Liver disease: types, symptoms, causes and treatment explained

Your liver is the second largest organ in your body and has several vital functions including filtering and detoxifying your blood, processing digested food, making bile, hormones and enzymes, and storing iron, vitamins and minerals.  

As your liver is involved in so many important bodily functions, liver disease can cause a wide range of symptoms. To understand liver disease, it first helps to have an idea of the anatomy of your liver. 

The anatomy of your liver

Your liver is located in the upper right area of your abdomen but also extends, in part, into the upper left area of your abdomen. It sits under your diaphragm and above your stomach. It is surrounded by a tough outer covering called a capsule, which protects it and holds it in place.

Blood vessels, bile ducts carrying bile and supporting tissue called parenchyma also form part of your liver. Depending on which part of your liver is affected, your symptoms may vary.

However, as your liver has a great ability to regenerate and heal, symptoms often don’t occur in the early stages of liver disease. Consequently, liver disease is often only diagnosed incidentally during investigations into another health problem, or in later stages.

Diagnosing liver disease

To diagnose liver disease, your doctor will ask you about your medical history, including all medications and supplements you’re taking, and the medical history of your family.

You may have a physical examination, where your doctor will look for visible signs of liver disease. They may also refer you for specific blood tests and imaging tests, such as an ultrasound scan, CT scan or MRI scan. 

If the results aren’t conclusive, you may also need to have a liver biopsy. This involves a minimally invasive procedure where a needle is inserted into your abdomen to collect a tissue sample from your liver. The sample is then sent to a lab for analysis.

Types of liver disease

Alcoholic-related liver disease (ARLD)

ARLD is the most common type of liver disease in the UK and is caused by drinking too much alcohol over many years. This causes fat to build up in your liver. 

Symptoms don’t usually occur until your liver is severely damaged, and include nausea, vomiting, fatigue, unintentional weight loss, loss of appetite, jaundice, swelling of your ankles, legs and abdomen, and passing blood in your stools. 

As your liver can’t clear toxins from your blood, these toxins can go to your brain and lead to confusion and disorientation as well. 

There are three stages of ARLD. The first stage is alcoholic fatty liver disease (AFLD) where fat builds up in your liver. This is reversible if you stop drinking.

The second stage of ARLD is alcoholic hepatitis where you may start to experience the symptoms of a damaged liver. Mild alcoholic hepatitis is reversible if you stop drinking but severe alcoholic hepatitis is life-threatening. 

The third stage of ARLD is liver cirrhosis where your liver shrinks, becomes permanently scarred and rigid, and can’t function properly. Although scarring can't be reversed, if you stop drinking, you can prolong your life.

To treat ARLD, you need to stop drinking alcohol. However, you may also need additional treatments to help resolve some of your symptoms eg fluid (oedema) causing swelling may need to be drained with a needle. 

Non-alcoholic fatty liver disease (NAFLD)

This is the second most common type of liver disease in the UK, also known as metabolic liver disease, and causes fat to build up in your liver. It is not caused by drinking too much alcohol. 

Symptoms include pain in the upper right area of your abdomen, fatigue, unexplained weight loss and weakness. 

There are several risk factors for NAFLD including being overweight, having poorly controlled diabetes, metabolic syndrome, high cholesterol and high blood pressure. 

There are four stages of NAFLD. The first stage is simple fatty liver (steatosis), where fat builds up in your liver without causing any symptoms. The second stage is non-alcoholic steatohepatitis (NASH) where your liver becomes inflamed. 

The third stage is liver fibrosis where parts of your liver become scarred but your liver can still function. The fourth stage is liver cirrhosis where your liver is scarred and stops working properly. 

Treating NAFLD involves following a healthy lifestyle to reduce your risk factors eg controlling diabetes, losing any excess weight and reducing high cholesterol and high blood pressure. 

Autoimmune hepatitis (AIH)

This is a rare type of liver disease where your body’s immune system mistakenly attacks your liver, causing inflammation.

Around half of all people with AIH also have another autoimmune condition eg type 1 diabetes, ulcerative colitis, rheumatoid arthritis or thyroid disease. 

Symptoms include a rash, fatigue, feeling unwell, joint pain, muscle pain, loss of appetite, unintentional weight loss, nausea, itchy skin, diarrhoea, abdominal bloating and abdominal pain. 

AIH can be effectively treated by taking medication to suppress your immune system and reduce inflammation. 

Infiltrative liver disease

This occurs when specific substances are deposited in your liver that lead to injury and disease. 

There are several conditions that can lead to infiltrative liver disease, most commonly haemochromatosis, where your body absorbs too much iron from your food, and Wilson disease where your copper metabolism is defective. Haemochromatosis and Wilson disease lead to the build-up of iron and copper, respectively, in your liver. 

Symptoms of infiltrative liver disease include abdominal pain, fatigue, jaundice, swelling of your ankles, legs and abdomen, weakness and unintentional weight loss. 

Haemochromatosis can also cause joint pain, loss of libido, erectile dysfunction and darkening of your skin, while Wilson disease can also cause golden-brown eye discolouration, speech and swallowing problems, muscle stiffness and uncontrolled movements.

Treatment for haemochromatosis involves visiting the hospital for venesection (phlebotomy), where some of your blood is removed. For the first year, you may need venesection weekly and thereafter several times a year. The levels of iron in your blood will be closely monitored to determine how often you need treatment. 

Treatment for copper accumulation involves taking medication to bind the excess copper, reducing the amount of copper-containing food in your diet and managing any symptoms related to liver or nerve damage. 

Viral hepatitis

This occurs when your liver is infected with a virus. In some cases, the virus damages the liver but is cleared quickly (acute viral hepatitis), while in other cases, the virus persists, causing mild illness, which worsens over time (chronic viral hepatitis).

Acute viral hepatitis is usually caused by the hepatitis A virus from food contaminated with the stools of an infected individual. Chronic (long-term) viral hepatitis can be caused by hepatitis B, C or D viruses from infected blood or hepatitis E virus from infected, undercooked animal products.

In both acute and chronic viral hepatitis, you may not develop any symptoms. With chronic viral hepatitis, symptoms may only become apparent once your liver has been severely damaged.

If symptoms develop, they include abdominal pain, joint pain, muscle pain, fever, nausea, vomiting, feeling unwell, fatigue, loss of appetite, dark urine, pale grey stools and itchy skin.

Acute viral hepatitis is usually treated through rest, staying hydrated and following a healthy, balanced diet. Chronic viral hepatitis is treated with a variety of different antiviral drugs.

Primary biliary cholangitis (PBC)

This is an autoimmune condition where your body mistakenly attacks the bile ducts of your liver. Consequently, bile builds up in your liver, causing damage. Symptoms include abdominal pain, bone pain, joint pain, fatigue, itchy skin, and dry eyes and mouth.

PBC is treated with a medication called ursodeoxycholic acid alongside antihistamines to reduce itchiness.

Liver cancer

Liver cancer can be caused by primary cancer starting in any part of your liver or by secondary cancer ie cancer cells from elsewhere that are carried through your blood into your liver where they multiply. If you have liver cirrhosis, you are 10 times more likely to develop liver cancer. 

Symptoms include jaundice, itchy skin, dark urine, pale grey stools, loss of appetite, unintentional weight loss, fatigue, feeling unwell, a lump in your upper right abdomen, abdominal swelling, nausea and vomiting. 

Treatment will depend on the stage, size and progress of your cancer. It may include surgery, chemotherapy, radiotherapy, targeted medications and thermal ablation. 

Drug-induced liver injury (DILI)

Although rare, taking certain medications and herbal supplements can damage your liver. In most cases, stopping or changing the medication is enough to treat DILI, allowing the liver to recover.

Symptoms include fatigue, loss of appetite, jaundice, itchy skin, abdominal pain, nausea and a rash. If you notice any of these symptoms a few days or weeks after taking a new medication, see your GP immediately.