What does the liver do?

The liver is the largest organ inside your body, and is essential to life, carrying out 500 different functions. It is the factory of the body, making proteins, blood clotting factors, and products to help with digestion and energy release. Your body uses it as a store for energy and iron. It also purifies the blood of bacteria, by-products of digestion, alcohol and drugs.

I've just had a liver function test and been told the results are abnormal, what does this mean?

Liver function blood tests, referred to as LFTs, are often ordered by your GP to find out whether you have increased levels of certain enzymes that might indicate a problem with your liver. There are many reasons why you have abnormal results. There is no need to be alarmed, as it is quite common to have an abnormal LFT. Your doctor will probably order further tests to get a fuller picture of your liver health before reaching a conclusion. LFTs are a useful test but are not the only test your doctor will use or rely on to diagnose problems or give you a clean bill of health.

I've been told I have a liver disease. What has caused it?

There are many causes of liver disease:-

Drinking too much alcohol, usually over many years, is the single largest cause.
There are also viruses that damage the liver; the most important are the blood-borne viruses hepatitis B and C.
Some people lay down fat cells in their liver, often connected with being overweight or having diabetes.
Other people carry genetic or develop autoimmune conditions that can lead to liver damage. It is also possible to suffer adverse reactions to medicines or drugs, resulting in liver failure.
Cancer is both a cause and a consequence of liver disease. Finding the cause is important in designing the right treatment and stopping the progression of the disease

My brother has been told he has cirrhosis. Does this mean he is an alcoholic?

No, there are many different causes of cirrhosis. Alcohol is only one of these. Cirrhosis may be caused by viruses, iron overload, copper overload, metabolic disease, fat and autoimmune conditions.

What are the symptoms of liver disease?

Liver disease is sometimes referred to as the ‘silent killer’ as there are often only vague symptoms until liver damage is quite severe. Early symptoms can include feeling generally unwell or tired, having poor appetite, weight loss, a tender abdomen, feeling itchy or vomiting. These are symptoms that are common in other medical conditions as well, however. Most people with liver disease only find out during tests for an unrelated illness or a medical check-up. When liver damage is quite severe, people can experience some of the following symptoms including yellow eyes and skin, called jaundice; bleeding problems; drowsiness and confusion; fever; swollen abdomen and legs; and tarry black stools or vomiting blood. If you have any of the symptoms consult your doctor.

How can liver disease affect quality of life?

Many people with liver disease will feel quite well and even severe symptoms may occur only in episodes that people recover from. However, the symptoms, side-effects of treatment and outlook of liver disease can really affect people with liver disease and their families, causing discomfort, pain, anxiety and depression. Your doctor and the medical team they work with can give you advice on how to manage the symptoms of your disease and direct you to other sources of help, like social services. Many people also find that talking with other people with liver disease can offer practical advice and support.

How common is liver disease?

However, there are many more people living with liver disease and others who have a liver disease but are not aware of it. There are also a large number of people with a liver problem of some description, such as gallstones, and problems that resolve themselves over time without medical treatment.

How can you get infected with hepatitis B and C?

Hepatitis B and C are infectious blood borne viruses which can cause severe liver damage. A tiny amount of blood getting into your bloodstream from an infected person can cause infection, for example through an open wound, cut or scratch. Some of the main routes of transmission are mother-to-baby (during birth); sharing needles and equipment for use in taking drugs, tattoos or piercing; unsafe sex; and from medical treatment in a country with poor hygiene standards. To protect yourself, don’t share personal equipment, use a condom and cover all cuts and wounds.

Can you get vaccinated against viral hepatitis?

There is a vaccine against hepatitis A , spread by infected food and water, which it is a good idea to have before travelling abroad outside Europe and the US. There is also a vaccine against hepatitis B which all people in high-risk groups should have. People in high-risk groups include those travelling to visit friends and family for long periods in areas where the infection is common, including South Asia, China and Africa. People receiving blood products, with kidney or liver problems or needing medical treatment abroad should be vaccinated. Some people are at risk because their job puts them in contact with other people’s body fluids. Other people at risk are those who change sexual partners frequently; inject drugs or men who have sex with men. Particularly for hepatitis B, it is important to complete the course and if you are having the vaccine before you travel, allow plenty of time to have the course and for it to take effect.

My GP wants to charge me for a hepatitis B vaccine, why?

The NHS only covers the cost of the vaccine for some people, e.g. those at risk as part of their day-to-day lives in the UK (click on hepatitis B prevention for more information). Your employer has a legal obligation to look at the risk of you being infected at work, and if you are, to pay for and arrange vaccination.

What treatments are available for hepatitis B and C?

There are a number of medicines to treat both diseases, many of which are quite new. They generally need to be taken over a period of several months. For hepatitis C, they may help you clear the infection. For hepatitis B, they can stop or delay the progression of the disease. The treatments have side-effects though and so wherever possible, preventing infection is the priority.

Should I see a specialist about my liver disease?

Many people with liver disease benefit from specialist assessment and for a specialist to design a package of ongoing treatment. As a result, we recommend you speak to your GP to request a referral to a specialist, preferably a hepatologist or a gastroenterologist if a hepatologist is not available. After you have seen a consultant, your GP will probably monitor your day-to-day care with review by your consultant.

How can I find out which hospital can best look after liver disease patients?

You have the right to choose which hospital your GP refers you to. Some hospitals have a specialist team dealing with liver patients. You can ask your GP or contact the British Liver Trust to find a hospital with a liver specialist near you.

I've been told I have end-stage liver disease, does this mean I'm going to die?

No, this means you have advanced disease, but many people live normal lives for many years even with end-stage liver disease. There are different ways of grading how serious your liver disease is, and you can find more information about this in our Cirrhosis publication. It is best to talk with your doctor about your condition, your treatment options and what you can expect.

Can prescription medicines, common pharmacy medicines, herbal remedies and illegal drugs affect my liver disease?

Yes. Most drugs (whether prescription, legal or illegal) are processed and broken down by the liver. In people with liver disease where the liver is already under strain, the extra work in breaking down drugs can be dangerous. Make sure all the health professionals (such as your GP, dentist and pharmacist) know about your liver disease before you are given or buy medicines from them. Even common tablets such as aspirin can be dangerous to people with liver problems. Herbal remedies and illegal drugs are a particular risk, as they are not regulated and can contain impurities that cause liver damage. If in doubt, speak to your liver specialist before taking any medicines or drugs.

I have liver disease, what can I do to keep myself well? Is there a special diet which would help my liver disease?

There are many things you can do to look after yourself. No specific foods are of benefit, but you should however try to have a diet that is well balanced with protein, carbohydrate and plenty of fresh vegetables. Some patients with fatty liver disease will need special dietary advice. You may find it helpful to undertake gentle exercise, without getting yourself over-tired. Alcohol should be avoided as it places an increased burden on your liver and smoking places a burden on your body and can accelerate some conditions. It is also essential to check that any prescription or over-the-counter medicines are safe to take with your liver disease. Plan things that increase your sense of wellbeing, such as a massage, aromatherapy, time with friends, music or relaxation time, but avoid stress and becoming exhausted.

What treatments are there for liver disease?

There are many different liver diseases, and the treatment that is right for you depends on the type of liver disease, its cause and how much damage it has done.

For advanced liver disease, there are a number of treatments aimed at reducing the impact of the symptoms. For example, you might be given diuretics for portal hypertension, lactulose for hepatic encephalopathy and regular drains for ascites. You may be offered surgery such as liver resection for liver cancer. You may be assessed for a liver transplant. There are also a range of lifestyle measures that can help some people, including changes to diet. Your liver specialist will design a package of treatment that is right for you. For more information, see our Cirrhosis publication.

Isn't it true that the liver can regenerate and does this mean I can get better on my own?

Your body can replace old liver cells, called hepatocytes, with new ones. This means that your liver can recover from minor stresses and strains. However, over time damage can cause fibrous scar tissue. This changes the structure of the liver and cannot be repaired. This is why it is so important to spot liver problems before the damage builds up and becomes irreversible.

Can I travel after a transplant?

Having a liver transplant is a major operation and the transplant together with anti-rejection medicines will have a lifelong impact on you. As a result, there are a whole range of things you’ll need to consider when travelling, such as how to avoid infection, vaccines, sunscreen, being close to medical help and travel insurance. You’ll be advised not to travel long distances away from your transplant centre in the early weeks. After this, speak to your transplant centre about what precautions you should take.

I've been told I have gallstones and suffer pain. What are the possible complications?

Gallstones can cause a condition called a cholangitis attack and also less severe pain and discomfort . Cholangitis is an inflammation of the bile duct system that is usually related to a bacterial infection that can be caused by gallstones blocking the ducts. The main symptom is severe abdominal pain and tenderness, in the ‘upper right quadrant’ area, although pain can be felt in the chest, upper back or right shoulder. Other symptoms include nausea and vomiting, belching, pale stools and dark urine. You may also have a fever, jaundice, feel lethargic and itchy. An attack of acute cholangitis can make you feel very unwell, so most people will consult a doctor or go to hospital fast. Doctors can treat with antibiotics and painkillers, and schedule an operation to remove the gallbladder to stop the attack happening again.

Should I get the flu vaccination if I have liver disease?

Everyone with liver disease should keep up-to-date with their vaccines, including the annual vaccine against seasonal flu which becomes available in October. This vaccine now also protects against swine flu. Seasonal flu can be particularly dangerous for people with cirrhosis, chronic hepatitis, biliary atresia or those taking immunosuppresants for example, after a liver transplant.

We advise you to get this vaccine as soon as it becomes available. If you have symptoms of flu, stay at home and contact your GP for advice. Do not take over-the-counter flu remedies or painkillers like aspirin unless you have been told by a doctor they are safe for you.