Word on Health

Word on Liver Disease

Our grateful thanks to Dr Trisha Macnair from the Primary care society for Gastroenterology for your contribution to our  radio report - which you can hear again at the bottom of this page via our audio player.

For more information on all aspects of liver disease, visit www.britishlivertrust.org.uk - the charity also has a helpline 0800 652 7330 (10am to 3:00pm Monday to Friday). We thank them for the use of the support information below.

Liver Disease is now the biggest cause of death in the 35-49 age group and the third biggest cause of premature death overall, having seen a 400% increase in cases since 1970 whilst other major causes of death have remained stable or decreased. 

Despite the statistics, recent research from the British Liver Trust shows, only 5% of us ‘would have great concern’ if told there was a problem with our liver, compared to 72% if the same was said of the heart. 

To  find out your risk  try the British Liver Trust Screening Tool

About our liver-  Did you know that your liver is the biggest organ inside your body and does hundreds of essential jobs? No ? - here's what it does...

  • Fights infection and disease
  • Destroys poisons and drugs (including alcohol)
  • Cleans the blood
  • Controls the amount of cholesterol
  • Processes food once it has been digested

It works hard and can take a lot of abuse, but it is like an elastic band – it can only stretch so far before it breaks.

As we highlighted, Liver disease is on the increase in the UK. It can be a silent killer, with no symptoms until it is too late.  There are many causes of liver disease but there are three main threats to protect your liver against:

  1. Alcohol
  2. Fatty liver disease
  3. Viral hepatitis

Alcohol. Most people, wrongly think, that alcohol is fairly harmless and just something to be enjoyed. Other than a few ill-effects the next day and maybe putting on a bit of extra weight, alcohol does not seem to have any long lasting effects. But alcohol can cause harm.

It is a mistake to think that you have to be a heavy drinker to run into liver problems. Although it can take as long as 10 to 20 years, drinking just a bit more than you should over time can seriously harm your liver. Not feeling any side effects from drinking does not mean that you are not risking chronic ill-health or lasting liver damage from alcohol-related liver disease. Vast numbers of us now fall into this category.

If you’re drinking too much, your liver has to literally soak up the punishment. With so few nerve endings to signal pain you won’t know that your liver is complaining. If you’re drinking a lot on a regular basis, chances are that you will not feel anything happening until your liver has had enough. The harm to your liver at this stage will be severe – and could even be fatal.

This is not an attempt to put you off drinking. Being more sensible about how you drink is the aim. It can be easy to underestimate how much alcohol you are drinking and often difficult to stop after a certain number of drinks. A little more knowledge about alcohol itself will help. Taking a few minutes to read this leaflet to help you understand the effect alcohol has on you and your liver is a big step in the right direction.

The message is simple: when you raise a glass, spare your liver a thought. If you keep track of how much you drink, you should stay in better shape and around for longer to enjoy it.

Your liver can only handle a certain amount of alcohol in any given time (one unit an hour). If you are drinking quickly, your liver cells will have to work overtime to process the alcohol. When this is more than the liver can deal with, the excess is transported to the rest of your organs.

Your liver needs water to do its job. As alcohol acts as a diuretic (makes you pass urine), it dehydrates you and forces the liver to divert water from elsewhere.

When the liver is processing alcohol it produces a substance called acetaldehyde. This has a toxic effect on the liver itself, as well as the brain and stomach lining. This is what causes your hangover.

Regular and heavy drinking over time can strain or disrupt this process, leading to alcoholic liver disease.  The first stage of disease may not seem all that significant but must be acted upon. The later stages are very serious and can threaten your life.

Fatty liver - When the liver breaks down alcohol, it stores the fat in your liver. There should be little or no fat in a healthy liver. Too much of this fat can build up if you drink more than the liver can cope with, leading to fatty liver disease. You can get a fatty liver without drinking. This is called, perhaps unoriginally, ‘non-alcoholic fatty liver disease’ (NAFLD). So you not only have to be careful with the amount and frequency of alcohol intake but you also need to keep an eye on your diet and the amount of sugar and fat you consume. It's also important to keep active. 

It is thought that if you are overweight and drinking too much, you will be increasing the chances of damaging your liver, as it receives fat from both food and alcohol.

Alcoholic hepatitis  If you have a fatty liver and continue to drink, you have up to a one in three chance of getting alcoholic hepatitis. This is a condition where your liver becomes puffy, swollen and tender. It can affect you suddenly – after a weekend of binge drinking, for example – and if your liver fails, it can kill you. Alcoholic hepatitis can happen to you at an early stage or after many years of excessive drinking.

Fibrosis  Scar tissue, which is generated to protect injured tissue from further damage and will disappear in a healthy liver, may keep building up. This scarring is known as fibrosis.

Cirrhosis  The final stage of alcoholic liver disease is cirrhosis. This is usually the result of long-term, continuous damage to the liver Irregular bumps, known as nodules, replace the smooth liver tissue and the liver becomes harder. The effect of this, together with continued scarring from fibrosis, means that the liver will run out of healthy cells to support normal functions. This can lead to complete liver failure.

By the time you discover you have cirrhosis your quality of life may be severely damaged as your liver will have stopped working efficiently. If you carry on drinking at this stage you will speed up the damage to your liver and rapidly increase your chances of dying. The odds are one in ten that you will develop cirrhosis if you drink too much over a long period of time. In the UK, the number of people dying from cirrhosis each year is increasing.  As well as all the problems related to the liver not doing its job, people with cirrhosis also have a much higher chance of getting liver cancer. Each year, three to five per cent of people with cirrhosis will develop liver cancer.

Your liver is tough. It can withstand years of damage by repairing itself and protecting the rest of your body. However, the liver is unable to signal real distress until it is in the end stages of liver failure, so that by the time you feel any symptoms of liver problems, the damage may be done.

What are the symptoms of alcoholic liver damage?  If you have alcoholic liver damage you may have some vague symptoms such as:

  • feeling some pain in the liver (place your right hand over the lower right hand side of your ribs
  • and it will cover the area of your liver)
  • having a general feeling of poor health and fatigue
  • loss of appetite
  • a sick, nauseous feeling, especially in the mornings and often accompanied by diarrhoea.

If you have any of the following specific symptoms, it is likely that your liver is already quite badly damaged with alcoholic hepatitis or cirrhosis and you should talk to your doctor at once.

  • yellow eyes or, in more severe cases, yellow skin (jaundice)
  • vomiting blood (haematemesis)
  • dark black, tarry, stools (melena)
  • significant weight loss
  • periods of confusion or poor memory (hepatic encephalopathy)

If your doctor suspects you may have liver damage, he or she will look out for the following signs:

  • tender, firm, or possibly enlarged liver (hepatomegaly)
  • red and mottled palms (palpar erythema)
  • partly white fingernails (clubbing)
  • enlargement of the male breasts, which may be tender (gynaecomastia)
  • swollen abdomen (ascites)
  • thinning hair (alopecia)
  • weakness and wasting of the muscles (atrophy)
  • drink-related problems affecting your family relationships
  • drink-related problems affecting your work or career
  • drink-related financial problems
  • drinking that leads to trouble with authorities and/or the police.

These are tell-tale signs that your drinking is out of hand and that you need some help.

Prevention:  Can I avoid liver damage?  Everyone reacts to alcohol in different ways so it is difficult to tell in advance who is most likely to suffer liver damage. However, research shows that the following three groups may be more at risk than most:

  • women, partly because of their smaller body size and build
  • people who are overweight
  • people who inherit genes that don’t allow proper metabolism of alcohol.

Studies suggest that immune response (how the body recognizes and defends itself against invading illness) may be a factor. This means that drinking alcohol triggers an aggressive physical reaction in some people that attacks their liver. This may explain why cirrhosis, unusually, can occur quite quickly in some drinkers. As we heard on air a good balanced, low fat diet that keeps sugar intake down together with regular exercise are important.

Women are more susceptible to liver damage than men, even if they drink less. Women are generally smaller than men. A greater proportion of their body mass is fat tissue which means they have less body water. This results in higher blood alcohol levels (blood alcohol concentration, or ‘BAC’) for each unit of alcohol they consume.

How much can I drink?  If you are healthy and eat a balanced diet then sensible drinking should not give you problems. But what is sensible drinking?

(The British Liver Trust advise avoidance of alcohol for a minimum of three days a week to give your liver a break)

Regular drinking

You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level. If you do drink as much as 14 units per week, it is best to spread this over 3 days or more, rather than save up units for a single drinking session.

Single episodes of drinking

  • Limit the total amount of alcohol drunk on any occasion
  • Drinking more slowly, drinking with food, and alternating alcoholic drinks with water
  • Avoid risky places and activities.

Pregnancy and drinking

If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.'

Treatment:  Stop drinking  The most effective way to treat alcohol related liver disease is to stop drinking. For most people withfatty liver and alcohol related hepatitis the liver will recover and heal itself if they stop drinking.

Even if you have cirrhosis, you will reduce any further damage to your liver and increase your chances of survival if you stop drinking.   If you have alcohol related liver damage, cutting down will only reduce the rate of damage.

The symptoms of liver damage may disappear when you cut down the amount you drink, but this does not mean that damage is not taking place. Cirrhosis can develop even after drinking just a little too much over the years, with possibly no early warning signs of disease. Treatments are available that will alleviate the symptoms of cirrhosis, but they cannot reverse it.

Diet:  Drinking alcohol can lead to malnutrition. The consumption of empty calories, a loss of appetite and malabsorption (poor absorption of food nutrients) caused by alcohol’s toxic effect on the gut can all play a part in this. For this reason, eating well is important in helping your liver recover.

If you have alcohol related liver damage it is likely that you lack vitamins, in particular thiamine (a B vitamin that helps the body convert carbohydrates into energy), and your doctor may have to prescribe vitamin supplements

Other treatments  If you have severe alcohol related hepatitis you may have to be admitted to hospital. Steroids (drugs used to control the inflammation of your liver) may be used if you are very ill and can improve your chance of survival from between 60 and 70 per cent to between 90 and 95 per cent if you are free of infection and have no internal bleeding from your gut.

For people with alcohol related cirrhosis there is no specific treatment other than to stop drinking or, if available, undergo a liver transplant. This can only happen if you are a suitable ‘candidate’.

Liver transplants  For some people with cirrhosis and/or life-threatening liver complications, a transplant may be the only option.

In the UK, alcohol related cirrhosis is the most common reason people need a liver transplant (and runs only second to hepatitis C in Europe as a whole). Only patients whose liver disease fails to improve after a period of abstinence (usually six months) are considered candidates for transplantation in the UK. If you are a candidate for a transplant you will be carefully assessed and may be put on the waiting list for a donor liver. If you continue to drink you will not be offered a transplant.

If doctors consider that you need a liver transplant then you are unlikely to survive for more than a few years without one.  A liver transplant is a major operation – after all, the liver is a major organ. One in twenty people do not survive the operation. If the transplant is successful you will need to take drugs for the rest of your life to stop your body rejecting the donor liver.  Survival following a liver transplant is improving all the time, with about three quarters of those having a successful transplant now living longer than five years.  If your liver transplant is alcohol-related, you will be required to abstain from alcohol permanently in order to remain in good health.

Looking after yourself: Can my liver recover?  What happens depends on how badly your liver is damaged and on your general health. If you have a fatty liver, you can help your liver to recover by stopping or cutting down on your drinking. You can aloas reduce the amount of sugar and fat you consume.

If you have alcohol related hepatitis, most people can recover if they stop drinking completely (cutting down will only reduce the amount of damage done). But people with severe alcohol related hepatitis, who need to be admitted to hospital, have around a one in three chance of dying in the first month after admission.

If you have cirrhosis, your liver cannot fully recover. But you can prevent any further damage being done to your liver and increase your survival rate if you stop drinking.

If your liver is badly affected by cirrhosis and you continue to drink, it is estimated that you have only a one in three chance of living for five years. However, if you stop drinking, you can almost double your survival chances.

To learn more about Viral Hepatitis and Fatty Liver disease visit www.britishlivertrust.org.uk - they also have a helpline 0800 652 7330 (10am to 3:00pm Monday to Friday)

Listen to this weeks radio report

All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.