The liver cells on the left are from a healthy liver, while the cells on the right came from the liver of a person with cirrhosis of the liver. Cirrhosis is usually caused by toxins (including alcohol) in the blood or by hepatitis. In cirrhosis, dead and damaged liver cells are replaced by fibrous tissue, which can form masses of scar tissue and dramatically change the structure of the liver. These fibrous areas can slow the flow of blood through the liver.
Although the liver is exposed to many potentially harmful substances, it is a remarkable organ that is able to regenerate, or repair or replace, injured tissue. Its construction, in which many lobules perform the same task, means that if one section of the liver is damaged, another section will perform the functions of the injured area indefinitely or until the damaged section is repaired. But the liver is subject to many diseases that can overwhelm its regeneration abilities, threatening a person’s health.
Diseases of the liver range from mild infection to life-threatening liver failure. For many of these ailments, the first sign of a problem is a condition called jaundice, characterized by a yellowish coloring of the skin and the whites of the eye. It develops when liver cells lose their ability to process bilirubin, the yellowish-brown pigment found in bile.
The liver can be harmed whenever injury or disease affects the rest of the body. For example, cancer may spread from the stomach or intestines to the liver, and diabetes, if not properly treated, may result in damage to the liver. Some diseases caused by parasites, including amebiasis and schistosomiasis, can damage the liver. Drug use, including long-term use of some prescription medications as well as illegal drugs, can also cause liver damage. Poisons can easily damage liver cells and even cause complete liver failure, especially the poisons found in certain mushrooms.
One of the most common liver diseases is hepatitis, an inflammation of the liver. Hepatitis may be caused by exposure to certain chemicals, by autoimmune diseases, or by bacterial infections. But hepatitis is most often caused by one of several viruses. The hepatitis A virus (HAV) can produce flulike symptoms and jaundice, but many people who contract it have no symptoms. The disease tends to resolve on its own. Because HAV lives in feces in the intestinal tract, hepatitis A is prevalent in areas where drinking water is contaminated with raw sewage. Good hygiene practices and a hepatitis A vaccination are effective measures of prevention.
Hepatitis B is a more serious ailment. Unlike HAV, hepatitis B virus (HBV) may remain active in the body for many years after the time of infection, sometimes permanently damaging the liver. HBV is found in blood and other body fluids—tears, saliva, and semen—and is spread through unprotected sexual intercourse and the sharing of infected needles or other sharp objects that puncture the skin.
In developed countries, alcohol-induced liver diseases far outnumber hepatitis and all other liver disorders. Heavy alcohol use causes fat deposits to build up in the liver, possibly leading to chronic hepatitis, which causes scarring and destruction of liver cells. Over many years, scarring in the liver can progress to cirrhosis, a disease characterized by diminished blood flow through this important organ. When this occurs, toxins are not adequately removed from the blood, blood pressure increases in the hepatic portal vein, and substances produced by the liver, such as blood proteins, are not adequately regulated. Cirrhosis cannot be reversed, but liver function can significantly improve in people who stop consuming alcohol during the early stages of this condition. Beyond abstinence from alcohol, treatments for cirrhosis may include drug therapy or surgery to redirect blood flow.
For people with severe liver disease or impending liver failure, organ transplantation may be an option. Unlike some organ transplants, such as kidney transplants, liver transplants are complex procedures that have not had high long-term success rates. Fortunately, new techniques and drugs are improving the outcome of liver transplants. Current success rates range between 60 and 80 percent, with more than half of recent transplant recipients surviving more than five years. Most of these people have an excellent prognosis for leading healthy, normal lives.