for chronic hepatitis will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • cause of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

The goal of treatment is to stop damage to the liver and alleviate symptoms. Treatment may include:

  • antiviral agent
    When caused by hepatitis B or C, inflammation of the liver may be stopped with the antiviral agent interferon-alpha.

  • corticosteroids
    Corticosteroids may be used to treat chronic liver disease caused by an autoimmune disorder. Inflammation is suppressed, but scarring of the liver may continue.

  • discontinuation of certain drugs
    When chronic hepatitis is caused by certain drugs, discontinuing those drugs usually clears up any symptoms.

Preventing the spread of viral hepatitis:

Proper hygiene is the key to preventing the spread of many diseases, including hepatitis. Other preventive measures include the following:

  • vaccinations
    A hepatitis B vaccine is routinely given to toddlers as part of their immunization schedule. A hepatitis A vaccine is available for people at risk. (There are no vaccines for hepatitis C, D, E, or G at this time.)

  • blood transfusion
    Blood transfusions are routinely screened for hepatitis B and C to reduce the risk of infection.

  • antibody preparation
    If a person has been exposed to hepatitis, an antibody preparation can be administered to help protect them from contracting the disease.

Hepatitis A

Back to Hepatitis

What is hepatitis?

The liver is one of the organs that helps with digestion but is not part of the digestive tract. It is the largest organ in the body and carries out many important functions, such as making bile, changing food into energy, and cleaning alcohol and poisons from the blood.

Hepatitis is inflammation of the liver that sometimes causes permanent damage. It is caused by viruses, bacteria, certain medications, or alcohol. It may also be caused by certain diseases such as: autoimmune diseases, metabolic diseases, and congenital (present at birth) abnormalities (biliary atresia, Wilson's disease). Generally, symptoms of hepatitis include fever, jaundice, and an enlarged liver. There are several types of hepatitis.

Illustration of the  anatomy of the biliary system
Click Image to Enlarge

What is hepatitis A?

Hepatitis A is a highly contagious and sometimes serious liver disease caused by the hepatitis A virus. Once called infectious hepatitis, today it is more commonly known as hepatitis A. Approximately one-third of Americans have been exposed to hepatitis A.

Hepatitis A does not result in chronic infection, but complete recovery from hepatitis A can be slow. In adult patients with hepatitis A, the illness may last for at least one month, with recovery taking up to six months. Hepatitis A rates in the United States have declined by 92 percent since the vaccine (hepatitis A) first became available in 1995.

What are the symptoms of hepatitis A?

The following are the most common symptoms of hepatitis A. However, each individual may experience symptoms differently. Symptoms of hepatitis A often resemble flu-like symptoms. Symptoms may include:

  • fever

  • chills

  • joint pain

  • fatigue

  • general feeling of weakness

  • loss of appetite

  • nausea

  • vomiting

  • abdominal discomfort

  • dark urine

  • clay-colored stools

  • jaundice - yellowing of the skin and eyes

  • diarrhea

In some adults, and in children (about 70 percent), especially in those younger than 6 years of age, there are often no symptoms. The symptoms of hepatitis A may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

What causes hepatitis A?

This type of hepatitis is usually spread by fecal-oral contact or fecal-infected food and water, and may also be spread by blood-borne infection (which is rare). The following is a list of modes of transmission for hepatitis A:

  • consuming food made by someone who touched infected feces

  • drinking water that is contaminated by infected feces (a problem in developing countries with poor sewage removal)

  • touching an infected person's feces, which may occur with poor hand washing

  • outbreaks may occur in large childcare centers, especially when there are children in diapers

  • residents of American Indian reservations or Native Alaskan villages where hepatitis A may be more common

  • sexual contact with an infected person

Generally, casual contact in school or the workplace does not cause spread of the virus.

What are the risk factors for hepatitis A?

Children, teens, and adults who may be at high risk of hepatitis A include the following:

  • people traveling to areas of where hepatitis A is prevalent, including, but not limited to: Africa, Asia (except Japan), the Mediterranean basin, Eastern Europe, the Middle East, Central and South America, Mexico, and parts of the Caribbean

  • people living in or relocating to any community in the US or abroad with one or more recorded hepatitis A outbreaks within the past five years

  • military personnel

  • people who engage in high-risk sexual activity

  • users of illegal intravenous (IV) drugs

  • hemophiliacs and other recipients of therapeutic blood products

  • employees of daycare centers

  • institutional care workers

  • laboratory workers who handle live hepatitis A virus

  • people who handle primate animals that may be carrying the hepatitis A virus

Hepatitis A is sometimes called a traveler's disease because it is the most frequently occurring, vaccine-preventable infection in travelers. However, it is possible to become infected with hepatitis A virus without ever leaving the United States. Some cases reported in the United States have occurred in people with no identifiable risk factors.

Prevention of hepatitis A:

In addition to avoiding risky behaviors, there are two methods for prevention of hepatitis A:

  • immune globulin
    A preparation of antibodies that is given both before anticipated exposure to the hepatitis A virus and soon after exposure.

  • hepatitis A vaccine
    Researchers at the National Institute of Allergy and Infectious Diseases have found the genes that make hepatitis A virulent. However, when the researchers altered those genes to weaken the virus, the virus quickly reverted itself back to its natural infectious form, making it difficult to create an improved vaccine. Currently, the vaccine consists of killed hepatitis A virus. Please consult your physician if you have any questions about its use.

The Centers for Disease Control and Prevention (CDC) recommend the hepatitis A vaccine for the following groups who are at risk for the infection, as well as for anyone who wants to have the vaccine:

  • people traveling to or working in countries that have high or intermediate rates of hepatitis A

  • children who are at 12 months and 2 years of age and older children and adults in communities that have high rates of hepatitis A and periodic outbreaks of the disease

  • men who have sex with men

  • illegal drug users

  • people at occupational risk for the disease

  • people with chronic liver disease

  • people with clotting-factor disorders such as hemophilia

How is hepatitis A diagnosed?

In addition to a complete medical history and physical examination, a blood test called IgM ant-HAV is needed to diagnose hepatitis A.

Treatment for hepatitis A:

Specific treatment for hepatitis A will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Most people recover from hepatitis A infection without medical intervention; however, bedrest and some medications may be suggested.

Hepatitis B

Back to Hepatitis

Illustration of the  anatomy of the biliary system
Click Image to Enlarge

What is hepatitis?

The liver is one of the organs that helps with digestion but is not part of the digestive tract. It is the largest organ in the body and carries out many important functions, such as making bile, changing food into energy, and cleaning alcohol and poisons from the blood.

Hepatitis is inflammation of the liver that sometimes causes permanent damage. It is caused by viruses, bacteria, certain medicines, or alcohol. It may also be caused by certain diseases such as: autoimmune diseases, metabolic diseases, and congenital (present at birth) abnormalities (biliary atresia, Wilson's disease). Generally, symptoms of hepatitis include fever, jaundice, and an enlarged liver. There are several types of hepatitis.

What is hepatitis B?

Hepatitis B (HBV) is a blood-borne microorganism transmitted by exposure to the hepatitis B virus through infectious body fluids or blood.

Hepatitis B is one of the most frequently reported, vaccine-preventable diseases in the United States. It is estimated that 2,000 to 5,000 deaths will occur each year from a chronic HBV infection, and an estimated 800,000 to 1.4 million people have chronic hepatitis B.

What are the symptoms of hepatitis B?

Hepatitis B has a wide range of symptoms. It may be mild, without symptoms, or it may cause chronic hepatitis. In some cases, hepatitis B can lead to full-blown liver failure and death. The following are the most common symptoms of hepatitis B. However, each individual may experience symptoms differently. Symptoms may include:

  • loss of appetite

  • nausea

  • fatigue

  • vomiting

  • jaundice - yellowing of the skin and eyes.

  • dark urine

  • clay colored or light stools

  • abdominal pain

  • occasionally, skin rashes, arthralgias (joint pain), and arthritis occur

  • enlarged liver

The symptoms of hepatitis B may resemble other medical conditions or problems. Most children, 4 years or younger, and newly infected immunosuppressed adults are asymptomatic, whereas 30% to 50% of persons, 5 years and older, have initial signs and symptoms. Always consult your physician for a diagnosis.

How is hepatitis B transmitted?

Transmission of hepatitis B virus occurs through blood and body fluid exposure such as blood, semen, vaginal secretions, or saliva. Needle sticks, sharp instruments, sharing items (razors, toothbrushes) and sex with an infected person are primary modes of transmission. Infants may also develop the disease if they are born to a mother who has the virus. Infected children often spread the virus to other children if there is frequent contact or a child has many scrapes or cuts.

Who is at risk for hepatitis B:

One out of 20 people in the US will develop hepatitis B at some time during their lives. The following describe persons who are at risk for developing hepatitis B:

  • children born to mothers who have hepatitis B (the illness may present up to five years after the child is born)

  • children who are born to mothers who have immigrated from a country where hepatitis B is widespread such as southeast Asia and China

  • persons who live in long-term care facilities or who are disabled

  • persons who live in households where another member is infected with the virus

  • persons who have a blood-clotting disorder such as hemophilia

  • persons who require dialysis for kidney failure

  • persons who may participate in high-risk activities such as intravenous (IV) drug use and/or unprotected heterosexual or homosexual sexual contact

  • persons who have a job that involves contact with human blood

  • persons who received blood transfusions or blood products before the early 1990s

A vaccine for hepatitis B does exist and is now widely used for routine childhood immunization.

Prevention of hepatitis B:

A vaccine for the prevention of hepatitis B is available. Given in three shots over a period of time, the vaccine is suggested for everyone age 18 years and younger, as well as for adults over age 18 who are at risk for the infection.

How is hepatitis B diagnosed?

In addition to a complete physical examination and laboratory tests for blood and urine, diagnostic procedures for hepatitis B may involve a liver biopsy (a procedure performed to remove tissue or cells from the body for examination under a microscope).

Treatment for hepatitis B:

Specific treatment for hepatitis B will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Treatment may include biological therapy with interferon. Currently, there is no cure for hepatitis B. Prevention is crucial.

Hepatitis C

Back to Hepatitis

Illustration of the  anatomy of the biliary system
Click Image to Enlarge

What is hepatitis?

The liver is one of the organs that helps with digestion but is not part of the digestive tract. It is the largest organ in the body and carries out many important functions, such as making bile, changing food into energy, and cleaning alcohol and poisons from the blood.

Hepatitis is inflammation of the liver that sometimes causes permanent damage. It is caused by viruses, bacteria, certain medications, or alcohol. It may also be caused by certain diseases such as: autoimmune diseases, metabolic diseases, and congenital (present at birth) abnormalities (biliary atresia, Wilson's disease). Generally, symptoms of hepatitis include fever, jaundice, and an enlarged liver. There are several types of hepatitis.

What is hepatitis C?

Hepatitis C (known as HCV, once called non-A, non-B hepatitis) is a liver disease caused by a recently identified blood-borne virus. Discovered in 1989, this strain of acute viral hepatitis causes approximately 20,000 new infections in the US each year.

Recovery from this infection is rare - about 75 to 85 percent of infected persons become chronic carriers of the virus. Approximately 20 percent of people infected with hepatitis C virus will become sick with jaundice or other symptoms of hepatitis. Sixty to 70 percent of these individuals may go on to develop chronic liver disease.

Chronic liver disease due to hepatitis C causes between 8,000 and 10,000 deaths and is the leading indication for liver transplantation each year in the United States. By the year 2010, the number of deaths from hepatitis C is expected to rise to 38,000 each year.

What causes hepatitis C?

Transmission of hepatitis C occurs primarily from contact with infected blood, but can also occur from sexual contact or from an infected mother to her baby. Blood transfusions prior to 1992 and the use of shared needles are other significant causes of the spread of hepatitis C.

Who is at risk for hepatitis C?

The following describes persons who may be at risk for contracting hepatitis C:

  • children born to mothers who are infected with the virus

  • persons who have a blood-clotting disorder such as hemophilia and received clotting factors before 1987

  • persons who require dialysis for kidney failure

  • individuals who received a blood transfusion before 1992

  • persons who may participate in high-risk activities such as intravenous (IV) drug use and/or unprotected heterosexual or homosexual sexual contact

There is no vaccine for hepatitis C. Persons who are at risk should be checked regularly for hepatitis C. Persons who have hepatitis C should be monitored closely for signs of chronic hepatitis and liver failure.

What are the symptoms of hepatitis C?

The following are the most common symptoms for hepatitis C. However, each individual may experience symptoms differently. Symptoms may include:

  • loss of appetite

  • fatigue

  • nausea and vomiting

  • vague stomach pain

  • jaundice - yellowing of the skin and eyes.

  • fever

  • dark yellow urine

  • light-colored stools

  • muscle and joint pain

Symptoms may occur from two weeks to six months after exposure. The symptoms of hepatitis C may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is hepatitis C diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for hepatitis C may include the following:

  • blood tests

  • liver biopsy - a procedure performed to remove tissue or cells from the body for examination under a microscope.

Treatment for hepatitis C:

Specific treatment for hepatitis C will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

At the present time, a vaccine is not available for the prevention of hepatitis C. Treatment may include biological therapy with interferon.

Drug-Induced Hepatitis

Back to Hepatitis

What is drug-induced hepatitis?

Hepatitis is the inflammation of the liver, resulting in liver cell damage and destruction. Drug-induced hepatitis is rare and is caused by toxic exposure to certain medications, vitamins, herbal remedies, or food supplements. Usually, the toxicity occurs after taking the causative agent for several months, or from an overdose of a medication such as acetaminophen. Usually, the agent is discontinued once hepatitis is suspected and is rarely restarted unless it is absolutely essential for treatment.

What are the symptoms of drug-induced hepatitis?

The following are the most common symptoms of drug-induced hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

  • fever

  • rash or itchy red hives on skin

  • joint pain

  • sore muscles

  • flu-like symptoms

  • nausea

  • vomiting

  • decreased appetite

  • sore muscles

  • dark urine

  • pale or clay-colored stools

  • jaundice - yellowing of the skin and eyes.

The symptoms of drug-induced hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is drug-induced hepatitis diagnosed?

In addition to complete medical history and physical examination, diagnostic procedures for drug-induced hepatitis may include the following:

  • specific laboratory blood tests, such as the following:

    • liver function studies

    • cellular blood counts

    • bleeding times

    • electrolyte tests

    • tests for other chemicals in the body

    • drug screening tests

  • ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver spleen, and kidneys and to assess blood flow through various vessels.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

Treatment for drug-induced hepatitis:

Specific treatment for drug-induced hepatitis will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

The goal of treatment for drug-induced hepatitis is to discontinue taking the causative agent and monitor the liver closely while it recovers. Some drugs may cause a slight increase in liver enzymes without symptoms. It may not be necessary to discontinue using these medications. Always consult your physician. If drug-induced hepatitis is suspected and confirmed, serial blood tests will be necessary, and possibly a referral to a liver specialist. Your physician will report the findings to the US Food and Drug Administration (FDA) and the pharmaceutical manufacturer.

Alcoholic Hepatitis

Back to Hepatitis

What is alcoholic hepatitis?

Hepatitis is the inflammation of the liver, resulting in liver cell damage and destruction. Alcoholic hepatitis is a complex problem and is a precursor to chronic liver disease and cirrhosis. If an individual develops alcoholic hepatitis and abstains from drinking, the inflammation is often reversible over time. However, if the individual has already developed cirrhosis, the liver disease can progress rapidly to liver failure.

What are the symptoms of alcoholic hepatitis?

The following are the most common symptoms of alcoholic hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

  • abdominal tenderness or pain

  • nausea

  • vomiting

  • spider-like blood vessels in the skin

  • ascites - fluid build-up in the abdominal cavity.

  • poor appetite

  • jaundice - yellowing of the skin and eyes.

  • low fever

  • fatigue

  • feeling ill

The symptoms of alcoholic hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is alcoholic hepatitis diagnosed?

In addition to complete medical history and physical examination, diagnostic procedures for alcoholic hepatitis may include the following:

  • specific laboratory blood tests, such as the following:

    • liver function studies

    • cellular blood counts

    • bleeding times

    • electrolyte tests

    • tests for other chemicals in the body

  • computed tomography scan (CT or CAT scan) - This diagnostic imaging procedure uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

  • magnetic resonance imaging (MRI) - MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. The patient lies on a bed that moves into the cylindrical MRI machine. The machine takes a series of pictures of the inside of the body using a magnetic field and radio waves. The computer enhances the pictures produced. The test is painless, and does not involve exposure to radiation. Because the MRI machine is like a tunnel, some people are claustrophobic or unable to hold still during the test, and may be given a sedative to help them relax. Metal objects cannot be present in the MRI room, so persons with pacemakers or metal clips or rods inside the body cannot have this test done. All jewelry must be removed before the procedure.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

Treatment for alcoholic hepatitis:

Specific treatment for alcoholic hepatitis will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

The individual with alcoholic hepatitis may be admitted to the hospital or treated on an outpatient basis. Abstinence from alcohol is essential for reversing the hepatitis. This is a complex problem that may require an alcohol treatment program. There is no medication to cure alcoholic hepatitis; therefore, treatment involves reducing the symptoms and halting the progression of the disease.

Liver Tumors

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What is a tumor?

Tumors are abnormal masses of tissue that form when cells begin to reproduce at an increased rate. The liver can grow both non-cancerous (benign) and cancerous (malignant) tumors.

What are non-cancerous liver tumors?

Non-cancerous (benign) tumors are quite common and usually do not produce symptoms. Often, they are not diagnosed until an ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan is performed. There are several types of benign liver tumors, including the following:

  • hepatocellular adenoma
    This benign tumor is linked to the use of certain drugs. Most of these tumors remain undetected. Sometimes, an adenoma will rupture and bleed into the abdominal cavity, requiring surgery. Adenomas rarely become cancerous.

  • hemangioma
    This type of benign tumor is a mass of abnormal blood vessels. Treatment is usually not required. Sometimes, infants with large liver hemangiomas require surgery to prevent clotting and heart failure.

What are cancerous liver tumors?

Cancerous (malignant) tumors in the liver have either originated in the liver (primary liver cancer) or spread from cancer sites elsewhere in the body (metastatic liver cancer). Most cancerous tumors in the liver are metastatic.

What is hepatoma (primary liver cancer)?

Also called hepatocellular carcinoma, this is the most common form of primary liver cancer. Chronic infection with hepatitis B and C increases the risk of developing this type of cancer. Other causes include cancer-causing substances, alcoholism, and chronic liver cirrhosis.

What are the symptoms of a liver hepatoma?

The following are the most common symptoms of a liver hepatoma. However, each individual may experience symptoms differently. Symptoms may include:

  • abdominal pain

  • weight loss

  • nausea

  • vomiting

  • large mass can be felt in upper, right part of abdomen

  • fever

  • jaundice - yellowing of the skin and eyes.

The symptoms of a liver hepatoma may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is liver hepatoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for a liver hepatoma may include the following:

  • liver function tests - a series of special blood tests that can determine if the liver is functioning properly.

  • abdominal ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen, and kidneys and to assess blood flow through various vessels.

  • computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

  • hepatic arteriography - x-rays taken after a substance in injected into the hepatic artery.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

Treatment for liver hepatoma:

Specific treatment for liver hepatoma will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance of specific medicines, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Treatment may include:

  • surgery
    In some cases surgery may be used to remove cancerous tissue from the liver. However, the tumor must be small and confined.

  • radiation therapy
    Radiation therapy uses high-energy rays to kill or shrink cancer cells.

  • chemotherapy
    Chemotherapy uses anticancer drugs to kill cancer cells.

  • liver transplantation

What are other types of primary liver cancers?

Other, less common primary liver cancers include the following:

  • cholangiocarcinoma - a cancer that originates in the lining of the bile channels in the liver or in the bile ducts.

  • hepatoblastoma - a cancer in infants and children, sometimes causing the release of hormones that result in early puberty.

  • angiosarcoma - a rare cancer that originates in the blood vessels of the liver.

What are the stages of liver cancer?

When a physician diagnoses liver cancer, the next step is to determine how far the cancer cells have spread (a process called staging). The National Cancer Institute defines the following stages for primary liver cancer:

localized resectable

Cancer is in the liver only, has not spread, and can be removed completely with surgery.

localized unresectable

Cancer is in the liver only, has not spread, but cannot be totally removed.

advanced

Cancer has spread throughout the liver or to other parts of the body.

recurrent

Cancer has come back after it was treated.

What is metastatic liver cancer?

Cancer that has spread from other areas in the body to the liver usually originated in the lung, breast, colon, pancreas, and stomach. Leukemia and other blood cancers sometimes also spread to the liver.

What are the symptoms of metastatic liver cancer?

The following are the most common symptoms of metastatic liver cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • weight loss

  • poor appetite

  • enlarged, hard and tender liver

  • fever

  • enlarged spleen

  • ascites - fluid build-up in the abdominal cavity.

  • jaundice - yellowing of the skin and eyes.

  • confusion

  • drowsiness

The symptoms of metastatic liver cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is metastatic liver cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for metastatic liver cancer may include the following:

  • liver function tests - a series of special blood tests that can determine if the liver is functioning properly.

  • abdominal ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver spleen, and kidneys and to assess blood flow through various vessels.

  • computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

Treatment for metastatic liver cancer:

Specific treatment for metastatic liver cancer will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disease

  • your tolerance of specific medicines, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Treatment may include:

  • surgery
    In some cases surgery may be used to remove cancerous tissue from the liver. However, the tumor must be small and confined.

  • radiation therapy
    Radiation therapy uses high-energy rays to kill or shrink cancer cells.

  • chemotherapy
    Chemotherapy uses anticancer drugs to kill cancer cells.

Other Liver Disorders

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What are autoimmune liver disorders?

An autoimmune disorder is any reaction or attack of a person's immune system against its own organs and tissues. In the liver, the immune system can destroy liver cells and damage bile ducts. Chronic active hepatitis can be caused by an autoimmune disorder.

In autoimmune hepatitis, the body's own immune system destroys the cells of the liver. It may be classified as type 1 or type 2. Type 1 (classic) is the most common form. It may occur at any age, but usually affects young women more than men. Also, other autoimmune disorders can be associated with type 1 such as thyroiditis, Grave's disease, and ulcerative colitis. Type 2 autoimmune hepatitis generally affects girls between the ages of two and 14, but does occur in adults.

What are metabolic liver disorders?

Two main metabolic disorders affect the liver:

  • hemochromatosis (Also called iron overload disease.) - characterized by the absorption of too much iron from food. Instead of secreting the excess iron, the iron is stored throughout the body, including the liver and pancreas. The excess iron can damage these organs. Hemochromatosis is a hereditary disease that can lead to liver disease, liver failure, liver cancer, heart disease, and diabetes.

  • Wilson's disease - characterized by the retention of too much copper in the liver. Instead of releasing the copper into the bile, the liver retains the copper. Eventually, the damaged liver releases copper into the bloodstream. This hereditary disease can cause damage to the kidneys, brain, and eyes, and can lead to severe brain damage, liver failure, and death.

Liver Transplantation

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What is a liver transplant?

A liver transplant is a surgical procedure performed to replace a diseased liver with a healthy liver from another person. The liver may come from a deceased organ donor or from a living donor. Family members or individuals who are unrelated but make a good match may be able to donate a portion of their liver. This type of transplant is called a living transplant. Individuals who donate a portion of their liver can live healthy lives with the remaining liver.

An entire liver may be transplanted, or just a section. Because the liver is the only organ in the body able to regenerate, a transplanted portion of a liver can rebuild to normal capacity within weeks.

Why is a liver transplant recommended?

A liver transplant is recommended for individuals who have serious liver dysfunction and will not be able to live without having the liver replaced. The most common liver disease for which transplants are done is cirrhosis. Other diseases may include the following:

  • acute hepatic necrosis

  • biliary atresia

  • metabolic disease

  • liver cancers

  • autoimmune hepatitis

  • liver damage from overdose of medications toxic to the liver

How many individuals in the United States need liver transplants?

Visit the United Network for Organ Sharing (UNOS) Web site for statistics of patients awaiting a liver transplant, and the number of patients who underwent a transplant this year.

Where do transplanted organs come from?

The majority of livers that are transplanted come from organ donors who have died. These organ donors are adults or children who have become critically ill (often due to an accidental injury) and have died as a result of their illness. If the donor is an adult, he/she may have agreed to be an organ donor before becoming ill. Parents or spouses can also agree to donate a relative's organs. Donors can come from any part of the United States. This type of transplant is called a cadaveric transplant.

An individual receiving a transplant may either get a whole liver, or a segment of one. If an adult liver is available and is an appropriate match for two individuals on the waiting list, the donor liver can be divided into two segments and each part is transplanted. This is more often done in children than adults.

Living family members may also be able to donate a section of their liver. This type of transplant is called a living-related transplant. Individuals receiving a partial liver seem to do as well as those receiving a whole liver. Relatives who donate a portion of their liver can live healthy lives with the segment that remains.

How are transplanted organs allocated?

The United Network for Organ Sharing is responsible for transplant organ distribution in the United States. UNOS oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung, and cornea.

UNOS receives data from hospitals and medical centers throughout the country regarding adults and children who need organ transplants. The medical team is responsible for sending the data to UNOS, and updating them as your condition changes.

Criteria have been developed to ensure that all people on the waiting list are judged fairly as to the severity of their illness and the urgency of receiving a transplant. Once UNOS receives the data from local hospitals, people waiting for a transplant are placed on a waiting list and given a "status" code. The people in most urgent need of a transplant are placed highest on the status list and are given first priority when a donor liver becomes available.

When a donor organ becomes available, a computer searches all the people on the waiting list for a liver and sets aside those who are not good matches for the available liver. A new list is made from the remaining candidates. The person at the top of the specialized list is considered for the transplant. If he/she is not a good candidate, for whatever reason, the next person is considered, and so forth. Some reasons that people lower on the list might be considered before a person at the top include the size of the donor organ and the distance between the donor and the recipient.

How is an individual placed on the waiting list for a new liver?

Extensive testing must be done before an individual can be placed on the transplant list. Testing includes:

  • psychological and social evaluation

  • diagnostic tests

  • blood tests
    Blood tests are done to gather information that will help determine how urgent it is that an individual is placed on the transplant list, as well as ensure the individual receives a donor organ that is a good match. These tests may include:

    • liver enzymes
      Elevated levels of liver enzymes can alert physicians to liver damage or injury, since the enzymes leak from the liver into the bloodstream under these circumstances.

    • bilirubin
      Bilirubin is produced by the liver and is excreted in the bile. Elevated levels of bilirubin often indicate an obstruction of bile flow or a defect in the processing of bile by the liver.

    • albumin, total protein, and globulin
      Below-normal levels of proteins made by the liver are associated with many chronic liver disorders.

    • clotting studies, such as prothrombin time (PT) and partial thromboplastin time (PTT)
      Tests that measure the time it takes for blood to clot are often used prior to liver transplantation. Blood clotting requires vitamin K and proteins made by the liver. Liver cell damage and bile obstruction can both interfere with proper blood clotting.

Other blood tests will help improve the chances that the donor organ will not be rejected. They may include:

  • your blood type
    Each person has a specific blood type: type A+, A -, B+, B -, AB+. AB -, O+, or O -. When receiving a transfusion, the blood received must be a compatible type with an individual's type of blood or an allergic reaction will occur. The same allergic reaction will occur if the blood contained within a donor organ enters an individual's body during a transplant.

  • viral studies
    These tests determine if you have viruses that may increase the likelihood of infecting the donor organ, such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV).

Diagnostic tests may include any of the tests that have been done to evaluate the extent of the disease, including the following:

  • abdominal ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

How long will it take to get a new liver?

There is no definite answer to this question. Sometimes, individuals wait only a few days or weeks before receiving a donor organ. If no living-related donor is available, it may take months or years on the waiting list before a suitable donor organ is available. Unfortunately, some people die before an acceptable donor organ can be found.

How are we notified when a liver is available?

Each transplant team has their own specific guidelines regarding waiting on the transplant list and being notified when a donor organ is available. In most instances, you will notified by phone or pager that an organ is available. You will be told to come to the hospital immediately so you can be prepared for the transplant.

What is rejection?

Rejection is a normal reaction of the body to a foreign object. When a new liver is placed in a person's body, the body sees the transplanted organ as a threat and tries to attack it. The immune system makes antibodies to try to kill the new organ, not realizing that the transplanted liver is beneficial. To allow the organ to successfully live in a new body, medications must be given to trick the immune system into accepting the transplant and not thinking it is a foreign object.

What is done to prevent rejection?

Medications must be given for the rest of the individual's life to fight rejection. Each person is individual, and each transplant team has preferences for different medications. The anti-rejection medications most commonly used include:

  • Cyclosporine

  • Tacrolimus

  • Sirolimus

  • Prednisone

  • Azathioprine

  • Mycophenolate mofetil

The doses of these medications may change frequently, depending upon your response. Because anti-rejection medications affect the immune system, individuals who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and making you very susceptible to infection. Blood tests to measure the amount of medication in the body are done periodically to make sure you do not get too much or too little of the medications. White blood cells are also an important indicator of how much medication you may need.

This risk of infection is especially great in the first few months because higher doses of anti-rejection medications are given during this time. You will most likely need to take medications to prevent other infections from occurring. Some of the infections you will be especially susceptible to include oral yeast infection (thrush), herpes, and respiratory viruses.

What are the signs of rejection?

The following are the most common symptoms of rejection. However, each individual may experience symptoms differently. Symptoms may include:

  • fever greater than 100? F

  • jaundice - yellowing of the skin and eyes.

  • dark urine

  • itching

  • abdominal swelling or tenderness

  • fatigue

  • irritability

  • headache

  • nausea

The symptoms of rejection may resemble other medical conditions or problems. Consult your transplant team with any concerns you have.

Long-term outlook after a liver transplant:

Living with a transplant is a life-long process. Medications must be given that trick the immune system so it will not attack the transplanted organ. Other medications must be given to prevent side effects of the anti-rejection medications, such as infection. Frequent visits to and contact with the transplant team are essential.

There is no good answer to how long an individual can be expected to live after a liver transplant. Each person is different and every transplant is different. Results improve continually as physicians and scientists learn more about how the body deals with transplanted organs and search for ways to improve the success of transplantation.




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