General Information on Liver Disease

How the Liver Works
Weighing about three pounds, the liver is the second largest organ in the body--only the skin takes up more room. The liver is divided into lobes that contain liver cells and passageways for blood circulation, called sinusoids. It is within the lobules that the specialized liver cells transform chemical substances into nutrients the body can use or neutralizes potential toxins to protect the body from damage.

Because the liver plays a major role in the circulation and the composition of blood, its health has an impact on all body systems, from hormone regulation to thinking.

Liver Disease
The six most common causes of chronic liver disease in the United States are alcohol, hepatitis viruses (especially hepatitis B and C), fatty liver, medications and hemochromatosis (too much iron in the liver).

Other causes of liver disease and cirrhosis include autoimmune hepatitis (condition in which a patient's immune cells attack the liver); primary biliary cirrhosis (an autoimmune disease in which the bile tubes that drain bile from the liver are attacked); primary sclerosing cholangitis (a disease in which the bile tubes become blocked); alpha-1 antitrypsin deficiency (this enzyme protects the lung from destruction) and Wilson's disease (too much copper in the liver).

Terminology
The liver is a factory and filter system. Two categories of blood tests are used to analyze the activity of this system and determine how a patient's liver is working:

  • Liver enzymes: AST (SGOT), ALT (SGPT), Alkaline Phosphatase, GammaGT all indicate liver injury or inflammation. These tests do not indicate bad function.
  • Liver function tests: Protime or INR (a clotting test), cholesterol, albumin (a protein in the blood), bilirubin (the substance that makes a person yellow) all indicate a problem with the liver function if abnormal.

Medications and Alcohol
If you have liver disease you should not drink alcohol (less is better, none is the best). Pain relievers such as Tylenol™ (acetaminophen) is safe if you take less than six 325 mg tablets each day (2 gms). Ibuprofen is safe if you have no ulcers, cirrhosis and normal kidneys. Do not use nasal decongestants/antihistamines such as terfenidine(Seldane) and astimazole (Hismanal) if cirrhosis is present. Patients who are taking the medications: 1) Isoniazid, 2) Voltaren, 3) valproic acid or 4) Flutamide must undergo liver enzyme testing at 1 and 3 months of therapy.

Diet
Patients with liver disease should monitor their diet, especially if cirrhosis is present. If you do not have cirrhosis, a low fat, low cholesterol, low sodium diet is advised. Patients should watch their diet to maintain an ideal body weight (overweight patients have too much fat in their liver and may develop liver damage from fat.

If you have cirrhosis, an 80-100-gram protein diet is advised, with most protein coming from vegetable sources such as soybeans or beans; white meat (fish or chicken). Red meat should be avoided. Five meals per day are recommended, with an emphasis on complex carbohydrates such as rice, potatoes, pasta and bread.

Vaccines
Because patients with liver disease are at increased risk of acquiring infections and having a more severe disease if infection occurs, it is necessary to discuss the need for vaccines with your doctors. Inquire about vaccination for hepatitis B, hepatitis A and pneumonia.