Douglas R. LaBrecque, MD, Professor of Internal Medicine
University of Iowa Hospitals and Clinics
Creation Date: May 2001
Last Revision Date: May 2001
Peer Review Status: Internally Peer Reviewed
Moderator: Dr. LaBrecque is associated with University of Iowa Health Care, where
he is a hepatologist, a professor, and Director of Liver Services in the Department
of Internal Medicine.
What are some of the symptoms of liver disease?
The most important thing to recognize about liver disease is that up to 50
percent of individuals with underlying liver disease have no symptoms. The most
common symptoms are very non-specific and they include fatigue or excessive
tiredness, lack of drive, occasionally itching. Signs of liver disease that
are more prominent are jaundice or yellowing of the eyes and skin, dark urine,
very pale or light colored stool or bowel movements, bleeding from the GI tract,
mental confusion, and retention of fluids in the abdomen or belly.
What quantity of alcohol usage should be seen as being a risk to the liver?
First, it should be understood that alcohol is a poison. Any amount of alcohol
can produce damage to the liver. In an otherwise healthy person with no underlying
liver problems, the general rule of thumb is different for men and women. Men
metabolize and are able to clear alcohol more efficiently than women due to
body size, body fat and certain enzymes. Because of this the maximum "safe"
daily intake of alcohol for a woman is 1 - 2 drink per day; for the male it
is 3 - 4 over a 24-hour period. It is also important to recognize the body and
the liver in particular does not distinguish between different forms of alcohol.
Beer and wine are not "safer" than whiskey or spirits. One drink is defined
as one shot (1 and 1/4 ounces) of whiskey or spirits, one four-ounce can of
wine or one 12-ounce can of beer. If an individual has an underlying liver condition
such as hepatitis B or C, or prior damage from alcohol or other diseases, the
liver is very sensitive to any amount of alcohol. In those conditions, the only
safe dose of alcohol is zero.
Can liver damage be reversed?
The liver is a unique organ. It is the only organ in the body that is able
to regenerate... that is completely repair the damage. With most organs, such
as the heart, the damaged tissue is replaced with scar, like on the skin. The
liver, however, is able to replace damaged tissue with new cells. An extreme
example is a patient who suffers an overdose from Tylenol. In this example up
to 50 - 60 percent of the liver cells may be killed within 3 - 4 days. However,
if no other complications arise, the patient's liver will repair completely,
and a liver biopsy after 30 days will appear completely normal with no signs
of damage and no scar. However, the long-term complications of liver disease
occur when regeneration is either incomplete or prevented by progressive development
of scar tissue within the liver. This occurs when the damaging agent such as
a virus, a drug, alcohol, etc., continues to attack the liver and prevents complete
regeneration. Once scar tissue has developed it is very difficult to reverse
that process. Severe scarring of the liver is the condition known as cirrhosis.
The development of cirrhosis indicates late stage liver disease and is usually
followed by the onset of complications.
How necessary is it to inform employers about HCV status?
Hepatitis C virus-positive patients face a number of difficulties due to the
unfortunate stigma that is attached to this carrier status. Transmission or
passing of this virus to others requires that they be exposed to the HCV positive
individual's blood or bodily fluid. In most occupations this is not a risk and
can be avoided by common sense. In situations where there is a risk of exposure
due to trauma, due to use of needles or knives or other situations of this sort,
it is probably best and most appropriate to let the employer know. In most situations
including the health care field, this is not a reason to not employ the individuals.
Local laws may vary and this needs to be checked locally. If one does inadvertently
expose one to blood or bodily fluid, there would be a moral obligation to let
the other individual know.
I know alcoholism damages the liver, what other toxic substances are there
that will do damage?
The most common agent is probably acetaminophen (Tylenol although it is contained
in many OTC medications). It probably remains the safest medication for fevers,
aches and pains, but only taken in small recommended amounts. Large amounts,
greater than those recommended, can result in liver damage or failure. Acetaminophen
overdose is a common reason for considering a transplant. A more serious problem,
however, occurs in patients who drink alcohol on a daily basis, particularly
more than 2 drinks, in those situations, normal doses of Tylenol 3 - 4 times
a day can produce severe liver damage. The same problem can occur in patients
with the other liver diseases such as viral hepatitis. Additionally more common
toxins tend to be those that are inhaled, such as cleaning solvents, aerosolized
paints, thinners, etc. Again, these are more dangerous if there is a preexisting
underlying liver condition.
What causes hepatitis?
Hepatitis is a generic term. It indicates inflammation and damage to liver
cells. This damage can be caused by drugs, toxins, alcohol, inherited diseases,
certain metabolic diseases and viruses. Commonly, however, hepatitis refers
to viral hepatitis. There are a wide variety of viruses that can cause hepatitis,
but again most commonly the term refers to the viruses designated A, B, C, D,
E, and G. In the United States, the most common causes are hepatitis A, B, and
C. There are over 4 million chronic carriers of hepatitis C in the US. And almost
one and a half million carriers of hepatitis D. Almost 15,000 individuals die
from viral hepatitis in the U.S. Hepatitis C is the commonest reason for liver
transplant in the U.S.
My 5 year-old son has severe ADHD and OCD. He can't take Ritalin and etc.,
so his psychiatrist has him on Tenex. Can this drug damage his liver?
This is outside the realm of my expertise.
I have a husband who drinks everyday. How long can he go on drinking and
have it effect his liver?
The largest risk factor for liver disease from alcohol is the amount and the
length of time the individual has been drinking. Males often develop complications
that appear to be on a gender basis as well. Each individual is entirely different.
Complication can develop after 5 - 10 years, more commonly it takes 20 - 30
years. Many individuals appear to never develop end stage liver disease from
alcohol. This is impossible to predict ahead of time. And many other factors
such as other diseases, hepatitis C, exposure to other toxins, as well as the
individual's own genetic make-up play a role.
I took Rezulin and Lipitor. Also, my liver enzymes are up to 68.
Rezulin was removed from the market because a small number of patients developed
serious liver damage. It does not produce chronic problems and should not produce
abnormal enzymes once the drug is discontinued. Lipitor can produce liver enzyme
abnormalities in a small number of patients. This is something that should be
reviewed with your primary care physician. Especially if the enzymes were previously
How important are hepatitis vaccines?
There are vaccines to prevent hepatitis A and B. Hepatitis B is a disease that
could be completely eradicated with universal vaccination. It is now one part
of the newborn vaccination series. Attempts are ongoing to vaccinate all children
by the time they reach junior high age. Adults who are in high-risk occupations
such as the health care field or carry out high-risk activities, such as IV
drug use and multiple sexual partners should also be vaccinated. Hepatitis A
vaccine is recommended in a number of child-care settings and should be discussed
with your pediatrician. Adults or children traveling to areas of the world where
hepatitis A is very common, including all underdeveloped or poorly developed
countries, should be vaccinated before they go. Any individual with underlying
chronic liver disease that is not due to hepatitis B, particular those with
hepatitis C or cirrhosis should be vaccinated against both Hepatitis A and Hepatitis
B, unless they are already immune.
What are the symptoms of liver damage caused by Rezulin?
The symptoms are the same as they are for any other hepatitis.
Is hepatitis C caused only by an exchange of bodily fluid?
The majority of patients with hepatitis C are found to have a risk factor such
as needle exposure, blood exposure, tattooing, body piercing or sexual exposure
which would allow for an exchange of blood or bodily fluids. Depending on the
study, a small percentage of patients, ranging from 5 to 30 percent have no
identifiable risk factor. Presumably, they acquired the disease through inadvertent
exposure. Up to 50 percent of patients with hepatitis C have no symptoms. A
larger percentage do not know they are carrying the virus. There are many opportunities
for inadvertent exposure such as sharing a razor, sharing a toothbrush, sharing
scissor for cutting hair or manicure tools, etc.