Diseases of the Digestive System - Liver disease

Cirrhosis

Chronic disease of the liver with the destruction of liver cells is known as cirrhosis . A common cause is excessive intake of alcoholic beverages along with malnutrition. However, there are other predisposing factors, such as inflammation of the liver ( hepatitis ), syphilis, intestinal worms, jaundice or biliary tract inflammation, and disorders in blood circulation to the liver.

Victims of cirrhosis are usually anemic and have an elevated temperature, around 100° F. Alcoholics very often lose weight, suffer from indigestion, and have distended abdomens.

Accurate diagnosis of cirrhosis depends on complex laboratory tests of liver function, urine, and blood. If liver damage is not too far advanced, treatment of the complications and underlying causes can aid the liver cells in the process of regeneration. In long-standing chronic disease, liver damage may be irreversible. Alcoholics who forgo alcohol may be restored to health, depending on the extent of liver damage, with a proper diet rich in proteins and vitamins.

Successful treatment of liver cirrhosis may require long hospitalization with drug therapy and blood transfusions. During alcoholic withdrawal, the patient may require close medical observation and psychiatric help. If the patient's jaundice improves and his appetite returns, recovery in milder cirrhosis cases is possible.

Jaundice

In diseases of the liver and biliary tract, excessive bile pigment ( bilirubin ) is recirculated into the bloodstream. It enters the mucous membranes and skin, giving them the characteristic yellow pigmentation of the disease. Gallstones or tumors that obstruct the free flow of bile are one cause of jaundice. Other causes include hepatitis, overproduction of bile pigments with resultant accumulation of bile within the liver, cirrhosis, and congenital closure of the bile ducts, the last a common cause of jaundice in infancy. Apart from the typical yellow appearance of the skin, jaundice generates such symptoms as body itching, vomiting with bile (indicated by the green appearance and bitter taste), diarrhea with undigested fats present in the stools, and enlargement of the liver with pain and tenderness in the right upper abdomen. Treatment requires continued medical care with hospitalization. Surgery may be necessary to remove stones in the biliary tract or other obstructions. If there is bacterial infection, antibiotic therapy is necessary.

Hepatitis

Infectious hepatitis or hepatitis A virus (HAV) is spread in food and water contaminated by the feces of infected individuals. The incubation period of HAV lasts from one to six weeks. Symptoms include fever, nausea, vomiting, aching muscles, fatigue, loss of appetite, and sometimes jaundice. HAV can usually be cured by a few weeks of bed rest. Treatment with immune globulin will halt the virus if given early enough to those exposed. Those infected with HAV will not become carriers upon full recovery. Vaccines against HAV are available. Good sanitary practices can halt the spread of HAV. Vigorous hand-washing after restroom use or changing diapers and before preparing and eating food is strongly recommended.

The hepatitis B virus (HBV) is more serious than HAV because it often causes long-term infection and chronic liver disease, such as cancer and cirrhosis. Most HBV is transmitted through exposure to blood and other bodily fluids via sexual contact, the sharing of needles in illicit drug use, being stuck with an infected needle in a hospital setting, and the use of unsterilized instruments in body piercing or tattooing. A newborn can also be infected if the mother is a carrier. The incubation period of HBV is from forty days to six months. Symptoms, while similar to those of HAV, are usually more severe. A small percentage of adults and a high percentage of babies who contract HBV will become chronic carriers of the virus, placing them at risk for serious health problems later in life. Vaccines for hepatitis B exist, and vaccination is recommended for children and adolescents and for high-risk groups such as health care workers, intravenous drug users, and those with multiple sex partners. Treatment with alpha interferon or lamivudine also reduces the severity of infection.

The hepatitis C virus (HCV) is transmitted through blood transfusions or blood to blood contact. HCV is spread through sexual contact in about 10 percent of cases. Many people infected with HCV remain healthy for years and even decades before symptoms occur. Those with asymptomatic infection eventually develop serious liver ailments. Symptoms include darkening of the urine, abdominal discomfort, loss of appetite, nausea and vomiting, severe fatigue, muscle pain and tenderness, accumulation of fluid in the abdomen and legs, and sometimes jaundice. No vaccine exists for HCV. Treatment can be interferon injections alone or interferon and the oral drug ribavirin. The methods have different success rates in clearing the virus from the blood. If liver damage becomes too great, a transplant will be necessary. End-stage hepatitis C patients account for half of all liver transplants.

The hepatitis D virus (HDV) occurs only in those infected with HBV. HDV is transmitted through contaminated blood and sexual contact. Those infected with both HBV and HDV are at greater risk of severe infection and death than those infected with HBV alone. Prevention methods used for HBV, such as vaccination and immune globulin, should prevent the contraction of HDV.

The hepatitis E virus (HEY) is transmitted in the same manner as HAV. The incubation period for HEV averages forty days. Symptoms of HEV are similar to other forms of the virus, but severe infection and increased mortality are common, especially in pregnant women. There is no treatment for HEV. HEV has not been documented in western Europe or the United States.

Hepatitis G (HGV) is transmitted through the blood and possibly through sexual contact. It is sometimes found in association with HCV. The initial acute infection apparently does not become chronic, although the virus does persist in the blood. Hepatitis G is the most recently identified type, and more research is needed on transmission, treatment, and other aspects.