Liver Disease

Overview

Your liver is a large organ in the upper right part of your belly. It cleans your blood, helps digest food, stores energy, and fights infection. "Liver disease" is a broad term for many different conditions that damage the liver or stop it working properly. Some liver problems come on quickly and get better with treatment. Others develop slowly over many years. Some are caused by alcohol, some by fat build-up, some by viruses, and some by genes you inherited or by your immune system. Because the liver can repair itself well, damage found early often can be slowed or even reversed.

Yes. Liver disease is common worldwide. Fatty liver disease linked to weight and diabetes is now one of the most common liver conditions, and viral hepatitis affects millions of people. Serious liver scarring is less common, but numbers are rising.

Anyone can get liver disease, at any age. Some liver conditions run in families or start in childhood. Risk is higher in people who drink a lot of alcohol, carry extra weight around the belly, have type 2 diabetes or high cholesterol, or have been exposed to hepatitis viruses. Some medicines, herbal remedies and supplements can also affect the liver.

Symptoms

Common symptoms

• Often no symptoms at all, especially in the early stages
• Feeling very tired or lacking energy
• A dull ache or heaviness in the upper right side of the belly
• Feeling sick, or losing your appetite
• Losing weight without trying
• Yellowing of the skin or the whites of the eyes (this is called jaundice)
• Dark urine, or stools that look pale, chalky or greasy
• Itchy skin
• Bruising or bleeding more easily than usual
• Swelling in the ankles and legs, or a bloated, swollen belly
• Confusion, poor concentration or forgetfulness (this can happen when the liver is badly affected)

Symptoms in children

• Yellow skin or yellow eyes, which may be noticed by a parent, nurse or teacher
• Pale or chalky stools and dark urine
• Poor feeding, slow weight gain or slower growth than expected
• Being unusually sleepy or unsettled
• Itchy skin, or scratching a lot
• Some liver conditions are present from birth and are picked up in newborn checks

Symptoms in older adults

• Confusion, memory problems or falls, which may be put down to 'old age' but can be linked to the liver
• Feeling much more tired than usual, or losing strength
• Swelling in the legs or belly
• Weight loss and poor appetite
• Symptoms may be milder or blamed on other long-term conditions, so liver problems can be missed

Causes

Main causes

• Alcohol-related liver disease, from drinking heavily over many years
• Fatty liver disease, linked to extra body weight, type 2 diabetes and high cholesterol
• Viral hepatitis (hepatitis B and hepatitis C), infections that attack the liver
• Autoimmune liver conditions, where the body's immune system attacks its own liver
• Inherited conditions, such as haemochromatosis (too much iron stored) or Wilson's disease (too much copper stored)
• Some medicines, herbal remedies, supplements or harmful substances, especially if taken in large amounts or mixed together
• Gallstones or blocked bile ducts
• Liver cancer, or cancer that has spread to the liver from elsewhere

Risk factors

• Drinking alcohol regularly, or drinking heavily
• Carrying extra weight, especially around the middle
• Type 2 diabetes, high blood pressure or high cholesterol
• Having a family member with liver disease
• Ever having injected drugs, or sharing needles or straws
• Having had a tattoo or piercing with unsterile equipment
• Unprotected sex with someone who has hepatitis B or C
• Being born or living in a region where hepatitis B is common
• Long-term use of certain medicines, herbal products or supplements
• Working with chemicals or toxins without protective equipment

When to see a doctor

See a doctor urgently if:

• You notice yellowing of your skin or eyes
• Your urine is dark and your stools are pale
• Your belly or legs are swelling
• You are bruising or bleeding more easily than usual
• You feel confused, unusually sleepy or forgetful
• You have a fever with belly pain

Book a routine appointment if:

• You feel tired all the time and it is not getting better
• You have a dull ache in the upper right part of your belly
• You have lost weight without trying
• Your skin is itchy for no clear reason
• You have been told your liver blood tests were abnormal
• You drink alcohol regularly and want advice about your liver
• You have a family history of liver disease

Diagnosis

Your doctor will start by asking about your symptoms, your health history, your alcohol intake, the medicines and supplements you take, and your family history. They will examine you, including feeling your belly. Then they will usually arrange blood tests, and possibly a scan, to see how your liver is working and whether it looks inflamed, fatty or scarred.

Tests that may be done

• Blood tests, including liver function tests, which show whether the liver is inflamed or damaged
• A blood test for hepatitis B and hepatitis C
• Other blood tests to check for other causes and to see how well your liver is working
• An ultrasound scan of the belly, which is painless and quick
• A special scan that measures how stiff the liver is (often called a FibroScan), which shows how much scarring there is
• CT or MRI scans if more detail is needed
• A liver biopsy, where a tiny sample of liver is taken with a needle, only if other tests are not clear
• Urine tests or genetic tests for specific inherited conditions

What to expect at your appointment

Most people start with a simple blood test and an ultrasound scan, and get results within a few days to a couple of weeks. These tests are quick and usually painless. If results are normal, you may not need anything further. If something shows up, your doctor will explain what it means and may refer you to a liver specialist. You are welcome to bring someone with you and to ask questions.

Treatment

Treatment depends completely on what is causing your liver problem. The aim is always the same: remove or control the cause, protect the liver from further damage, and manage any symptoms. Many people improve a great deal once the cause is treated — for example, by cutting out alcohol, losing some weight, or clearing a hepatitis infection.

Self-care at home

• Avoid alcohol completely if your liver is damaged — this is the single most helpful step for many people
• Eat a balanced diet with plenty of vegetables, fruit, whole grains and lean protein
• Lose some weight if you carry extra weight; even a small loss can help a fatty liver
• Check with your doctor or pharmacist before taking any new medicine, herbal remedy or supplement, as some can harm the liver
• Stay active in a way that suits you, such as walking regularly
• Get recommended vaccinations after talking to your doctor
• Keep any appointments for monitoring, even if you feel well
• Stop smoking if you smoke, as it adds to liver damage

Medical treatments

Your doctor will focus on the cause. If a virus is the cause, there are treatments that can control or clear it. If your immune system is attacking the liver, treatment can calm it down. If fat build-up is the cause, the main treatment is weight loss and control of blood sugar and cholesterol, sometimes with medicines. If a medicine or supplement is causing the problem, you will be advised to stop it safely. Doctors can also treat symptoms such as itch, swelling and infection, and give vitamins or nutrition support if needed. Some people are given treatment to reduce the risk of bleeding or infection. Your doctor will explain which of these applies to you.

When is surgery considered?

Surgery or procedures are only needed for some liver problems. Examples include removing gallstones or unblocking a bile duct, draining extra fluid from the belly, or, in serious cases, a liver transplant. A transplant is considered only when other treatments are no longer enough, and many people who have one go on to live active lives. Your specialist team will discuss this with you in detail if it ever becomes relevant.

Living with this condition

Many people live well with liver disease for years, especially when the cause is found and managed. You may need regular check-ups, blood tests or scans, and it helps to keep a simple record of your symptoms and appointments. Pace yourself, plan rest into your day, and ask for practical help when you need it. Avoiding alcohol and checking every medicine with a pharmacist will protect your liver day to day.

Lifestyle tips

• Stop drinking alcohol, or cut down as much as your doctor advises
• Aim for gradual, steady weight loss if you are overweight
• Eat regular meals and avoid skipping food
• Wash your hands well and avoid sharing razors, toothbrushes or needles
• Get enough sleep and build rest into busy days
• Keep up with vaccinations recommended for you
• Tell any doctor, dentist or pharmacist that you have liver disease before they prescribe anything

Diet and exercise

A balanced, mostly plant-based diet is good for your liver: vegetables, fruit, beans, whole grains, fish, eggs and lean meat, with less sugar, salt and fried food. If you have a lot of fluid build-up, your doctor may ask you to cut down on salt. Regular gentle exercise — like a daily walk, swimming or cycling — helps your liver, your heart and your mood. Start where you are and build up slowly. A dietitian can give you advice that fits your own situation.

Mental health and emotional wellbeing

It is very normal to feel worried, frustrated or low when you are living with a liver condition. You may worry about the future, about work, or about telling other people. These feelings are common and there is support. Talking to friends, family or a counsellor can help a lot. If you feel anxious or low for more than a couple of weeks, tell your doctor — support is available. If you ever have thoughts of harming yourself, please contact your local emergency number or a crisis helpline in your country straight away, or go to the nearest emergency department. You deserve help right away.

Prevention

Many — though not all — types of liver disease can be prevented or greatly reduced. Keeping alcohol low or avoiding it, staying at a healthy weight, managing diabetes and cholesterol, and avoiding sharing needles or unprotected sex all lower your risk. Always check medicines, herbal remedies and supplements with a pharmacist, and never take more than the recommended amount.

Vaccines

There are safe, effective vaccines against hepatitis A and hepatitis B. These are recommended for some groups, including people with certain liver conditions, travellers to some regions, and some healthcare workers. Ask your doctor or pharmacist whether hepatitis vaccination is right for you. There is no vaccine for hepatitis C, but it can be cured with treatment.

Screening programmes

If you are at higher risk — for example, you drink heavily, have type 2 diabetes, have a family history of liver disease, or come from a region where hepatitis B is common — ask your doctor whether you should have liver blood tests. Many countries offer hepatitis B and C testing to people in higher-risk groups. Finding liver problems early means treatment works better.

Complications

If left untreated

• Scarring of the liver (called cirrhosis), which can build up over years
• Liver failure, where the liver stops working properly
• A build-up of fluid in the belly or legs
• Internal bleeding, often from swollen veins in the food pipe
• Confusion and drowsiness caused by toxins building up (this is called hepatic encephalopathy)
• A higher chance of liver cancer
• Bruising and bleeding more easily, and getting infections more often
• Bone thinning and poor nutrition

Long-term outlook

The outlook for liver disease today is much better than it used to be. When the cause is found and managed early, damage can often be slowed and sometimes even reversed. Many people live long, full lives with a liver condition, especially with regular check-ups and a few key changes. If you are worried, the most useful thing you can do is talk to your doctor — early action makes the biggest difference.

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