Hepatitis infections (inflammation of the liver) are one of the most widespread infectious diseases in the world. They can lead to acute and/or chronic inflammation. Unlike liver tumors, liver inflammation often affects not just a section of the liver, but the entire organ.
Liver inflammation can occur acutely or chronically. Liver failure is feared. It can develop
- in the course of a severe acute inflammation of the liver (hepatitis) or
- as a result of less pronounced but persistent and therefore chronic inflammatory activity.
develop.
The position of the liver in the human body © yodiyim | AdobeStock
The inflammation leads to the destruction of the liver cells, i.e. the death of the cells.
Ultimately, hepatitis is an expression of a uniform reaction of the liver to various causes of illness and pathogens. These can be viruses or bacteria, but autoimmune diseases of the liver and/or bile ducts can also lead to hepatitis.
Chronic hepatitis occurs when the disease lasts longer than six months.
Common causes of acute or chronic hepatitis are
- Excessive consumption of alcohol and
- obesity with corresponding impairment of fat and sugar metabolism.
In the latter cases, fatty liver inflammation, known as steatohepatitis, occurs. It can
- be triggered by alcohol (so-called alcoholic steatohepatitis, ASH) or
- develop without alcohol consumption (non-alcoholic steatohepatitis, NASH).
A distinction is made between inflammatory and tumorous liver diseases. Liver diseases include
- Hepatitis
- fatty liver
- Cirrhosis of the liver
- hepatic coma
- Acute liver failure
- Echinococcosis (infections with fox or dog tapeworm).
The liver and the gallbladder © Maksym Yemelyanov | AdobeStock
The liver is connected to the gallbladder via the bile ducts . They transport the bile from the liver into the duodenum. Therefore, liver diseases in the broader sense also include inflammation of the bile ducts, also known as cholangitis.
A distinction is made between primary biliary cirrhosis and primary sclerosing cholangitis. These clinical pictures belong to the cholestatic liver diseases.
Liver tumors can be malignant or benign. Benign tumors are not life-threatening, but can also cause symptoms. The size of the tumor is often the decisive factor here.
Malignant tumors break through the structural boundaries of the organs and can formmetastases in other organs.
Tumors of the liver can develop in the organ itself and are therefore referred to as primary tumors. These include, for example
In most cases, however, these are secondary tumors, i.e. liver metastases. In this case, the cancer cells have spread from another tumor to the liver via the bloodstream and lymphatic system. Liver metastases are often caused by
In the case of liver metastases, the original tumor must therefore also be treated.
Tumors of the liver are often only noticed when clear symptoms appear, such as
- weight loss,
- general exhaustion and
- weakness of the patient.
The bile ducts, stomach or intestines become constricted.
A typical symptom that can indicate liver disease is itching, which is triggered by a bile drainage disorder. Metabolic waste products then remain in the body and trigger this symptom, technically known as pruritus.
Sometimes the itching is referred to as "pain of the liver". The liver itself is only sensitive to pain in its capsule of connective tissue, but not inside the organ. Fatigue is also referred to as the "pain" of the liver, as it is often associated with chronic liver disease.
The cardinal symptom of the liver is the yellowing(icterus) of the sclera of the eyes and, in severe cases, of the skin. There is also a specific bad breath in patients with advanced liver disease. Medically, this bad breath is called foetor hepaticus. However, due to its late appearance in advanced stages of the disease, it is not suitable for the early detection of liver disease.
Chronic liver inflammation can lead to the stage of liver scarring, known as cirrhosis. In this case, liver function can only partially recover. In cirrhosis, liver tissue is transformed into connective tissue. These structural changes are sometimes so advanced that they can no longer be reversed.
However, in many cases the liver is still able to maintain its vital functions even with a reserve of only part of the organ.
Accompanying symptoms of liver cirrhosis are
- Increased blood pressure,
- impaired concentration,
- tremors and twitching of the muscles,
- severe exhaustion.
Illustration of liver cirrhosis in an advanced stage © SciePro | AdobeStock
If symptoms indicate liver disease, a thorough examination by a doctor is of great importance. The individual medical history, all symptoms and information on diet and lifestyle are recorded(anamnesis).
The doctor will palpate the upper abdomen to feel for any swelling, enlargement or hardening of the liver.
An ultrasound examination(sonography) shows the condition of the liver and bile ducts.
The bile ducts can also be examined endoscopically. Changes or even gallstones can be detected and removed.
A blood count provides information about possible deviations from normal values. Elevated leukocyte counts and elevated C-reactive protein are common inflammatory markers. Indications of a defensive reaction of the immune system in the case of an infection with hepatitis viruses can also be detected in the blood.
A liver biopsy (tissue sample) provides the doctor with information on the tissue condition of the liver. The organ is punctured through the abdominal skin and the ribs with a hollow needle. The procedure only takes a few seconds and is performed under light anesthesia.
The treatment of liver disease depends on its exact causes. A liver that is only slightly damaged can certainly recover. Damage to the liver in cirrhosis does not regress; the changes are irreversible. Serious liver diseases such as acute liver failure or hepatic coma are medical emergencies that must be treated clinically.
Many infectious diseases can be avoided by taking appropriate preventive measures : for example, vaccination against the hepatitis B virus can prevent infection. There are now very effective drugs against the hepatitis C virus. Effective medication is also available against bacterial or parasitic infections of the liver.
However, simple hygiene standards also help to prevent the development of hepatitis. In many countries around the world, contaminated drinking water or food is a possible route of infection for some of these diseases.
Clean drinking water is not a matter of course everywhere © noon@photo | AdobeStock
In the case of hepatitis caused by alcohol consumption or obesity, only avoiding these triggers can lead to an improvement. To date, only a few effective medications are available and the harmful factors practically always lead to a worsening of the disease. Liver damage caused by alcohol consumption can be halted by abstinence.
In advanced stages of chronic liver disease, a liver transplant may be the only chance of a longer-term survival. However, there are currently far fewer organs available than would be necessary.
Treatment of autoimmune liver inflammation (autoimmune hepatitis) is carried out with the administration of immunosuppressants. Cortisone preparations and other immunomodulatory therapeutics are mainly used. In most cases, a complete regression of the inflammatory activity cannot be achieved, so that the medication can be maintained for a long time.
