Liver Disorders

In this factsheet:
• The Facts on Liver Disorders
• Causes of Liver Disorders
• Symptoms and Complications of Liver Disorders
• Diagnosing Liver Disorders
• Treating and Preventing Liver Disorders

The Facts on Liver Disorders

The liver is the largest internal organ in the body. Its main functions are to:

• metabolize most of the nutrients that are absorbed by the intestine
• store nutrients
• produce proteins
• detoxify blood by removing medications, alcohol, and potentially harmful chemicals from the bloodstream and treating them chemically so they can be excreted by digestive or urinary systems

Because the liver comes in close contact with many harmful substances, it is protected against disease in two main ways. First, it can regenerate itself by repairing or replacing injured tissue. Second, the liver has many cell units responsible for the same task. Therefore, if one area is injured, other cells will perform the functions of the injured section indefinitely or until the damage has been repaired.

Different types of liver disorders include hepatitis, cirrhosis, liver tumours, and liver abscess (collection of pus), just to name a few. The focus here will be the two most common forms: hepatitis and cirrhosis.

There is more than one type of hepatitis, and although they have similar symptoms, they're contracted in very different ways.

Hepatitis A is the most common and the most infectious, spreading easily from person to person like most other viruses. It affects millions around the world and is responsible for more than 2 million deaths a year.

Hepatitis B is acquired through exposure to infected blood, vaginal fluids, or semen. It's estimated that about 0.5% to 1% of Canadians have hepatitis B.

Hepatitis C affects about 3.5 million North Americans. About 15% of those with hepatitis C may have been exposed to infected blood products before widespread blood testing began.

Hepatitis D is unique because it can only affect those that already have hepatitis B.

The second type of liver disorder is called cirrhosis. It's a major cause of death in Canadian men aged 25 to 64. It is twice as common in men as in women and 30 times as common among heavy drinkers.

Causes of Liver Disorders

Hepatitis is an inflammation of the liver that can be caused by a virus, by inherited disorders, and sometimes by certain medications or toxins such as alcohol and drugs. Scientists have identified four main types of viral hepatitis: hepatitis A, hepatitis B, hepatitis C, and hepatitis D. A fifth type, hepatitis E, is generally not found in North America.

Hepatitis A is waterborne and spread mainly via sewage and contaminated food and water.

Hepatitis B is transmitted by contact with infected semen, blood, or vaginal secretions, and from mother to newborn. Hepatitis B is most commonly spread by unprotected sex and by sharing of infected needles (including those used for tattooing, acupuncture, and ear piercing).

Hepatitis C spreads via direct blood-to-blood contact.

Hepatitis D is spread by infected needles and blood transfusions.

Improved screening of donated blood has greatly reduced the risk of catching hepatitis B or C from blood transfusions. Both hepatitis B and C can be spread through sharing of razors, toothbrushes, and nail clippers.

The main cause of cirrhosis is chronic infection with the hepatitis C virus. Other causes include:

• long-term, excessive alcohol consumption
• chronic infection with hepatitis B virus
• inherited disorders of iron and copper metabolism
• severe reactions to certain medications
• fatty liver caused by obesity
• infections from bacteria and parasites usually found in the tropics
• repeated episodes of heart failure with liver congestion and bile-duct obstruction

With cirrhosis, the liver tissue is irreversibly and progressively destroyed as a result of infection, poison, or some other disease. Normal liver tissue is replaced by scars and areas of regenerating liver cells.

Symptoms and Complications of Liver Disorders

Both hepatitis and cirrhosis show few warning signs. In the acute phase of most forms of hepatitis, there are flu-like symptoms such as tiredness, fever, nausea, loss of appetite, and pain (usually under the ribs on the right side of the abdomen). There may also be some jaundice (yellowing of the skin and whites of the eyes.)

Following the acute stage, hepatitis A will be cleared from the body and lifelong immunity develops. In hepatitis B and C, viral particles may linger in the body producing a chronic infection that lasts for years. This can eventually lead to liver cirrhosis and, in some cases, liver cancer.

Signs and symptoms of cirrhosis include:

• abdominal pain
• general fatigue
• intestinal bleeding
• itching
• jaundice (yellowing of the skin and eyes)
• loss of interest in sex
• nausea and vomiting
• small red, spider-like blood vessels under the skin or easy bruising
• swelling in the abdomen and legs caused by fluid accumulation
• weakness
• weight loss

If you have cirrhosis, you should seek emergency help if you experience any of the following:

• mental confusion
• rectal bleeding
• vomiting blood

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