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Fatty Liver Disease
Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells.
Nonalcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, nonalcoholic steatohepatitis can progress to cirrhosis and liver failure
Nonalcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people.
Nonalcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat.
Symptoms
Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include:
Enlarged liver
Fatigue
Pain in the upper right abdomen
Possible signs and symptoms of nonalcoholic steatohepatitis and cirrhosis (advanced scarring) include:
Abdominal swelling (ascites)
Enlarged blood vessels just beneath the skin's surface
Enlarged breasts in men
Enlarged spleen
Red palms
Yellowing of the skin and eyes (jaundice)
Causes
Experts don't know exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are both linked to the following:
Overweight or obesity
Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin
High blood sugar (hyperglycemia), indicating prediabetes or actual type 2 diabetes
High levels of fats, particularly triglycerides, in the blood
These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and nonalcoholic steatohepatitis, which may lead to a buildup of scar tissue (fibrosis) in the liver.
Diagnosis
A diagnosis can be made using many tests including:
Plain ultrasound, which is often the initial test when liver disease is suspected.
Transient elastography, an enhanced form of ultrasound that measures the stiffness of your liver. Liver stiffness indicates fibrosis or scarring.
Liver tissue examination. If other tests are inconclusive, your doctor may recommend a procedure to remove a sample of tissue from your liver (liver biopsy). The tissue sample is examined in a laboratory to look for signs of inflammation and scarring.
If you are concerned you have fatty liver disease or have been diagnosed with fatty liver disease, contact your doctor. You can also call us at 978-459-6737 to request an appointment.
Hepatitis C
Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood. Until recently, hepatitis C treatment required weekly injections and oral medications that many HCV-infected people couldn't take because of other health problems or unacceptable side effects. That's changing. Today, chronic HCV is usually curable with oral medications taken every day for two to six months. Still, about half of people with HCV don't know they're infected, mainly because they have no symptoms, which can take decades to appear. For that reason, the U.S. Centers for Disease Control and Prevention recommends a one-time screening blood test for everyone at increased risk of the infection. The largest group at risk includes everyone born between 1945 and 1965 — a population five times more likely to be infected than those born in other years.
Symptoms
Long-term infection with the hepatitis C virus (HCV) is known as chronic hepatitis C. Chronic hepatitis C is usually a "silent" infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease. Among these signs and symptoms are:
Bleeding easily
Bruising easily
Fatigue
Poor appetite
Yellow discoloration of the skin and eyes (jaundice)
Dark-colored urine
Itchy skin
Fluid buildup in your abdomen (ascites)
Swelling in your legs
Weight loss
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Spider-like blood vessels on your skin (spider angiomas)
Your risk of hepatitis C infection is increased if you:
Are a health care worker who has been exposed to infected blood, which may happen if an infected needle pierces your skin
Have ever injected or inhaled illicit drugs
Have HIV
Received a piercing or tattoo in an unclean environment using unsterile equipment
Received a blood transfusion or organ transplant before 1992
Received clotting factor concentrates before 1987
Received hemodialysis treatments for a long period of time
Were born to a woman with a hepatitis C infection
Were ever in prison
Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C infection
Hepatitis C infection that continues over many years can cause significant complications, such as:
Scarring of the liver (cirrhosis). After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in your liver makes it difficult for your liver to function.
Liver cancer. A small number of people with hepatitis C infection may develop liver cancer.
Liver failure. Advanced cirrhosis may cause your liver to stop functioning.
Diagnosis
Health officials recommend that anyone at high risk of exposure to HCV get a blood test to screen for hepatitis C infection.
Doctors typically use one or more of the following tests to assess liver damage in chronic hepatitis C.
Transient elastography. Another noninvasive test, transient elastography is a type of ultrasound that transmits vibrations into the liver and measures the speed of their dispersal through liver tissue to estimate its stiffness.
Liver biopsy. Typically done using endoscopic ultrasound guidance, this test involves inserting a thin needle through the stomach wall under anesthesia to remove a small sample of liver tissue for laboratory testing.
Treatment
Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body. The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you complete treatment.
If you think you are at risk of having hepatitis C, call your doctor who can test you very quickly with a simple blood test. If you have hepatitis C, call us at 978-459-6737 to request an appointment. We can talk to you about how to get rid of the virus and manage any damage you may have suffered as a result of infection.
Hepatitis B
Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing liver failure, liver cancer or cirrhosis — a condition that permanently scars of the liver.
Most adults with hepatitis B recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic (long-lasting) hepatitis B infection.
A vaccine can prevent hepatitis B, but there's no cure if you have the condition. If you're infected, taking certain precautions can help prevent spreading the virus to others.
Symptoms
Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to four months after you've been infected, although you could see them as early as two weeks post-infection. Some people, usually young children, may not have any symptoms.
Hepatitis B signs and symptoms may include:
Abdominal pain
Dark urine
Fever
Joint pain
Loss of appetite
Nausea and vomiting
Weakness and fatigue
Yellowing of your skin and the whites of your eyes (jaundice)
Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person through blood, semen or other body fluids. It does not spread by sneezing or coughing.
Common ways that HBV can spread are:
Sexual contact. You may get hepatitis B if you have unprotected sex with someone who is infected. The virus can pass to you if the person's blood, saliva, semen or vaginal secretions enter your body.
Sharing of needles. HBV easily spreads through needles and syringes contaminated with infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B.
Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood.
Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become pregnant.
Having a chronic HBV infection can lead to serious complications, such as:
Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection can lead to extensive liver scarring (cirrhosis), which may impair the liver's ability to function.
Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer.
Diagnosis
Your doctor will examine you and look for signs of liver damage, such as yellowing skin or belly pain. Tests that can help diagnose hepatitis B or its complications are:
Blood tests. Blood tests can detect signs of the hepatitis B virus in your body and tell your doctor whether it's acute or chronic. A simple blood test can also determine if you're immune to the condition.
Liver ultrasound. A special ultrasound called transient elastography can show the amount of liver damage.
Liver biopsy. Your doctor might remove a small sample of your liver for testing (liver biopsy) to check for liver damage. During this test, your doctor inserts a thin needle through your skin and into your liver and removes a tissue sample for laboratory analysis.
If you have been exposed or believe you have been exposed to hepatitis B, call your doctor who can test you very quickly with a simple blood test. If you have hepatitis B, call us at 978-459-6737 to request an appointment.
Autoimmune Hepatitis
Autoimmune hepatitis is liver inflammation that occurs when your body's immune system turns against liver cells. The exact cause of autoimmune hepatitis is unclear, but genetic and environmental factors appear to interact over time in triggering the disease.
Untreated autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and eventually to liver failure. When diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system.
A liver transplant may be an option when autoimmune hepatitis doesn't respond to drug treatments or when liver disease is advanced.
Symptoms
Signs and symptoms of autoimmune hepatitis can range from minor to severe and may come on suddenly. Some people have few, if any, recognized problems in the early stages of the disease, whereas others experience signs and symptoms that may include:
Fatigue
Abdominal discomfort
Yellowing of the skin and whites of the eyes (jaundice)
An enlarged liver
Abnormal blood vessels on the skin (spider angiomas)
Skin rashes
Joint pains
In women, loss of menstruation
Diagnosis
Autoimmune hepatitis can be diagnosed through a combination of lab testing as well as by performing a liver biopsy.
If you believe you have autoimmune hepatitis or you have been diagnosed with autoimmune hepatitis, contact your doctor. You can also call 978-459-6737 to request an appointment.
Cirrhosis
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.
Cirrhosis occurs in response to damage to your liver. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function.
Decompensated cirrhosis is the term used to describe the development of specific complications resulting from the changes brought on by cirrhosis. Decompensated cirrhosis is life-threatening.
The liver damage done by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.
Symptoms
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
Fatigue
Bleeding easily
Bruising easily
Itchy skin
Yellow discoloration in the skin and eyes (jaundice)
Fluid accumulation in your abdomen (ascites)
Loss of appetite
Nausea
Swelling in your legs
Weight loss
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Spiderlike blood vessels on your skin
Redness in the palms of the hands
Testicular atrophy in men
Breast enlargement in men
Complications
Complications of cirrhosis can include:
High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.
Swelling in the legs and abdomen. Portal hypertension can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to the spleen. Decreased white blood cells and platelets in your blood can be a sign of cirrhosis with portal hypertension.
Bleeding. Portal hypertension can cause blood to be redirected to smaller veins, causing them to increase in size and become varices. Strained by the extra load, these smaller veins can burst, causing serious bleeding. Life-threatening bleeding most commonly occurs when veins in the lower esophagus (esophageal varices) or stomach (gastric varices) rupture. If the liver can't make enough clotting factors, this also can contribute to continued bleeding. Bacterial infections are a frequent trigger for bleeding.
Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to spontaneous bacterial peritonitis, a serious infection.
Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. Hepatic encephalopathy symptoms may range from fatigue and mild impairment in cognition to unresponsiveness or coma.
Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
Increased risk of liver cancer. A large proportion of people who develop liver cancer that forms within the liver itself have cirrhosis.
Acute-on-chronic liver failure. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don't fully understand its causes.
If you believe you have cirrhosis or you have been diagnosed with cirrhosis, contact your doctor. You can also call 978-459-6737 to request an appointment.