What Are Liver Injury and Hepatitis?

The liver filters toxins from your blood, helps digest food, stores energy, and produces proteins your body needs. Liver injury occurs when the liver becomes damaged or inflamed. Hepatitis is a broad term referring to inflammation of the liver.  Early detection and treatment can often prevent serious complications.

Common Causes of Liver Injury

• Medications and supplements: Certain prescription and over-the-counter medications can damage the liver. Acetaminophen (Tylenol) is the most common medication-related cause of liver injury, especially when taken in high doses or combined with alcohol. Some herbal supplements, vitamins, and dietary products can also be harmful to the liver.
• Alcohol: Drinking too much alcohol over time can cause fatty liver, inflammation (alcoholic hepatitis), and scarring (cirrhosis). Even short periods of heavy drinking can cause significant liver damage.
• Viral hepatitis: Infections caused by hepatitis A, B, or C viruses are among the most common causes of liver injury worldwide. Hepatitis A is usually short-term, while hepatitis B and C can become chronic and lead to long-term liver damage.
• Metabolic dysfunction-associated steatohepatitis (MASH): A buildup of fat in the liver due to the same metabolic dysfunction underlying diabetes, high cholesterol, and obesity. This is very common and is now a leading cause of liver transplant.
• Autoimmune hepatitis: A condition in which the body’s immune system mistakenly attacks the liver, causing inflammation and damage.
• Primary biliary cholangitis: an autoimmune disease that damages the small bile ducts in the liver.
• Genetic and inherited conditions: Some people inherit conditions that can damage the liver over time, such as hemochromatosis (too much iron), Wilson disease (too much copper), or alpha-1 antitrypsin deficiency.
• Bile duct problems: Conditions that block or damage the bile ducts (the tubes that carry bile from the liver) can cause liver injury. These include gallstones, primary sclerosing cholangitis, or other bile duct narrowings.

 

Signs and Symptoms

Mild liver injury may cause no symptoms at all, and is frequently found on routine bloodwork. When symptoms do occur, they may include:

• Fatigue and weakness
• Loss of appetite, nausea, or vomiting
• Pain or discomfort in the upper right side of the abdomen
• Dark-colored urine
• Pale or clay-colored stools
• Yellowing of the skin or eyes (jaundice)
• Itchy skin
• Easy bruising or bleeding
• Swelling in the abdomen or legs

 

How Liver Injury Is Diagnosed

• Blood tests can be used to assess degree and pattern of liver injury, as well as check for various viral, autoimmune, and genetic causes of liver injury.
• Ultrasound, CT, or MRI can assess for fat in the liver, bile duct blockage, liver size and shape, and check for any mass.
• Elastography uses a specialized ultrasound that measures liver stiffness, which helps determine if there is scarring (fibrosis).
• Liver biopsy: In some cases, a small sample of liver tissue is removed with a needle and examined under a microscope. This can help determine the exact type and severity of liver damage.

 

Treatment

General measures recommended for patients experiencing liver injury include:

• Avoiding alcohol completely to prevent compounding liver injury
• Limiting acetaminophen intake to 2,000 mg a day
• Get vaccinated against hepatitis A and B if you have not already
• Tell your doctor about all medications, supplements, and herbal products you take.
• Maintain a healthy weight through balanced nutrition and regular physical activity.

Depending on the cause and severity of the liver injury:

• Stopping harmful medications and supplements
• Viral hepatitis: Hepatitis B can be managed with antiviral drugs. Hepatitis C can now be cured in most people with a short course of antiviral medication.
• MASH: weight loss of 10% has been shown to improving inflammation and scarring. For patients unable to lose the weight, medications including semaglutide and resmetirom are now available to treat MASH with an intermediate amount of liver scarring.
• Autoimmune hepatitis is treated with immune suppressants such as corticosteroids to prevent cirrhosis.
• Primary biliary cholangitis is treated with medicines such as ursodiol to prevent cirrhosis.

The liver has a remarkable ability to heal itself when the cause of injury is identified and removed early. An incidental finding on routine bloodwork can uncover significant underlying liver disease.  If you are concerned about liver injury, contact our team at Salem Gastro for an evaluation.