Conditions and Treatment

Organs - Liver

Hepatitis | Fatty Liver | Primary Sclerosing Cholangitis

The liver produces bile to assist in the digestion process. It breaks down some chemicals and substances to non-toxic states. The liver also produces proteins necessary to prevent bleeding.

Hepatitis
Viral hepatitis is a common contagious disease caused by several viruses that attack the liver. Hepatitis means inflammation of the liver, usually producing swelling and tenderness and sometimes permanent damage to the liver. There are three types of hepatitis.

Hepatitis A is caused by fecal contamination of food and water. Although symptoms similar to the flu and fatigue may occur, the disease is rarely life threatening.
Hepatitis B is one of the most serious forms of hepatitis with over 300,000 new acute cases each year and an estimated one million carriers in the United States. This disease is more prevalent and infectious than AIDS, and may lead to scarring of the liver, called cirrhosis, and cancer of the liver.
Hepatitis C, formerly called non-A, non-B hepatitis, affects approximately 170,000 Americans each year. It may develop into a chronic form in approximately 50% of patients.

Hepatitis B and C can be transmitted through infected blood, blood products and needles. However, all blood is now tested for the presence of these viruses. Health care workers, laboratory technicians, dentists and other individuals who may come in contact with infected blood, instruments or needles, are at risk for acquiring hepatitis B and C.

Hepatitis C is rarely spread sexually, from an infected mother to her newborn, or to other members of the household. There is no vaccine for hepatitis C.

Hepatitis B is frequently spread through sexual contact and at birth from mother to baby. Vaccination is recommended for all newborns, infants, and sexually active teenagers. Individuals living in the same household with someone who is a carrier or has chronic active hepatitis B are at risk and should ask their physician about being vaccinated.

In a large percentage of cases of both hepatitis B and C, we do not know how the infection is acquired.

Hepatitis B and C are major health problems. Specific blood tests for both hepatitis B and C are necessary to help physicians evaluate whether treatment is indicated and to identify precautions to prevent the spread to others.

Most people have no symptoms and feel quite healthy. Come individuals will develop fatigue, mild fever, muscle and joint aches, nausea, vomiting, diarrhea, abdominal discomfort and changes in the color of urine and stools.

There are specific tests to identify hepatitis B and C. Blood banks screen all donated blood for these viruses and you may be notified that you have tested positive.

If you think you have been infected or are at risk, talk with your physician. He or she can answer your questions and address your concerns about these serious diseases.

The American Liver Foundation is the only national voluntary health organization dedicated to fighting all liver diseases through research, education, and support groups.

Research has recently opened up exciting new paths for investigation, but much more remains to be done to find cures for more than 100 different liver diseases.

Fatty Liver
Fatty liver is just what its name suggests: the build-up of fat in the liver cells. Although this is not a normal condition, fat in the liver usually causes no damage by itself. However, on some occasions it can be a sign that other more harmful conditions are at work. Fatty liver may be associated with or may lead to inflammation of the liver. This can cause scarring and hardening of the liver. When scarring becomes extensive, it is called cirrhosis, and this is a very serious condition. Therefore, it is important that a physician thoroughly examine a patient with fat in the liver.

It would seem logical that eating fatty foods would cause a fatty liver, but this is not the case. The liver does play an important role in the metabolism or breakdown of fats. Something goes wrong in this process of metabolism, but it is still not known what does cause fat to build-up in the liver. It is known that fat accumulates in the liver with a number of conditions. The most common is obesity. Fatty liver is also associated with diabetes mellitus, high blood triglycerides, and the heavy use of alcohol. It may occur with certain illnesses such as tuberculosis and malnutrition, intestinal bypass surgery for obesity, excess vitamin A in the body, or the use of certain drugs such as valproic acid (trade names: Depakene/Depakote) and corticosteroids (cortisone, prednisone). Sometimes fatty liver occurs as a complication of pregnancy.

There are usually no symptoms that are noticeable to the patient. In fact, fatty liver is frequently uncovered during a routine physical examination. There may be a rise in certain liver enzymes found in the blood, and sometimes the liver is slightly enlarged. Fatty liver may also be discovered while the physician is evaluating a patient for other illnesses. For example, an ultrasound exam of the abdomen done for other reasons may show fat in the liver. To be certain of a diagnosis of fatty liver, the physician may recommend a liver biopsy. Under local anesthesia, a slender needle is inserted through the right lower chest. A small piece of liver tissue is taken out with the needle and examined under a microscope.

The term hepatitis means inflammation of and damage to the liver cells. Steato (pronounced stee-at¢ toe) refers to fat. Therefore, steatohepatitis is inflammation of the liver related to fat accumulation. Heavy alcohol use can lead to fatty liver and inflammation, usually called alcoholic hepatitis. Steatohepatitis resembles alcoholic hepatitis, but it can and does occur in people who seldom or never drink alcohol. In this instance, it is often called nonalcoholic steatohepatitis or NASH. Both alcoholic hepatitis and steatohepatitis can lead to serious liver damage and cirrhosis.

Studies have shown that many people who are significantly overweight have developed, or will develop, steatohepatitis. It can also occur with rapid weight loss. Steatohepatitis has been connected to estrogen hormones in some women.

In the case of diabetes mellitus, researchers believe steatohepatitis may develop only in those patients whose diabetes is not properly controlled.

In most instances treatment of fatty liver and steatohepatitis requires control of the underlying conditions. This may include reduction of high blood triglycerides, good control of diabetes, or not drinking alcohol. In some cases, surgical reversal of intestinal bypass for obesity is required.

Since being overweight is by far the most critical factor, weight loss is the key to ridding the liver of fat. This is especially necessary if damage to the liver is occurring, and early signs of scarring are present on biopsy. High blood triglycerides and diabetes are also worse with obesity. So, when steatohepatitis is present with these conditions, people gain even greater benefits from losing weight. Losing weight can be difficult. However, it must be done because the alternative may be eventual cirrhosis and the need for a liver transplant.

Liver transplantation is now an accepted form of treatment for chronic, severe liver damage. Advances in surgical techniques and the use of new drugs to suppress rejection have dramatically improved the success rate. Steatohepatitis is one of the more uncommon reasons for a liver transplant. However, every transplant center does a few each year as a result of this disease. Survival rates at transplant centers are well over 90% with a good quality of life after recovery.

Primary Sclerosing Cholangitis
Primary sclerosing cholangitis is a disease in which the bile ducts inside and outside the liver progressively decrease in size due to inflammation and scarring. As a consequence, bile that is normally carried by these ducts accumulates within the liver. Such obstruction to bile flow can result in damage to liver cells.

Although primary sclerosing cholangitis has been considered a rare disease, recent studies suggest that it is probably more common than originally thought. The disease may occur alone, but frequently exists in association with inflammatory diseases of the colon, such as chronic ulcerative colitis.

Primary sclerosing cholangitis affects both sexes, but may be more common in men. The disease usually begins between ages 30 and 50, and is commonly associated with itching, tiredness, and jaundice. Initially, however, many individuals have no symptoms at all, and the disease becomes apparent because of abnormal blood tests.

The cause of primary sclerosing cholangitis remains unknown. However, there is currently no evidence that the disease is inherited, and viruses known to cause hepatitis have not been associated with primary sclerosing cholangitis. The frequent occurrence of primary sclerosing cholangitis in association with inflammatory bowel disease suggests that a common cause for both diseases may exist. More research is needed to determine the cause of the disease and to develop effective therapy.

Presently, there is no known specific therapy for primary sclerosing cholangitis. Symptoms of sclerosing cholangitis may be treated with varying success by antibiotics, vitamins, and a variety of medications to control itching. In some instances surgery may be effective in alleviating jaundice and other symptoms. Endoscopic therapy is a new method to treat sclerosing cholangitis.

Endoscopic therapy can be performed at the time of ERCP, including sphincterotomy, biliary duct dilatation, nasobiliary perfusion with antibiotics or steroids, or common bile duct stent placement. These methods are generally as effective as surgery in controlling jaundice and other symptoms, and have been shown to improve survival. However, despite adequate medical or surgical therapy, some patients continue to deteriorate because of liver failure. The surgical procedure of last resort in this instance is liver transplantation, which is being performed in centers throughout the United States, with a very good success rate. Careful planning for transplant makes this treatment feasible.