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Liver Disorders

A woman in a pink t-shirt clutches her side, where her livers are; she looks in pain. The words – Liver Disorders – can be seen

Please note that all content on this website (including, but not limited to, copy, images, commentary, advice, tips, hints, guides, observations) is provided as an informational resource only. It is not a substitute for correct and accurate diagnosis, or recommendation, or treatment by a medical professional. Please ensure that you obtain proper guidance from your GP, or another medical professional. The information provided on this website does not create any patient-medical expert relationship and must not be used in any way as a substitute for such.

It has been estimated that around 90% of liver disorders are preventable. Despite this, more than 40 people die every day in the UK from liver disease.

There are a variety of liver disorders that many people across the UK live with. Some of these conditions are terminal, and some are manageable with treatment.

The liver is responsible for numerous activities within the body and is robust at repairing itself. However, if liver disorders are left untreated for a significant amount of time, the effects are much more damaging.

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Alcohol-related Liver Disease (ARLD)

Alcohol-related liver disease (ARLD) is caused by excessive alcohol consumption. One in 5 adults consumes alcohol in a way that can negatively impact their liver.

ARLD is a chronic condition which usually takes several years to develop and has varying stages of severity.

When the body consumes alcohol, the liver acts as a filter and breaks the alcohol down and then removes the toxins from the body. This process damages the liver. Time is needed to allow the liver to recover, regenerate and produce new cells.

Drinking above the recommended daily number of units per week (no more than 14 for both men and women) increases a person’s risk of having ARLD.

Patients suffering from the most severe cases of alcohol-related liver disease may eventually require a liver transplant to survive. In some cases, this condition is terminal.

The severity of alcohol-related liver disease can be determined by the stage at which the disease has progressed to.

Stage 1 – fatty liver. If you consume more alcohol than the liver can cope with, fat can build up. When alcohol is metabolised, it causes an overproduction of fat in the liver. Typically, a healthy liver has little, or no fat.

Stage 2 – alcohol-related hepatitis can occur when you have a fatty liver and you don’t reduce, or stop your alcohol consumption. This can happen at an early stage, or over a prolonged period of excessive drinking. Alcohol-related hepatitis causes the liver to become inflamed and tender.

Stage 3 – cirrhosis. This tends to be the result of excessive alcohol consumption over a long time, damaging the liver irreversibly. Nodules (simplistically known as irregular bumps) replace the smooth liver tissue. Due to there being more scar tissue, the liver becomes stiffer. This then decreases the number of cells which are required to make the liver function properly and consequently, can result in liver failure.

NAFLD

NAFLD is a common liver disease typically affecting those who are severely overweight (obese).

It is estimated that 1 in 3 people in the UK are affected by the early stages of non-alcoholic fatty liver disease (NAFLD).

Typically, the early stages of NAFLD pose little threat. However, it can lead to severe liver damage if left untreated, such as cirrhosis. If detected early enough, it is possible to stop NAFLD from getting worse.

There are 4 main stages of NAFLD, and they are:
Stage 1 – simple fatty liver (steatosis). This is a relatively harmless build-up of fat in the liver cells. Sometimes, this can only be diagnosed when having tests for something unrelated to steatosis.

Stage 2 – non-alcoholic steatohepatitis (NASH). This is a more advanced type of NAFLD. It is caused by a build-up of fat in the liver, causing inflammation. This subsequently can lead to scarring of the liver. Statistically, it is estimated that this can affect up to 5% of the UK population.

Stage 3 – fibrosis. This is where persistent inflammation causes scar tissue around the liver, as well as around the blood cells surrounding the liver. It can occur when the liver tries to repair itself and reproduces damaged cells. The liver can still function, despite the fibrosis.

Stage 4 – cirrhosis. The final stage of NAFLD that can lead to liver cancer, or liver failure.

Hepatitis

Hepatitis is another common liver disease which is inflammation of the liver. Typically, it is caused by a viral infection, but is also linked to alcohol-related liver disease. Hepatitis has various types in the form of hepatitis A, B, C, D and E, as well as alcohol hepatitis.

Hepatitis A is a virus which is prevalent in countries with poor sanitation, as it is caused by consuming food, or drink, that have been contaminated with the faeces of an infected person. It is rare in the UK for a person to contract hepatitis A.

Hepatitis B is transmitted through contact with bodily fluids of an infected person. This can include blood, vaginal secretions and semen. It is relatively uncommon in the UK, but tends to be transmitted by unprotected sex and injected drug use.

Hepatitis C is the most universal form of viral hepatitis in the UK and is similar to hepatitis B. It is spread through blood-to-blood contact with an infected person.

Hepatitis C is most likely contracted in the UK from sharing needles to inject drugs. Around 1 in 4 people will get rid of the virus following treatment and continue to lead a “normal” life. However, in some cases, if left untreated, the virus will remain in the body for many years. This can result in Chronic Hepatitis C and can lead to much more serious liver disease, such as cirrhosis and liver failure. Currently, there is no vaccine for this virus, but it can be treated efficiently with antiviral medication.

Hepatitis D only affects people who are already infected with hepatitis B, as it needs the hepatitis B virus to survive in the body. Hepatitis D is usually spread through blood-to-blood, or sexual contact. It is uncommon in the UK. Long-term infection with hepatitis D can increase the risk of serious problems, such as cirrhosis and liver cancer. There’s no vaccine for hepatitis D, but the hepatitis B vaccine can help.

Hepatitis E. This virus is mainly associated with the consumption of raw, or undercooked pork meat, or offal, as well as wild boar meat, venison and shellfish. Hepatitis E tends to be a mild and short-term infection that does not require any treatment. However, it can be serious in some people, such as those who have a weakened immune system.

Alcoholic hepatitis is a type of hepatitis caused by drinking excessive amounts of alcohol over many years. The condition is common in the UK with many people not realising that they have it. This is because it doesn’t usually cause any symptoms. However, it can cause sudden jaundice and liver failure in some people.

Liver Cancer

Liver cancer can be primary, or secondary. Primary liver cancer is a cancer which starts in the liver. Secondary liver cancer means that the cancer started elsewhere in the body and has spread to the liver.

Liver cancer types vary. There are five main primary types of liver cancer – hepatocellular carcinoma (HCC), fibrolamellar carcinoma (FLC), cholangiocarcinoma (bile duct cancer), angiosarcoma and hepatoblastoma.

In the UK, there are over 5,000 cases of liver cancer diagnosed each year with hepatocellular carcinoma (HCC) being the most common.

HCC more commonly affects people who are already suffering from cirrhosis of the liver. This can be a consequence of other liver disorders, such as hepatitis B, or C.

Men are more likely to be diagnosed, and typically, there is a greater risk for those over 65.

Secondary liver cancer (metastasis) is much more common than primary cancer.

Any type of cancer can spread to the liver. Common cancers that spread are bowel cancer, breast cancer, stomach cancer, melanoma, cancer of the oesophagus, lung cancer, pancreatic cancer and neuroendocrine tumours.

Liver Tumours

Liver tumours can be cancerous (malignant), or non-cancerous (benign). Most tumours in the liver are benign and tend not to cause any symptoms, or pose any threat. Nevertheless, it is always important to have them investigated.

Liver tumours can often be linked to liver cancer. Although, in some cases, tumours can be non-cancerous. The ones that impact people’s lives the most are the cancerous tumours which require further treatment.

Malignant tumours are made up of cancer cells and can grow at a much faster rate than benign tumours. Additionally, they can spread into the surrounding tissue, which causes damage to other parts of the body.

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The symptoms of liver disorders can cross over and share similarities.

ARLD Symptoms

Symptoms to look out for include:

  • feeling sick
  • weight loss
  • yellowing of the skin and eyes (jaundice)
  • swelling in the ankles and stomach
  • confusion, or drowsiness
  • vomiting blood, or passing blood in your stools.

Liver Disease (Cirrhosis) Symptoms

Symptoms of various liver diseases differ from condition-to-condition. Ordinarily, there aren’t any symptoms until cirrhosis of the liver has developed. Some of the most common signs indicating cirrhosis in the early stages are:

  • generally feeling unwell and tired all the time
  • loss of appetite
  • loss of weight and muscle wasting
  • feeling sick (nausea) and vomiting
  • tenderness/pain in the liver area
  • spider-like small blood capillaries on the skin above waist level
  • blotchy red palms
  • disturbed sleep patterns.

Later Symptoms of Cirrhosis are:

  • intense itching
  • white nails
  • dark urine
  • hair loss
  • increased sensitivity to alcohol
  • yellowing of the whites of eyes and skin (jaundice)
  • impotence and loss of sexual desire.

Liver Cancer/Liver Tumour Symptoms

Liver cancer and liver tumour symptoms overlap, as liver tumours that are malignant require action.

Symptoms include:

  • loss of appetite, or losing weight, without trying to
  • your skin and/or whites of your eyes turning yellow (jaundice)
  • paler stools and/or dark urine
  • feeling fatigued, or having no energy
  • feeling generally unwell, or having flu-like symptoms
  • a lump in your abdomen.

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Living With ARLD

The first stage of ARLD can be reversed and could be abortive if a person stops drinking for 2 weeks minimum. This gives the liver time to recover and regenerate the cells. It is possible to continue drinking after this period, as long as it is within the Government guidelines.

It is vital that once diagnosed with ARLD, a person works with medical teams to reduce, or completely stop, their alcohol consumption. This can include a considerable change in a person’s lifestyle. There are programmes available on the NHS, or privately, to help patients work towards a healthier relationship with alcohol. Without this, a person living with ARLD has a 50% chance of not living longer than 5 years following their diagnosis.

Living With NAFLD

Having non-alcohol related fatty liver disease requires changes to your lifestyle, similar to living with ARLD.

Eating a balanced diet and exercising regularly helps to manage the disease. Incorporating fibre, starch, fruit and vegetables into your diet can ensure that the body is getting what it needs to function healthily. In addition to this, avoiding alcohol is important to sustain a healthy lifestyle.

Various medications can negatively affect your liver and therefore, it is important to consult a medical professional when taking new medication. This can include over the counter medication and vitamin supplements.

Living With Hepatitis C

As it currently has no cure, hepatitis C requires a person to make lifestyle changes to manage the virus and reduce the risk of transmission to others.

As it is a common trend with many liver disorders, reducing, or completely cutting out the consumption of alcohol, helps to prevent any further damage being done to the liver.

Eating a balanced diet can also put a stop to any additional damage to the liver. Cutting out fatty foods and eating plenty of fibre, starch, fruit and vegetables can help.

It is advised that if you are planning on having a baby, you should consult your local GP. There is no reason to suggest that someone with hepatitis C cannot have a baby. However, it is important to note that there’s a small chance the virus can be passed from mother to baby. This is found in about 1 in 20 cases. Similarly, there is a small risk that having unprotected sex with your partner, if one of you has the virus, can lead to the spread of infection.

If a person has hepatitis C, they are unable to donate blood. Maintaining strict hygiene when dealing with any lesions that break the skin will help to prevent the spread of the virus to other people.

Living With Liver Cancer/Liver Tumours

Liver cancer and malignant liver tumours can have a huge impact on a person’s lifestyle. Depending on what stage the cancer is at will determine what treatment medical teams deem necessary. If a person has secondary liver cancer, it is likely they will already be receiving treatment, or have had it in the past.

Treatment can range from surgery to chemotherapy. Going through this requires regular trips to the oncology department and other hospital facilities. It can be a difficult time for a person and can affect their home and work life, as well as those closest to them.

Following the course of treatment most suitable, the implications on a person’s lifestyle can be mixed. Surgery may require a period of time where assistance will be needed at home, or require a stay in hospital. In conjunction with this, chemotherapy can often make a person feel nauseous and weak. This can have a further impact on a person’s ability to live with their current situation and means that they may require assistance and support from their families, friends and health care providers.

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All liver disorders require some form of support for those with the conditions. Various organisations, healthcare providers, charities and helplines offer assistance to people.

It is possible that, at first, a person may not know how much support they are going to need. As liver diseases develop, and changes occur both good and bad, medical teams will work with each individual to work out what is best for them and their current situation.

There is also support available in regards to social care for those suffering with a liver disorder. A team of medical workers, such as a consultant, nurses and local social services will assess the patient to ascertain what is needed.

Additionally, there is financial support available for both patients and carers.

Liver disease and liver cancers in the later stages can make people fatigued, meaning that they struggle with their mobility. There are adaptations to the home that can be made and mobility aids which can help whilst out of the house. This can offer those suffering with a liver disorder support and independence at times when it’s needed most.

Receiving a diagnosis for any form of liver condition, whether it’s acute, or chronic, can be daunting. The majority of liver disorders require a change in lifestyle that can seem drastic for some and challenging to maintain. Subsequently, there are groups and online forums where people can find others in similar positions.

Club Soda provides blogs, events and courses to support people to help them change their drinking habits.

Hep C Trust have a dedicated team run solely by people with hepatitis C.

For further information on liver disorders, you can visit:

https://www.cancerresearchuk.org/about-cancer/liver-cancer

https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/

https://www.nhs.uk/conditions/liver-disease/

https://www.nhs.uk/conditions/liver-cancer/

https://britishlivertrust.org.uk/ 

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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.

Abortive – to stop the progression of a medical disease promptly

Acute – an illness that has had a quick onset and is severe, requiring urgent action

Benign – non-cancerous and therefore a tumour with fewer cells

Chronic – a condition, or illness, lasting for an extended period of time that can also frequently recur

Lesions – a cut that breaks the skin causing bleeding

Malignant – a cancerous tumour that has more cells and grows much quicker than a non-cancerous tumour

Metabolised – is a process of breaking down a substance, or food, in the body

Oncology – the treatment for various cancers including radio and chemotherapy

Surgery – a physical event that requires an operative procedure due to medical reasons

Vaginal secretions – vaginal discharge, usually of brown, or white colouring. This fluid is produced by the vaginal glands and can vary throughout a woman’s menstrual cycle