Steatotic, Hepatitis, Cirrhosis, and More
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What Are the Risk Factors for Liver Disease?
The two most common forms of liver disease in the United States right now are alcohol-related liver disease and steatotic liver disease, according to Lindenmeyer. As its name suggests, alcohol-related liver disease is linked with heavy alcohol ingestion, she says, while steatotic 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. “The majority of people who have hepatitis C have no idea, because they don’t have symptoms,” Lindenmeyer says. “This is why we recommend screening for hepatitis C for everyone over 18.”
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 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, adults should be sure to be screened 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 who have a genetically inherited risk for a 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 steatotic 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 infection with hepatitis A or B,” she says, adding that there is no vaccine for hepatitis C.
The U.S. Food and Drug Administration (FDA) has not approved medical therapies for steatotic liver disease, but there are a number of evolving approaches, including weight loss surgery and medications that may promote weight loss, such as Ozempic, 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 stage scarring of the liver, they’re at risk for what’s called portal hypertension,” she says.
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 liver cancer, says Lindenmeyer. Because of that risk, people diagnosed with cirrhosis should be screened for cancer with imaging studies every six months.
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. Keep your body weight in a healthy range to reduce your risk of steatotic 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 protects the liver by preventing liver inflammation.
- Improve your diet. “The Mediterranean diet has been shown to be beneficial for patients with steatotic liver disease,” says Lindenmeyer. Drinking coffee has been linked to benefits for people with steatotic liver disease as well, she adds.
What Resources Are There for People With Chronic Liver Disease?
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.
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