Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons.

There are many kinds of liver diseases:

• Diseases caused by viruses, such as hepatitis A, hepatitis B, and hepatitis C
• Diseases caused by drugs, poisons, or too much alcohol. Examples include fatty liver disease and cirrhosis.
• Liver cancer
• Inherited diseases, such as hemochromatosis and Wilson disease

Symptoms of liver disease can vary, but they often include swelling of the abdomen and legs, bruising easily, changes in the color of your stool and urine, and jaundice, or yellowing of the skin and eyes. Sometimes there are no symptoms. Tests such as imaging tests and liver function tests can check for liver damage and help to diagnose liver diseases.

The liver is one of the largest organs in your body. It has many important jobs. It's like a factory that makes vital substances (such as albumin and proteins that help with blood clotting). It cleanses the body of toxins (like alcohol) and bacteria. It produces bile that helps digest food. The healthy liver also gathers and stores important substances for your body to use later, such as sugar and vitamins.

The liver can perform these tasks because millions of cells work as a team around the clock. Everything that enters the body through the mouth is digested in the stomach and intestines. These raw materials then enter the liver factory through the bloodstream and the liver cells break them down, purify them, make useful products, and get rid of harmful products.

Liver disease is caused by damage to the liver. Liver damage can be caused by many things, including:

• Viruses (such as the hepatitis viruses)
• Drinking alcohol heavily
• Being very overweight
• Certain medications--for example, acetaminophen (Tylenol), can cause severe liver damage in people who also have heavy alcohol use
• Exposure to industrial chemicals, including cleaning solvents, aerosolized paints, and paint thinners

Liver damage can lead to livers that are swollen, shrunken, hard, or scarred. Such livers do not work well, and you can get very sick, or even die, if your liver stops working altogether.

Acute

If something happens to the liver suddenly, it is "acute." Some acute liver problems will cause symptoms suddenly as well. Symptoms of acute liver disease can include:

• Tiredness or weakness
• Jaundice (yellowing of the eyes and skin)
• Fever
• Nausea and vomiting
• Dark urine or very pale colored stools
• Pain under the ribs on the right side

Up to half of all people with acute liver disease have no symptoms at all. Some types of acute liver disease get better without treatment, and the liver heals itself entirely. On rare occasions an acute liver injury can require hospitalization and even liver transplant right away.

Chronic

If something is continuing to affect the liver over time, after 6 months it is "chronic." Many people with chronic liver problems will have no symptoms at all and may not even know they have a liver problem. Sometimes they develop symptoms only when the liver has been damaged for many years.

What is cirrhosis?

Cirrhosis is the term used to describe a severely scarred liver. Scar tissue forms in the liver when the liver is healing from an injury. For example, heavy alcohol use can cause the liver to become inflamed, which can result in scar tissue developing in the liver. When the injury to the liver is chronic and persistent, scar tissue builds up over time. Eventually, the scarring becomes so severe that the liver is considered "cirrhotic." A person with a severely scarred liver is considered to have cirrhosis.

The liver can have some scar tissue and still perform its usual functions: producing proteins for blood clotting, producing albumin for maintaining fluid balances, and breaking down toxins and medications. However, a cirrhotic liver eventually will be unable to function normally, and the person with cirrhosis will become ill.Many factors can cause cirrhosis, most commonly long-term, heavy alcohol use and chronic hepatitis B and hepatitis C infection.

How do I know if I have cirrhosis if I feel well?

In the early stages of cirrhosis, you may not have any symptoms. The only way to know for sure is to get examined by your provider. Early diagnosis of cirrhosis can help prevent symptoms from developing.

It's also important to see your provider if you do have symptoms. These can include fluid buildup in the belly, swelling in the lower legs, small spidery-veins on your skin, easy bruising, itching, or shortness of breath. Your provider might be able to diagnose cirrhosis during an office examination. Sometimes, however, it may require blood tests, abdominal ultrasound, or a CT scan.

If I have cirrhosis, is there anything I can do to reverse it?

Cirrhosis is generally not considered to be reversible. However, there are different degrees of cirrhosis. "Compensated" cirrhosis means that a patient has cirrhosis but no complications such as fluid in the abdomen (ascites), disorientation or confusion (hepatic encephalopathy), or bleeding in the stomach or esophagus (variceal bleeding). A patient is considered to have "decompensated" cirrhosis if any of these complications are present.

If you are in a compensated state of cirrhosis, there are ways you can delay progression to a decompensated state:

It is more difficult to go in the reverse direction--from a decompensated state to a compensated state.

• If you routinely drink alcohol, stop drinking.
• If you are overweight or obese, lose weight and exercise more.
• If you have hepatitis C or hepatitis B and are eligible for treatment, get started on medications to try to clear the virus.
• If you drink alcohol, stop completely and permanently. With time, you may reverse to a compensated state.

Don't you have to be a drinker to get cirrhosis?

No, cirrhosis can result from many things, not just heavy drinking. When something attacks and damages the liver, liver cells are killed and scar tissue is formed. When the whole liver is scarred, it shrinks, hardens, and can stop working properly. This is called cirrhosis. Cirrhosis is the most severe stage of liver damage.

Heavy drinking is certainly one cause, but any condition or illness that affects the liver over a long period of time eventually could lead to cirrhosis. That includes hepatitis B, hepatitis C, non-alcoholic steatohepatitis, autoimmune hepatitis, primary biliary cirrhosis (PBC), and other diseases. Some people have more than one of these conditions (for example, alcohol use plus hepatitis B infection). Sometimes those combinations will speed up the development of cirrhosis.

If you have cirrhosis, won't you look yellow?

Cirrhosis is advanced scarring (fibrosis) in the liver. Many people who develop cirrhosis show no signs at all--they look exactly the same as they did before. For some people with cirrhosis, the scarring in the liver causes a buildup of bile and increases the level of bilirubin (a brownish-yellow substance found in bile) in the bloodstream. High bilirubin levels can make the skin appear yellow. So, although the skin of some people with cirrhosis may turn yellow, it does not happen to most people.

It is also important to know that a yellowish skin tone may be caused by cirrhosis, but it also could be caused by a different illness such as pancreatic cancer or colon cancer that has spread to the liver.

If you have cirrhosis, are there any medications you need to avoid?

Acetaminophen (Tylenol) is considered safe in limited doses (a maximum of 2,000 mg, or 2 grams, every 24 hours) and some experts recommend limiting Tylenol to 1,000 mg (1 gram) per day.

Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, naproxen, diclofenac, and piroxicam, should be avoided. These can cause reduced kidney function in patients with cirrhosis. Do not take these without first consulting your provider.

Iron supplements, in general, should be avoided. If you take a multivitamin, it should not contain iron.

There are many other medications with potential for causing liver injury, including certain antibiotics, high blood pressure medications, diabetes medications, hormones, and antiretrovirals. Patients who already have cirrhosis should be particularly cautious when starting to use them. Before taking any new medication--whether prescription or over-the-counter or herbal--discuss it with your health care provider.

Of course, the most important substance to avoid when you have cirrhosis is alcohol.

If you have cirrhosis from hepatitis C, are there certain tests that you need to have?

If you have cirrhosis, you should:

1. Get screened for liver cancer (hepatocellular carcinoma). Screening involves an ultrasound of the abdomen every 6 months.
2. Get tested for the presence of abnormal blood vessels in the esophagus or stomach that can lead to bleeding. These are called varices. Typically, this involves an EGD (upper GI endoscopy) procedure and it is recommended this test be done, on average, every 2 years.
3. Get blood tests 2-3 times per year to evaluate how your liver is doing. Typically, this involves blood cell counts, blood clotting measurements, liver enzyme tests, and tests of kidney function.
4. Have your MELD score calculated. Your provider can calculate this using the results of your blood tests. The MELD score represents the severity of your liver disease.

Rena K. Fox, MD

The word "hepatitis" means inflammation or swelling of the liver. Hepatitis is often caused by a virus (such as hepatitis A, hepatitis B, and hepatitis C), but the inflammation can also be triggered by medications, alcohol, and even some genetic diseases. (Genetic diseases are ones that are passed down from your biological parents.)

Sometimes liver inflammation gets better on its own, but sometimes treatment with medications is required to stop the inflammation.

If you have hepatitis, you need to be very careful not to do things that might irritate your liver even more. Alcohol irritates the liver, even in someone who doesn't have any other liver problems.

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Hepatitis is an inflammation of the liver. One type, hepatitis A, is caused by the hepatitis A virus (HAV). The disease spreads through contact with an infected person's stool. You can get it from

• Eating food made by an infected person who did not wash their hands after using the bathroom
• Drinking untreated water or eating food washed in untreated water
• Putting into your mouth a finger or object that came into contact with an infected person's stool
• Having close contact with an infected person, such as through sex or caring for someone who is ill

Most people do not have any symptoms. If you do have symptoms, you may feel as if you have the flu. You may also have yellowish eyes and skin, called jaundice. A blood test will show if you have HAV.

HAV usually gets better in a few weeks without treatment. However, some people can have symptoms for up to 6 months. Your doctor may suggest medicines to help relieve your symptoms.

The hepatitis A vaccine can prevent HAV. Good hygiene can also help. Wash your hands thoroughly before preparing food, after using the toilet, or after changing a diaper. International travelers should be careful about drinking tap water.

What is hepatitis?

Hepatitis is inflammation of the liver. Inflammation is swelling that happens when tissues of the body are injured or infected. It can damage your liver. This swelling and damage can affect how well your liver functions.

What is hepatitis B?

Hepatitis B is a type of viral hepatitis. It can cause an acute (short-term) or chronic (long-term) infection. People with an acute infection usually get better on their own without treatment. Some people with chronic hepatitis B will need treatment.

Thanks to a vaccine, hepatitis B is not very common in the United States. It is more common in certain parts of the world, such as sub-Saharan Africa and parts of Asia.

What causes hepatitis B?

Hepatitis B is caused by the hepatitis B virus. The virus spreads through contact with blood, semen, or other body fluids from a person who has the virus.

Who is at risk for hepatitis B?

Anyone can get hepatitis B, but the risk is higher in

• Infants born to mothers who have hepatitis B
• People who inject drugs or share needles, syringes, and other types of drug equipment
• Sex partners of people with hepatitis B, especially if they are not using latex or polyurethane condoms during sex
• Men who have sex with men
• People who live with someone who has hepatitis B, especially if they use the same razor, toothbrush, or nail clippers
• Health care and public-safety workers who are exposed to blood on the job
• Hemodialysis patients
• People who have lived in or traveled often to parts of the world where hepatitis B is common
• Have diabetes, hepatitis C, or HIV

What are the symptoms of hepatitis B?

Often, people with hepatitis B don't have symptoms. Adults and children over 5 are more likely to have symptoms than younger children.

Some people with acute hepatitis B have symptoms 2 to 5 months after infection. These symptoms can include

• Dark yellow urine
• Diarrhea
• Fatigue
• Fever
• Gray- or clay-colored stools
• Joint pain
• Loss of appetite
• Nausea and/or vomiting
• Abdominal pain
• Yellowish eyes and skin, called jaundice

If you have chronic hepatitis B, you may not have symptoms until complications develop. This could be decades after you were infected. For this reason, hepatitis B screening is important, even if you have no symptoms. Screening means that you are tested for a disease even though you don't have symptoms. If you are at high risk, your health care provider may suggest screening.

What other problems can hepatitis B cause?

In rare cases, acute hepatitis B can cause liver failure.

Chronic hepatitis B can develop into a serious disease that causes long-term health problems such as cirrhosis (scarring of the liver), liver cancer, and liver failure.

If you have ever had hepatitis B, the virus may become active again, or reactivated, later in life. This could start to damage the liver and cause symptoms.

How is hepatitis B diagnosed?

To diagnose hepatitis B, your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• Blood tests, including tests for viral hepatitis

What are the treatments for hepatitis B?

If you have acute hepatitis B, you probably don't need treatment. Some people with chronic hepatitis B don't need treatment. But if you have a chronic infection and blood tests show that hepatitis B could be damaging your liver, you may need to take antiviral medicines.

Can hepatitis B be prevented?

The best way to prevent hepatitis B is to get the hepatitis B vaccine.

You can also reduce your chance of hepatitis B infection by

• Not sharing drug needles or other drug materials
• Wearing gloves if you have to touch another person's blood or open sores
• Making sure your tattoo artist or body piercer uses sterile tools
• Not sharing personal items, such as toothbrushes, razors, or nail clippers
• Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

If you think you have been in contact with the hepatitis B virus, see your health care provider right away. Your provider may give you a dose of the hepatitis B vaccine to prevent infection. In some cases, your provider may also give you a medicine called hepatitis B immune globulin (HBIG). You need to get the vaccine and the HBIG (if needed) as soon as possible after coming into contact with the virus. It is best if you can get them within 24 hours.

What is hepatitis C?

Hepatitis is inflammation of the liver. Inflammation is swelling that happens when tissues of the body are injured or infected. Inflammation can damage organs.

There are different types of hepatitis. One type, hepatitis C, is caused by the hepatitis C virus (HCV). Hepatitis C can range from a mild illness lasting a few weeks to a serious, lifelong illness.

Hepatitis C can be acute or chronic:

• Acute hepatitis C is a short-term infection. The symptoms can last up to 6 months. Sometimes your body is able to fight off the infection and the virus goes away. But for most people, an acute infection leads to chronic infection.
• Chronic hepatitis C is a long-lasting infection. If it is not treated, it can last for a lifetime and cause serious health problems, including liver damage, cirrhosis (scarring of the liver), liver cancer, and even death.

How is hepatitis C spread?

Hepatitis C spreads through contact with the blood of someone who has HCV. This contact may be through:

• Sharing drug needles or other drug materials with someone who has HCV. In the United States, this is the most common way that people get hepatitis C.
• Getting an accidental stick with a needle that was used on someone who has HCV. This can happen in health care settings.
• Being tattooed or pierced with tools or inks that were not sterilized after being used on someone who has HCV
• Having contact with the blood or open sores of someone who has HCV
• Sharing personal care items that may have come in contact with another person's blood, such as razors or toothbrushes
• Being born to a mother with HCV
• Having unprotected sex with someone who has HCV

Before 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants. Since then, there has been routine testing of the U.S. blood supply for HCV. It is now very rare for someone to get HCV this way.

Who is at risk for hepatitis C?

You are more likely to get hepatitis C if you:

• Have injected drugs
• Had a blood transfusion or organ transplant before July 1992
• Have hemophilia and received clotting factor before 1987
• Have been on kidney dialysis
• Were born between 1945 and 1965
• Have abnormal liver tests or liver disease
• Have been in contact with blood or infected needles at work
• Have had tattoos or body piercings
• Have worked or lived in a prison
• Were born to a mother with hepatitis C
• Have HIV/AIDS
• Have had more than one sex partner in the last 6 months
• Have had a sexually transmitted disease
• Are a man who has had sex with men

If you are at high risk for hepatitis C, your health care provider will likely recommend that you get tested for it.

What are the symptoms of hepatitis C?

Most people with hepatitis C have no symptoms. Some people with acute hepatitis C do have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may include:

• Dark yellow urine
• Fatigue
• Fever
• Gray- or clay-colored stools
• Joint pain
• Loss of appetite
• Nausea and/or vomiting
• Pain in your abdomen
• Jaundice (yellowish eyes and skin)

If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.

What other problems can hepatitis C cause?

Without treatment, hepatitis C may lead to cirrhosis, liver failure, and liver cancer. Early diagnosis and treatment of hepatitis C can prevent these complications.

How is hepatitis C diagnosed?

Health care providers diagnose hepatitis C based on your medical history, a physical exam, and blood tests.

If you do have hepatitis C, you may need additional tests to check for liver damage. These tests may include other blood tests, an ultrasound of the liver, and a liver biopsy.

What are the treatments for hepatitis C?

Treatment for hepatitis C is with antiviral medicines. They can cure the disease in most cases.

If you have acute hepatitis C, your health care provider may wait to see if your infection becomes chronic before starting treatment.

If your hepatitis C causes cirrhosis, you should see a doctor who specializes in liver diseases. Treatments for health problems related to cirrhosis include medicines, surgery, and other medical procedures. If your hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.

Can hepatitis C be prevented?

There is no vaccine for hepatitis C. But you can help protect yourself from hepatitis C infection by:

• Not sharing drug needles or other drug materials
• Wearing gloves if you have to touch another person's blood or open sores
• Making sure your tattoo artist or body piercer uses sterile tools and unopened ink
• Not sharing personal items such toothbrushes, razors, or nail clippers
• Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

Hepatitis D is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.

Viruses invade normal cells in your body. Many viruses cause infections that can spread from person to person.

The hepatitis D virus is unusual because it can only infect you when you also have a hepatitis B virus infection. In this way, hepatitis D is a double infection. You can protect yourself from hepatitis D by protecting yourself from hepatitis B by getting the hepatitis B vaccine.

Hepatitis D spreads the same way that hepatitis B spreads, through contact with an infected person’s blood or other body fluids.

The hepatitis D virus can cause an acute or chronic infection, or both.

Acute hepatitis D

Acute hepatitis D is a short-term infection. The symptoms of acute hepatitis D are the same as the symptoms of any type of hepatitis and are often more severe. Sometimes your body is able to fight off the infection and the virus goes away.

Chronic hepatitis D

Chronic hepatitis D is a long-lasting infection. Chronic hepatitis D occurs when your body is not able to fight off the virus and the virus does not go away. People who have chronic hepatitis B and D develop complications more often and more quickly than people who have chronic hepatitis B alone.

Hepatitis E is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.

Viruses invade normal cells in your body. The hepatitis E virus has different types that spread in different ways.

• Some types are spread by drinking contaminated water. These types are more common in developing countries, including parts of Africa, Asia, Central America, and the Middle East.
• Other types are spread by eating undercooked pork or wild game, such as deer. These types are more common in developed countries, such as the United States, Australia, Japan, and parts of Europe and East Asia.

Hepatitis E typically causes acute, or short-term, infection.

Acute hepatitis E

Acute hepatitis E is a short-term infection. In most cases, people’s bodies are able to recover and fight off the infection and the virus goes away. People usually get better without treatment after several weeks.

Chronic hepatitis E

Chronic hepatitis E is a long-lasting infection that occurs when your body isn’t able to fight off the virus and the virus does not go away. Chronic hepatitis E is rare and only occurs in people with weakened immune systems. For example, hepatitis E may become chronic in people taking medicines that weaken their immune system after an organ transplant, or in people who have HIV or AIDS.

Aside from viral hepatitis, the most common liver problems in the United States are:

• Alcoholic liver disease
• Non-alcoholic fatty liver disease

Some genetic disorders cause the liver to build up toxic substances. These include:

• Hemochromatosis (too much iron)
• Wilson's disease (too much copper)

Other less common liver diseases include:

• Autoimmune hepatitis (the body attacks its own liver cells)
• Primary sclerosing cholangitis (the liver's large bile ducts become blocked, leading to infection, jaundice, and eventual cirrhosis)
• Primary biliary cirrhosis (liver's small bile ducts become inflamed and bile backs up, leading to itchy skin, jaundice, and eventual cirrhosis)

Alcoholic fatty liver disease is due to heavy alcohol use. Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can generate harmful substances. These substances can damage liver cells, promote inflammation, and weaken your body's natural defenses. The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Fatty liver disease is a condition in which fat builds up in your liver. There are two main types:

• Nonalcoholic fatty liver disease (NAFLD)
• Alcoholic fatty liver disease, also called alcoholic steatohepatitis

Jaundice causes your skin and the whites of your eyes to turn yellow. Too much bilirubin causes jaundice. Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in your red blood cells. As red blood cells break down, your body builds new cells to replace them. The old ones are processed by the liver. If the liver cannot handle the blood cells as they break down, bilirubin builds up in the body and your skin may look yellow.

Many healthy babies have some jaundice during the first week of life. It usually goes away. However, jaundice can happen at any age and may be a sign of a problem. Jaundice can happen for many reasons, such as

• Blood diseases
• Genetic syndromes
• Liver diseases, such as hepatitis or cirrhosis
• Blockage of bile ducts
• Infections
• Medicines

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Primary liver cancer starts in the liver. Metastatic liver cancer starts somewhere else and spreads to your liver.

Risk factors for primary liver cancer include

• Having hepatitis B or C
• Heavy alcohol use
• Having cirrhosis, or scarring of the liver
• Having hemochromatosis, an iron storage disease
• Obesity and diabetes

Symptoms can include a lump or pain on the right side of your abdomen and yellowing of the skin. However, you may not have symptoms until the cancer is advanced. This makes it harder to treat. Doctors use tests that examine the liver and the blood to diagnose liver cancer. Treatment options include surgery, radiation, chemotherapy, or liver transplantation.

Nonalcoholic fatty liver disease (NAFLD) is a condition in which excess fat is stored in your liver. This buildup of fat is not caused by heavy alcohol use. When heavy alcohol use causes fat to build up in the liver, this condition is called alcohol-associated liver disease.

Two types of NAFLD are nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). People typically develop one type of NAFLD or the other, although sometimes people with one form are later diagnosed with the other form of NAFLD.

NAFL

NAFL is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver damage. NAFL typically does not progress to cause liver damage or complications. However, NAFL can cause pain from enlargement of the liver.

NASH

NASH is the form of NAFLD in which you have inflammation of the liver and liver damage, in addition to fat in your liver. The inflammation and liver damage of NASH can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis, in which the liver is scarred and permanently damaged. Cirrhosis can lead to liver cancer.

Experts are not sure why some people with NAFLD have NASH while others have NAFL.

Reye syndrome is a rare illness that can affect the blood, liver, and brain of someone who has recently had a viral infection. It always follows another illness. Although it mostly affects children and teens, anyone can get it. It can develop quickly and without warning. It is most common during flu season. Symptoms include

• Nausea and vomiting
• Listlessness
• Personality change - such as irritability, combativeness or confusion
• Delirium
• Convulsions
• Loss of consciousness

If these symptoms occur soon after a viral illness, seek medical attention immediately. Reye syndrome can lead to a coma and brain death, so quick diagnosis and treatment are critical. Treatment focuses on preventing brain damage. There is no cure.

The cause of Reye syndrome is unknown. Studies have shown that taking aspirin increases the risk of getting it. Because of that, health care professionals now recommend other pain relievers for young patients.

Wilson disease is a rare inherited disorder that prevents your body from getting rid of extra copper. You need a small amount of copper from food to stay healthy. Too much copper is poisonous.

Normally, your liver releases extra copper into bile, a digestive fluid. With Wilson disease, the copper builds up in your liver, and it releases the copper directly into your bloodstream. This can cause damage to your brain, kidneys, and eyes.

Wilson disease is present at birth, but symptoms usually start between ages 5 and 35. It first attacks the liver, the central nervous system or both. The most characteristic sign is a rusty brown ring around the cornea of the eye. A physical exam and laboratory tests can diagnose it.

Treatment is with drugs to remove the extra copper from your body. You need to take medicine and follow a low-copper diet for the rest of your life. Don't eat shellfish or liver, as these foods may contain high levels of copper. At the beginning of treatment, you'll also need to avoid chocolate, mushrooms, and nuts. Have your drinking water checked for copper content and don't take multivitamins that contain copper.

With early detection and proper treatment, you can enjoy good health.

Most people with chronic liver disease will have no ongoing symptoms, and the damage will be detected only by blood tests. The tests (called a "liver panel") measure:

• your level of liver enzymes (see next section)
• your level of bilirubin (pronounced "billy-roo-bin"), which rises when the liver is not working well
• a protein called albumin (pronounced "al-byoo-min"), whose levels go down when the liver is damaged

Your provider can run more blood tests if needed in order to find out what is causing the damage to your liver.

Ultrasound, CAT scans, and MRI are the 3 main methods of taking pictures of the liver. They can often show if the liver injury has become serious.

Fibroscan is a non-invasive procedure. It may be requested by your provider to assess the amount of fibrosis or scarring in the liver. In some situations, a liver biopsy may be needed to identify the cause of liver damage. A liver biopsy is a medical procedure in which a doctor uses a special needle to remove a small piece of tissue in order to check for signs and identify a causes for the liver damage. A liver biopsy isn't necessary with many types of liver disease. If your doctor does recommend it, it will be helpful in learning more about your liver's health and guiding treatment.

Some people with liver problems can have a swollen liver. Others may have severe scarring or a shrunken liver. During an examination, your doctor can feel the liver to find out if it is shrunken, hard, or swollen.

Liver enzymes

Enzymes are proteins found in your body that speed up certain chemical reactions. Liver enzymes perform these jobs within the liver. Two of the common ones are known as "AST" and "ALT."

If the liver is damaged, AST and ALT pass into the bloodstream. When your provider looks at the results from your blood tests, AST and ALT values are higher than normal if your liver is damaged.

The damage to the liver can come from viruses, such as the hepatitis C virus, over-the-counter drugs, and prescription and street drugs. If your provider starts you on a certain medication, they may need to monitor your blood chemistries to make sure the medication is not causing further harm to your liver.

Results of liver enzyme tests

Low level of liver enzymes in blood:

• Usually, this means the liver is healthy. However, a patient may have normal liver enzymes levels but still have liver damage.

Higher than normal level of liver enzymes in blood:

• This can mean the liver is unhealthy. Patients also can have higher than normal liver enzyme levels related to problems in other organs, such as their bile ducts.