A number of diseases can affect the liver. In some people, liver disease occurs without symptoms. Liver disease, in general, can manifest itself in several ways. Some symptoms that occur include a yellowish discoloration of the skin and the whites of eyes known as jaundice, a reduction or stopping of bile flow known as cholestasis, and liver enlargement. Other symptoms and conditions include abnormally high blood pressure in the veins of the liver (portal hypertension), a liver disorder where toxins accumulate in the blood and cause brain dysfunction (hepatic encephalopathy), and liver failure, among others.
Inflammation of the liver from long-term, heavy alcohol use is known as alcoholic hepatitis. This condition results in widespread damage and destruction to the cells of the liver. Alcoholic hepatitis can affect heavy and moderate drinkers alike; a single episode of binge drinking can cause this liver disease. Signs and symptoms of alcoholic hepatitis generally arise during or after a drinking episode and include loss of appetite, nausea, vomiting, abdominal pain and tenderness, fever, jaundice, mental confusion, and abdominal swelling.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Pentoxifylline, Prednisolone
Ascites is extra fluid in the space between the membranes that line the abdomen and the abdominal organs. Ascites is a common complication in liver cirrhosis and is associated with a grave prognosis; approximately 50% of patients die within two years of diagnosis. Causes of ascites include liver cirrhosis, alcoholic hepatitis, chronic hepatitis, and obstruction of the hepatic vein. Ascites, as a result of liver disease, generally accompany other disease characteristics such as high blood pressure. Symptoms of ascites can include a distended abdominal cavity, discomfort, and shortness of breath. Treatment goals for ascites include symptom relief, correction of the underlying abnormalities, and prevention of complications.
Commonly Prescribed (On-Label) Drugs: Spironolactone
Off-Label Prescription Drugs Breakthrough Options: Amiloride, Furosemide (Lasix)
Chronic hepatitis B is a lifelong liver disease caused by the hepatitis B virus (HBV). Symptoms include tiredness, jaundice, stomach pain, vomiting, appetite loss, fever, and joint aches. In some persons, symptoms of HBV may not be present; however, this does not mean that the virus cannot be passed to others. Prevention of chronic HBV transmission to other persons includes vaccinations, practicing good hygiene and safe sex, and not sharing personal care items (razors, toothbrushes, and hypodermic needles). Long-term effects of chronic hepatitis include scarring of the liver tissue known as cirrhosis and liver cancer.
Commonly Prescribed (On-Label) Drugs: Interferon alfa-2b, Lamivudine
Off-Label Prescription Drug Breakthrough Option: Famciclovir
Chronic hepatitis C is a lifelong liver disease caused by the hepatitis C virus (HCV), and accounts for 60% to 70% of chronic hepatitis cases. Complications of HCV include cirrhosis, liver failure, and liver cancer. HCV is mainly spread by contact with blood or blood products; those at highest risk include injection drug users, people who have had blood transfusions before 1992, persons who have frequent exposure to blood products, infants born to HCV-infected mothers, healthcare workers, and persons who participate in high-risk sexual behavior. Symptoms can include fatigue, nausea, poor appetite, and muscle and joint pains.
Commonly Prescribed (On-Label) Drugs: Interferon alfa-2b, Interferon alfa-N1
Off-Label Prescription Drug Breakthrough Option: Amantadine
Brain and nervous system damage that occurs as a complication of liver diseases such as cirrhosis or hepatitis or conditions where blood circulation bypasses the liver is known as hepatic encephalopathy. This disorder is characterized by various neurologic symptoms including changes in consciousness, reflexes, and behavior that can range from mild to severe. Other symptoms and signs include confusion, forgetfulness, changes in mood, decreased alertness, muscle stiffness or rigidity, jaundice, and fluid collection in the abdomen, among others.
Commonly Prescribed (On-Label) Drugs: Amino acid solutions, Kanamycin
Off-Label Prescription Drugs Breakthrough Options: Metronidazole, Vancomycinthe liver and liver dysfunction. Conditions that cause liver cirrhosis include alcohol abuse, chronic hepatitis B, chronic hepatitis C, autoimmune hepatitis, nonalcoholic fatty liver disease, inherited liver diseases (Wilson’s disease), blocked or inflamed bile ducts, and prolonged exposure to toxic materials (certain drugs). Signs and symptoms of liver cirrhosis include appetite loss, weight loss, nausea, small red spider veins under the skin, weakness, fatigue, jaundice, and bleeding from veins in the esophagus or intestines, among others.
Commonly Prescribed (On-Label) Drugs: Indinavir
Off-Label Prescription Drugs Breakthrough Options: Interferon Alfa-2a, Interferon Alfa-2b, Lamivudine, Ribavirin, Peginterferon Alfa-2b
The accumulation of tough, fibrous scar tissue in the liver is known as liver fibrosis. Chronic infection with hepatitis C or hepatitis B can lead to liver fibrosis. In general, it occurs more rapidly in men than women, and in persons over age 50. Liver fibrosis appears to speed up once liver disease has progressed. Other conditions that can accelerate liver fibrosis include immune system dysfunction, HIV infection, use of immunosuppressive drugs, heavy alcohol intake, fatty liver diseases, and insulin resistance.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Azathioprine, Cyclosporine, Interferon Alfa - 2a, Interferon Alfa-2b, Lamivudine, Peginterferon Alfa-2b, Prednisolone, Ribavirin-interferon Alfa-2b
An increase in the pressure in the portal vein, which carries blood from the digestive organs to the liver, is known as portal hypertension. This increased pressure in the portal vein is caused by a blockage of blood flow through the liver. Causes of portal hypertension include cirrhosis (scarring of the liver) and thrombosis (clotting in the portal vein). Symptoms and complications of portal hypertension include GI bleeding, black stools, vomiting blood, ascites (excess fluid in the abdomen), encephalopathy, reduced levels of blood platelets, and decreased white blood cell count.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Carvedilol, Nadolol, Propranolol
About one-third of people with liver cirrhosis experience bleeding and the mortality rate associated with the first bleeding episode can be as high as 50%. In liver cirrhosis, scar tissue blocks the flow of blood through the liver and results in liver dysfunction. This blockage results in large, swollen veins that can rupture and leak blood. Symptoms include vomiting blood, black stools, low blood pressure, rapid heart rate, and shock. Prevention of bleeding in high-risk patients is mandatory and involves nonselective beta-blocker drugs.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Nadolol, Propranolol
Primary biliary cirrhosis is a liver disease that slowly destroys the liver bile ducts. When these ducts are damaged, bile, which aids in fat digestion, accumulates in the liver, damages surrounding tissue, and can cause cirrhosis. Primary biliary cirrhosis affects women more than men and occurs between the ages of 30 and 60 years. Symptoms of biliary cirrhosis include itchy skin, fatigue, jaundice, cholesterol deposits in the skin, fluid retention, dry eyes, and dry mouth.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Azathioprine, Budesonide (with UDCA), Colestipol, Cyclosporine, Methotrexate, Naloxone, Naltrexone, Prednisolone
Hepatitis C is a disease caused by the hepatitis C virus (HCV) and results in liver swelling and liver dysfunction. This disease is transmitted by sharing drug needles, getting pricked by a contaminated needle, having a blood transfusion before 1992, having sex with an infected person, and being born to a mother who is infected with HCV. Symptoms include tiredness, stomach pains, fever, appetite loss, and diarrhea. Some patients are unresponsive to conventional treatment with interferons (immunomodulator drugs); hence these patients have a form of hepatitis that is resistant to these types of drugs and is called "therapy-resistant hepatitis C."
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Peginterferon Alfa-2a, Peginterferon Alfa-2b, Ribavirin, Ribavirin-interferon alfa-2b
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