What are the main types of liver problems. How can you recognize liver disease symptoms. What causes liver damage and failure. How to prevent and treat various liver conditions.

Understanding Liver Function and Disease

The liver is a crucial organ responsible for numerous vital functions in the body. It plays a central role in metabolism, energy storage, and toxin filtration. When liver disease occurs, it can disrupt these essential processes and lead to a variety of health complications.

Liver disease is a broad term encompassing various conditions that affect liver function. While symptoms can vary depending on the specific condition, some general signs may indicate severe liver damage:

• Jaundice (yellowing of skin and eyes)
• Pale, bloody, or black stools
• Enlarged stomach due to ascites
• Encephalopathy (brain dysfunction causing mood, sleep, and cognitive changes)

Viral Hepatitis: A Major Cause of Liver Inflammation

Hepatitis, defined as inflammation of the liver, is a significant cause of liver disease. Viral hepatitis, in particular, can lead to substantial liver damage and impaired function. There are five main types of viral hepatitis:

Hepatitis A

Typically spread through contaminated food or water, hepatitis A is usually a short-term infection. Can it be prevented? Yes, vaccination is an effective preventive measure against hepatitis A.

Hepatitis B

This form of hepatitis can be either acute or chronic and is transmitted through bodily fluids. While treatable, there is no cure for hepatitis B. Early detection and treatment are crucial to prevent complications.

Hepatitis C

Hepatitis C can also be acute or chronic and is often spread through blood contact. In its early stages, it may not cause noticeable symptoms, but it can lead to permanent liver damage if left untreated.

Hepatitis D and E

Hepatitis D only develops in individuals already infected with hepatitis B, while hepatitis E is typically caused by drinking contaminated water and usually resolves on its own.

Fatty Liver Disease: A Growing Concern

Fatty liver disease occurs when excess fat accumulates in liver cells. There are two main types:

1. Alcoholic fatty liver disease: caused by heavy alcohol consumption
2. Nonalcoholic fatty liver disease: caused by factors other than alcohol, which are still being studied

Both types can lead to liver damage, cirrhosis, and liver failure if not managed properly. Is fatty liver disease reversible? In many cases, dietary changes and lifestyle modifications can improve symptoms and reduce the risk of complications.

Autoimmune Liver Conditions: When the Body Attacks Itself

Autoimmune liver conditions occur when the immune system mistakenly attacks healthy liver cells. Three primary autoimmune liver conditions are:

• Autoimmune hepatitis
• Primary biliary cirrhosis (PBC)
• Primary sclerosing cholangitis

These conditions can lead to inflammation, bile duct damage, and potentially cirrhosis or liver failure if left untreated. How are autoimmune liver conditions managed? Treatment typically involves immunosuppressive medications to control the immune response and prevent further liver damage.

Genetic Liver Disorders: Inherited Liver Conditions

Several genetic conditions can affect liver function, passed down from parents to children. Three notable genetic liver disorders are:

Hemochromatosis

This condition causes excessive iron storage in the body, including the liver. Over time, this iron buildup can lead to liver damage. How is hemochromatosis treated? Regular blood removal (phlebotomy) and dietary modifications are common treatment approaches.

Wilson’s Disease

Wilson’s disease results in abnormal copper accumulation in the liver and other organs. As the liver becomes overwhelmed, copper can enter the bloodstream and damage other parts of the body, including the brain. What is the primary treatment for Wilson’s disease? Chelation therapy to remove excess copper and zinc supplementation are standard treatments.

Alpha-1 Antitrypsin Deficiency

This genetic disorder affects the liver’s ability to produce alpha-1 antitrypsin, a protein that protects against enzyme breakdown. It can lead to both liver and lung disease. While there’s no cure, how is alpha-1 antitrypsin deficiency managed? Treatment focuses on managing symptoms and preventing complications through lifestyle changes and, in some cases, augmentation therapy.

Drug-Induced Liver Injury: The Impact of Medications

Certain medications and supplements can cause liver damage, a condition known as drug-induced liver injury (DILI). This type of liver injury can range from mild to severe and may even lead to acute liver failure in some cases.

Common drugs associated with liver injury include:

• Acetaminophen (when taken in high doses)
• Certain antibiotics
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Some herbal supplements

How can drug-induced liver injury be prevented? Always follow prescribed dosages, inform your healthcare provider of all medications and supplements you’re taking, and be aware of potential drug interactions.

Cirrhosis: The Advanced Stage of Liver Disease

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions. As healthy liver tissue is replaced by scar tissue, liver function progressively deteriorates.

Common causes of cirrhosis include:

• Chronic alcohol abuse
• Chronic viral hepatitis (B and C)
• Nonalcoholic fatty liver disease
• Autoimmune liver diseases

Is cirrhosis reversible? While early stages of liver fibrosis may be reversible, advanced cirrhosis is generally not. However, treating the underlying cause can help slow or stop the progression of liver damage.

Liver Cancer: A Serious Complication of Chronic Liver Disease

Liver cancer, particularly hepatocellular carcinoma (HCC), is a potential complication of chronic liver disease. Individuals with cirrhosis or chronic hepatitis B or C are at increased risk for developing liver cancer.

Risk factors for liver cancer include:

• Chronic viral hepatitis
• Cirrhosis
• Excessive alcohol consumption
• Nonalcoholic fatty liver disease
• Certain genetic disorders

How is liver cancer detected? Regular screening for individuals at high risk, including ultrasound examinations and blood tests for alpha-fetoprotein (AFP), can help detect liver cancer at an earlier, more treatable stage.

Preventing Liver Disease: Lifestyle Choices and Vaccinations

Many liver diseases are preventable through lifestyle modifications and preventive measures. Some key strategies for maintaining liver health include:

1. Limiting alcohol consumption
2. Maintaining a healthy weight
3. Eating a balanced diet rich in fruits, vegetables, and whole grains
4. Exercising regularly
5. Practicing safe sex and avoiding shared needles
6. Getting vaccinated against hepatitis A and B
7. Using medications as directed and being cautious with supplements

Can lifestyle changes reverse liver damage? In many cases, especially in early stages of liver disease, positive lifestyle changes can significantly improve liver health and even reverse some damage.

Diagnosis and Treatment of Liver Diseases

Diagnosing liver diseases often involves a combination of methods, including:

• Blood tests to assess liver function and detect viral infections
• Imaging studies such as ultrasound, CT, or MRI scans
• Liver biopsy in some cases

Treatment approaches vary depending on the specific liver condition but may include:

1. Medications to treat underlying causes or manage symptoms
2. Lifestyle modifications, including dietary changes and alcohol cessation
3. Antiviral treatments for viral hepatitis
4. Immunosuppressive drugs for autoimmune liver diseases
5. Liver transplantation in cases of severe liver failure or certain liver cancers

What is the outlook for individuals with liver disease? The prognosis varies greatly depending on the type and severity of the liver condition, as well as how early it is diagnosed and treated. Many liver diseases can be effectively managed with proper care and lifestyle changes, while others may require more intensive interventions.

Emerging Treatments and Research in Liver Disease

The field of hepatology is constantly evolving, with researchers exploring new treatments and therapeutic approaches for various liver diseases. Some promising areas of research include:

• Gene therapy for genetic liver disorders
• Immunotherapy for liver cancer
• Stem cell treatments for liver regeneration
• Novel antifibrotic drugs to combat liver fibrosis and cirrhosis
• Improved antiviral therapies for hepatitis B and D

How might these advances impact liver disease treatment in the future? As research progresses, we may see more targeted, effective treatments with fewer side effects, potentially improving outcomes for patients with various liver conditions.

Living with Liver Disease: Coping Strategies and Support

Living with liver disease can be challenging, but there are numerous strategies to help manage symptoms and improve quality of life:

1. Adhering to prescribed treatments and medications
2. Maintaining a liver-friendly diet
3. Staying physically active as recommended by healthcare providers
4. Managing stress through relaxation techniques or counseling
5. Joining support groups to connect with others facing similar challenges
6. Regular check-ups and open communication with healthcare team

What resources are available for individuals with liver disease? Many organizations, such as the American Liver Foundation and local support groups, offer educational materials, support services, and community connections for those affected by liver disease.

In conclusion, liver diseases encompass a wide range of conditions with varying causes, symptoms, and treatment approaches. Understanding the different types of liver problems, their causes, and available treatment options is crucial for early detection and effective management. By adopting healthy lifestyle habits, undergoing regular check-ups, and staying informed about liver health, individuals can take proactive steps to protect this vital organ and maintain overall well-being.

Types of Liver Problems, Causes, and More

Your liver is a vital organ that performs hundreds of tasks related to metabolism, energy storage, and waste filtering. It helps you digest food, convert it to energy, and store the energy until you need it. It also helps filter toxic substances out of your bloodstream.

Liver disease is a general term that refers to any condition affecting your liver. These conditions may develop for different reasons, but they can all damage your liver and affect its function.

Liver disease symptoms vary, depending on the underlying cause. It’s also possible for someone to have liver disease and not have any symptoms at all. However, Hepatitis NSW says that a few general symptoms can indicate some kind of severe liver damage.

These include:

• yellowish skin and eyes, known as jaundice
• pale, bloody, or black stools
• enlarged stomach due to ascites, which may make it uncomfortable to lie down or eat
• encephalopathy, a brain issue resulting in marked changes in mood, sleep, and cognition

Many conditions can affect your liver. Here’s a look at some of the main ones.

Hepatitis

Hepatitis is defined as an inflammation of the liver. When that inflammation is caused by a virus, it’s referred to as viral hepatitis. Hepatitis can cause liver damage, making it difficult for your liver to function as it should.

Most types of viral hepatitis are contagious, but you can reduce your risk by getting vaccinated for types A and B and by taking other preventive steps, including using a condom during sex and not sharing needles.

Five types of hepatitis include:

• Hepatitis A. Hepatitis A is typically spread through contact with contaminated food or water. Symptoms may clear up without treatment, but recovery can take a few weeks.
• Hepatitis B. This type of viral hepatitis can be acute (short-term) or chronic (long-term). It’s spread through bodily fluids, such as blood and semen. While hepatitis B is treatable, there’s no cure for it. Early treatment is key to avoiding complications, so it’s best to get regular screenings if you’re at risk.
• Hepatitis C. Hepatitis C can also be acute or chronic. It’s often spread through contact with blood from someone with hepatitis C. While it often doesn’t cause symptoms in its early stages, it can lead to permanent liver damage in its later stages.
• Hepatitis D. This is a serious form of hepatitis that only develops in people with hepatitis B — it can’t be contracted on its own. It can also be either acute or chronic.
• Hepatitis E. Hepatitis E is usually caused by drinking contaminated water. Generally, it clears up on its own within a few weeks without any lasting complications.

Fatty liver disease

Fat buildup in the liver can lead to fatty liver disease.

There are two types of fatty liver disease. These two types can manifest alone, or they can overlap:

• alcoholic fatty liver disease, which is caused by heavy alcohol consumption
• nonalcoholic fatty liver disease, which is caused by other factors experts are still trying to understand

Without management, both types of fatty liver disease can cause liver damage, leading to cirrhosis and liver failure. Diet and other lifestyle changes can often improve symptoms and lower your risk of complications.

Autoimmune conditions

Autoimmune conditions involve your immune system mistakenly attacking healthy cells in your body.

Several autoimmune conditions involve your immune system attacking cells in your liver, including:

• Autoimmune hepatitis. This condition causes your immune system to attack your liver, resulting in inflammation. Without treatment, it can lead to cirrhosis and liver failure.
• Primary biliary cirrhosis (PBC). This results from damage to the bile ducts in your liver, causing a buildup of bile. PBC can eventually lead to cirrhosis and liver failure.
• Primary sclerosing cholangitis. This inflammatory condition causes gradual damage to your bile ducts. They eventually become blocked, causing bile to build up in your liver. This can lead to cirrhosis or liver failure.

Genetic conditions

Several genetic conditions, which you inherit from one of your parents, can also affect your liver:

• Hemochromatosis causes your body to store more iron than it needs. This iron remains in your organs, including your liver. This can lead to damage over a long period of time if not managed.
• Wilson’s disease causes your liver to absorb copper instead of releasing it into your bile ducts. Eventually, your liver may become too damaged to store more copper, allowing it to travel through your bloodstream and damage other parts of your body, including your brain.
• Alpha-1 antitrypsin deficiency occurs when your liver can’t make enough alpha-1 antitrypsin, a protein that helps prevent enzyme breakdowns throughout your body. This condition can cause lung disease as well as liver disease. There’s no cure, but treatment can help.

Drug-induced liver disease

It’s possible to damage your liver by overexposing it to certain drugs and supplements, as seen in a 2019 study. Many times, this damage can be reversed once you stop taking the drug. But if it continues, the damage can become chronic.

Cancer

Liver cancer first develops in your liver. If cancer starts elsewhere in the body but spreads to the liver, it’s called secondary liver cancer.

The most common type of liver cancer is hepatocellular carcinoma. It tends to develop as several small spots of cancer in your liver, though it can also start as a single tumor.

Complications of other liver diseases, especially those that aren’t treated, may contribute to the development of liver cancer.

Cirrhosis

Cirrhosis refers to scarring that results from liver diseases and other causes of liver damage, such as alcohol use disorder. Cystic fibrosis and syphilis may also lead to liver damage and, eventually, cirrhosis — although these two causes are much less common.

Your liver can regenerate in response to damage, but this process usually results in the development of scar tissue. The more scar tissue that develops, the harder it is for your liver to function properly.

In its early stages, cirrhosis is often treatable by addressing the underlying cause. But without management, it can lead to other complications and become life threatening.

Liver failure

Chronic liver failure typically happens when a significant part of your liver is damaged and can’t function properly. Generally, liver failure related to liver disease and cirrhosis happens slowly. You may not have any symptoms at first. But over time, you might start to notice:

• jaundice
• diarrhea
• confusion
• fatigue and weakness
• nausea

It’s a serious condition that requires ongoing management.

Acute liver failure, on the other hand, happens suddenly, often in response to an overdose or poisoning.

Certain things can make you more likely to develop certain liver diseases. One of the most well-known risk factors is heavy drinking, which the Centers for Disease Control and Prevention (CDC) defines as more than 8 alcoholic drinks per week for women and more than 15 drinks per week for men.

Other risk factors include:

• sharing needles
• getting a tattoo or body piercing with nonsterile needles
• having a job where you’re exposed to blood and other bodily fluids
• having sex without using protection against sexually transmitted infections
• living with diabetes or high cholesterol
• having a family history of liver disease
• living with extra weight
• being exposed to toxins or pesticides
• taking certain supplements or herbs, especially in large amounts
• mixing certain medications with alcohol
• taking more than the recommended dose of certain medications

While not all liver disease or damage can be prevented, lifestyle choices can make a big difference when it comes to keeping your liver healthy. Like the risk factors above, many of the methods around prevention involve dietary decisions and physical activity.

The American Liver Foundation says that you can help prevent liver disease by:

• eating a nutritious diet that includes lots of fruits, vegetables, lean proteins, and whole grains
• increasing physical activity
• limiting alcohol
• avoiding smoking and using drugs
• maintaining a moderate weight
• interacting cautiously with toxic chemicals like aerosol cleaners, bug sprays, and other cleaning products
• using a condom or other barrier method during sex
• visiting your doctor for annual physicals, including blood work

If you’re concerned about liver disease, it’s best to make an appointment with a healthcare professional.

They’ll start by looking over your medical history and asking about any family history of liver problems. Next, they’ll likely ask you some questions about symptoms you may be experiencing, including when they started and whether certain things make them better or worse.

Depending on your symptoms, they’ll likely ask you about your drinking and eating habits. Make sure to also tell them about any prescription or over-the-counter medications you take, including vitamins and supplements.

Once they’ve collected all this information, they may recommend:

• liver function tests
• a complete blood count test
• CT scans, MRIs, or ultrasounds to check for liver damage or tumors
• a liver biopsy, which involves removing a small sample of your liver and examining it for signs of damage or disease

Many liver diseases are chronic, meaning they last for years and may never go away. But even chronic liver diseases can usually be managed.

For some people, lifestyle changes are enough to control symptoms. These might include:

• limiting alcohol
• maintaining a moderate weight
• drinking more water
• adopting a liver-friendly diet that includes plenty of fiber while avoiding unhealthy fats, refined sugar, and salt

Depending on the specific liver condition you have, your doctor may recommend other dietary changes. For example, people living with Wilson’s disease should limit foods containing copper, including shellfish, mushrooms, and nuts.

Depending on the condition affecting your liver, you may also need medical treatment, such as:

• antiviral drugs to treat hepatitis
• steroids to lower liver inflammation
• blood pressure medication
• antibiotics
• medications to target specific symptoms, such as itchy skin
• vitamins and supplements to boost liver health

In some cases, you may need surgery to remove all or part of your liver. Generally, a liver transplant is only done when other options have failed.

Many liver diseases are manageable if you catch them early. Without treatment, however, they can cause permanent damage.

The complications of untreated or unmanaged liver disease can lead to cirrhosis, severe scarring that cannot be reversed. If cirrhosis has gone too far, a liver transplant may be your only option.

Because some liver diseases can develop without symptoms, making it a point to schedule annual physicals, along with the typical physical blood work, can help you and your doctor stay one step ahead.

Focusing on a nutritious diet, physical exercise, and other healthy lifestyle choices such as limiting alcohol can also help with prevention or management.

Liver Disease Stages: Causes, Symptoms, Diagnosis, Treatment

Liver damage typically has four stages, beginning with inflammation and progressing all the way to cirrosis and end-stage liver disease (ESLD).

Liver disease refers to any condition that inflames or damages your liver.

Damage to your liver can accumulate through several stages of liver disease. Each stage has a cumulative effect on your liver’s ability to function properly.

The four stages of liver damage or disease are:

• inflammation
• fibrosis
• cirrhosis
• end-stage liver disease (ESLD)

Learn more about liver damage and disease.

Damage from liver disease can accrue throughout several stages. With each stage, your liver’s ability to function is increasingly affected.

Inflammation

In this early stage, your liver becomes enlarged or inflamed. Many people with liver inflammation don’t experience symptoms. If the inflammation continues, permanent liver damage can occur.

Fibrosis

Fibrosis happens when an inflamed liver begins to develop scars.

The scar tissue that’s generated in this stage takes the place of healthy liver tissue, but it can’t perform the same functions. This can start to affect your liver’s ability to function optimally.

Liver fibrosis can be hard to detect because symptoms aren’t often present.

Cirrhosis

In cirrhosis, severe liver scarring has occurred, leading to a buildup of scar tissue. Because there isn’t as much healthy liver tissue, it becomes very difficult for your liver to function properly.

While symptoms may not have been present in earlier stages, you may begin to experience symptoms of liver disease.

End-stage liver disease (ESLD)

ESLD is an umbrella term that can be used to describe conditions such as:

• decompensated cirrhosis, or advanced cirrhosis
• stage 4 hepatitis C
• chronic liver failure

At this stage, liver function has deteriorated dramatically.

ESLD is associated with complications such as ascites (a type of abdominal swelling) and hepatic encephalopathy (reduced brain function). The only treatment that can reverse ESLD is a liver transplant.

Liver failure is when your liver can’t work well enough to perform its many vital functions, such as clearing your blood of toxic substances and producing bile to help you digest food.

Liver failure can occur due to liver damage caused by liver disease. However, it’s not inevitable that liver damage and disease will lead to liver failure.

Liver failure can be a life threatening emergency, and it may be acute or chronic.

Acute liver failure comes on quickly and often occurs in people who don’t have a preexisting liver condition. Chronic liver failure occurs due to liver damage that develops slowly over time.

Causes of liver damage and failure include:

• viral infections, such as:
  • hepatitis A
  • hepatitis E
  • chronic hepatitis B
  • chronic hepatitis C
• genetic conditions, such as Wilson’s disease
• autoimmune conditions, such as autoimmune hepatitis
• alcohol misuse
• alcohol-related liver disease
• nonalcoholic fatty liver disease
• diseases that affect your bile ducts, such as cholangitis
• conditions that affect the veins of the liver, such as Budd-Chiari syndrome
• overdose of acetaminophen (Tylenol)
• reactions to other medications, such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), or antiepileptic drugs
• reactions to herbal supplements, such as ma huang and kava kava
• exposure to toxins, such as those found in industrial chemicals or poisonous wild mushrooms

The cause of liver failure can depend on whether the liver failure is acute or chronic. In some cases, the exact cause of acute liver failure may be unknown. Chronic liver failure is associated with liver damage or disease.

Inflammation and fibrosis, the earliest stages of liver damage or disease, rarely cause noticeable symptoms. Symptoms are associated with more advanced stages.

Symptoms of cirrhosis

Early on, cirrhosis may cause symptoms such as:

• tiredness or weakness
• loss of appetite
• unexplained weight loss
• mild abdominal pain
• nausea and vomiting

Symptoms of ESLD

The symptoms of ESLD can include:

• confusion or disorientation
• jaundice
• severe skin itching
• easy bruising or bleeding
• the buildup of fluid in your abdomen, arms, or legs
• abdominal discomfort or pain
• loss of appetite
• darkening of your urine
• pale stools
• blood in your vomit or stool
• nausea or vomiting

They may be present if you have a condition like decompensated cirrhosis, chronic hepatitis C, or advanced chronic liver failure.

When to seek medical attention

Acute liver failure is always a medical emergency. If you’re experiencing symptoms consistent with acute liver failure, seek medical attention immediately.

These symptoms include:

• tiredness or sleepiness
• confusion or disorientation
• jaundice
• abdominal pain or abdominal swelling
• nausea or vomiting
• malaise, or feeling unwell

Chronic liver failure can sometimes be a medical emergency, especially in cases where:

• you develop confusion
• you have internal bleeding
• swelling becomes severe

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To diagnose liver issues, a doctor will start by taking your medical history and performing a physical examination.

Afterward, they may perform a variety of additional tests, including:

• Liver function tests: Liver function tests assess the levels of various proteins and enzymes in your blood. These proteins and enzymes can indicate how well your liver functions.
• Other blood tests: The doctor may also perform a complete blood count or test for conditions that can cause liver damage, such as viral hepatitis or genetic conditions.
• Imaging tests: Imaging technology such as an ultrasound, a CT scan, or an MRI can help the doctor visualize your liver.
• Biopsy: Taking a tissue sample from your liver can help the doctor see if scar tissue is present. The sample can also help them identify what may be causing your condition. Learn more about liver biopsy.

Various treatments are available for liver damage, disease, and failure.

Medications

Antiviral medications can treat a viral hepatitis infection, and immune-suppressing medications can treat autoimmune hepatitis.

Lifestyle changes

The doctor may recommend lifestyle changes as part of your treatment. These changes can include:

• abstaining from alcohol
• losing weight, if you have overweight
• avoiding certain medications

Acute liver failure treatment

Acute liver failure is often treated in a hospital’s intensive care unit (ICU). You’ll receive supportive care to help stabilize your condition and help you manage any complications during treatment and recovery.

If a healthcare professional suspects a medication overdose or reaction, they may give you drugs to reverse the effects. A doctor may also recommend a liver transplant for some people with acute liver failure.

Can liver damage be reversed?

According to the advocacy group American Liver Foundation, damage from the inflammation and fibrosis stages of liver failure may be reversed and healed over time if properly identified and treated early.

The liver damage caused by cirrhosis is often not reversible, although it can be slowed or stopped.

If you have ESLD, you may require a liver transplant. During a transplant, a surgeon removes the diseased liver and replaces it with a liver from a healthy donor.

You can help prevent liver damage, disease, and failure by making lifestyle changes that keep your liver happy and healthy. Here are some tips for improving liver health:

• Drink alcohol in moderation, and never mix medications with alcohol.
• Take medications only when needed, and carefully follow any dosing instructions.
• Consult a doctor before mixing medications.
• Maintain a moderate weight. There’s a connection between obesity and fatty liver disease.
• Get vaccinated against hepatitis A and hepatitis B.
• Have regular physicals during which your doctor performs liver function tests.

If you’re in the early stages of liver damage or disease, you can often heal over time with proper treatment and lifestyle changes.

However, the later stages aren’t reversible and sometimes require a liver transplant.

Liver failure can be a life threatening emergency that requires prompt medical intervention, regardless of whether it’s acute or chronic.

People diagnosed with liver disease are often monitored throughout their lives to ensure that their condition is not worsening or causing further liver damage. If you have concerns about liver health or liver failure, talk with a doctor.

Skin itching. Systemic diseases as the cause of skin itching – St. Petersburg State Budgetary Institution of Health “Dermatovenerologic Dispensary No. 4”

Itching is one of the forms of the skin analyzer, close to other types of skin sensations, such as touch, pain. Some researchers regard itching not as an independent sensation, but as a modified sense of pain. In areas of the skin devoid of the epidermis, itching is absent. Reflex actions leading to a temporary reduction in the sensation of itching include scratching, stroking, rubbing, pressure, pinching, kneading, and warming. Severe itching is relieved only by severe self-damage of the skin, resulting in the sensation of itching being replaced by a feeling of pain.

Due to the subjectivity of pruritus, the difficulty of its precise definition, the mechanism of pruritus is largely unclear. Itching is the second most common reason for a patient to visit a dermatologist.

The causes of itching are extremely varied.

Firstly, it acts as a subjective symptom of many skin diseases (fungal infection, urticaria, atopic dermatitis, eczema, lichen planus, scabies, etc.) Itching is a signal of danger, an undesirable effect on the body as a protective reaction to bites of blood-sucking insects and various skin impurities.

Secondly, itching can occur as an independent disease.

Thirdly, itching can be a symptom of various diseases of internal organs, including latent ones (diabetes mellitus, myxedema, iron deficiency anemia, psychoneurosis, liver disease, leukemia, malignant neoplasms, chronic renal failure, helminthiasis, systemic lupus erythematosus, progressive paralysis , multiple sclerosis, stroke, gout). In some diseases, itching has a certain prognostic and diagnostic significance. In chronic cholestasis, which accompanies many liver diseases (cirrhosis, extrahepatic obstruction of the bile ducts, hepatitis of various etiologies), itching is one of the most painful and most constant symptoms for the patient. The development of intrahepatic cholestasis and therefore itching is promoted by drugs: phenothiazines, erythromycin, anabolic steroids, testosterone, oral contraceptives, progesterone. Aspirin, quinidine, B vitamins and nicotinamide can cause itching without any skin rash. With primary biliary cirrhosis, itching is observed in 100% and in 50% of patients it is a reason to see a doctor. The disappearance of itching in liver diseases in some cases is a poor prognostic sign indicating liver failure. The cause of itching in liver diseases is considered to be an increase in the level of bile salts in plasma. Itching can occur with cholestasis of pregnant women in the later stages and completely disappear after childbirth.

Separate forms of generalized pruritus include senile pruritus, altitude and caisson pruritus. Senile pruritus is more often observed in men aged 60-70 years. It is painful, worse at night. On the skin, as a rule, there are no scratches, “polishing” and thinning of the free edge of the nail plates are observed. The causes of senile itching are varied (atherosclerosis, decreased activity and atrophy of the intestinal glands, prostatic hypertrophy, degenerative changes in peripheral nerve endings, atrophic processes in the epidermis, sebaceous, sweat glands, dermis, xerosis).

Altitude pruritus is observed in some people when climbing to an altitude of 8000-10000 m or more and is one of the symptoms of altitude sickness. Itching that occurs when immersed in water is a manifestation of decompression sickness (caisson itch).

Voynilko M.V.

Question to the doctor: what symptoms can tell about diseases of the liver

Doctors of antiquity called the liver the main organ for a person.
Galen considered it to be a sort of center of the organism’s universe. The definitions of temperament types proposed by Hippocrates (“ratio of parts”) – melancholic, choleric, phlegmatic – are directly related to the bile that the liver produces. And this terminology is still used today.
In Chinese medicine, acupuncture for almost all chronic diseases is used to influence the liver meridian.
Modern hepatologists know how much the liver affects the state of many organs and systems, as well as thinking, memory, mood, vision, skin color.

The liver is our largest parenchymal organ, it occupies almost the entire upper floor of the abdominal cavity on the right. This is a huge biochemical plant. In fact, all proteins that circulate in the body are synthesized here. In addition, the liver is a hematopoietic organ and a thermoregulator, it provides detoxification of the body, actively participates in various areas of its life. So you can not live without a liver.

Is it possible to replace its function, as happens, for example, in kidney diseases, when, thanks to hemodialysis, the patient can live for years? Artificial liver systems for severe liver failure allow you to try to “pull” a person out of a dangerous situation for a while. But with a neglected disease, it is still impossible to live on artificial support for a long time. Therefore, if the disease is not amenable to radical treatment, the question of transplantation arises.

What can be done to prevent liver diseases or to diagnose them in time? What symptoms should alert? What signals of the body should be treated with particular attention? Which doctor should I contact? What to do in the first place: what examinations to pass, what tests to pass?
About this – Professor, Doctor of Medical Sciences, Head of the Department of Surgical Methods of Treatment and Antitumor Drug Therapy of the N.N. A.V. Vishnevsky Alexey Vladimirovich Zhao.

Jaundice

Yellow coloration of the sclera, the appearance of yellowness of the skin, dark urine (“beer color”), discolored (white) stools are evidence that there is a malfunction with the outflow of bile that our liver produces. Most often we are talking about obstructive jaundice, when stones block the bile ducts and the outflow of bile into the duodenum is disturbed. When this happens, you need to act quickly. Make an ultrasound of the abdominal cavity, take blood tests (general, biochemical – bilirubin, ALT, AST, alkaline phosphatase, urea, creatinine, albumin, cholinesterase) and – run to the surgeon. (More about obstructive jaundice and how it is treated at the A.V. Vishnevsky National Medical Research Center for Surgery: https://www.vishnevskogo.ru/news/vopros-vrachu-kak-lechat-mekhanicheskuyu-zheltukhu).

What to do if there are no signs of cholelithiasis and tumors (they can also prevent the outflow of bile) and the surgeon said: “We have nothing”?
The next stage is a gastroenterologist-hepatologist. He will assess the situation for jaundice of another origin – parenchymal, which may be based on viral hepatitis.
If the gastroenterologist-hepatologist does not find anything, but there is jaundice, then what to do next? Contact an infectious disease specialist, because it may be infectious hepatitis.

In practice, unfortunately, the sequence is most often reversed. Jaundice begins, a person calls an ambulance, he is hospitalized with suspected infectious hepatitis. He can spend several days in the infectious diseases hospital until it turns out that there is no infection. But I repeat: jaundice is an urgent matter, the diagnosis must be made quickly, and it is necessary to start with a surgeon in order to exclude “mechanics”.

Itchy skin

Where does a person usually go when they get itchy skin? To the dermatologist. This is correct, but we must keep in mind that the answer may not lie in the field of dermatology at all. Very often the reason is the accumulation of bile acids under the skin (they irritate the receptors, and skin itching begins). And bile acids accumulate precisely when the liver does not function well. These may be tumors that cause a violation of the mechanical passage of bile into the intestine. These can be diffuse liver diseases – primary sclerosing cholangitis, primary biliary cirrhosis. Or other diseases in which there are symptoms of cholestasis (impaired outflow of bile) – for example, drug-induced hepatitis. It provokes the use of medications (especially uncontrolled).
In any case, if you start taking a medicine and the result is jaundice or itching, think that drug-induced hepatitis may be the cause. Where do you need to go? To the gastroenterologist-hepatologist.

Changes in the skin

When the liver is not in order, some hormones are poorly utilized, and small subcutaneous vessels begin to dilate. Telangiectasias appear – spider veins (they are also described as “spiders” – “spiders”). Their presence should lead you to the idea that something needs to be addressed to a gastroenterologist-hepatologist.
Another symptom of liver problems can be xanthelasma – yellowish plaques on the eyelids associated with the deposition of cholesterol under the skin.

Coat of tongue, bitterness in the mouth

They say that the tongue is the mirror of the stomach. If the tongue is coated, white or yellowish, if you also constantly feel bitterness in your mouth, you need to be examined. The reason here may be the reflux of bile from the duodenum into the stomach, and from there into the esophagus, associated both with various liver diseases (for example, fatty hepatosis), and with diseases of the gastrointestinal tract and the development of neoplasms.
Make an ultrasound, take blood tests (general, biochemical – bilirubin, ALT, AST, alkaline phosphatase, urea, creatinine, albumin, cholinosterase) and – contact a gastroenterologist-hepatologist.

“Liver” smell

One of the signs of liver disease is the smell of baked apples from the mouth. This is a specific smell of products of nitrogen metabolism – it arises from the fact that the liver does not provide normal detoxification. Previously, doctors, having discovered such a symptom in a patient, could say without any computed tomography: you have something with the liver, let’s urgently be examined.
By the way, any bad breath indicates that there is a problem – either in the gastrointestinal tract, or in the oral cavity (teeth), or in the tonsils. You need to go to the doctor and find out what exactly is the matter. It is very important.

“Liver” palms

Red palms (palmar erythema) may be one of the manifestations of liver disease. Consult with a gastroenterologist-hepatologist!

Bruising, increased bleeding

Bruising that appears out of the blue (a person touched something and immediately – a huge bruise), bleeding gums – what could be the reason for this?
99% of blood coagulation factors are synthesized in our liver. When it works poorly, blood clotting deteriorates and there is increased bleeding. If a hematologist excludes “his” pathology, the situation should be studied by a gastroenterologist-hepatologist – the problem may be in the liver.

Enlargement of the abdomen

One of the later signs of liver problems is an increase in the volume of the abdomen. A person drinks a lot of fluids, but little urine. The fact is that with certain diseases, ascites begins – the accumulation of fluid in the abdominal cavity. And this is an urgent reason to do an ultrasound scan and contact a gastroenterologist-hepatologist.

Deterioration of memory, attention, vision, sleep disturbances, changes in mood attention, sleep inversions (you want to sleep during the day, but you don’t want to sleep in the evening), decreased visual acuity, hand tremors.
An inadequate mood is also a clinical manifestation of liver dysfunction. It can be a state close to euphoria, when a person laughs for no reason and it is not clear what amuses him so much. Or, on the contrary, the mood is constantly bad, up to depression.

When, for one reason or another, the detoxification function of the liver is disturbed, ammonia accumulates in the blood, which has a toxic effect on brain cells. Don’t blame everything on stress, suggest a mental disorder, or explain (in the case of an elderly person) dementia. Rule out liver disease first.

Risk groups

Against the background of past and chronic liver diseases, unfortunately, malignant tumors often develop. Early diagnosis of these tumors is in the hands of the patient. He should say to himself: nothing bothers me, but I know that I have chronic hepatitis. This means that once every six months – an ultrasound of the abdominal cavity and an analysis for alpha-fetoprotein are required – this enzyme can increase in 40-50% of cases if primary liver cancer occurs.

Listen to yourself!

If you don’t have any of the above symptoms, great. Be physically active, do not abuse alcohol, fatty and spicy foods. But in no case do not neglect regular medical examinations (screening, as they say now), because diseases can be asymptomatic. Take special responsibility for your health if you are over 40, as the incidence of cancer is increasing in this age group.

And don’t forget to listen to your body! If you don’t like something, don’t waste time: do an ultrasound scan, take a blood test and contact a specialist (start with a surgeon). No need to panic and immediately think about the rarest and most severe diseases.