Liver Disease: Fatty Liver, Hepatitis, Cirrhosis, and More

There’s a good chance that you or someone you know has or will develop liver disease in your lifetime. That’s because 4.5 million adults in the United States — about 2 percent of the population — have been diagnosed with chronic liver disease. It’s the cause of death for more than 51,000 Americans annually. (1)

The liver is the second largest organ in the body, weighing about 3 pounds and located under the rib cage on the right side. (2) Most people don’t give much thought to the liver or its role in maintaining overall health, but it performs several key functions: (3)

• It cleans your blood to remove toxins. Whether it be food, drink, medicines, or anything else you ingest, it all gets filtered by the liver.
• It provides your body with energy. The liver removes sugar (glucose) from the blood and stores it in a form called glycogen for use when you need it. When glycogen is depleted, the liver also creates, or synthesizes, glucose in a process known as gluconeogenesis.
• It synthesizes proteins (from amino acids) and fatty acids (from carbohydrates and proteins).
• It produces bile to help break down and absorb fats. Your body gets rid of waste products and toxins through bile.

Liver disease is a spectrum of clinical entities, says Christina Lindenmeyer, MD, a gastroenterologist at the Cleveland Clinic in Ohio. “It can vary from mild abnormalities in your liver function test that are completely benign with no clinical significance, to acute or chronic liver disease,” Dr. Lindenmeyer says. “At the very end of the spectrum are cirrhosis and end-stage liver disease with liver failure.”

The following are some common — and uncommon — forms of liver disease. (4)

Nonalcoholic fatty liver disease is fat buildup in the liver that is not caused by alcohol consumption. Certain conditions, including type 2 diabetes, high blood pressure, and obesity, particularly if excess fat is carried around the midsection, make a person more likely to develop this chronic liver condition.

When inflammation and liver cell damage occur along with fat in the liver, it’s called nonalcoholic steatohepatitis (NASH). If NASH progresses, it can lead to cirrhosis.

NAFLD typically causes no symptoms. The most effective form of treatment is weight loss.

Learn More About Nonalcoholic Fatty Liver Disease

Hepatitis A is a short-term viral infection that is generally acquired by consuming contaminated food. The virus lives in the feces and blood and is passed from one person to another through the “fecal-oral” route.

Like other forms of hepatitis, hepatitis A leads to inflammation in the liver. Early symptoms include fever, fatigue, loss of appetite, nausea, and diarrhea. In otherwise healthy people, hepatitis A usually lasts only a few weeks and then resolves without treatment. In people with other liver diseases or poor health, hepatitis A can result in serious illness and even death.

The incidence of hepatitis A in the United States has dropped considerably since 1996, when the hepatitis A vaccine was first recommended for children and adult populations at risk, according to the Centers for Disease Control and Prevention (CDC). (5)

But beginning in 2017, several U.S. states reported hepatitis A outbreaks, primarily among drug users and homeless individuals. (These populations are at higher risk for this disease, but it’s important to remember that anyone can get hepatitis A — for example, by eating food prepared by someone who is infected.) The CDC responded with a health advisory for state health departments and healthcare providers to step up their efforts to identify the disease and encourage vaccination among people at risk of acquiring hepatitis A. (6)

Learn More About Hepatitis A

Hepatitis B is a viral infection that is spread through contact with an infected person’s blood, semen, or other body fluids. It can be an acute or chronic condition and can lead to complications including cirrhosis, liver failure, and liver cancer.

Similar to hepatitis A, acute hepatitis B can cause fever, fatigue, loss of appetite, nausea, vomiting, and abdominal pain, although many people with acute hepatitis B experience no symptoms.

Most people who have chronic hepatitis B have no symptoms and neither look nor feel sick. But they can still spread the virus through such routes as sexual activity; sharing needles, syringes, or other drug preparation equipment; sharing toothbrushes, razors, and other personal items that may come into contact with blood; and giving birth.

In the United States, the rate of acute hepatitis B infection has dropped significantly since 1991, the first year hepatitis B vaccinations were recommended for infants in the United States. The number of confirmed new cases of acute hepatitis B reported in 2020 was 2,157, although the estimated actual number of new cases was 14,000. (7)

The estimated number of cases of chronic hepatitis B in the United States is between 880,000 and 1.9 million, according to the CDC. Worldwide, the World Health Organization estimates that 296 million people are infected with the hepatitis B virus. (8)

Learn More About Hepatitis B

Hepatitis C is a bloodborne virus that is spread through contact with infected blood. In years past, hepatitis C was spread through blood transfusions and organ transplants, but modern blood screening techniques have made this route of infection highly unlikely. This is one reason why, in the United States, the baby boomer generation has a high rate of hepatitis C — many were infected before the introduction of these blood-screening protocols.

Today most people acquire hepatitis C by sharing needles or other equipment used to inject drugs. Other ways the virus can be spread is through unprotected sex, sharing razors or toothbrushes, and using unsterile equipment for tattoos or piercings.

Hepatitis C can be acute or chronic, but most people — 75 to 85 percent — who are infected develop chronic hepatitis C. In 2017, there were an estimated 3.5 million people living with hepatitis C in the United States (9) and 58 million worldwide. (10)

Although there currently is no vaccine for hepatitis C, early diagnosis and treatment of chronic hepatitis C can frequently cure the disease and prevent liver damage.

Learn More About Hepatitis C

Hemochromatosis is a hereditary disorder in which the body absorbs more iron than it should, sometimes leading to damage to the liver, heart, pancreas, joints, and testicles. Iron overload in the liver, for example, can lead to cirrhosis, which raises the risk for liver cancer. Too much iron in the pancreas can lead to diabetes.

Many people with hemochromatosis never have any symptoms. Those who do have symptoms may experience joint pain, fatigue, unexplained weight loss, abnormal skin coloration (skin may appear gray or bronze), abdominal pain, and loss of sex drive.

Because hemochromatosis can lead to serious complications, persistent symptoms of the disorder should be brought to the attention of a doctor. Hemochromatosis is a genetic disease, so be sure to let your doctor know if you have a family history of liver disease.

Treatment for hemochromatosis is phlebotomy, or drawing blood, to lower the body’s iron levels.

Learn More About Hemochromatosis

Overconsumption of alcohol can lead to a range of liver problems and diseases, including fatty liver, alcoholic hepatitis, and cirrhosis, although not all heavy drinkers develop liver disease.

The Centers for Disease Control and Prevention (CDC) defines heavy drinking as more than 14 drinks per week for men and more than 8 drinks per week for women. (11)

The risk of developing alcohol-related liver disease is further increased by obesity, malnutrition, being a woman, and having chronic viral hepatitis, particularly hepatitis C.

Ending alcohol use is the most important part of the treatment for alcohol-related liver disease.

Learn More About Alcohol-Related Liver Disease

Previously known as primary biliary cirrhosis, primary biliary cholangitis (PBC) is a rare disease, primarily affecting women, that slowly destroys the small bile ducts of the liver. It is an autoimmune disease that may be triggered in susceptible individuals by such things as infections or exposure to tobacco smoke and other toxic chemicals.

Signs and symptoms of primary biliary cholangitis include fatigue, severe itching, dry mouth and eyes, high cholesterol, jaundice, and abdominal pain.

The only cure for PBC is a liver transplant. However, there are a growing number of options for managing symptoms and possibly slowing the disease’s progression that can help people avoid having a liver transplant for as long as possible.

Learn More About Primary Biliary Cholangitis

Cirrhosis

In cirrhosis, a final stage of chronic liver disease, the liver is scarred and permanently damaged, usually from long-term alcohol use, fatty liver disease, or a viral infection. The scar tissue replaces healthy liver tissue and the liver can no longer function normally.

Symptoms of cirrhosis include loss of appetite, fatigue, weight loss or sudden weight gain, itchy skin, brownish or orange urine, light-colored stools, blood in the stool, and fever.

The main approach to treating cirrhosis is treating the underlying cause of it to slow the progression of liver scarring.

What Are the Risk Factors for Liver Disease?

The two most common forms of liver disease in the United States right now are both forms of fatty liver disease — alcohol-related liver disease and nonalcoholic fatty liver disease, according to Dr. Lindenmeyer. As its name suggests, alcohol-related liver disease is linked with heavy alcohol ingestion, she says, while nonalcoholic fatty liver disease is linked with metabolic syndrome.

Risk factors for liver disease and liver problems include the following:

• Metabolic syndrome, which is a term for a group of risk factors including high triglycerides, high levels of blood sugar, low levels of HDL (good cholesterol), high blood pressure, and carrying extra weight around your midsection
• Excessive alcohol use
• Chronic liver infections such as chronic hepatitis B or C
• Genetic or acquired medical conditions that make liver disease more likely
• Autoimmune-associated disorders of the liver

What Are the Symptoms of Liver Disease?

At the beginning of the spectrum of liver disease, it can be asymptomatic for many years. Take hepatitis C, for example, Lindenmeyer says: “The majority of people who have hepatitis C have no idea, because they don’t have symptoms,” she says. “This is why we recommend screening for hepatitis C for the baby boomer cohort, or everyone born between 1945 and 1965.”

Early symptoms of cirrhosis may include feeling tired or weak, loss of appetite, weight loss, nausea and vomiting, and pain in the upper right side of your abdomen. With more advanced liver disease, as well as liver failure, symptoms include fluid accumulation in the abdomen or legs, yellowing of the skin or eyes, fatigue, mental confusion, and bleeding in the gastrointestinal tract, says Lindenmeyer.

How Is Liver Disease Diagnosed?

Screening for liver disease typically starts with blood tests that check what is called liver biochemistries, or tests of the liver function, says Lindenmeyer. These tests are often part of routine blood tests given during a physical exam. If the results are abnormal, more targeted blood tests may be performed to look for specific liver diseases such as hepatitis.

“If those are abnormal, then frequently we follow that up with an imaging study of the liver, whether it be an ultrasound, a CT scan, or an MRI,” she says. A specialized ultrasound device called FibroScan can give an estimate of the amount of scarring and fatty buildup in the liver.

It’s important to note that sometimes people who have liver disease may have no evidence of abnormalities in their blood, says Lindenmeyer.

In some cases, a liver biopsy may be necessary to see how much scarring is in the liver.

Given that hepatitis C is often asymptomatic, screening baby boomers is critical for early diagnosis, says Lindenmeyer. “We have excellent medications for hepatitis C that have excellent cure rates. It’s something that can halt the progression of liver disease and potentially even improve the liver once it’s been treated,” she says.

People who have a history of alcohol abuse or are known to drink alcohol excessively should have their liver function tested, along with those with a history of liver disease, as well as people at risk for having a genetically inherited form of liver disease, says Lindenmeyer.

Current treatment guidelines don’t mandate that people with metabolic syndrome be screened for liver disease, but a liver function test is often done as part of their monitoring for medications they are taking, says Lindenmeyer. “If the results are found to be abnormal, we recommend that those patients be screened with liver imaging,” she says.

How Is Liver Disease Treated?

Although every form of liver disease is different, early diagnosis and subsequent treatment and lifestyle changes improve your chances for preserving normal liver function, says Lindenmeyer.

“Liver disease in general is very treatable if you catch it early and prevent ongoing insult to the liver over time,” she says. For any alcohol-related liver disease, it is essential to stop consuming alcohol right away to avoid any further damage to the liver, says Lindenmeyer.

For people with hepatitis C, early diagnosis and treatment can halt the progression of liver disease or even improve liver function, she says.

“If you can diagnose fatty liver disease without the presence of advanced inflammation or scarring, there’s a lot of evidence that you can improve your liver inflammation and reduce fat with multiple interventions,” says Lindenmeyer. Strategies include weight loss and tight control of the metabolic risk factors, including diabetes and dyslipidemia (abnormal cholesterol and triglyceride levels).

Treatment varies according to the kind of liver disease you have, says Lindenmeyer. “There are antiviral medications for hepatitis B and C; there is no treatment for hepatitis A,” she says. “It’s important to maintain your vaccination status to prevent getting infected with hepatitis A or B,” she says, adding that there is no vaccine for hepatitis C.

The Food and Drug Administration has not approved medical therapies for fatty liver disease, but there are a number of evolving approaches, including weight loss surgery and medications that may promote weight loss, according to Harvard Health. But in general, says Lindenmeyer, “This is something we typically manage with lifestyle modifications and weight loss.”

Hemochromatosis can be treated by removing blood periodically. “It sounds like a medieval therapy, but it actually works very well for this specific liver disease,” says Lindenmeyer. There are also medications to remove excess iron.

What Happens if Liver Disease Goes Untreated?

Untreated liver disease can result in cirrhosis and end-stage liver disease, which carries its own spectrum of complications, according to Lindenmeyer. “Once patients have cirrhosis, or end stages scarring of the liver, they’re at risk for developing what’s called portal hypertension,” she says.

Portal hypertension is a high-pressure system in the liver that causes complications that can be associated with ascites (the accumulation of fluid in the abdomen) and edema (the buildup of fluid in extremities), as well as gastrointestinal bleeding. (12)

Confusion can result from advanced or end-stage liver disease and infections, says Lindenmeyer. This happens when the liver isn’t adequately removing toxins from your blood and they build up in the brain.

Does Chronic Liver Disease Raise the Risk of Liver Cancer?

Beyond the complications related to portal hypertension, anyone with cirrhosis is at risk for developing liver cancer, says Lindenmeyer. Because of that risk, people diagnosed with cirrhosis should be screened for cancer with imaging studies every six months.

Other types of liver disease are also linked to a higher risk of developing liver cancer, including NAFLD, hemochromatosis, and chronic hepatitis B and C. (13)

Tips to Keep Your Liver Healthy

If you have liver disease or you’re at risk for chronic liver disease because of a family history or underlying medical condition, it’s essential to make and keep regular appointments with your liver doctor or primary care doctor and take your medications as directed, says Lindenmeyer.

Other tips to keep your liver healthy include:

• Limit your alcohol consumption. Follow the recommendations for alcohol consumption, which are different for men and women, says Lindenmeyer. “For men, drink no more than two alcoholic drinks per day and for women, no more than one,” she says.
• Maintain a normal weight. Keeping your body weight in a healthy range can reduce your risk of developing fatty liver disease. Adopt an exercise regimen that includes cardiovascular and strength training, says Lindenmeyer. Not only will this help with weight management and other chronic conditions, there’s even some research that suggests aerobic exercise could help protect the liver by preventing liver inflammation. (14)
• Improve your diet. “The Mediterranean diet has been shown to be beneficial for patients with fatty liver disease,” says Lindenmeyer. Drinking coffee has been linked to benefits for people with fatty liver disease as well, she adds.

Resources for people with liver disease range from organizations that provide information about symptoms, diagnosis, and treatment, to support groups and online communities that provide opportunities to connect and share experiences.

Some of these resources are national organizations, some exist primarily online, and others have information on more local resources. You may be able to connect with local organizations and in-person support groups through your healthcare provider or hospital.