Liver disease: Frequently asked questions

What are some of the symptoms of liver disease?

The most important thing to recognize about liver disease is that up to 50 percent of individuals with underlying liver disease have no symptoms. The most common symptoms are very non-specific and they include fatigue or excessive tiredness, lack of drive, and sometimes itching. Signs of liver disease that are more prominent are jaundice or yellowing of the eyes and skin, dark urine, very pale or light colored stool, bleeding from the GI tract, mental confusion, and retention of fluids in the abdomen or belly.

What quantity of alcohol usage should be seen as being a risk to the liver?

Any amount of alcohol can produce damage to the liver. In an otherwise healthy person with no underlying liver problems, the general rule of thumb is different for men and women:

• Men metabolize and are able to clear alcohol more efficiently than women due to body size, body fat, and certain enzymes, so they should limit to three to four drinks in a day.
• Women, because of the same reasons, should limit to one to two drinks in a day.

Beer and wine are not “safer” than whiskey or spirits. One drink is defined as one shot (1 and 1/4 ounces) of whiskey or spirits, one four-ounce glass of wine, or one 12-ounce beer. If an individual has an underlying liver condition such as hepatitis B or C, or prior damage from alcohol or other diseases, the liver is very sensitive to any amount of alcohol. In those conditions, the only safe dose of alcohol is zero.

I know alcoholism damages the liver, what other toxic substances are there that will do damage?

The most common agent is probably acetaminophen (Tylenol, although it is contained in many OTC medications). It remains the safest medication for fevers, aches, and pains, but only taken in small recommended amounts. Amounts greater than those recommended can result in liver damage or failure. Acetaminophen overdose is a common reason for considering a liver transplant.

A more serious problem occurs in patients who drink alcohol on a daily basis, particularly more than two drinks. In those situations, normal doses of Tylenol three to four times a day can produce severe liver damage. The same problem can occur in patients with the other liver diseases such as viral hepatitis. Additionally, more common toxins tend to be those that are inhaled, such as cleaning solvents, aerosolized paints, thinners, etc., which are more dangerous with an underlying condition.

Can liver damage be reversed?

The liver is a unique organ. It is the only organ in the body that is able to regenerate. With most organs, such as the heart, the damaged tissue is replaced with scar, like on the skin. The liver, however, is able to replace damaged tissue with new cells. If up to 50 to 60 percent of the liver cells may be killed within three to four days in an extreme case like a Tylenol overdose, the liver will repair completely after 30 days if no complications arise.

Complications of liver disease occur when regeneration is either incomplete or prevented by progressive development of scar tissue within the liver. This occurs when the damaging agent such as a virus, a drug, alcohol, etc., continues to attack the liver and prevents complete regeneration. Once scar tissue has developed it is very difficult to reverse that process. Severe scarring of the liver is the condition known as cirrhosis. The development of cirrhosis indicates late stage liver disease and is usually followed by the onset of complications.

How long can I go on drinking every day before it affects my liver?

The largest risk factor for liver disease from alcohol is the amount and the length of time the individual has been drinking. Males often develop complications that appear to be on a gender basis as well. Each individual is entirely different. Complication can develop after 5 to 10 years, though it more commonly it takes 20 to 30 years. Many individuals appear to never develop end stage liver disease from alcohol. This is impossible to predict ahead of time. And many other factors such as other diseases, hepatitis C, exposure to other toxins, as well as the individual’s own genetic make-up play a role.

What causes hepatitis?

Hepatitis is a generic term. It indicates inflammation and damage to liver cells. This damage can be caused by drugs, toxins, alcohol, inherited diseases, certain metabolic diseases, and viruses. Commonly, hepatitis refers to viral hepatitis. There are a wide variety of viruses that can cause hepatitis, but again most commonly the term refers to the viruses designated A, B, C, D, E, and G. In the United States, the most common causes are hepatitis A, B, and C.

How necessary is it to inform employers about HCV status?

Hepatitis C virus-positive patients face a number of difficulties due to the unfortunate stigma that is attached to this carrier status. Transmission or passing of this virus to others requires that they be exposed to the HCV-positive individual’s blood or bodily fluid. In most occupations this is not a risk and can be avoided by common sense. In situations where there is a risk of exposure due to trauma, due to use of needles or knives or other situations of this sort, it is probably best and most appropriate to let the employer know. In most situations, including the health care field, this is not a reason to not employ the individuals. Local laws may vary and this needs to be checked locally. If one does inadvertently expose one to blood or bodily fluid, there would be a moral obligation to let the other individual know.

How important are hepatitis vaccines?

There are vaccines to prevent hepatitis A and B. Hepatitis B is a disease that could be completely eradicated with universal vaccination. It is now one part of the newborn vaccination series. Attempts are ongoing to vaccinate all children by the time they reach junior high age. Adults who are in high-risk occupations such as the health care field or carry out high-risk activities, such as IV drug use and multiple sexual partners, should also be vaccinated. Hepatitis A vaccine is recommended in a number of child-care settings and should be discussed with your pediatrician. Adults or children traveling to areas of the world where hepatitis A is very common, including all underdeveloped or poorly developed countries, should be vaccinated before they go. Any individual with underlying chronic liver disease that is not due to hepatitis B, particularly those with hepatitis C or cirrhosis, should be vaccinated against both hepatitis A and hepatitis B, unless they are already immune.

Is hepatitis C caused only by an exchange of bodily fluid?

The majority of patients with hepatitis C are found to have a risk factor such as needle exposure, blood exposure, tattooing, body piercing, or sexual exposure that would allow for an exchange of blood or bodily fluids. Depending on the study, a small percentage of patients, ranging from 5 to 30 percent, have no identifiable risk factor. Presumably, they acquired the disease through inadvertent exposure. Up to 50 percent of patients with hepatitis C have no symptoms. A larger percentage do not know they are carrying the virus. There are many opportunities for inadvertent exposure such as sharing a razor, sharing a toothbrush, sharing scissors for cutting hair, or manicure tools, etc.