Liver Diseases: What You Should Know

Medically Reviewed by Jabeen Begum, MD on December 13, 2023
13 min read

Liver disease is any disease that directly affects your liver. Unlike acute liver failure, which happens suddenly, liver disease progresses slowly over time. 

Some types of liver disease, like hepatitis C, can often be cured. Others, like liver cirrhosis, can’t, but some treatments can slow them down. Untreated liver disease can lead to liver failure and liver cancer.

Your liver is a vital organ that you can’t live without. It turns nutrients into chemicals your body needs. It filters out poisons. It helps turn food into energy. So when your liver doesn’t work well, your whole body can be affected.

Where is the liver?

In an adult, a healthy liver is about the size of a football. It’s found on the right side of your belly, right under your rib cage. If it’s enlarged (bigger than it should be), your doctor may be able to feel your liver when pressing down on your belly.

How common is liver disease?

Liver disease is common in the US. About 4.5 million adults (1.8%) are diagnosed with some form of liver disease, but more than 100 million actually have it. They just don’t know. 

Liver disease is the ninth most common cause of death in the U.S. (more than 55,000 deaths a year). The disease also hits some ethnic and racial groups harder than others. For example, Black men are 60% more likely to have liver-related cancers and die from them than non-Hispanic White men. Black women also have a higher rate of liver-related cancer deaths, compared to non-Hispanic White women (30% more likely).

There are several types of liver disease. Some are genetic (you are born with them), while others are caused by viruses or other illnesses, or by toxins, such as drugs or alcohol.

Hepatitis

There are a few types of hepatitis, three of which are caused by viruses. Hepatitis means inflammation of the liver.

Hepatitis A. Every year, over 180,000 people in the U.S. contract hepatitis A. It spreads from person to person through intimate contact, injected drugs, and shared food and drinks. Most people get it by eating or drinking something that’s tainted by fecal matter. It can spread easily in overcrowded areas or in unsanitary conditions. This includes after floods or other natural disasters, where you can be exposed to sewage. You might not have any symptoms. It usually goes away by itself within 6 months without any long-term harm.

Hepatitis B. Between 730,000 and 2.2 million people in the U.S. have hepatitis B. You get hepatitis B from somebody else, such as through unprotected sex or taking drugs with shared needles. If it lasts longer than 6 months, it makes you more likely to get liver cancer or other diseases. If you have hepatitis B, you can pass it to your baby at birth.

Hepatitis C. The government estimates that 2.4 million to 4.7 million people in the U.S. may have hepatitis C. This virus comes from infected blood that gets into your blood. You might get it if you take drugs with shared needles or in connection with HIV. If you’re a health care worker, you might get it from an infected needle that accidentally sticks you. Symptoms may not show up for many years. Baby boomers are at risk for hepatitis C and should be tested for it.

Autoimmune hepatitis. Unlike hepatitis A, B, and C, autoimmune hepatitis is caused by your own immune system. For some reason, your own immune system begins to attack your liver cells, causing damage. It can lead to other disorders and even liver failure. It strikes girls and women more often than boys or men. Doctors aren’t sure how many people have this condition in the U.S.

Alcohol-associated liver disease 

Alcohol-associated liver disease is an umbrella term for liver diseases caused by too much alcohol consumption. It’s most common among people who drink a lot for a long time, but you don’t have to be dependent on alcohol to get alcohol-associated liver disease. People can also get the disease if they drink a very large amount of alcohol in a short period, called bingeing.

Alcohol-associated fatty liver. This is the earliest stage of alcohol-associated liver disease. Your liver breaks down alcohol, but if you drink too much, especially over a long period, your liver cells become damaged. The more alcohol you drink, the more your liver is damaged.

Alcohol-associated hepatitis. If you have alcohol-associated fatty liver disease and you continue to drink alcohol, you can get alcohol-associated hepatitis. This type of hepatitis damages the liver cells and causes inflammation. If this is caught early enough, it may be reversed if you stop drinking alcohol.

Alcohol-associated cirrhosis. This the most serious alcohol-associated liver disease. Scar tissue has formed in the liver, making it difficult for the liver to work properly.

Nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) happens when there is too much fat inside your liver. The extra fat can inflame your liver. One type of NAFLD is nonalcoholic steatohepatitis (NASH). It means you have inflammation and cell damage in your liver, as well as fat. It can scar your liver and lead to other disorders, like cirrhosis.

Primary biliary cholangitis

Primary biliary cholangitis attacks tiny tubes in your liver called bile ducts. They carry bile, a chemical that helps you digest food. When the ducts are injured, the bile backs up inside your liver and scars it. Women have this more often than men.

Primary sclerosing cholangitis

Primary sclerosing cholangitis scars your bile ducts, and it can eventually block them. The bile builds up inside your liver, and that makes it harder for your liver to work. It may lead to liver cancer, and you might someday need a liver transplant. Men are more likely than women to get it.

Liver cancer

If cancer shows up in your liver, it’s most likely because it has spread from another part of your body, like your lungs, colon, or breasts. But a few cancers can start in the liver.

Liver cancer affects men more often than women, and Black people more often than white people. Your doctor might call it hepatocellular carcinoma. It’s more likely if you have hepatitis or drink too much alcohol.

Bile duct cancer strikes the tubes that run from your liver to your small intestine to carry bile, a fluid that helps you digest food. This kind of cancer mainly affects people over age 50, but it’s uncommon.

Liver cell adenoma is a tumor that doesn’t have cancer. It’s uncommon, but women who take birth control pills for a long time are more likely to get it than other people. There’s a small chance the tumor could eventually turn into cancer. 

Liver disease is often caught only after it progresses. There are usually no symptoms in the early stages. But sometimes, early liver disease is found by accident. Routine blood tests or tests to diagnose another problem could show signs that your liver is struggling. CT scans for other problems, such as with your kidney, could show a fatty liver or even scarring. 

When the disease gets worse, you could have:

  • Jaundice, yellowing of the eyes and skin
  • Belly pain
  • Swelling in your belly, called ascites
  • Swollen legs and ankles
  • Dark urine
  • Pale-colored stool
  • A poor appetite
  • Nausea and vomiting
  • Frequent and easy bruising on the skin

When caught early enough, before cirrhosis happens, liver disease can often be reversed. The liver is a unique organ. It can repair cell damage as long as it hasn't gone too far. 

Life expectancy with fatty liver disease

Whether you have alcoholic or nonalcoholic fatty liver disease, there is a good chance you can reverse the liver damage and go on to live a normal life expectancy. People who can’t reverse the liver damage can still go on to live for many years. 

Nonalcoholic fatty liver disease: About one-third of people with nonalcoholic fatty liver disease progress to NASH, and many will continue on to get end-stage cirrhosis.  

Alcoholic-associated fatty liver disease: About one-third of people who drink heavily progress to cirrhosis.

Liver disease can affect children as well as adults. It could be caused by:

  • Viruses
  • Genetic (inherited) diseases
  • Low blood supply to the liver, often caused by heart disease
  • Blocked liver ducts 
  • Toxins or medications
  • Autoimmune disorders

Children usually have the same symptoms as adults. Children with liver disease can also be quite tired (fatigued) and may become confused or cranky if the disease gets worse.

If you suspect that your child may have liver disease, contact your doctor right away.

There are several things that can cause liver disease, and different diseases have different causes.

Infections

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C

Toxins

  • Alcohol abuse can lead to cirrhosis. So can nonalcoholic fatty liver disease and long-term cases of hepatitis B and C.
  • Drug overdoses. Taking too much acetaminophen or other medications that break down your liver can harm it. Make sure you follow the dosing instructions on the label, and be aware that acetaminophen might be in more than one medicine you take.

Other chronic diseases

  • High cholesterol
  • Diabetes
  • Hypertension (high blood pressure)

Genetic disorders

Some inherited liver disorders only happen if they run in your family.

  • Hemochromatosis makes your body store up too much of the iron from your food. The extra iron builds up in your liver, heart, or other organs. It can lead to life-threatening conditions such as liver diseases, heart disease, or diabetes.
  • Hyperoxaluria hits when your urine has too much of a chemical called oxalate. In this condition, your liver makes too much oxalate due to a genetic mutation. This can cause kidney stones and kidney failure. If your kidneys do fail, that can give you oxalosis, where the oxalate collects in other organs and causes more trouble.
  • Wilson's disease makes copper build up in your liver and other organs. Its first symptoms usually show up when you’re between the ages of 6 and 35, most often in your teens. It not only affects your liver, but it can cause nerve and psychiatric problems.
  • Alpha-1 antitrypsin deficiency involves a chemical that helps your lungs resist infections. Your liver makes it. But when your liver gets the recipe wrong, the faulty chemical can build up and cause liver disease.

Other possible causes include:

  • Obesity
  • High cholesterol 
  • Hypertension (high blood pressure)
  • Diabetes or prediabetes
  • Exposure to toxins, including overdosing on drugs that are broken down in the liver
  • Acute liver failure
  • Genetic disorders, like hemochromatosis
  • Blockage of the ducts leading to the liver
  • Autoimmune diseases
  • Heart disease

If you are having symptoms of liver disease, your doctor will ask you for your medical history, including if you have diabetes, high blood pressure, or high cholesterol, as well as: 

  • How much alcohol you drink and how often
  • What medications, supplements, and natural products you take

After a physical exam, your doctor may recommend some of these tests:

  • Blood tests. Called liver function tests, these check for liver enzymes, proteins, and other substances that can show the liver isn’t working properly. 
  • Imaging tests. These allow your doctor to see your liver and check for liver damage. These could include an ultrasound, CT scan, or MRI. 
  • Biopsy. After numbing the skin on your belly just above the liver, your doctor would use a long needle to remove a tiny bit of tissue from the liver so it can be sent to a lab for examination under a microscope.

Treating liver disease depends on what type of disease you have, but there is one thing that is recommended regardless of the type: Avoid taking any medications or supplements that break down in your liver. Some of these include:

  • Acetaminophen
  • Statins, used to lower cholesterol
  • Comfrey tea
  • Certain vitamin or dietary supplements, such as weight loss products

Other general treatments could include:

  • Corticosteroid medications, like prednisone, which reduce inflammation in the liver
  • Immunosuppressant medications, which keep your immune system from attacking healthy tissue

Hepatitis 

There are now antiviral drugs that can help treat hepatitis C. You take these medications for up to 12 weeks, and if they’re successful, the virus goes away. There are no cures for hepatitis A or B. 

Treatment for hepatitis A involves taking care of yourself, resting, and eating well. It usually goes away on its own. 

Hepatitis B also goes away on its own for many people, with care and rest, but some get chronic hepatitis B. When this happens, there are some antiviral medications that can help slow down the disease and reduce the risk of liver cancer. 

If your liver is too damaged, your doctor may refer you for a liver transplant.

There is no home remedy for liver disease, but your doctor may recommend making changes to your diet to help your liver stay as healthy as possible, even if you already have liver disease.

Liver disease diet

In general, recommendations for a liver disease diet include limiting food and drinks that can strain your liver. They include:

  • Animal proteins, like milk, meat, and eggs
  • Salt
  • Foods high in fat
  • Foods high in sugar
  • Alcohol

Unless your doctor or dietitian says otherwise, you could include foods like:

  • Fruit
  • Vegetables
  • Legumes (chickpeas, black beans, kidney beans, etc.)
  • Chicken
  • Fish
  • Grains (brown rice, barley, quinoa, etc.)

Ask your doctor about vitamin supplements too. They may recommend some but tell you to avoid others.

 

Eventually, end-stage liver disease can cause other complications. They can include:

  • Portal hypertension (Veins in your liver start to break and leak blood.)
  • Liver cancer
  • Hepatic encephalopathy, which affects your nervous system and can cause cognitive impairment, or dementia
  • Hepatorenal syndrome, which affects your kidneys
  • Ascites, a buildup of fluid in the belly

 Extreme complications of liver disease include:

  • Acute liver failure. This happens when you don’t have a long-term liver disease but your liver quits working within a very short time – days or weeks. That may happen because of an overdose of acetaminophen, infections, or because of prescription drugs.
  • Cirrhosis is a buildup of scars in your liver. The more scars replace the healthy parts of your liver, the harder it is for your liver to do its job. Over time, it may not work the way it should.

You can prevent many types of liver disease by making some lifestyle changes and getting vaccinations. Children should also receive hepatitis vaccines.

Hepatitis A. Get vaccinated. It is a two-shot vaccine, so be sure to get both. Just one shot is not enough, but if you are traveling and you don’t have time to get both, getting one is better than nothing. But don’t forget to get the second shot when you return home. Also, since this virus is spread through stool, ensure you wash your hands well after using the bathroom, handling diapers or briefs from someone else, and before touching food or drink.

Hepatitis B. There is also a vaccination for hepatitis B, so be sure to get that too. There are vaccines that combine both hepatitis A and B protection. Since this virus is spread through blood, semen, or other body fluids, practice safe sex (using condoms), and avoid sharing needles or other drug injection equipment. Also, don’t share personal items like razors or anything that could have body fluid.

Hepatitis C. There is no vaccine for this type. It is spread by blood, so you should take the same precautions as you would to prevent hepatitis B.

For other liver diseases, you can reduce your risk by:

  • Limiting how much alcohol you drink
  • Not abusing medications or taking higher doses of them than you should, including over-the-counter drugs
  • Following treatment plans if you have a chronic disease, like diabetes or high blood pressure
     

Your liver is a vital organ and needs to be taken care of. Many liver diseases are preventable with vaccines and lifestyle changes. If you do have liver disease, some types, like alcoholic fatty liver disease, can be reversed in many cases. If it can’t be reversed, good care may slow the progress of the disease.

If you have any signs of liver disease, contact your doctor as soon as possible. The earlier the diagnosis, the better.

What are common diseases of the liver? Non-alcoholic fatty liver disease, cirrhosis, and hepatitis

What are the first signs of a bad liver?

Early liver disease doesn’t usually cause any symptoms. If you notice that the whites of your eyes or you skin are starting to look yellow, there may be something wrong with your liver.

What are the most serious liver diseases?

All liver diseases are serious, but cirrhosis is quite serious. Once the liver gets scars, it can’t work properly.

What is the first stage of liver disease?

The first stage of liver disease is fatty liver disease. This is when you get fat inside the liver.