Liver disease, or hepatic disease, is a disease that prevents the healthy performance of your liver. There are many potential causes of the condition including infections, inherited conditions, alcohol abuse and obesity.

Here, we’ll explore the many types of liver disease, common symptoms in men and women, the various causes, recommended treatments and how to live with the condition. For more information and support in navigating liver disease, sign up to Carecircle and connect with fellow patients, carers and other experts.

What is liver disease?

The liver is one of the human body’s essential organs, tasked with the important responsibility of digesting food and ridding the body of toxic substances. Roughly the size of a football, it is the second-largest organ in the body (after the skin) and sits just under the ribcage on the right side.

Liver disease is a disease that causes inflammation or damage to the liver, preventing the organ from performing healthily. There are many causes of the condition including infections, genetics, obesity and alcohol misuse.

Liver disease vs liver failure

While liver disease refers to a condition that affects your liver’s overall function as a result of damage or inflammation, liver failure is when your liver has lost some or all of its functionality. It is an ultimately life-threatening emergency and can be caused by liver disease if left untreated.

There are two types of liver failure: acute and chronic. Acute liver failure comes on rapidly, while chronic liver failure develops gradually over time. The damage caused by liver failure has several stages:

• Inflammation – when the liver becomes inflamed or enlarged
• Fibrosis – when the inflamed liver begins to scar
• Cirrhosis – when severe scarring builds up on your liver
• End-stage liver disease – when the liver’s function has dramatically deteriorated
• Liver cancer – when cancerous cells have developed and multiplied throughout the body. Liver cancer is one of the leading causes of cancer-related deaths worldwide

Types of liver disease

There are five main types of liver disease including:

• Alcohol-related liver disease (ARLD) – Liver disease caused by regular and heavy alcohol misuse. Usually, there are no symptoms of ARLD until the liver has been severely damaged
• Non-alcoholic fatty liver disease (NAFLD) – Liver disease caused by fatty build-ups in the liver as a result of being overweight or obese. Early-stage NAFLD can be harmless but may lead to serious liver damage (cirrhosis) if it progresses
• Hepatitis – Liver disease caused by catching a viral infection or regularly drinking too much alcohol. This type causes inflammation in the liver and may pass without problems or be long-lasting, potentially causing cirrhosis, loss of liver function and liver cancer
• Haemochromatosis – Hereditary liver disease that can be passed from parents to children. It starts with a build-up of iron levels and leads to iron overload, causing damage to the liver and other organs in the body
• Prime biliary cirrhosis – Liver disease caused by issues with the immune system. This type gradually gets worse over time and may lead to liver failure if left untreated

Liver disease symptoms

Many types of liver diseases do not show any noticeable signs or symptoms – particularly in the early stages. When symptoms do present themselves, the liver will already be damaged or scarred – also known as cirrhosis. The symptoms of this include:

• Chronic fatigue and feelings of weakness
• Loss of appetite
• Loss of libido or sex drive
• Skin and eyes that appear yellowish (jaundice)
• Itchy skin
• Dark urine colour
• Pale stool colour
• Abdominal pain and swelling
• Swelling in the legs and ankles
• Skin that bruises easily
• Nausea or vomiting
• Right shoulder pain
• Hair loss

If you have been diagnosed with liver disease and experience symptoms such as fever, shivers, shortness of breath, vomiting blood, black tarry stools or periods of mental confusion, you must see a doctor straight away.

Liver disease symptoms in men

While the majority of symptoms apply to both men and women, there are unique symptoms for each individual sex.

In addition to the above symptoms listed, men with liver disease may also experience enlarged breasts, impotence and shrunken testes.

Liver disease symptoms in women

Women with liver disease can also have their own unique symptoms. As well as the main symptoms listed above, they may also experience irregular or lack of menstrual periods.

What causes liver disease?

There are many causes of liver disease including:

• Infections – Hepatitis A, Hepatitis B, Hepatitis C and other viruses and parasites can infect the liver and cause inflammation that affects the liver’s functionality. These viruses can be spread through blood, semen, contaminated water or close contact with an infected person
• Immune system disorders – When the body is battling autoimmune liver diseases like autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis, the immune system can attack certain parts of the body including the liver
• Genetics – Certain liver diseases like hemochromatosis, Wilson’s disease and alpha-1 antitrypsin deficiency can be passed from parent to child, causing various substances to build up in the liver and ultimately causing liver damage
• Obesity – If you are overweight or obese, you are at risk of developing a build-up of fat in the liver, which can ultimately lead to non-alcoholic fatty liver disease (NAFLD)
• Alcohol misuse – Drinking alcohol heavily on a regular basis can cause severe damage to the liver including cirrhosis
• Cancers – Cancers including liver cancer, bile duct cancer and liver adenoma can develop as a result of abnormal cells multiplying in the liver and developing into tumours
• Certain prescriptions and over-the-counter medications – Drugs like too much acetaminophen can cause serious harm to the liver.

How do you diagnose liver disease?

If you are showing symptoms of liver disease and you are concerned that you may have the condition, you should arrange to see your GP. They will discuss your health history and may carry out a physical examination. From there, they may arrange:

• Blood tests – Also known as liver function tests, doctors will use your blood samples to assess your liver and detect whether you have low levels of certain substances such as a protein called serum albumin, which may suggest the liver is not functioning properly. However, even in people with different stages of liver disease, blood test results can still sometimes show up as normal
• Imaging tests – If your doctor suspects that you have advanced alcohol hepatitis or cirrhosis, they may arrange scans to produce detailed images of your liver. These tests may include ultrasounds, CTI scans or MRI scans
• Liver biopsy – This is where a fine needle is inserted into your body under local anaesthetic to take a small sample of liver cells. This is then sent to the lab and examined to determine your level of liver scarring and liver damage
• Endoscopy – With cirrhosis, swollen veins may appear on your oesophagus and stomach. To look for these, your doctor may pass a long, thin and flexible tube with a light and video down your oesophagus and into your stomach to capture images, which are then transmitted to an external screen.

Liver disease treatment

Treatment for liver disease will depend on the type and severity of your condition. In some cases, simple lifestyle changes like reducing alcohol intake or losing weight can help, while more severe cases may require more specialist treatments. Here are the most common treatments for each of the main types of liver disease:

• Alcohol-related liver disease (ARLD) – Stopping alcohol consumption can prevent your liver disease from getting worse and developing into liver failure. An estimated 70% of people with ARLD have an alcohol dependency problem so this may not be easy and the sufferer may experience withdrawal symptoms for a few days. Many people with ARLD also have malnutrition so it’s important that a well-balanced and nutritious diet is introduced. In more serious cases of ARLD, medications or liver transplants may be recommended
• Non-alcoholic fatty liver disease (NAFLD) – Many people with NAFLD may not develop any serious problems but it’s a good idea to prevent the condition from getting worse. Lifestyle changes such as losing weight, eating healthily, drinking water instead of sweet drinks, exercising regularly and stopping smoking may be recommended. If the condition worsens and your liver stops functioning properly, a liver transplant may be required
• Hepatitis – Treatment for hepatitis depends on the type. Hepatitis A, Hepatitis B and Hepatitis E usually pass on their own within a few months and therefore don’t usually require treatment. 1 in 4 people will recover from Hepatitis C independently but if it stays in the body, effective antiviral medications may be recommended. Hepatitis D only develops if the person already has Hepatitis B so a Hepatitis B vaccine may be recommended for the prevention of Hepatitis D. Meanwhile, alcohol hepatitis can be improved by stopping drinking and autoimmune hepatitis can be treated by effective medicines that reduce inflammation and suppress the immune system
• Haemochromatosis – If haemochromatosis is inherited, the sufferer may require phlebotomy, a procedure that removes some of the blood, or chelation therapy to reduce the amount of iron in the body. If you undergo either of these treatments, you will likely be advised to avoid alcohol, iron or vitamin C supplements and breakfast cereals containing iron
• Primary biliary cholangitis (PBC) – PBC can develop at different rates in different people. If allowed to develop, it can cause liver failure and death. Usually, the sufferer will be treated with certain acids to prevent this from happening. In some cases, a liver transplant might be needed

Living with liver disease

As liver disease presents itself differently in different people depending on the type and stage, there are ways of living with the disease. Sometimes, it may take years for any further damage to develop – if at all.

If you have been diagnosed, it is important to look after yourself as liver disease makes you more prone to becoming severely ill from infections. Ways to do this include:

• Visiting your GP for a flu jab every autumn
• Eating a balanced diet and maintaining a healthy weight
• Reducing your salt intake and eating plenty of protein
• Stopping or reducing your smoking and alcohol consumption
• Getting your jabs to avoid pneumococcal infection, Hepatitis A and Hepatitis C
• Staying up to date with other vaccinations if travelling abroad
• Maintaining good standards of hygiene – particularly around food
• Visiting the dentist every 6 months
• Keeping toenails and fingernails trimmed
• Avoiding close contact with adults and children carrying infections
• Sleeping well at night and getting enough rest during the day
• Asking for help when you need it
• Avoiding illegal drugs

You may also be entitled to statutory sick pay, disability living allowance (DLA), attendance allowance (AA), employment and support allowance, carer’s allowance and direct payments due to your condition.

Liver disease FAQs

It’s natural to have questions about liver disease. Here are the answers to some FAQs.

When to worry about ALT levels?

When liver cells are damaged, alanine transaminase enzymes (ALT) can release into the bloodstream. If an ALT test shows up high levels of ALT, it can indicate problems with your liver.

The upper limit for normal ALT is 55 IU/L. If your levels are double or triple this figure, your ALT levels are considered mildly elevated. However, if they are 50 times the upper limit of normal, they are considered severely elevated.

What causes high liver enzymes?

Liver enzymes are proteins that speed up chemical reactions in your body. If you have high levels of liver enzymes, you are at a higher risk of developing liver damage.

If you already have liver disease, your condition may be what’s causing the high level of liver enzymes. Types of liver disease that cause high liver enzymes include Hepatitis A, Hepatitis B, Hepatitis C, alcohol hepatitis and autoimmune hepatitis.

Elevated liver enzymes are also caused by certain medical conditions, medications and infections. You are also more at risk if you drink heavily, have diabetes and take certain herbs and vitamin supplements.

What does liver pain feel like?

Liver pain can take many forms, making it difficult to diagnose. And because the liver doesn’t have any nerves that sense pain, the discomfort felt is usually a result of the inflammation and damage caused to the surrounding tissues.

People with cirrhosis generally report a dull or throbbing pain in the abdomen and sometimes experience back pain, shoulder pain and joint pain too. It is quite common for liver disease to cause discomfort in the shoulders and neck, as well as inflammation throughout the body that can feel uncomfortable. Liver disease can also cause ascites, which are fluid build-ups in the abdomen and this can cause sharp pain when breathing.

Where is my liver?

Your liver is located towards the bottom of your rib cage on the right-hand side. It sits beneath the diaphragm and on top of the stomach, right kidney and intestines. As the size of a football, it is the second-largest organ in the body after the skin.

Where is liver pain located?

Because the liver can cause pain throughout the body, it can be difficult to pinpoint. However, if you were to have cirrhosis, it is likely you will experience severe pain in the abdomen. But often, liver pain can be felt in the back and shoulders too.

Since liver disease doesn’t always cause symptoms, you may not experience any liver pain until the condition is at an advanced stage.

Can stress cause elevated liver enzymes?

Elevated liver enzymes are mostly caused by fatty liver disease. It’s also commonly caused by hepatitis, alcohol or drug misuse and cirrhosis.

Another common cause is metabolic syndrome, which can be brought on by stress. So while stress isn’t a direct cause of elevated liver enzymes, it can indirectly lead to them.

Being stressed can also impact the part of the brain that controls the liver and impact blood flow to the liver, suggesting that stress has strong connections to liver damage.

How to make your liver healthy again?

Although the liver can regenerate itself, if there is severe damage or scarring, there is sometimes little you can do to make it healthy again. The good news is that your liver disease would have to be at a very advanced stage for this to be the situation.

Things you can do to help improve the health of your liver include maintaining a healthy weight, avoiding alcohol or using it responsibly, stopping smoking, avoiding illicit drug use, getting vaccinated for Hepatitis A and Hepatitis B, practising safe sex and avoiding toxins.

Liver disease Resources

If you’re suffering from the effects of liver disease, you may find the following resources and links useful:

• Liver disease – NHS
• British Liver Trust
• Children’s Liver Disease Foundation
• Liver 4 Life

Liver disease is a condition that affects the health and performance of your liver. It can be caused by many things including infections, genetics, obesity, medications and alcohol misuse. If mild, liver disease may improve on its own but can quickly worsen and develop into liver failure, a serious and life-threatening condition.

It’s never too late to join the conversation on liver disease. Sign up to Carecircle for free and find help, hope and control with your liver disease diagnosis. Our global network for health makes you part of a worldwide community where your voice matters. Together, we can work toward a better future.

Guide Sources

• https://www.nhs.uk/conditions/liver-disease/
• https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502
• https://my.clevelandclinic.org/health/diseases/17179-liver-disease
• https://www.niddk.nih.gov/health-information/liver-disease
• https://www.webmd.com/hepatitis/liver-and-hepatic-diseases
• https://www.healthline.com/health/liver-failure-stages#causes
• https://uihc.org/health-topics/liver-disease-frequently-asked-questions
• https://britishlivertrust.org.uk/information-and-support/living-with-a-liver-condition/living-with-liver-disease/
• https://medlineplus.gov/lab-tests/alt-blood-test/
• https://www.verywellhealth.com/liver-enzymes-1759916
• https://my.clevelandclinic.org/health/symptoms/17679-elevated-liver-enzymes
• https://www.healthline.com/health/liver-pain#what-it-feels-like
• https://www.stanfordchildrens.org/en/topic/default?id=anatomy-and-function-of-the-liver-90-P03069
• https://www.medicalnewstoday.com/articles/317259#Liver-pain-and-liver-disease
• https://www.medicalnewstoday.com/articles/325838
• https://www.desunhospital.com/world-liver-day-2019.php
• https://liverfoundation.org/13-ways-to-a-healthy-liver/
• https://britishlivertrust.org.uk/information-and-support/liver-health-2/symptoms-of-liver-disease/