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Health


HIDDEN RISK FACTORS, WARNING SIGNS OF LIVER DISEASE


DRINKING, TAKING ANTIBIOTICS, EVEN HIGH BLOOD PRESSURE CAN TAX YOUR LIVER IN
POTENTIALLY DANGEROUS WAYS

--------------------------------------------------------------------------------

By

Beth Howard,

 
AARP

En español
Published November 09, 2021
/ Updated October 17, 2024
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Many think of alcohol as the main cause of liver complications. But contrary to
popular belief, various factors impact liver health, including weight, certain
medications, genetics and even viral infections.



No matter the trigger, a major concern surrounding liver disease is its silent
progression. Your liver could be losing its ability to filter out harmful
substances from your blood long before symptoms appear.



Most of the time you don’t know your liver has been harmed until you develop the
advanced symptoms of cirrhosis. “That’s the tough part of treatment,” says
Anurag Maheshwari, M.D., a gastroenterologist with the Institute for Digestive
Health and Liver Disease at Mercy Medical Center in Baltimore. “Convincing
patients that they need to act now in order to avoid complications in the future
can sometimes be a challenge, because they don’t feel any different today.”

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EARLY SYMPTOMS AND WARNING SIGNS OF LIVER DAMAGE



In the early stages of chronic liver disease there are often no symptoms.
Occasionally people with early-stage liver disease experience fatigue,
right-side abdominal pain, increased bruising or itching — symptoms that are
usually missed because they could be caused by other ailments.

Getty Images

WHERE IS THE LIVER?

The liver is located in the upper-right portion of the abdomen, below the
diaphragm and on top of the stomach, right kidney and intestines. In adults, it
weighs about three pounds and is shaped like a cone.

“If you have discomfort on your side, for instance, it could be a million other
things,” says Jamile Wakim-Fleming, M.D., director of the Fatty Liver Disease
Program at Cleveland Clinic.



Routine checkups, lab tests or imaging studies are typically how patients first
find out if they’re developing a liver problem or disease.




SIGNS OF ADVANCED LIVER DISEASE



As liver disease advances, the signs become clearer and warrant immediate
medical attention. These symptoms include:

 * Jaundice or yellowing of the eyes or skin.
 * Pain and distention of the abdomen due to the release of fluid from the
   liver.
 * Swelling of the lower legs due to fluid retention.
 * Confusion or forgetfulness. When the liver isn’t functioning properly, toxins
   build up in the blood and can travel to the brain, affecting brain function.
 * Dark-colored urine.
 * Pale-colored stool.
 * Chronic fatigue.
 * Nausea or vomiting




LIVER DISEASE AND AGE



Older adults who are in good health are not inherently more prone to liver
disease. But older age can amplify the severity of symptoms associated with
liver problems, making recovery more challenging. What’s more, treatments may
not work as well in older people as they do in younger people.




5 CAUSES OF LIVER DISEASE



It’s always better to prevent liver failure than to treat it. Here are some
common — and not so common — risks and how you can avoid or stop the damage.




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RISK NO. 1: ALCOHOL INTAKE



We all know that alcohol can be hard on your liver. But how much is too much?



Maheshwari notes that a safe alcohol limit may seem surprisingly low: no more
than one alcoholic beverage a day (or seven drinks in a one-week period) for
women and two or fewer drinks for men (or 14 drinks over a week’s time).



“When patients drink alcohol in excess, beyond the capacity of the liver to
metabolize it, the excess alcohol is turned into fat and stored,” Maheshwari
says. “Called steatosis, this fat interferes with the liver’s function and
causes cell death.”



The good news? Putting the brakes on alcohol consumption can stop the
progression of fibrosis, and liver function may improve. “But it depends on when
it was caught,” says Wakim-Fleming. “A lot of people who have alcoholic liver
disease end up needing liver transplants because they don’t stop drinking until
[too] late.”



If you suspect you may have a problem, talk to your doctor, who may refer you to
a specialist for evaluation and tests.

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RISK NO. 2: WEIGHT 



With obesity rates on the rise in the U.S., there’s been — along with an
alarming increase in diabetes and other metabolic ills — a growing epidemic of
nonalcoholic fatty liver disease (NAFLD), which occurs when too much fat is
stored in the liver.



“Obesity, diabetes, high blood pressure, high cholesterol — common features of
metabolic syndrome — are all known major risk factors for the development of
fatty liver disease,” says Craig Lammert, M.D., associate professor of medicine
at the Indiana University School of Medicine and a practicing gastroenterologist
and hepatologist at IU Health. As with alcohol-related liver damage, these
conditions cause fat to be deposited in the liver.



“The scary piece of this is, anywhere from 15 to 50 percent of the nation’s
population may have too much fat in the liver,” says Lammert. Of those, he says,
about 5 percent are at risk of inflammation that can damage the liver. “But we
don’t always know who that’s going to be.”



Inflammation hurts the liver by way of a condition known as nonalcoholic
steatohepatitis (NASH), which damages and kills liver cells. “We’re hearing a
lot about this because over the next few years, fatty liver disease will
probably be near the top, if not the top, cause for liver transplantation in
this country,” Lammert notes.



If you’re carrying around excess pounds or battling diabetes, high cholesterol
or high blood pressure, the risk of liver failure just adds another good reason
to shed some weight and get your blood sugar, cholesterol and blood pressure
under control. Although there is no cure for NAFLD, it can be reversed.

DIET, EXERCISE CAN REVERSE LIVER DAMAGE

A new study published in the Journal of Hepatology found that diet and exercise
are an effective way to treat and improve liver disease that’s often associated
with excess weight.

Researchers at the University of Missouri School of Medicine divided 24 patients
with a type of liver disease caused by excessive fat buildup into two groups.
One followed an intensive diet and exercise program for 10 months; the other
followed the standard of care treatment. The diet and exercise group saw
“significant and clinically meaningful” effects on their liver health, the
researchers discovered with imaging and diagnostic biopsies.

“Obesity and diabetes are going up in the country, and they are the two main
risk factors for fatty liver disease,” said study author Elizabeth Parks, a
professor of nutrition and exercise physiology at the University of Missouri
School of Medicine. “We know diet and exercise can alleviate these health
conditions. Liver disease is increasing too fast. We were able to show in our
research how diet and exercise should be the mainstay of treatment for the
disease.”


RISK NO. 3: DRUGS AND SUPPLEMENTS



Certain drugs and supplements can also injure your liver, depending on the dose
and other factors. Taking too much acetaminophen (Tylenol) is the most common
over-the-counter risk. “People who overdose with Tylenol overwhelm the
metabolizing system and drive liver toxicity,” Lammert says.



But patients should have few problems if they take the pain reliever as
prescribed, which includes consuming no more than 4,000 milligrams in a day.
Those with existing liver disease may be advised to take less than 2,000
milligrams. One caveat: If you’re taking acetaminophen at those levels, be sure
to avoid alcohol, which would add to the cumulative burden on the liver, Lammert
advises. Other painkillers, including NSAIDs like ibuprofen (Motrin) and
naproxen (Aleve), can be similarly harmful under the same circumstances.



If you are taking anything approaching the maximum dose of acetaminophen, be
aware that the drug is often found in other products, such as multi-symptom cold
and flu formulations, making it easy to unwittingly double the amount you are
taking. So be sure to check product labels for acetaminophen.



Surprisingly, “antibiotics are probably the most important cause of liver injury
we see,” Lammert says. This is particularly true of Augmentin (a combination of
amoxicillin and clavulanate), which is used to treat common bacterial problems
like sinus and urinary tract infections. Liver complications affect an estimated
30,000 people a year taking this compound in the U.S. And although most of the
harm is temporary, some is so damaging as to require a liver transplant.



There are also reports of liver damage with certain supplements, including
bodybuilding and weight-loss supplements that contain green tea extract,
linoleic acid and androgenic anabolic steroids. Even two essential nutrients,
vitamin A and niacin, can harm the liver if taken above the recommended doses.




RISK NO. 4: VIRAL INFECTIONS



Hepatitis B and C are viral infections of the liver that can lead to liver
damage and even cancer. (The vast majority of people with hepatitis A recover
with no lasting harm.) As with other liver diseases, people with hepatitis often
don’t have symptoms and may not know they are infected, Wakim-Fleming says.



People contract hepatitis B (HBV) through blood, semen and other body fluids and
by sharing personal items (needles, razors) with someone who has the infection.
Hepatitis C (HCV) is contracted through contact with the blood of someone with
HCV, often through the sharing of drug paraphernalia or through a transfusion of
contaminated blood or organ transplant prior to 1992, when blood started to be
screened for the virus. More than half of people with HCV develop a chronic
infection, and up to 25 percent develop cirrhosis over 10 to 20 years, according
to the Centers for Disease Control and Prevention.



Vaccines are available for HBV, and everyone ages 18 to 79 should get an HCV
test at least once, particularly those born between 1945 and 1965. “The
guidelines over the past 10 years or so are that all baby boomers should be
screened for hepatitis C,” Lammert says. Despite this recommendation, too few
people who are eligible seek testing. “The good news is we now have good
treatments to eradicate the disease.”




RISK NO. 5: GENETICS AND AUTOIMMUNE CONDITIONS



Genetic conditions like hemochromatosis and Wilson’s disease can contribute to
the development of liver disease. In these conditions, excess metals can build
up in the liver, causing cirrhosis and organ toxicity.



Additionally, autoimmune conditions may lead to liver disease and, to some
extent, genetics may play a role as well. The exact cause of autoimmune liver
disease is not fully understood by doctors; however, it is theorized that
factors such as infection, medication or chemical exposure could act as
triggers. While there may be a genetic predisposition, the specific role of
genetics in causing autoimmune diseases remains unclear. Treatment for
autoimmune liver disease typically involves long-term management, and while the
majority of patients respond well to treatment, they often require lifelong
medication.



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WHEN TO SEE A DOCTOR



Given liver disease’s silent nature, patients should see a doctor as soon as
they become concerned about their liver function, Maheshwari says. Make sure
that routine liver tests are incorporated into physical exams so any
abnormalities can be detected early.




Note that AST and ALP blood tests, which assess liver function, don’t
necessarily correlate with liver injury. If levels are slightly elevated longer
than six months, a full evaluation may be necessary to determine the underlying
cause. A specialist may administer a noninvasive test, such as an elastography,
to better understand liver function.



Treatment options for liver disease vary depending on the cause, with a liver
transplant being the last resort. For some, eliminating alcohol or inflammatory
medications may be necessary. In the case of viral hepatitis, medications may be
required to combat the virus.



Meanwhile, for individuals dealing with an autoimmune liver disease, a
medication to suppress the immune system from attacking itself may be needed.
Unfortunately, genetic conditions often have limited treatment options, and a
liver transplant becomes the ultimate recourse for those with end-stage liver
damage.

THE FOUR STAGES OF CHRONIC LIVER DISEASE

 1. Hepatitis: Inflammation in your liver that can lead to scarring, known as
    fibrosis
 2. Fibrosis: The liver gradually stiffens and scar tissue replaces healthy
    tissue, restricting blood flow. Some amount of fibrosis can be reversible if
    detected early because liver cells can regenerate.
 3. Cirrhosis: Scarring of the liver becomes irreversible because there are no
    longer cells healthy enough to regenerate lost tissue. The damage can be
    slowed or stopped at this stage by consulting a liver specialist.
 4. Liver failure: The liver can no longer function adequately for the body’s
    needs and has lost the ability to regenerate and its function is slowly
    declining.

Editor’s Note: This story, originally published Nov. 9, 2021, was updated to
reflect new information.


%{postComment}%

Beth Howard is a North Carolina–based health and lifestyle writer. She has
written for dozens of publications, including U.S. News & World Report, The Wall
Street Journal, The Washington Post, Prevention, Better Homes & Gardens and
Reader’s Digest.

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