Your Liver: It's the Strong, Silent Type

ãA person may have liver disease for many years without being aware of it,ä said Adrian Reuben, M.D., director of liver studies and medical director of liver transplantation. ãA liver operating at 50 percent strength may still be doing pretty well.ä Yet Reuben said itâs much better if the disease is discovered early so that treatment can begin early and further deterioration can be avoided.

You may be at risk for developing liver disease if you have a family history of the disease or if you engage in high-risk behavior, including consuming excessive amounts of alcohol.

ãWhat is surprising to many is what can be considered Îexcessive,â ä Reuben said. ãA man who drinks a six-pack of beer a day (or six glasses of wine or six mixed drinks) for 10 or 15 years is risking developing liver disease. However, it has been determined that women are about three times more susceptible to the harmful effects of alcohol. For women, two drinks a day over the same span is considered excessive and therefore a risk factor.ä

While only about 20 percent of those who drink this amount for so long develop liver disease, Reuben cautions against drinking this much alcohol regularly. ãWe just donât know yet why some people are affected and others are not.ä

A risk factor for developing liver diseases like hepatitis B or C is needle use, which is not limited to intravenous drug use. The needles used in tattooing and body piercing may also be culprits of spreading hepatitis. Hepatitis B or C can even be spread by the unlikely toothbrush if the previous (infected) user had bleeding gums. Sharing razors also can be risky. Unprotected sex and promiscuous sex spread hepatitis B and, to a small extent, hepatitis C, too.

ãWe have an effective vaccine for hepatitis B, and all children should be vaccinated,ä Reuben said. ãAdults who work in any type of high-risk environment or who travel to underdeveloped parts of the world should be vaccinated for hepatitis B and hepatitis A.ä

Certain drugs have side effects that constitute risk factors for liver disease. Your physician knows what medicines need to be monitored.

Obesity also is now associated with liver disease. ãWe are discovering that people with obesity may not only have fat in the liver but inflammation and scarring too,ä Reuben said. ãThings associated with obesity, such as high lipids in the blood, diabetes and high blood pressure, can also be associated with cirrhosis. If you need another reason to lose weight, lowering your risk for developing liver disease would be one.ä

Another liver disease thatâs common (especially in whites of northern European descent) is hemochromatosis ÷ excess iron in the body. The faulty gene responsible for the disease is carried by one in 20 people, although youâd need a faulty gene from both parents to develop the disease. ãThe problem is the gut, which absorbs too much iron from food, but the gut doesnât suffer from the results of the disease,ä Reuben said. ãInstead, the excess iron deposits in the liver, heart, joints and other organs. The treatment for hemochromatosis is very simple and rather old-fashioned: blood letting. A pint of blood is taken out once a week until the iron levels are back to normal.

ãWe have much more in the way of investigations and treatment for liver diseases now than weâve ever had,ä Reuben said. Doctors can examine the biliary system using magneticresonance imaging, and sophisticated blood tests using molecular biology reveal more information, as do sophisticated scanning methods. ãWe also know much more about the causes of liver disease.ä

Yet Reuben believes that social attitudes toward liver disease need an overhaul. ãWhen people think of liver disease, they very often think of alcoholism and the negative stigma attached to it, or of hepatitis and its hinting of needle sharing. But there are many other causes of liver disease that are not the fault of substance abuse.ä He noted that while alcoholism and chronic viral hepatitis account for the vast majority of liver disease in this country, itâs important to get to the true causes of disease.

ãWe now know that alcoholism is a disease, just as is diabetes,ä Reuben said.

ãWe shouldnât call the problems of an alcoholic self-induced any more than we call the problems of a diabetic self-induced. If a diabetic doesnât take care of himself or refuses to take his insulin, he gets sick. If an alcoholic doesnât take care of himself, he gets sick. To dismiss alcoholics as social lepers is backward thinking. Instead, we must use what we know about the disease and help in the battle against it.ä

Reuben said that costs of liver disease to patients, their families, our communities and to our country are enormous. For example, one of the complications of cirrhosis of the liver is varicose veins, called varices, which develop in the esophagus and bleed. Treatment costs for blood products, ICU beds and hospital stays, and in suffering for the patients and their families are high.

ãIn the last 10 years, advances in understanding why these varices form and bleed and in devising treatments have been remarkable,ä Reuben said. ãHere at MUSC we have an outstanding interventional radiologist who is very skillful in a relatively new technique where a small tube inserted through the liver allows blood to bypass it and the resistance it would normally meet in a cirrhotic liver. Although this blood is not filtered by the liver, the pressure in the varicose veins is relieved.ä

Simple tests to identify liver disease can be done during a routine blood test, and any abnormal result should be checked, no matter how trivial it may seem, Reuben advised. Of the four million people who have hepatitis C, he said, three-fourths of them have normal blood tests and the other quarter may show only minor abnormalities.

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Editor's note: The article is reprinted from Checkup newsletter, produced by MUSC Creative Services.