Liver Disease + Pancreatitis

Including Autoimmune Hepatitis, Primary Biliary Cholangitis (PBC), Primary Sclerosing Cholangitis (PSC), Non-alcoholic Steatohepatitis (NASH), Cirrhosis, and Acute/Chronic Pancreatitis

Summary:
Liver disease affects approximately 3 million people in the United States and is responsible for 1.2 million hospitalizations and more than 6,000 liver transplants every year. The term “liver disease” is a broad one that refers to any disturbance of liver function that causes illness. While there are many types of liver disease, all of them tend to involve a similar progression of liver damage.

Common liver diseases, which will be covered in this section, include: autoimmune hepatitis, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), non-alcoholic steatohepatitis (NASH), cirrhosis, and pancreatitis.

Overview

  • Liver disease can be genetic (inherited), caused by an infection (such as hepatitis B and C), or caused by other factors that damage the liver, such as viruses, alcohol use, and obesity.
  • About 70% of people with autoimmune hepatitis, a disease in which the body’s own immune system attacks the liver, are women.
  • Women are nine times more likely than men to develop primary biliary cholangitis (PBC), a chronic (long-term) liver disease caused by destruction of the bile ducts in the liver. Bile is a liquid that helps in the digestion of fats and fatty vitamins.
  • Primary sclerosing cholangitis (PSC) is a chronic disease that slowly causes bile ducts to become blocked, forcing bile to accumulate in the liver, where it gradually damages liver cells.
  • Non-alcoholic steatohepatitis (NASH) is a fatty liver disease that occurs in people who drink little or no alcohol. NASH affects approximately 2-5% of Americans.
  • Chronic alcoholism is the leading cause of cirrhosis, a condition in which the liver is permanently damaged and cannot function properly.
  • Pancreatitis, which is an inflammation of the pancreas, has two forms: acute and chronic. Acute pancreatitis occurs suddenly and usually resolves within a few days of treatment. Chronic pancreatitis, on the other hand, does not improve over time.

Natural History

  • Left untreated, autoimmune hepatitis can lead to cirrhosis and liver failure.
  • PBC typically progresses slowly over a period of years. While there is no cure for PBC, adhering to a medication regimen and maintaining a healthy lifestyle can slow disease progression and allow people to live longer without complications.
  • PSC advances very slowly. Liver failure may occur approximately 10-15 years after diagnosis, although for some PSC patients, this may take longer.
  • Although most people with NASH experience no symptoms, the disease can nevertheless be severe and lead to cirrhosis.
  • Untreated cirrhosis results in liver failure, in which the liver will not be able to function well or at all.
  • Acute pancreatitis can develop into chronic pancreatitis if pancreatic tissue is permanently destroyed and scarring develops.

Etiology and Disease Pathogenesis

  • In patients with autoimmune hepatitis, the immune system attacks their liver cells. Heredity and prior infections may play a role in this immune system reaction.
  • While the causes of PBC and PSC are unknown, problems in the immune system are believed to play a role. Genetic factors may also be involved.
  • The underlying cause of NASH is not clear and can occur without any apparent risk factor.
  • Cirrhosis is caused by chronic liver diseases that result in liver tissue damage. The most common causes of cirrhosis are chronic alcoholism and chronic viral hepatitis.
  • Common causes of pancreatitis include gallstones and heavy alcohol use.

Identifying Patients

  • A diagnosis of autoimmune hepatitis is confirmed through blood tests and a liver biopsy.
  • Because many people with PBC and PSC have no symptoms, the diseases are often discovered through abnormal results on routine liver blood tests.
  • NASH is usually first suspected when a person is found to have elevations in liver tests. The only means of distinguishing NASH from simple fatty liver is by performing a liver biopsy.
  • Cirrhosis is diagnosed by a physical examination, medical history, and blood tests. A liver biopsy may be needed to assess the extent of liver damage.
  • Diagnosing acute pancreatitis can be difficult because of the deep location of the pancreas. Often, one or more tests—such as an abdominal ultrasound, CT scan, or endoscopic ultrasound—will need to be performed.
  • With chronic pancreatitis, blood, urine, and stool tests can help medical professionals diagnose and monitor the progression of this condition.

Symptoms

  • Symptoms of autoimmune hepatitis are often minor. When symptoms do occur, they can range from fatigue and abdominal discomfort to jaundice (a yellowing of the skin and whites of the eyes) and spider angiomas (swollen blood vessels). Other symptoms may include dark urine, pale stools, and absence of menstruation.
  • The most common initial symptoms of PBC are fatigue and pruritus (itching of the skin). Other symptoms may include abdominal pain, darkening of the skin, and small yellow or white bumps under the skin or around the eyes.
  • Many patients with PSC may have the disease for years before symptoms, such as fatigue, unexplained weight loss or general weakness develop. Symptoms may be stable, may come and go, or progress gradually.
  • NASH is usually a silent disease with few or no symptoms. Once the disease is more advanced, symptoms such as fatigue, weight loss, and weakness may develop.
  • Symptoms of cirrhosis include: loss of appetite, fatigue, nausea, weight loss, abdominal pain, spider-like blood vessels, and severe itching.
  • Severe pain in the upper abdomen is a common symptom of acute pancreatitis. Other symptoms may include nausea, vomiting, fever, and a rapid pulse. While upper abdominal pain is common among patients with chronic pancreatitis, some people with this condition experience no pain at all.

Potential Complications of Liver Disease

Complications of autoimmune hepatitis include:

  • Ascites—fluid in the abdomen.
  • Mental confusion.

Complications of PBC include:

  • Jaundice—yellowing of the skin.
  • Edema—swelling of the legs and feet.
  • Ascites.
  • Internal bleeding in the upper stomach and esophagus caused by enlarged veins.
  • Osteoporosis—thinning of the bones.

Complications of PSC include:

  • Liver failure (many people with PSC will ultimately need a liver transplant).
  • Bile duct cancer.

Complications of NASH include:

  • Scarring of the liver, leading to cirrhosis.
  • Advanced cirrhosis with liver failure requires liver transplantation.

Complications of cirrhosis include:

  • Jaundice.
  • Gallstones.
  • Bruising and bleeding easily.
  • Painful swelling of the legs and abdomen.
  • Hepatic Encephalopathy—a buildup of toxins in the brain that causes both mental and physical complications.

Complications of acute pancreatitis include:

  • Gallstones.
  • Pseudocysts—accumulations of fluid and tissue debris—in the pancreas.
  • Kidney failure.
  • Breathing problems.

Complications of chronic pancreatitis include:

  • Gallstones.
  • Pseudocysts—accumulations of fluid and tissue debris—in the pancreas.
  • Calcification of the pancreas.

Liver Diseases Resources for In-depth Information