Liver Disease

This article was last reviewed

on 10 July 2014.
This article was last modified
on 5 November 2020.

Overview of the Liver

The liver is a vital organ located in the upper right-hand side of the abdomen. It performs numerous
functions for the body: converting nutrients derived from food into essential blood components, storing
vitamins and minerals, regulating blood clotting, producing proteins and enzymes, maintaining hormone
balances, and metabolising and detoxifying substances that would otherwise be harmful to the body. The
liver also makes factors that help the human immune system fight infection, removes bacteria from the
blood, and makes bile, which is essential for digestion.

Bile, a greenish-yellow fluid consisting of bile acids (or salts) and waste products, such as bile pigments,
flows through small bile ducts inside the liver. The bile flows from these small ducts into larger ones, like
streams into a river, eventually leading to the common bile duct. The cystic duct connects the common
bile duct to the gallbladder. After eating, the gallbladder, an organ that sits next to the liver and stores
bile, releases bile into the small intestine where it helps to digest fats.

About Liver Disease

Liver Conditions

What is liver disease?

Liver disease can result from acute or chronic damage to the liver, usually caused by infection,
injury, exposure to drugs or toxic compounds, an autoimmune process, or an inherited defect. The
disease can be classified by the effect it has on the liver and its functions.  The following table
summarises the main categories of liver disease

Liver Examples of
Description
Disease Causes
Hepatitis

An Infection

inflammation Infection by one of the hepatitis viruses causing

In the UK the most
of the liver inflammation and damage to liver cells.  The damage
common causes
causing liver may be cause quickly (acute hepatitis) or slowly (chronic
are hepatitis A, B &
cell damage hepatitis) which depends on the virus.
C viruses
 

Drugs or
Many substances are processed and eliminated by the
Chemicals

liver that may come from normal metabolism or ingested

  Acute or chronic
compounds such as drugs or alcohol. Some of these
exposure to alcohol
substances are potentially toxic.
or paracetamol

Inherited

Alpha 1 antitrypsin Some gene mutations result in diseases that may cause
  deficiency, problems with depositions that result in damage to the
Haemochromatosis, liver.
Wilson’s disease.

Autoimmune

Type 1 diabetes, In these conditions, antibodies are produced which are

 
Sjorgren’s directed against the liver causing damage.
syndrome

Non-alcoholic
fatty liver - Increased deposits of fat in the liver can lead to
 
Metabolic decreased amounts of healthy liver tissue.
syndrome

Cirrhosis

Prolonged
Alcohol, hepatitis, Prolonged and persistent damage to the liver can lead to
damage to
biliary obstruction, the accumulation of excess connective tissue in the
the liver
congestive heart organ. This is called fibrosis of the liver. Over a period of
replaced by
failure, inherited time fibrosis can progress to liver cirrhosis. In cirrhosis
scar tissue
cause, drugs and the structure of the liver changes with nodules of liver
affecting
sometimes cells surrounded by fibrous tissue that does not function
liver
unknown. like healthy liver tissue.
structure &
function
 Obstruction

Tumours, trauma, inflammation or gallstones of a

Can be
sufficient size can cause blockage or obstructions in the
either within Gallstones,
ducts draining the liver (bile ducts). Bile and bilirubin then
the liver or tumours, trauma,
accumulate in the blood and the patient becomes
outside the inflammation or
jaundiced. Tumours or blood clots may also obstruct the
liver in the infection.
vein from the liver. This may be chronic with few
main bile
symptoms or acute and life threatening.
duct

Fatty Liver

Fat is
Fatty liver causes liver enlargement, tenderness and
deposited in
abnormal liver function. The most common cause is
the liver
Alcohol, obesity, excessive intake of alcohol. Another cause is NASH
which can
diabetes (non-alcoholic steatohepatitis) which may progress to
reduce the
cirrhosis. It is seen most commonly in overweight and
amount of
diabetic individuals.
healthy liver
tissue

Cancer

Hepatitis and cirrhosis may lead to liver cancer in some

Tumours Primary liver cancer
cases but cancer from other parts of the body that
can damage or secondaries from
spreads to the liver (secondaries) is more common.
healthy liver another primary
People who have chronic hepatitis or cirrhosis may be
tissue and cancer spreading to
checked on a regular basis for cancer, often with an
affect liver the liver
alpha-fetoprotein (AFP) test and/or an ultrasound scan.
function

Inherited

Genetic
Haemochromatosis is a genetic disorder resulting in
defects can
Haemochromatosis, excess iron storage in the liver, usually diagnosed in
prevent vital
Wilsons disease, adults. Genetic diseases affecting children may involve a
liver
cystic fibrosis, structural defect (biliary atresia), a missing enzyme or
functions
alpha 1 antitrypsin protein leading to damaging deposits such as galactose
and by
deficiency build-up in galactosaemia and copper accumulation in
depositing
Wilson’s disease.
damaging
substances

Signs and Symptoms

Liver disease is often discovered during routine testing. It may not cause any symptoms at first or
the symptoms may be vague, like weakness and loss of energy. In acute liver disease, most
commonly symptoms related to:

problems handling bilirubin, including jaundice (yellowing of the skin and eyes), dark urine, and
light stools
loss of appetite
nausea
vomiting
diarrhoea

Chronic liver disease symptoms may not be present until the disease has reached an advanced
stage. They include:-

jaundice, dark urine

abdominal swelling due to the accumulation of fluid (ascites)
pruritus (itching)
unexplained weight loss or gain
abdominal pain

Tests

Three types of tests are often used to detect liver disease; these tests either measure the levels of
specific enzymes, bilirubin, or protein present in the test sample (usually a blood sample).  Among
the more common tests in these three categories are:

1. Enzymes: Enzymes are proteins that help cells do their work. When cells are injured, enzymes
can leak into the blood at higher-than-normal levels. Three common enzymes used to detect liver
disease are:

Alanine aminotransferase (ALT) – an enzyme found mainly in the liver; the best test for detecting
hepatitis
Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased when they are
blocked
Aspartate aminotransferase (AST) – an enzyme found in the liver and a few other places,
particularly the heart and other muscles

2. Bilirubin: Bilirubin, a waste product made from old blood cells, is a yellow compound that causes
jaundice and dark urine when present in increased amounts. Two different tests of bilirubin are often
used together, especially if a person has jaundice:
 Total bilirubin - measures all the bilirubin in the blood
Conjugated bilirubin - measures a form made in the liver

3. Protein: One of the main functions of the liver is to make protein. Two important liver tests
include:

Albumin - measures the main protein made by the liver and tells how well the liver is making this
protein
Total Protein - measures albumin and all other proteins in blood, including antibodies made to
help fight off infections (antibodies are not made in the liver) 

Doctors often use these tests together to tell whether liver damage has occurred and how severe it
is. When requested together, these tests are called liver function tests.

More specialised blood tests for liver disease may be requested by the doctor in addition to the
tests above to investigate or monitor specific liver conditions. These tests are referred to within the
individual sections on liver disorders on this site.

Related Content

On This Site

Tests: Liver function tests, ALP, ALT, Albumin, Bilirubin, PT, AFP, Total Protein

Conditions: Alcoholism, Hepatitis, Haemochromatosis, Cirrhosis, Autoimmune Disorders, Gallstones,

Jaundice, Metabolic Syndrome, Wilson’s disease.

Elsewhere on the Web

ACB, NICE Guideline summary QS152

NICE Guideline QS152: Liver Disease

NHS: Liver Disease

British Liver Trust

Hepatitis C Trust
 

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