The liver is a large and powerful organ that performs hundreds of essential functions in the human body. One of the liver's most important functions is to filter toxins from the blood. While the liver is well suited for this job, as a filter, it is vulnerable to toxins. Too many toxins can overwhelm the liver's resources and functions.

About 1.8% of American adults (4.5 million adults) have liver disease. About 57,000 Americans die from liver disease each year. Globally, liver disease causes about 2 million deaths each year, accounting for 4% of all deaths. Most deaths come from complications of cirrhosis, of which acute liver failure accounts for a small proportion. Men and people assigned male at birth (AMAB) are twice as likely to develop liver disease as women and people assigned female at birth (AFAB).

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Chronic liver disease develops in four broad stages:

Stage 1: Hepatitis

Hepatitis is inflammation of the liver tissue. Inflammation is the liver's response to injury or toxicity. It tries to clear the infection and start the healing process. Acute hepatitis (an immediate and temporary response) usually accomplishes this. But when damage or toxicity persists, so does inflammation. Chronic hepatitis can lead to excessive healing, which eventually results in scarring (fibrosis).

Stage 2: Fibrosis

Fibrosis is the gradual stiffening of the liver as thin bands of scar tissue build up. Scar tissue reduces blood flow to the liver, which reduces the liver's access to oxygen and nutrients. This is why the vitality of the liver begins to decline gradually. It's important to note that some degree of fibrosis is reversible. If the damage is slowed enough to recover, liver cells can regenerate and scarring will decrease.

Stage 3: Cirrhosis

Cirrhosis is severe, permanent scarring in the liver. This is the stage of fibrosis that is irreversible. When the liver no longer has enough healthy cells to work with, its tissue can no longer regenerate. But you can still slow or stop the damage at this stage. Cirrhosis will begin to affect your liver function, but your body will try to make up for the loss, so you may not notice at first.

Stage 4: Liver Failure

Liver failure occurs when the liver can no longer adequately meet the body's needs. This is also called "decompensated cirrhosis"—your body can no longer compensate for the loss. As liver function begins to decline, you'll start to feel the effects throughout your body. Chronic liver failure is a gradual process, but it's ultimately fatal without a liver transplant. You need a liver to survive.

What are the first signs and symptoms of liver disease?

Chronic liver disease often causes no symptoms in the early stages. But sometimes it starts with an acute attack of hepatitis. For example, if you have viral hepatitis, there's an acute phase before it goes into the chronic phase. You might have a short fever, stomach pain, or nausea while your immune system works to fight the infection. If it can't fight the infection, it becomes a chronic infection.

Some other causes of liver disease may also start with more acute symptoms, or have acute symptoms only occasionally. Early symptoms of liver disease are often not obvious. They may include:

• Pain in the upper abdomen.
• Nausea or loss of appetite.
• Fatigue and malaise (feeling tired and unwell).

What are the signs and symptoms of advanced liver disease?

You may start to notice more symptoms when your liver function begins to decline. This happens in the later stages of liver disease. One of the first side effects of decreased liver function is a stagnation of bile flow in your bile ducts. Your liver no longer effectively produces or delivers bile to your small intestine. Instead, bile begins to seep into your bloodstream. This causes specific symptoms, including:

• Jaundice (a yellow tint to the whites of your eyes and skin).
• Dark urine.
• Light-colored stools.
• Difficulty digesting food, especially fat.
• Weight loss and muscle loss.
• A musty taste in your mouth.
• Mild brain damage (hepatic encephalopathy).
• Pruritus (itchy skin without a noticeable rash).

What are the causes of liver disease?

There are more than 100 types of liver disease, but they are divided into several subtypes. Causes include:

• Viral infections. Chronic viral hepatitis infections can lead to chronic hepatitis, including hepatitis B and hepatitis C.
• Alcoholic hepatitis. Alcohol abuse can lead to acute or chronic hepatitis. Over time, it can lead to cirrhosis and liver failure.
• Toxic hepatitis. Long-term overexposure to toxins, such as industrial chemicals or drugs, can lead to acute or chronic hepatitis.
• Nonalcoholic fatty liver disease. Metabolic conditions associated with obesity, high blood sugar, and high blood lipids can cause excess fat to be stored in the liver, which can cause inflammation (nonalcoholic steatohepatitis).
• Cholestasis. Congenital (present at birth) conditions that block or prevent bile from flowing through the bile ducts can cause bile to build up and damage the liver, including biliary atresia and cystic fibrosis. Noncongenital causes include bile duct strictures and gallstones.
• Autoimmune disorders. Autoimmune disorders can cause chronic inflammation and scarring of the liver or bile ducts and include autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis.
• Inherited metabolic disorders. Disorders that cause toxic buildup in the blood—such as glycogen storage disease (GSD), Wilson disease, hemochromatosis, and Gaucher disease—can cause chronic liver damage.
• Cardiovascular disease. Disorders that affect blood flow to the liver, including Budd-Chiari syndrome, ischemia, arterial disease, and right heart failure, can cause chronic liver damage.

What are the risk factors for liver disease?

You are more likely to develop liver disease if you:

• Drink a lot of alcohol.
• Use IV drugs.
• Use pain relievers such as aspirin or acetaminophen
• Have metabolic syndrome.
• Are regularly exposed to toxic chemicals.
• Are regularly exposed to the blood or body fluids of others.

Is liver disease curable?

Many types of liver disease are curable. Toxic and alcoholic liver disease can improve when you are no longer exposed to toxins. Nonalcoholic fatty liver disease can improve with dietary and lifestyle changes. Other types of liver disease can't be cured but can often be managed with medication. Some genetic disorders, autoimmune diseases, and viral infections may require lifelong treatment.

How can I take care of myself when I have liver disease?

If you have liver disease, you can help protect your liver by:

• Eat a healthy diet. Focus on whole foods, lots of plants, and lean protein.
• Maintain a healthy BMI (body mass index). Your healthcare provider can advise you.
• Avoid alcohol, tobacco, and over-the-counter medication use. Ask your healthcare provider for resources to help you quit smoking.
• Take medications only as directed. Be sure to discuss any new medications with your healthcare provider.
• Protect yourself from infections. Practice good hygiene and safe sex to avoid putting extra strain on your liver.
• Attend your healthcare appointments on time. Get regular checkups so that complications can be detected early.

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Summary

The liver plays an important role in your overall health, and when it's sick, it can affect you in a variety of ways. However, you may not feel the effects of liver disease until it's already advanced. To protect your liver, it's important to understand factors that can damage it and try to avoid them. Sticking to regular health checkups can also help detect liver disease early.