Questions & Answers

Frequently asked questions by patients with liver disease

What warning signs are there for a diseased liver?

Unfortunately, there are often no noticeable signs that warn patients at an early stage. The following symptoms may indicate a liver disease (not every symptom must have a serious cause, but the cause must be clarified):

  • Fatigue
  • Concentration and sleep disorders
  • Pressure sensation and pain sensitivity in the right upper abdomen
  • Tendency to flatulence
  • Loss of appetite
  • Nosebleeds and tendency to bruising

With progressive liver disease, these symptoms may also occur:

  • Forgetfulness
  • Increased irritability
  • Itching all over the body
  • Jaundice, yellowing of the skin
  • Dark urine, light stool

What causes liver diseases?

Viral infection:
Infectious inflammation of the liver, known as viral hepatitis, is caused by various hepatitis viruses (A, B, C, D, E).

Hepatitis A:
Transmission mainly via contaminated water and food, especially in countries with poor hygienic conditions; no chronic course of disease known. There is an active preventive vaccination.

Hepatitis B:
Transmission mainly via blood, blood products, intravenous drug use and sexual contact. Chronic course in 5 to 10% of cases. Cirrhosis of the liver can be the result of chronic progression. There is an active preventive vaccination.

Hepatitis C:
Transmission as with hepatitis B. Chronic course in up to 80% of cases; cirrhosis of the liver can be the result of a chronic course.

Hepatitis D:
only in combination with hepatitis B infection.

How does viral hepatitis manifest itself?
Apart from a rather rare jaundice, the symptoms of acute viral hepatitis are unspecific and often not present at all. In many cases the virus hepatitis is misinterpreted as „flu“ or „intestinal disorder“.
In chronic viral hepatitis, the patient is symptom-free for a longer period of time. In addition to increased transaminases, chronic hepatitis also manifests itself in reduced performance, fatigue, psychological instability, joint pain and flatulence.

The therapy of chronic viral hepatitis aims to eliminate or reduce the viral load and normalize liver function.

People who drink too much alcohol regularly damage their liver. Alcohol causes fatty liver. This can lead to liver cirrhosis, a chronic liver disease.

The threshold value (per day) for healthy liver is
Women: Maximum 0.5 l beer (or 1 glass of wine) (equivalent to 20 g alcohol per day)
Men: Maximum 1 l beer (or 2 glasses of wine) (equivalent to 40 g alcohol per day)

Overweight / diabetes type 2:
If the fat metabolism is disturbed by overweight or diabetes type 2, liver cell fatliquoring may occur. If the basic disease is not treated, a non-alcoholic fatty liver hepatitis (= non-alcoholic steatohepatitis [NASH]) may develop (see also question on „fatty liver“).

Metabolic disorders:
In iron storage disease, a hereditary disorder of the iron balance, iron is increasingly absorbed into the organs, but especially into the liver. The copper storage disease (Wilson’s disease) is a hereditary copper metabolic disorder that leads to an increased deposition of copper in the liver. Early diagnosis is important in the case of iron and copper storage disease so that suitable therapy can counteract severe liver damage and thus the development of liver cirrhosis.

Drugs and chemical toxins:
The pathological changes of liver tissue look very different depending on type and quantity of the toxic foreign substance.

In addition to direct damage to the liver cells with cell death (necrosis), an inflammatory change such as hepatitis (inflammation of the liver) can occur. Some substances lead to fatty liver, others to cholestasis (= obstruction of bile flow).

Individual predisposition as well as gender and age differences determine the „sensitivity“ of the liver.

In most cases, the discontinuation of medication or the absence of the chemical poison leads to regeneration of the liver. If this does not happen, however, chemical toxins and drugs can lead to liver failure with a fatal outcome.

Cholestatic liver diseases:
Primary biliary cirrhosis (PBC) is a chronic inflammation of the bile ducts in the liver that leads to the destruction of the small bile ducts located between the lobules of the liver. Chronic bile congestion occurs which damages the liver and leads to cirrhosis over the years. The cause is still unknown, but immunological reactions are being discussed.

Therapy consists in administration of a water-soluble bile acid, which is supposed to replace the harmful, fat-soluble bile acid.

Primary sclerosing cholangitis (PSC) is a chronic, scarring inflammation of the bile duct leading to narrowing of the bile ducts inside and outside the liver. Immunological events are discussed as the cause.

What is fatty liver?

Fatty liver means that the fat content of the liver cell is greatly increased. This makes the liver bigger and heavier and gives it a „fat-yellow“ color.

Fatty liver is usually an expression of over-nutrition and/or excessive alcohol consumption over a longer period of time. Metabolic disorders, e.g. type 2 diabetes, can also be causes of fatty liver. If only 5 to 15% of the liver cells are fatty, the doctor speaks of a mild, with 15 to 30% of a moderate and with 30 to 50% of a moderate to strong fatty liver cell.

Fatty liver is revealed less by abnormally altered blood values than by a typical „ultrasound pattern“.

The treatment of fatty liver is complex. The doctor first tries to eliminate the causes, while the patient must be willing to change diet and lifestyle on a long-term basis, including alcohol abstinence. The light fatty liver is a mostly harmless, recoverable disease. However, fatty liver can become a danger if the causes are not eliminated and its progression is not slowed down. This can lead to cirrhosis with irreparable damage at the end of a long period of development.

What is hepatic fibrosis?

If the liver is permanently damaged, the connective tissue of the liver increases – fibrosis of the liver occurs. Minor liver fibrosis does not cause any discomfort and is a common diagnosis amongst older patients.

Chronic progressive liver disease leads to severe liver fibrosis, which then leads to cirrhosis. In contrast to liver fibrosis, liver cirrhosis can no longer be reversed.

What are the consequences of chronic liver disease?

The most common complication of chronic liver disease is cirrhosis, which affects the entire organ. Liver cells are increasingly destroyed. The liver tries to compensate for this loss by forming new liver cells and scarring connective tissue. However, this replacement tissue cannot fully take over the functions of the healthy liver. The liver functions are permanently disturbed. As this process progresses, the liver hardens, becomes nodular and eventually shrinks. As a result of this destruction of the liver structure, the blood supply to the liver is also severely impaired, so that the blood can no longer flow through the liver from the portal vein and hepatic artery, resulting in portal hypertension.

Cirrhosis of the liver is the common final stage of various liver diseases!

Liver cirrhosis is a slowly progressing destruction process of the liver characterized by the following:

  • Liver cells perish.
  • New replacement cells and connective tissue proliferate randomly.
  • The liver hardens, becomes nodular and can shrink.
  • The liver functions are severely damaged.
  • Complications can occur, e.g. brain dysfunction (hepatic encephalopathy), portal hypertension, bleeding from the varicose veins of the esophagus and stomach, ascites, kidney dysfunction, bleeding tendency, liver cell cancer.

What is hepatic encephalopathy?

The liver has the task of rebuilding and detoxifying digestive products supplied by the intestine. If the liver can no longer perform its detoxification function in the case of chronic damage, a particularly serious complication of cirrhosis of the liver occurs, which is described by the technical term hepatic encephalopathy. It is a liver-induced brain dysfunction:

  • The diseased liver can no longer detoxify nitrogen-containing, harmful metabolic products.
  • These substances, especially ammonia, enter the brain in high concentrations.

Disturbances of metabolism and the functions of the brain are the result.
First signs of hepatic encephalopathy are:

  • Decreasing ability to concentrate
  • Deterioration of short-term memory
  • Limited fine motor skills
  • Decrease in responsiveness
  • Mood swings and character changes

If these symptoms are associated with chronic liver disease (mostly cirrhosis), diagnosis of hepatic encephalopathy must be considered. Further investigations help to confirm the diagnosis.

Early stages of hepatic encephalopathy should be treated. First, an attempt should be made to treat the underlying liver disease and thus maintain the detoxification function of the liver as far as possible.

There are also suitable therapeutic options, such as the administration of a special amino acid compound that increases detoxification ability of the liver. In this way, the neurological complications of hepatic encephalopathy can be quickly and effectively eliminated or minimized.

What do liver values from blood test results mean?

Certain proteins (enzymes) play an important role as biocatalysts in metabolic processes in the liver.

The routinely determined enzymes (liver values) merely indicate damage to the liver, they do not say anything about the type of liver disease. The evaluation of enzyme values (liver values) requires medical experience, since some of the enzymes important for liver diagnostics also occur in cells of other organs. They may therefore be altered due to various clinical reasons. Decisive are the enzyme pattern and correspondence with further test results.

What are mormal liver values?

Here you will find an overview of the liver values.

In principle, a check should be carried out at monthly intervals after elevated liver values are detected for the first time.

Where can I find detailed clinical information?

If you are a healthcare professional and/or interested in further medical information and clinical studies on hepatic encephalopathy, please visit our website for medical professionals: