Liver Disease: Your GoodRx Guide

What are liver diseases?

Liver disease is any and all problems that disrupt the liver’s ability to do its job. 

The liver is a large solid organ that sits in the right upper part of the abdomen. Most of us don’t think about our liver on a regular basis. But it has many jobs behind the scenes to maintain and sustain our bodies. It works hard to:

• Produce bile: Bile is a substance that helps absorb fat from foods, aids in digestion, and helps get rid of waste.

• Metabolize and detoxify: One of the liver's main functions is to chemically change drugs, toxins, and even old red blood cells into forms that can be excreted.

• Maintain blood sugar levels: Depending on the body’s needs, the liver makes, stores, and releases glucose (sugar) into the bloodstream.

• Activate and deactivate hormones: The liver processes substances like thyroid hormone and vitamin D.

• Vitamin and mineral storage: The liver holds the body’s supply of fat-soluble vitamins (A, D, E, and K), iron, and copper.

• Cholesterol production: The liver is headquarters for making and regulating cholesterol, which is an important building block for different substances in the body.

• Protein production: Albumin is one common protein made in the liver that your body needs for many different functions. 

• Make blood clotting factors: The liver makes compounds essential to the body’s ability to stop bleeding, and also the ones that break down blood clots.

A diseased liver may come from being overwhelmed by the drugs and toxins it processes. Liver disease can also come from infection, inflammation, or other problems that may limit the liver’s ability to function.

Liver diseases can be acute (sudden) or chronic (develops slowly over time). Sometimes acute liver problems become chronic and vice versa. If the liver becomes so damaged that it cannot perform its jobs, it’s called liver failure. Cirrhosis is chronic liver failure — when the liver is so scarred from long-term damage that it cannot recover. 

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What causes liver disease?

Because the liver is involved in lots of body processes, liver disease has many different causes. The most common of these include:

• Viral hepatitis: Some viruses specifically target the liver. Hepatitis A comes from eating contaminated food, and it causes acute liver problems. Hepatitis B and hepatitis C come from contact with blood or body fluids from someone who has the infection, and these viruses may cause both acute and chronic liver disease.

• Drugs and toxins: Medications and drugs can hurt the liver. Tylenol is particularly toxic at high doses, and can cause acute liver failure. Prescription medications (like antibiotics, antifungals, and cholesterol medicines) and herbal supplements (like kava kava and ma huang), are also known to cause liver problems in some people.

• Alcohol: Alcohol changes liver metabolism and causes fat to build up in the liver. Alcoholic hepatitis is an acute condition of inflammation from drinking too much. And long-term excessive alcohol use is a major cause of liver cirrhosis.

• Autoimmune disease: Many autoimmune diseases can negatively affect the liver. But when the body’s immune system specifically attacks the liver, it’s called autoimmune hepatitis.

• Genetic conditions: Families can pass down health conditions that predispose people to liver problems. For example, hemochromatosis is a genetic condition that leads to iron being deposited in tissues, especially the liver.

• Fatty liver disease: This condition is a buildup of fat in the liver that’s not associated with alcohol, so it’s called nonalcoholic fatty liver disease (NAFLD). Increased body fat and type 2 diabetes can raise someone’s risk for this problem. In some cases NAFLD can progress to liver failure in a process called nonalcoholic steatohepatitis (NASH).

• Bile duct blockage: Normally, bile produced by the liver goes to the gallbladder. But if a gallstone gets lodged in a bile duct, the liver gets backed up and doesn’t work well.

• Cancer: Cancer can start in the liver, or it can start elsewhere and spread to the liver. In either case, normal functioning liver cells are replaced with nonfunctioning cancer cells. This can sometimes lead to liver failure.

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What are the symptoms of liver disease?

Many people with mild or even moderate liver disease have no symptoms. If an acute liver disease — like viral hepatitis — causes the liver to stop working suddenly, symptoms are common. But if liver problems develop slowly over time, symptoms may only be present in the end stages. 

The following are signs and symptoms of acute or severe liver disease:

•  Abdominal pain, especially in the right upper area of the stomach 

• An enlarged liver, which may feel like a hard mass extending into the abdomen below the right rib cage 

• Jaundice, or yellowing of the skin or eyes

• Abdominal distention from fluid in the abdominal cavity, called ascites

• Clay-colored or light-colored stools

• Dark-colored urine

• Frequent bruising and bleeding

Liver disease can also cause general symptoms like fatigue, itching, fever, chills, vomiting, or diarrhea.

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How is liver disease diagnosed?

Liver disease may be suspected based on symptoms, or common screening blood tests. In most cases, the first clue will be abnormal liver function tests. But diagnosis of liver disease requires further testing. These may involve: 

• Liver-specific blood testing for things like hepatitis or autoimmune disease

• Imaging studies like ultrasound, CT, or MRI of the liver that can show excess fat, tumors, or scarring

• Transient elastography (FibroScan), which estimates the amount of scarring in the liver, which indicates poorer function

• A liver biopsy is the gold standard method for helping diagnose liver disease. This requires taking a piece of the liver and looking at it under the microscope. The procedure does have risks, so it’s usually saved for when other testing isn’t enough.

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How do I treat liver disease?

Treatment for liver disease depends on the cause. It’s specific to each person. For example, hepatitis C is treated with antiviral medications. Hemochromatosis is treated with phlebotomy (donating blood) to remove excess iron. And autoimmune hepatitis is treated with medications like prednisone and azathioprine.

More advanced liver disease may require:

• Fluid removal (paracentesis) for cirrhosis

• A procedure known as transjugular intrahepatic portosystemic shunt (TIPS) in which a shunt is placed within the liver to keep blood flowing

• Liver transplant

Protecting the liver is recommended in all stages of liver disease. This includes getting vaccines against hepatitis A and B, avoiding medications that are hard on the liver, and abstaining from alcohol.

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Can liver disease be reversed?

Advanced cirrhosis or liver failure is considered irreversible. But treatment of early-stage liver disease can improve — and in some cases reverse — liver damage.

One of the most common forms of chronic liver disease is nonalcoholic fatty liver disease (NAFLD). Increased body fat or diabetes with a fatty liver increases the risk that liver disease will progress. So if someone is in the early stages of disease, weight loss can help reverse the condition, or prevent it from getting worse.

Hepatitis C is another example. It’s curable with current medications. And many people don’t know they’ve acquired hepatitis C. That’s why all adults should be tested for hepatitis C at least once.

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How do I prevent liver disease?

Preventing liver disease is easier than treating it. Recommendations include:

• Avoid use or overuse of known liver toxins, like alcohol and Tylenol.

• Talk with your healthcare provider to see if your current medications can cause liver problems.

• Maintain a moderate weight. 

• Get vaccinated for hepatitis A and B, which are standard childhood immunizations.

• If you’re sexually active, use barrier protection. 

• Get tested and treated for sexually transmitted infections like hepatitis C.

• If you use IV (intravenous) drugs, don’t share needles. 

• Don’t share razors or toothbrushes with someone who has hepatitis.

• Learn your family history, and get tested if a genetic liver problem runs in the family.

• If you have diabetes, keeping your blood sugar within a normal range will help prevent NAFLD.

• Keep up with recommended cancer screenings like colonoscopy and mammogram.

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