The liver is a vital organ located under the diaphragm in the abdominal cavity. It performs a huge number of functions, including cleansing the body of toxins and excess hormones and vitamins, participating in metabolism, synthesizing cholesterol, bile acids and other chemicals necessary for our body. Therefore, it is extremely important to identify signs of dangerous liver disease before it causes irreparable harm to health.

In order to recognize the first symptoms in time, it is necessary to have at least a rough idea of ​​the location of the liver. Like other vital organs, it is located in the abdominal cavity, namely in its upper right corner, under the muscular septum of the diaphragm. In shape it is an obtuse triangle with rounded corners, consisting of two lobes. With the first lobe it attaches to the anterior abdominal wall in the area of ​​the right hypochondrium, with the second lobe it tapers to the left costal arch. Painful symptoms appear with liver disease on the right side of the upper abdomen.

Sometimes signs of a diseased liver, if symptoms are not expressed, can be confused with pain in the gallbladder or stomach, since unpleasant sensations tend to radiate (spread) to nearby areas. To unambiguously determine the localization of the pathology, it is necessary to contact a therapist or hepatologist, who, by collecting an anamnesis and using palpation, will accurately determine which organ hurts.

Types of pain

Any pathology begins with mild, dull or aching pain in the right hypochondrium. With the development of tumor formations, a feeling of heaviness may occur. The pain actively radiates to different areas of the abdomen. The development of the pathology is characterized by an increase in pain symptoms. Acute pain in this case indicates purulent or inflammatory processes. They are also accompanied by fever.

Indolent problems may not manifest themselves until liver failure or coma occurs. This is the most dangerous type of pathology, since not all patients respond to other external signs of the disease. It is important to pay attention to the condition of the skin, the color of stool, and general well-being, as this will help with early diagnosis of the disease.

Other unpleasant sensations accompanying liver disease

The manifestation of an unhealthy liver does not end with pain alone. Disruption of such an important organ is accompanied by digestive disorders, heartburn and a feeling of nausea. Patients are often tormented by a persistent feeling of hunger, and chills at night (which are later easily replaced by fever).

The first signs of liver disease, which may indirectly indicate the presence of problems in the functioning of the organ:

The more acute the pathology, the stronger the internal symptoms. With their prolonged development, hepatic coma can occur, characterized by almost complete failure of the liver, impaired blood supply, respiratory function and leading to death without proper medical intervention.

External manifestations of pathology

Not only subjective sensations will help identify the disease. External signs may also indicate pathology. Thus, a decrease in the detoxification function of the liver leads to a change in the color of stool, the smell of sweat becomes stronger, and urine acquires an unhealthy brown tint.

Other signs and indicators of poor liver function:

The patient looks extremely sick. The tongue becomes covered with cracks and a white coating, the person loses weight and suffers from headaches. Particular danger is posed by increased bleeding - one of the causes of possible death. Intestinal dysfunction also occurs, and tachycardia occurs in the cardiovascular system.

Symptoms of individual diseases

Not all liver pathologies are characterized by the symptoms described above. Their intensity and degree of manifestation directly depends on the type of disease. Therefore, it is important to know about the most common diseases and their characteristic symptoms.

For example, cirrhosis of the liver is characterized by the following symptoms:

• proliferation of connective tissue replacing parenchymal tissue;
• increased pressure in the portal vein system;
• dysfunction of liver regeneration;
• sharp pain in the right hypochondrium;
• flatulence;
• weight loss;
• temperature from 37.1 to 38 degrees;
• splenomegaly - an increase in the size of the spleen.

The formation of spider veins (the same ones that are usually observed with varicose veins) on the pubis, a change in the color of the nails. Hormonal imbalance in men leads to gynecomastia. The body is subject to edema and venous collaterals (due to which bleeding often occurs).

What can the disease be confused with?

Non-acute diseases can often be confused with other, similar diseases of the gastrointestinal tract. Gastritis can manifest itself as bitterness in the mouth, and a change in the color of urine may well accompany kidney disease. Therefore, you should remember that only a hepatologist or, at worst, a general practitioner can give you an accurate diagnosis. To make an accurate diagnosis, a liver profile is usually used through blood tests or ultrasound.

What diseases at an early stage resemble liver pathologies?

1. Gastritis or ulcer.
2. Intestinal colitis, irritable bowel syndrome.
3. Gallbladder diseases.
4. Pathologies of the pancreas.
5. Kidney failure and others.

Pronounced liver symptoms occur already at an advanced stage of the disease. At the first signs, you should consult a doctor and differentiate the diagnosis, without waiting for the development of venous bleeding or acute colic.

In an adult, the liver weighs one and a half to two kilograms. This is the largest gland. In the body, it combines three functions, participating in the processes of blood circulation, food digestion and metabolism. The work of the organ is associated with numerous exchanges in the body: lipid, carbohydrate, water-salt, protein, bile, vitamin. It performs neutralizing enzymatic, protective and excretory functions that support the autonomous coordinated functioning of the body.
The key causes of liver diseases are infectious lesions, poisoning of the body with toxins, circulatory disorders, immune system disorders, nutritional and metabolic disorders.

Symptoms of liver damage

Symptoms of acute liver damage are quite obvious and help the doctor almost immediately assume that the gland is involved in the pathological process. This is pain under the right rib, sudden changes in body temperature, jaundice, colorless feces, dark urine.

Chronic diseases do not manifest themselves, and for a long time the signs of a diseased liver are characterized by general symptoms: loss of strength, fatigue, sleep disorders, depressed mood. However, with consistent detailed questioning, it will not be difficult for the doctor to suspect liver disease with a minimum of symptoms.

Main symptoms of liver disease

Significant, but less common signs of a diseased liver are yellowness of the skin and mucous membranes, an enlarged spleen, and itching. The skin acquires a jaundiced tint when infected with hepatitis in the acute period, with toxic hepatitis and with cirrhosis. Chronic hepatitis often occurs without this symptom.

Simultaneous jaundice and itching of the skin indicate a disorder in the outflow of bile. This is how sclerosing cholangitis, biliary cirrhosis manifest, and also indicate stones in the bile canaliculi, especially if there is additionally pain under the right rib (pain in the liver), and an increase in body temperature.

Liver cells do not have nerve fibers, and therefore even severe liver damage due to cirrhosis does not cause pain. Rarely, pain under the right rib can be caused by simultaneous damage to the gallbladder, bile ducts, or nearby intestines.

Nerve fibers are present in the connective capsule covering the surface of the gland. The liver hurts only when the organ is significantly enlarged due to stretching of the membrane - there is a feeling of heaviness in the right side, a dull pain. An increase in liver volume is sometimes the only, but one of the key symptoms of chronic pathologies of the organ.

Nonspecific symptoms of liver disease

Chronic liver diseases are accompanied by less obvious signs of pathology. But a combination of several nonspecific symptoms may indicate problems with the gland:

• • expansion of small vessels - mesh or asterisks - on the skin in the upper part of the body;
  • redness of the palms;
  • smooth, without papillae, crimson-colored tongue;
  • trembling of fingers, protruding tongue;
  • yellowed membrane of the eye;
  • shortened flexor tendons of the fingers, preventing the finger from fully straightening;
  • flat benign growths in the form of plaques, most often located on the upper eyelid;
  • fingers like drumsticks;
  • enlargement of the mammary gland in men, impaired hair growth on the chin and under the arms.

The simultaneous presence of several of the above symptoms suggests that the patient has liver disease associated with alcohol consumption.

Common symptoms of chronic liver diseases

Chronic liver diseases are often accompanied by general symptoms characteristic of other diseases. In some cases, they are not diagnosed immediately, since there is no pain in the liver, the patient comes to see doctors of a different profile. Nonspecific signs of a diseased liver: lethargy, painful condition, rash or hemorrhages on the skin, muscle and joint pain, dry mouth, dry eyes, deterioration in the general blood test, signs of kidney disorder (poor urine test).

Infectious liver diseases

Infectious pathologies of the liver include viral hepatitis - inflammation of the liver that affects its cells. Inflammation is caused by various viruses. Viral hepatitis A, B, C, D, E, G are known and described. The greatest threat to health is posed by infections with parenteral (bypassing the digestive tract, through blood, mucus, subcutaneously, muscularly, during pregnancy) transmission ¬– B, C and D.

Acute viral hepatitis A

The pathogen spreads through the fecal-oral route in close contact if basic personal hygiene rules are not observed, through raw water containing the virus. Infection also occurs among drug addicts who inject drugs intravenously - the virus tends to penetrate the blood for a short period of time. The latent period of the disease lasts 15–40 days.
Signs of illness: loss of appetite, vomiting, sore throat, fever, lethargy, fatigue. After 2–5 days, dark urine, discoloration of stool, and yellowness of the skin may occur.

The virus mainly infects children aged 5–14 years, and very rarely adults. The disease usually goes away easily. Jaundice is more common in adults. The transition of hepatitis A to the chronic stage and cirrhosis is impossible, but there have been cases of long-term (up to 4 months) infection.
Viral hepatitis A is an acute disease. It requires isolation of the patient, as it has high infectious properties. Treatment of the disease involves eliminating symptoms and maintaining bed rest.

Acute viral hepatitis E

Hepatitis E spreads in countries with tropical and subtropical climates. The virus often penetrates through water and is mainly recorded in adults.
Signs of the disease are similar to those of hepatitis A. The disease is mild, but dangerous for pregnant women. There are known deaths among this category of women.

Acute viral hepatitis B

The infection spreads through sexual contact, from mother to newborn during childbirth, through blood (transfusion, use of contaminated needles, tattooing). The latent period of the disease is 1 – 6 months.
This viral inflammation occurs in an icteric or anicteric form. The appearance of jaundice most likely has a favorable prognosis for recovery. The disease without jaundice is hidden, the percentage of transition to the chronic stage is high. The disease is detected by a laboratory blood test.

Treatment for acute hepatitis B is usually not carried out, since in 80% of cases the body copes on its own and spontaneous recovery occurs. About 5% of patients become inactive carriers of the virus without obvious signs of inflammation in the liver.

For severe or rapid viral inflammation, lamivudine, telbivudine and entecavir are prescribed. Many patients with rapid infection require liver transplantation.

Hepatitis B infection can be prevented by getting vaccinated.

Chronic hepatitis B

Chronic hepatitis B is an inflammation of the liver that develops after the hepatitis B virus remains in the body for more than six months. Infection leads to tissue necrosis (death).
The disease has a varied course: from asymptomatic and slowly progressing stages to aggressive ones, with rapid cirrhosis and liver failure. Inflammation may resume in inactive carriers of the virus. The chronic stage of virus B occurs with general manifestations of infection up to the development of inflammatory damage to small and medium-sized blood vessels with the development of arterial hypertension, multiple nerve damage, kidney and brain damage.

The severity of the disease largely depends on the state of the human body’s immune system and the degree of viral infection load. The treatment tactic is to suppress the DNA of the virus to a very low level, preferably undetectable in laboratory conditions. It becomes a regular practice for the patient to quantify the DNA of the virus at various stages of the disease.
When diagnosing chronic hepatitis B in a particular patient, vaccination of all his relatives, especially those who have sexual contact with the infected person, is justified.
Standard therapy is the prescription of interferon-α. It stimulates the immune system, has an antiviral effect and supposedly prevents tissue degeneration.

Chronic hepatitis B+D

Viral hepatitis D (delta) is widespread. Transmitted parenterally. The source of infection is a virus carrier or a sick person.
Viral hepatitis D becomes active only in conjunction with the hepatitis B virus. When infected together, chronic hepatitis B+D spreads, leading to cirrhosis. The clinical course of the disease is similar to hepatitis B infection, but in a more severe form.
The latent period lasts 3 – 7 weeks. Interferons-α are prescribed in high doses. The duration of treatment is 12 months. Often, after discontinuation of treatment, relapses of the disease occur. The hepatitis B vaccine is also effective against hepatitis D infection.

Acute hepatitis C

The virus is diverse, has more than 90 subtypes. The main route of transmission is through blood, very rarely through sexual intercourse. The latent course of the infection lasts from 1 to 5 months.
Risk groups for acute hepatitis C infection:

• • • prosthetics and tooth extraction;
    • tattoo, piercing;
    • blood transfusions, surgical operations;
    • artificial termination of pregnancy, especially those done in the twentieth century, when testing for the hepatitis C virus was not carried out;
    • elderly people;
    • people who abuse alcohol, carriers of HIV, hepatitis B virus;
    • patients with blood clotting disorders;
    • intravenous drug users;
    • persons with multiple sexual partners;
    • patients with extrarenal blood purification;
    • infants born to infected mothers;
    • medical workers, nail salon workers.

Infection with the virus occurs without symptoms and is taken as fatigue from work, lack of vitamins, or the consequences of a cold. Lethargy, decreased activity, depression, fatigue, and sleep disturbance are observed.

A third of patients are ill with obvious signs of infection: jaundice, dark urine, fever, increased activity of liver enzymes. With severe yellowness of the skin, the stool becomes light-colored, there may be itching, and the volume of the liver increases. The pre-icteric stage of the disease can begin with nausea, lack of appetite, weakness, pain under the right rib and lasts about a week.
Signs of the disease are present for 1–3 weeks. With recovery, appetite appears, other signs of the disease gradually disappear.
Treatment of acute hepatitis C:

• • • semi-bed rest in the acute period with its gradual relaxation as recovery and restoration of liver function;
    • eating protein-rich foods;
    • exclusion of alcohol and sexual contacts.

If you follow bed rest and diet, recovery occurs fairly quickly. In severe cases of the disease, the patient is hospitalized.

Chronic hepatitis C

In the majority of patients (75–80%), acute hepatitis C progresses to the chronic stage. The infection does not manifest itself for years, sometimes decades, but inflammatory processes in the liver develop. Cirrhosis is found in 15–30% of patients after 20 years. The progression of the pathology is facilitated by alcohol abuse, co-infection with other hepatitis viruses and

Pathology can only manifest itself with general symptoms: low performance, depressed mood up to depression, increased fatigue. There are patients who, despite infection, have no clinical signs of liver damage for many years. Only laboratory testing of blood serum using the polymerase chain reaction (PCR) method allows timely detection of the disease.

Signs of organ damage appear only when cirrhosis already exists or at least degenerative tissue changes have begun. In this case, antiviral therapy is often meaningless.
The hepatitis C virus has a systemic effect. Not only the liver may be affected, but also hematopoiesis, blood vessels, the nervous system, kidneys, lungs, thyroid gland, skin, joints, and heart.
In the twentieth century, treatment of patients was reduced to monitoring the course of the pathology, ascertaining the presence of its deterioration, detecting the onset of life-threatening complications and prescribing treatment that alleviates signs of inflammation.

Over the past two decades, treatment of the disease has advanced significantly. The therapy technique has changed. Its goal is to neutralize the virus in the early stages of infection. A number of circumstances are analyzed that are taken into account when prescribing therapy: the duration of infection, the patient’s age, his gender, the presence of other diseases. The characteristics of the hepatitis C virus itself are considered: not all genotypes of the virus respond to therapy.
The following indicators give a favorable response to treatment:

• • • short period after infection;
    • absence of fibrosis and cirrhosis;
    • low levels of hepatitis C viruses in the blood;
    • genotypes 2 and 3;
    • female gender;
    • young age;
    • lack of obesity.

The choice of drugs and duration of treatment depend on the genotype of the virus and the number of its copies in 1 ml of blood. Sometimes a liver biopsy is necessary.
An important factor for achieving a positive result of therapy is the patient’s desire to be cured. It is necessary to eliminate alcohol consumption, normalize excess weight, and adjust metabolic processes in the body. This will slow the progression of the disease and increase the chances of success.

Viral hepatitis G

Viral hepatitis G is transmitted parenterally through its carriers and from patients with acute or chronic hepatitis G. The inflammation occurs in an asymptomatic form and is detected in the blood and saliva. Risk factors include blood transfusions and intravenous drug use.
A characteristic feature of viral hepatitis G is that it is rarely detected as a single infection. Most often it is recorded with viruses B, C and D in acute and/or chronic form.
The disease is treated with interferon. The frequency of transition from acute to chronic varies from 2 to 9%.

Liver diseases resulting from intoxication of the body. Alcoholic liver disease

Alcoholic drinks and some of their breakdown products (acetaldehyde) poison liver cells. An increasing unfavorable factor may be a lack of protein and vitamins in the diet. The disease progresses in the following stages:

• • • fatty degeneration - alcoholic steatosis, early stage of the disease;
    • tissue inflammation - acute and chronic hepatitis;
    • proliferation of connective tissue – fibrosis;
    • atrophy and degenerative changes of the gland – cirrhosis;
    • malignant tumor – hepatocellular carcinoma.

Even short-term consumption of alcoholic beverages causes fatty liver degeneration. The progression of the disease depends on individual susceptibility, body constitution and hereditary characteristics of the body.

Fatty degeneration develops not only as a result of alcohol abuse, but also with various metabolic disorders: with an increased concentration of insulin in the blood plasma, accompanied by excessive deposition of adipose tissue, with impaired breakdown and removal of fats from the body, with type 2 diabetes.
Alcoholic liver disease is asymptomatic and is diagnosed when determining the state of chronic alcohol poisoning. Often patients do not admit that they constantly drink alcohol, fearing inattention to themselves on the part of the medical staff, so doctors have a certain method of clinical and laboratory signs of determining poisoning by alcohol toxins, which makes it possible to establish the cause of organ damage - alcohol intake.

Clinical course of the disease

Fatty liver degeneration is characterized by an increase in its size. There is no pain and there is usually no jaundice. Sometimes discomfort is present upon palpation. Laboratory tests do not show liver damage. A biopsy of the gland can confirm the diagnosis, but is usually not done. A balanced diet for several weeks and abstinence from alcohol eliminate steatosis.

If alcohol continues to poison liver cells, the disease progresses to alcoholic hepatitis - inflammation followed by necrosis (death) of the cells. Fibrosis develops, which also occurs without external symptoms of damage.

Taking ursodeoxycholic acid (Ursosan) at this stage will reduce and prevent liver intoxication. The effect has been confirmed by research in the fields of cardiology and oncology. An additional mild antidepressant effect is provided by a drug that has proven itself in narcology - ademetionine (Heptral, Russian analogue - Heptor).

Alcoholism of 5 to 15 years causes severe fibrosis or cirrhosis of the liver in 10–50% of patients with steatohepatitis.

The main signs of cirrhosis are increased pressure in the portal vein system detected by ultrasound, impaired liver function (liver failure). Additional signs of cirrhosis that may be complicated by bleeding:

• • • varicose veins of the esophagus and hemorrhoidal veins;
    • abdominal dropsy;
    • enlarged spleen.

Impaired liver function is accompanied by the following liver signs: spider veins, redness of the palms, enlarged breasts.
After a long alcohol binge, jaundice may appear - acute alcoholic hepatitis. The defeat is accompanied by abdominal pain, temperature fluctuations, loss of appetite and an increase in the number of white blood cells. Acute alcoholic hepatitis manifests itself, as a rule, with already formed cirrhosis and threatens the patient’s life.

Liver diseases resulting from intoxication of the body. Drug-induced liver damage

Cirrhosis from drug poisoning is uncommon. And yet there are medications (including those sold without a prescription) that have a toxic effect on the gland and contribute to the development of its other chronic pathologies.
Most medications are well absorbed from the gastrointestinal tract and enter the liver, where they are converted into simpler components (metabolized) that are more easily eliminated from the body.

About 1,000 drugs, both well-studied and new, can damage the liver. The degree of toxicity can vary - from a slight increase in enzyme activity to inflammation and cirrhosis. The same drug causes different types of reactions.

When taking high doses of drugs, paracetamol, amiodarone, cyclophosphamide, cyclosporine, methotrexate, niacin, oral contraceptives, and tetracycline can have a toxic effect on the liver. The toxicity of the drug increases with the simultaneous use of alcohol and other drugs. Liver damage caused by drugs with direct dose-dependent toxic effects can usually be predicted and therefore easier to diagnose.
But much more often, reactions of individual intolerance occur that cannot be predicted, and they appear much later after taking the tablets in usual therapeutic doses - after 5 to 90 days. Most of these reactions occur in women – 70% of cases.

Drugs with which reactions have been reported include quinidine, oral contraceptives, diltiazem, sulfonamides, anabolic steroids, carbamazepine, isoniazid, diclofenac, venlafaxine, lovastatin, macrolides, chlorpromazine, tetracycline, methyldopa, methotrexate, amoxiclav, cyclosporine and some others.

Drug intoxication can occur in different ways, but most drugs have a specific mechanism of action. Liver necrosis develops with intoxication with halothane and isoniazid; a decrease in bile flow in combination with hepatitis occurs when taking chlorpromazine and erythromycin. Mild jaundice may result from the destruction of red blood cells caused by the drug. In this case, the liver does not become inflamed, and liver enzymes are produced normally.
There are no special external signs of drug intoxication of the liver. Treatment of a diseased organ affected by drugs is the urgent withdrawal of medications that could cause damage. Usually this is enough to restore gland function in mild cases.

Liver diseases in cardiovascular diseases

The main causes of liver damage in cardiovascular diseases are chronic heart failure, heart rhythm disturbances, and shock.
In chronic heart failure, the following clinical forms of liver damage are distinguished:

• • • congestive hepatopathy - stagnation of venous blood in the liver;
    • ischemic hepatitis – decreased oxygen content in the gland;
    • cardiac fibrosis;
    • cirrhosis.

Symptoms of venous stagnation are an increase in the size of the liver, accumulation of free fluid in the abdominal cavity, and an increase in the size of the spleen.
Venous congestion develops ischemic hepatitis in 25–56% of cases. Clinical signs of ischemic hepatitis:

• • • nausea, vomiting, lack of appetite, malaise;
    • pain in the upper right sector of the abdomen;
    • jaundice.

The final stages of congestive liver damage are cardiac fibrosis and cirrhosis.

Autoimmune liver diseases

Autoimmune diseases are caused by a malfunction of the immune system. Immune cells attack their own tissues, leading to inflammation and damage. Autoimmune liver diseases include primary sclerosing cholangitis, autoimmune hepatitis, and primary biliary cirrhosis.

Autoimmune hepatitis

Autoimmune hepatitis is a progressive inflammation of the liver tissue, in which autoantibodies are formed to the structural components of the gland and an increased amount of immunoglobulins in the blood.

The causes of the disease are unknown. The disease develops after viral infection with hepatitis (A, B, C, D), human herpes virus type IV, and chickenpox. Immune organ damage can develop after interferon therapy prescribed for viral hepatitis. There is also an opinion about the supposed development of immune failure by products of the breakdown of medications (halothane, ticrinofen, isoniazid, alpha-methyldopa, diclofenac, dihydralazine), toxins, and some bacteria.
The disease is more common in women, at a young age (15–25 years) or during menopause. The pathology gradually progresses and often relapses. Manifestations range from mild elevations of liver enzymes to severe liver failure.
Clinical symptoms of the disease:

• • • jaundice, the degree of which gradually increases;
    • constant pain in the liver area;
    • small and larger hemorrhages on the skin;
    • enlarged liver and spleen;
    • red palms;
    • spider veins;
    • a prolonged increase in temperature is possible.

The pathological process is not limited only to changes in the liver. Symptoms of a systemic inflammatory process are often observed: swollen lymph nodes, joint pain, inflammation of muscle fibers, skin rashes. In 38% of patients, other immune diseases occur in parallel. Autoimmune hepatitis occurs without symptoms, so in 25% of patients the diagnosis is established already at the stage of cirrhosis.
During the acute period of inflammation, patients are hospitalized to assess the severity of the process and limit the physical activity of the sick. The sooner treatment is started, the better.

Primary biliary cirrhosis of the liver

Primary biliary cirrhosis is a slowly progressive autoimmune pathology of the small bile canaliculi of the liver. The disease develops mainly in middle-aged women, more often during menopause.
The cause of the pathology is a prolonged disruption of the outflow of bile from the liver, which is associated with disorders at different levels of the biliary system. In this case, a chronic inflammatory process occurs.
Signs of the disease:

• • • painful itching of the skin;
    • mild jaundice;
    • possible pain and sensations of heaviness in the right hypochondrium;
    • pain in the limbs;
    • Weight loss progresses.

In the treatment of primary biliary cirrhosis, ursodeoxycholic acid is prescribed for life. In 25–30% of patients, improvement in liver function is noted. The achieved effect of therapy lasts for 8 – 10 years.

Primary sclerosing cholangitis

Primary sclerosing cholangitis is a disease characterized by a chronic disturbance in the production of bile or its outflow associated with inflammation of the bile ducts.
Among men, the disease is twice as common. The pathology most often debuts at the age of 25–45 years, but it also occurs in young children. In most cases (70%) it occurs in parallel with ulcerative colitis, a chronic autoimmune inflammation of the colon mucosa.

The disease develops without symptoms and progresses. The first sign of the disease is changes in biochemical parameters in the blood serum - increased enzyme activity.
There is no effective therapy for primary sclerosing cholangitis. The administration of ursodeoxycholic acid reduces the activity of the disease, improving biochemical parameters. Liver transplantation remains the most effective, but it does not exclude recurrence of the disease.

Liver diseases associated with metabolic disorders

The primary form of non-alcoholic fatty liver disease is one of the organic manifestations of a complex of metabolic, hormonal and clinical disorders associated with obesity.
Non-alcoholic fatty liver disease is defined as a separate disease, but the pattern of liver damage in it is similar to intoxication due to alcohol abuse: as excess fat deposition increases, the amount of free fatty acids in the liver increases. This forms inflammatory-necrotic processes in the organ. The disease can develop into cirrhosis, develop liver failure and liver cancer.

The pathology occurs without any external signs, not making itself felt in any way until the development of final forms of liver damage. In the majority of patients, liver dysfunction is detected accidentally.
The basis of therapy is the elimination or reduction of factors that provoke the disease:

• • • change in diet;
    • weight loss;
    • reducing elevated levels of fat and glucose;
    • discontinuation of medications that are potentially toxic to the liver.

The most effective treatment is gradual, moderate weight loss. To reduce cholesterol levels, statins are taken - lipid-lowering drugs. Their safety and low toxicity have been confirmed by numerous controlled studies in tens of thousands of patients.

The liver is a vital and largest organ of the human body, taking an active part in digestive and metabolic processes. In addition, it is a kind of filter for purifying the blood of toxins. Minimal disruptions in the functioning of this body can lead to very serious consequences. Therefore, everyone should know the symptoms of a diseased liver.

In medical practice, a distinction is made between functional and organic disorders in the liver.

The occurrence of functional pain is associated with external factors. Among them are:

• poisoning;
• overeating (in particular, excessive indulgence in fatty, fried and high-cholesterol foods);
• alcohol intoxication and those caused by medications;
• overvoltage.

In some cases, pain can be caused by acute or chronic stress. Such situations are characterized by an implicit and not constant pain syndrome, but periodic, depending on the impact of negative factors.

It is not difficult to get rid of functional disorders; they can be easily corrected with the help of.

Organic lesions cause more serious diseases that not only affect the liver, but also lead to changes in it. Such pathologies can appear in both women and men. These include:

• cirrhosis;
• acute and chronic hepatitis;
• fatty liver;
• cysts;
• abscesses;
• tumors.

The first signs of a diseased liver

The presence of many liver diseases is indicated by a number of signs reflected on the human body or face. If such manifestations are not ignored and you do not consult a doctor in a timely manner, you will be able to avoid the development of serious problems. Even in the early stages, it will be useful to use traditional methods of treating the liver.

On the face

On the skin

Other symptoms

In addition to external manifestations, a person with liver pathology may experience other signs:

• fatigue, loss of performance;
• lack of appetite;
• the appearance of a protruding abdomen is an indicator of accumulated fluid in the abdominal area;
• the shade and structure of the hair may change, the weakness and fragility of which becomes clearly visible;
• at night the person sweats a lot;
• in some cases, insomnia appears;
• the patient is left with a feeling of bitterness in the mouth, and a yellow coating appears on the tongue.
• A patient with liver pathology often experiences intolerance to excessively fatty foods.

Important! Any manifestations of this kind, especially in a child, must be responded to and not delayed in going to the clinic.

How does the liver hurt?

The liver itself is not equipped with pain receptors; they are located only in the fibrous membrane that covers this organ. As the size of the liver increases, it begins to put pressure on the membrane. As a result, patients with pathologies of this vital organ begin to feel dull pain. If the pain is cramping and acute, then this indicates abnormalities in the activity of the biliary tract, or cholelithiasis.

If the liver hurts, then the feeling of discomfort is not necessarily localized in the area of ​​the right hypochondrium, where the organ itself is located, but often radiates to other areas of the body or may even blur.

Liver pathologies may be accompanied by:

• dull or acute painful manifestations under the ribs on the right side;
• the pain can be pressing or pulling;
• a feeling of discomfort arises after consuming fatty, spicy, fried, or alcohol-containing drinks.

Important! If a person’s liver begins to hurt, and no matter what the cause of the pathology is, there are symptoms that always appear. These include belching with the smell of a rotten egg, nausea, bloating, and abnormal bowel movements.

Diagnosis of liver diseases

A patient with obvious manifestations of liver disease is prescribed a special examination. First of all, using a special device, the appearance of the organ is examined. In this way, it is possible to notice even the most minor changes in its shape, color, and structure.

Analysis of such changes will help the doctor make an accurate diagnosis.

Important! Diagnosis at home and self-treatment of liver diseases can cause irreparable harm to the body.

How to help the body cope with the problem

Unfortunately, not all liver diseases can be completely eliminated. However, if you take all the necessary measures in a timely manner and strictly follow the doctor’s recommendations, you will be able to achieve a long and stable remission.

Treatment of pathologies of this organ should be carried out under the constant supervision of a doctor. Complex therapy, diet, dosing of physical activity, complete exclusion of alcohol from the diet - all these factors together will lead to the expected result.

Read about the most effective drugs for treating the liver.

It is important to help the body fight the disease. To do this, you need to make sure that the menu contains vitamins A, D, E, F, microelements, and phospholipids. Forget about fatty foods and alcohol completely. The daily menu should be enriched with antioxidants contained in large quantities in greens.

People suffering from liver diseases should not only take care to eliminate bad habits, but also limit the amount of spicy, fatty and hot foods. In addition, it is recommended to avoid heat and sunburn, minimize the consumption of fermented milk products, and eat vegetables raw. Steam, stew or boil dishes.

If an unpleasant diagnosis is made, then you should not immediately panic: the liver is an organ that has. However, it is not advisable to let everything take its course. Liver dysfunction poses a serious threat to human health and life. Knowing what symptoms and signs may indicate liver disease, you will be able to consult a doctor in time and begin treatment immediately, which is extremely important in this matter.

Anton palaznikov

Gastroenterologist, therapist

Work experience more than 7 years.

Professional skills: diagnosis and treatment of diseases of the gastrointestinal tract and biliary system.

Cirrhosis, hepatitis, hepatosis - these terrible words have long been known to everyone. Unfortunately, liver diseases do not lose their high positions among the list of other diseases. Medicine has made great strides in the treatment of this important gland, but either patients seek help quite late, or the aggressiveness of the external environment increases every year, but there are no fewer patients. It is important to know the main symptoms of liver disease, when you need to seek qualified help, and when you can cope with the problems yourself.

Why does the body need a liver?

The liver is considered one of the largest glands of the human body. It has a soft consistency, a red-brown tint, and is elastic. The organ occupies most of the abdominal cavity. In an adult, the gland weighs about 1500 g. A person is not able to live without the liver, since its functions are very important:

• cleanses the body of toxic substances;
• takes part in the process of hematopoiesis;
• occupies a leading place in the processes of metabolism of protein, lipids, vitamins and other vital substances;
• Thanks to the presence of the gallbladder and bile ducts, it takes part in digestion.

The gland tissue consists of hepatocyte cells. The outside of the gland is covered with Glisson's capsule. Inside the liver there are veins of connective tissue that divide the organ into separate parts - lobules. In the human liver, such layers are less pronounced than in the gland of animals. Vessels and the bile duct can be found inside the connective tissue layers. The gland cells are arranged in the form of cords, with small capillaries between them. Each hepatocyte is in contact with the bile capillary on one side and with the blood capillary on the other.

Important! This interesting structure ensures the continuous participation of the organ in the processes of bile formation and metabolism of proteins, fats, amino acids, vitamins, glucose, etc.

Can your liver hurt? The gland tissue itself does not have receptors, so it does not cause pain. The symptom appears only if the liver is enlarged and adjacent organs are compressed. The gallbladder is an organ whose main function is to store bile. It resembles a pear in shape. The gallbladder is located on the surface of the liver, and its edge protrudes slightly beyond the edge of the gland. The volume of the bubble reaches 70 ml, length – 10 cm.

The liver and gallbladder with the biliary tract are closely connected to each other, so usually a pathological process in one of the organs entails changes in the others. As a rule, inflammatory liver diseases initially appear. Next, it is worth mentioning the main pathologies: hepatitis, cirrhosis, hepatosis.

Why do problems appear?

Common causes of pathologies:

• poor nutrition;
• alcohol abuse;
• long-term use of medications that have hepatotoxic effects;
• infections of viral origin;
• inactive lifestyle;
• concomitant gastrointestinal diseases;
• hazards of industrial production.

These foods deal a devastating blow to liver health.

Hepatitis

Hepatitis is a group of inflammatory liver diseases. All of them have similar symptoms and are manifested by the gradual death of hepatocytes. A common cause of hepatitis is viruses (A, B, C, D, E). Pathologies can also occur as a result of autoimmune processes, due to the influence of alcohol and medications. Viral hepatitis is more dangerous, since some genotypes of pathogens can mutate during life in the host's body. This greatly complicates treatment.

The hepatitis virus penetrates the human body, namely the liver cells. Here the active process of its reproduction begins, the result of which is acute inflammation. The virus increases the permeability of hepatocyte walls. From the extracellular space, fluid penetrates into the cells, the latter increase in size, which means the size of the gland increases.

The destruction of hepatocytes leads to the release of their cellular enzymes in large quantities into the bloodstream. It is the determination of the amount of these substances that allows you to confirm or refute the presence of liver pathologies. Gradually, more and more hepatocytes die. Vivid symptoms are observed when the liver is damaged by hepatitis A and E viruses. Hepatitis B and C can occur unnoticed, which is why patients turn to specialists already in advanced stages.

Hepatitis A

Another name for liver disease in children and adults is Botkin’s disease. In its pathogenesis, the pathology resembles an intestinal infection, since a person becomes infected after consuming infected foods and water, through contact and household transmission. Children of school and preschool age are most often affected, but large outbreaks of the disease occur every decade.

The causative agent of hepatitis A is an RNA-containing virus, it is resistant to external influences and can survive for a long time in soil and water. Botkin's disease does not develop into cirrhosis or cancer; it is not characterized by a chronic course or viral carriage. However, if an already diseased liver encounters the hepatitis A virus, the pathology occurs in a rapid form, which ends in liver failure.

The first symptoms develop within a month from the moment of infection. The pre-icteric period lasts about a week. At this time, patients usually consult a doctor with flu-like complaints:

• increased body temperature;
• aches;
• chills;
• pain in muscles and joints.

Sometimes attacks of nausea and vomiting occur, appetite disappears, chronic weakness and abdominal pain appear. The next period is icteric. First of all, the color of urine and feces changes. Urine becomes darker, and feces, on the contrary, become lighter. Yellowness of the skin and mucous membranes, sclera, and itching of the skin appears. The temperature usually normalizes during this period. When examining the patient, the doctor discovers an increase in the size of the liver and moderate pain on palpation.

The lightning form develops quickly. Patients become aggressive, irritable, quickly get tired, and refuse to eat. A specific ammonia odor appears from the body and in the exhaled air. Vomiting with blood and internal bleeding occurs. This form of the disease occurs in only 0.5% of clinical cases.

Maintaining good hygiene helps prevent outbreaks of Botkin's disease

Important! After the disease, lifelong immunity is maintained, that is, the body becomes immune to new infection by the virus.

Hepatitis E

The hepatitis E virus predominantly affects young people (14–30 years old). Its transmission mechanism is similar to the previous one, that is, infection of people occurs from those who excrete pathogens in feces, as well as through food and water. The causative agent is an RNA virus. The first symptoms appear within 2 months. The clinical picture occurs in three periods: pre-icteric, icteric, and recovery.

The first period is characterized by weakness, digestive disorders, an increase in temperature is observed less frequently than with hepatitis A. Aching pain appears on the right under the ribs, in the stomach area. The icteric period proceeds similarly to liver damage by the A-type virus. The disease is dangerous for pregnant women. If infected during pregnancy, women almost always lose their fetus.

Hepatitis B

This type of viral liver inflammation is considered dangerous due to severe complications such as fibrosis, cirrhosis and cancer. Every year more than 600 thousand patients die. The pathogen enters the human body as follows:

• transfusion of infected blood;
• contact of the patient’s blood with the mucous membranes or damaged skin of a healthy person;
• sexual transmission, especially for homosexuals;
• tattooing, performing manipulations, including medical ones, with poorly processed instruments;
• among drug addicts who use one syringe.

Important! If a woman becomes infected while pregnant, there is a high probability that the baby will be born with the disease.

The incubation period lasts from 2 to 6 months. The pre-icteric stage lasts several weeks. Usually patients do not even know that they are faced with a very serious problem. Only 10% of patients complain of joint pain, weakness, and skin manifestations in the form of rashes and spots. The period of jaundice continues for a month. The following problems arise:

• nausea;
• feeling of heaviness on the right under the ribs;
• bitterness in the mouth;
• itchy skin;
• the skin acquires a more yellow tint;
• the size of the liver and spleen increases.

The chronic form of the disease is mild or asymptomatic. Sometimes patients complain of increased fatigue, lack of appetite, sweating, drowsiness, and a feeling of bitterness in the mouth. Skin manifestations are characterized by the appearance of spider veins on the face, arms, and abdomen. The palms acquire a specific red tint.

Hepatitis C

This variant of liver inflammation is called the “gentle killer” and often occurs in a chronic form. Until the stage of cirrhosis, it may not even have manifestations, that is, recognizing the disease in the early stages is only possible if you undergo regular medical examinations. Previously, the infection was called “neither A, nor B” hepatitis. If a vaccine has been developed against hepatitis B, then scientists cannot accumulate the causative agents of hepatitis C outside the human body in order to create a similar means for prevention.

The virus is insidious due to its large number of variations

There are 6 known genotypes of the pathogen, each of which has a number of subtypes. If we talk about the European part of Russia, genotypes 1b and 3a predominate here. The first symptoms of the disease appear within 1.5–2 months. The acute phase of hepatitis C often goes undetected because it can be asymptomatic. Other patients turn to specialists with the following complaints:

• fatigue;
• decreased appetite;
• attacks of nausea;
• pain on the right side under the ribs;
• slight yellowness of the skin and sclera.

The acute phase of liver inflammation has two outcomes: recovery, transition to a chronic form. If a person becomes a chronic carrier of the virus, the disease subsides for many years, but at the same time the person is a source of infection for others. The duration of the remission phase depends on the patient’s lifestyle, nutritional principles, level of physical activity, drinking alcohol, taking hepatotoxic drugs, etc.

Statistics show that remission usually ends after 10–13 years, cirrhosis occurs after 15–20 years, and liver cancer develops after another 10 years. The numbers are disappointing, but the development of pathologies can be avoided. To do this, you must strictly follow the advice of specialists regarding nutrition, completely abstain from alcohol, take the necessary medications according to the regimen, visit specialists on time and undergo regular scheduled tests.

Cirrhosis

Chronic liver diseases include cirrhosis. This is a serious pathology, the causes of which are most often untreated viral hepatitis and alcohol abuse. The condition is characterized by the fact that a certain part of the gland cells dies, and in their place connective tissue appears, which cannot perform the function of the liver. The changes observed in cirrhosis affect the functioning of other vital organs, such as the pancreas. The outcome of the disease is disability, cancer and even death.

Cirrhosis is characterized by the following manifestations:

• increased body temperature;
• chills;
• hepato- and splenomegaly;
• unhealthy yellowness of the skin, sclera and mucous membranes;
• red “liver” palms;
• spider veins on the skin;
• changes in visual acuity;
• swelling;
• accumulation of fluid in the abdominal cavity (ascites).

Ascites is a manifestation of portal hypertension syndrome

The patient is bothered by aching pain in the right hypochondrium, in the pit of the stomach, on the left under the ribs and from the back if the pancreas is involved in the pathological process. Against the background of chronic pathology, the tongue becomes crimson, covered with a white coating (it is important to differentiate it from scarlet fever). Against the background of cirrhosis, disorders of the endocrine system develop. In women, the menstrual cycle disappears or is disrupted, infertility appears, and the size of the mammary glands increases.

Alcoholic liver disease

Cirrhosis, which develops against the background of alcohol abuse, is quite common. Drinking 100 ml of strong alcohol daily increases the risk of developing the disease by 20 times for men and 500 times for women. Of course, it is not necessary for cirrhosis to appear against the background of alcohol. Ethanol “hits” the weakest point in the body. For some it is the brain, for others it is the heart and blood vessels, for others it is the liver. But if the liver is damaged, problems with other internal organs will certainly occur.

What are the forms of alcoholic liver disease: alcoholic hepatitis, steatosis (fatty liver), cirrhosis. Against the background of any of these pathologies, a change in the patient’s mental state occurs. In parallel, the stomach and intestinal tract, blood vessels, kidneys, and endocrine apparatus are involved in the process. Progression of the disease leads to coma and death.

Tumors

Liver neoplasms can be benign or malignant. Cysts, adenomas, hemangiomas (vascular tumors), and nodular hyperplasia are considered benign. The most common are hemangiomas. They slowly increase in size and may have absolutely no effect on the functioning of the gland. The large size of the tumors causes a feeling of discomfort in the liver and stomach, and a feeling of pressure. Patients may complain of shortness of breath, hyperthermia, and jaundice of the skin.

Important! Tumors are surgical diseases of the liver, which are treated by hepatologists together with doctors from the surgery department.

Malignant processes can be primary, if the tumor appeared directly in the liver, and metastatic, when cancer cells entered the gland from another organ. Liver cancer can be suspected if the patient complains of weight loss for no apparent reason, abdominal pain, deterioration in general health, or increased jaundice.

Acute liver dystrophy

This is a terminal condition, which is characterized by disruption of all vital processes of the gland. The reasons for the development of acute dystrophy may be hepatitis A, severe intoxication of the body with chemicals, taking high doses of alcohol, using a number of medications, and poisoning with certain mushrooms.

The gland decreases in size, and a persistent ammonia odor appears from the patient’s body and mouth. Patients become emotionally unstable: attacks of excitement are replaced by apathy. Later a coma sets in. Only intensive therapy can help a sick person with acute hepatic dystrophy, but more often the prognosis is unfavorable.

How to diagnose problems?

Liver diseases in children and adults are confirmed by laboratory and instrumental diagnostics, which are prescribed after collecting a history of life and illness, as well as a complete visual examination and palpation of the right hypochondrium. Laboratory methods are based on:

• on the study of pigment metabolism (quantitative indicators of bilirubin fractions in the blood and urine);
• determining the level of bile acids in bile (increased numbers indicate a violation of the outflow of bile);
• study of quantitative indicators of proteins;
• analysis of the blood coagulation system (amount of prothrombin);
• determining the amount of liver cell enzymes in the blood (ALT, AST, alkaline phosphatase).

Blood biochemistry is based on the collection of biomaterial from a vein with further study of its composition

The table below shows the main diagnosed indicators, their norms and diseases for which an increase or decrease in numbers is observed. Diagnosis is carried out using a general blood test and biochemical analysis.

Indicators	Norms	Diseases with increasing numbers	Diseases with decreasing numbers
Bilirubin	3.5-20.5 µmol/l, in newborns up to 210 µmol/l	Jaundice due to poisoning, infections, oncology, cirrhosis	IHD, sometimes due to taking a number of medications
Direct fraction of bilirubin	0.5-1 µmol/l	Hepatitis, poisoning, tumors	-
Indirect bilirubin fraction	Up to 16.5 µmol/l	Hemolytic anemia, infectious diseases	-
Bile acids	Less than 10 µmol/l	Viral hepatitis, cirrhosis, alcoholic liver damage	-
Total protein	64-84 g/l	Oncology, dehydration, autoimmune processes	Cirrhosis, hepatitis
Prothrombin	78-142 %	-	Hepatitis, cirrhosis
ALT	28-190mmol/l	Cirrhosis, jaundice, oncology	Necrosis, cirrhosis
AST	28-125 mmol/l	Oncology, hepatitis	Necrosis, liver rupture
Alkaline phosphatase	Up to 270 U/l	Cirrhosis, necrosis, hepatitis	Diseases not related to liver pathologies

Viral hepatitis is confirmed by clarifying the presence of antigens to pathogens, and the presence of DNA or RNA viruses in the patient’s body is also determined.

Instrumental diagnostic methods:

• Ultrasound is a method that allows using ultrasound to clarify the presence of tumors, cysts and other formations. You can assess the state of blood flow, the size of the gland;
• CT and MRI are research methods that allow, using X-rays, as well as magnetic and radio waves, to evaluate the structure and condition of an organ, the presence of tumors, study sections, vascular patency, etc.;
• liver elastometry and fibrotest - a method that allows you to assess the degree of fibrotic changes;
• biopsy – is carried out to remove part of the gland tissue for further histological examination. Usually the process is controlled using ultrasound;
• scintigraphy – the condition of an organ is studied using radioactive isotopes; it is used less frequently than other research methods.

Diet and regimen

Nutrition correction and lifestyle changes are important conditions for rapid liver regeneration. The gland is capable of repairing itself, but it needs support in this. Experts recommend completely abstaining from alcohol, reducing the amount of carbohydrates in food, limiting baked goods, pasta, store-bought sauces, mushrooms, coffee and cocoa.

The treating specialist will tell you in more detail about correcting your diet.

You should avoid fried, smoked, canned, sour and spicy foods. Preference is given to stewed, boiled, steamed dishes. Every day you can eat vegetables, herbs, lean fish and meats, fermented milk products, fruits and cereals. Doctors also recommend giving up “eating on the go” and evening overeating. It is better to eat often, but in small portions. All these points, combined with a sedentary lifestyle, provoke the development of obesity.

Excess weight is a concomitant pathology that aggravates problems with the hepatobiliary system. The gland suffers first of all, since obesity causes steatosis (excess lipids accumulate in the cells of the organ) or, as the condition is also called, “fatty liver”. The addition of the inflammatory process leads to a gradual transition of the disease to fibrosis and cirrhosis.

Prevention of obesity involves daily dosed physical activity. There is no need to lift weights or run 3-5 kilometer runs several times a week. This will not bring the expected result. If you have liver diseases, you can do a light set of exercises, walk in the fresh air before bed, do swimming, and yoga.

Treatment

If your liver is sick, you don’t need to find out the names of effective drugs from relatives and friends who have similar problems. It is better to contact a qualified specialist to make a correct diagnosis. After all, depending on what problem the patient came with, the doctor will select the necessary treatment regimen.

Drugs

The most commonly used groups of medications for the treatment of liver diseases:

• Hepatoprotectors are a group whose representatives protect gland cells from negative influences, help restore hepatocyte membranes, and support the detoxification function of the organ. Hepatoprotectors have several subgroups.
• Vitamins are an essential part of therapy. Vitamin E, A or vitamin complexes (Aevit, Revit) are most often used.
• Choleretic agents are used to improve the outflow of bile by relaxing the walls of the gallbladder or, conversely, increasing its tone.
• Homeopathic medicines are not prescribed by every doctor, so if you wish, you should find a qualified homeopath.
• Antiviral - used for hepatitis.
• Anthelmintics - prescribed in case of damage to the gland by Giardia, Echinococcus, and Ascaris.

The correct combination of drugs allows you to achieve effective results

Other methods

Other methods are also used in the treatment of pathologies of the hepatobiliary system:

• tubage (blind probing);
• sets of physical exercises before probing;
• hirudotherapy;
• massage;
• acupressure.

Surgical methods are also used, including gland resection and organ transplantation.

Disease Prevention

Prevention of the development of pathologies consists of the following: compliance with technologies for processing hazardous waste, testing water and products for the absence of infection, avoiding alcohol abuse, proper nutrition and regimen. It is important to undergo periodic examinations, observe personal hygiene rules, and use condoms. At blood transfusion stations, standards for examining biomaterial must be observed; timely vaccination and treatment of gastrointestinal diseases are also necessary.