Your Liver, Your Health: Part II – A Liver in Trouble

Editor’s note: This is Part 2 of “Your Liver, Your Health,” an eight- part series by Hollis Pickett.

All right, folks, stay with me. we’re going to get a little technical and detailed here, starting with some vocabulary and definitions.

Hepatitis – inflammation of the liver

Acute – you’re visibly ill and showing symptoms

Chronic – long-term, ongoing disease or illness – can follow an acute phase or occur without an acute phase

Fulminant liver failure – very sudden onset with widespread damage to liver tissue – potentially fatal

Fibrosis – scarring of liver tissue caused by inflammation (hepatitis)

As you can see above, the word hepatitis simply means “inflammation of the liver”. The most common causes of hepatitis are alcoholism, drugs (prescription or over-the-counter), viral hepatitis infection, exposure to other toxins (inhaled, ingested or environmental), fatty deposits in the liver, autoimmune conditions such as autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis and hereditary conditions such as Wilson’s disease, alpha-1-antitrypsin deficiency and hemochromatosis.

When you have “acute” anything, it usually means that you are visibly ill and symptomatic. Obvious symptoms of acute hepatitis are jaundice (yellowing of the skin and whites of the eyes), fatigue, anorexia, nausea/vomiting, diarrhea, pain or discomfort at the location of your liver, fever, dark urine and itchy skin. If you ever experience these symptoms, you need to seek medical attention immediately ! Jaundice is an indication of something seriously wrong with your liver.

Chronic hepatitis usually occurs as the result of infection with viral Hepatitis B or C. We’ll be discussing viral hepatitis in much more depth later. Chronic – an ongoing medical condition that persists without resolving on its own until (or even after) medical treatment is applied.

Fulminant hepatitis is a liver in crisis. Without intervention, complete liver failure can be sudden and imminent. The term “fulminant hepatitis” is typically not used for a chronic condition that has suddenly reached a point of no return. “Fulminant” refers to sudden onset. The most common causes for fulminant hepatitis are: ingestion of a large quantity of a toxic substance (most often acetaminophen), massive injury to the liver, shock caused by hemorrhage, viral infection, severe dehydration, or overwhelming infection (sepsis). A very delicate decision process determines whether the patient can be pulled through with management of the complications or if an immediate liver transplant is required. The decision may be made to transfer the patient to a hospital where a transplant can be performed if necessary.

Fibrosis is scarring of liver tissue caused by ongoing inflammation (hepatitis). The assessment of the amount of damage (scarring) that has taken place is called “staging”.

Although there are blood tests that can be used, the “gold standard” for staging is a liver biopsy. With the most commonly used scale, fibrosis is divided into four stages (particularly relevant for chronic viral hepatitis).

Stage I is mild scarring, usually around blood vessels known as the portal triad.

Stage II is the subtle spread of scarring outward from those blood vessels.

In Stage III those areas of scar tissue are starting to, in today’s vernacular, “hook up” (connect with other scarred areas) – this is called “bridging fibrosis”.

Stage IV is cirrhosis.

In Stages I through III, regeneration of healthy liver tissue can still occur. Once cirrhosis is present, it can be more difficult for the liver to heal. In cirrhosis, there are still pockets of healthy liver tissue, but they are surrounded by scar tissue making it harder to for them connect with other pockets of healthy tissue and enable widespread healing. A diagnosis of cirrhosis is not necessarily a death sentence, but it does come with a string of associated complications. Being cirrhotic does increase the risk for developing liver cancer. Cirrhotics need to be carefully monitored for liver cancer with regular blood work and liver ultrasounds. There are two types of cirrhosis – compensated and decompensated. A compensated cirrhotic can continue to function (sometimes reasonably well) for many years, depending on their overall health. Once a person becomes “decompensated”, however, they are in very late-stage or end-stage liver disease and may be headed for liver failure or a liver transplant.

Anyone with serious liver issues should be in the care of a gastroenterologist or a hepatologist. A gastroenterologist (sometimes referred to as a “GI”) covers everything from your intake manifold to your exhaust pipe. A hepatologist is a liver specialist.

The next segment will discuss specific conditions that cause liver disease. As we delve into what I consider to be the most common causes of liver disease, you’ll see why this whole topic merits your close attention.

Hollis Pickett, in partnership with Toni Donovan, runs a Redding area non-profit – Local Area Support For Hepatitis, also known as LASH. Hollis has been involved with hepatitis advocacy since 2002 and is a steering committee member with CalHEP Alliance. She has been the bookkeeper and office manager for the law firm of Carr, Kennedy, Peterson & Frost for the past 25 years. Toni has just completed a Masters in Public Health (MPH) and is currently employed by Planned Parenthood and Acaria Health (a specialty pharmacy). LASH provides community education and patient/caregiver support for those infected with chronic viral hepatitis. A support group meets once a month for patients and their families. LASH offers group presentations, individual counseling and clinical education for patients entering treatment. You can contact them via e-mail at or call Toni (945-7853) or Hollis (524-5601).

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7 Responses

  1. Avatar Canda says:

    Thanks for an interesting article. How much acetaminophen is considered toxic? That's so scary as many of us pop those things in our mouth for our aches and pains. It's easy to get into the mind set that anything over the counter is safe, but that's far from the truth. Thanks again for the info.

  2. Avatar pmarshall says:

    I agree with the note from Canda. Acetaminophen can be dangerous. I do take something that has this in my regular medicine, so I do think about it, although my blood test are OK. Thanks for the article.

  3. Avatar Hollis Pickett says:

    Finally – Lunch hour and I can "legally" be online…;-) So, this is from the Tylenol website: To help encourage appropriate acetaminophen use, the makers of Extra Strength TYLENOL® have implemented new dosing instructions lowering the maximum daily dose for single-ingredient Extra Strength TYLENOL® (acetaminophen) products sold in the U.S. from 8 pills per day (4,000 mg) to 6 pills per day (3,000 mg). The dosing interval has also changed from 2 pills every 4 – 6 hours to 2 pills every 6 hours.

    The hepatologists I know prefer to see their patients taking Tylenol (in most cases) as opposed to aspirin or ibuprophen (Advil-type) products. There's an increase risk of gastrointestinal bleeding with both aspirin and ibuprophen. Anyone going into surgery should stop taking any ibuprophen or aspirin for a few days prior to surgery (get the exact amount of time from your doc). My personal experience with both is – I prefer ibuprophen for achy-painy's – it just seems to work better. Tylenol works better on a fever (which I almost never have). Ibuprophen seems to work better for "female stuff" and for the mild restless-leg issues that can show up with menopause. My guidance to myself would be that long-term, constant use of any analgesic should be discussed with my doctor.

    Thanks for taking the time to read my articles!

    • Hollis, I really appreciate how well you've kept up with comments, and how you've kept it kosher with regard to your work time.

      (It if makes you feel any better, is a media site, so it's not in the same no-no work realm as your basic social media sites.)

  4. Avatar Hollis Pickett says:

    Nose to the grindstone….that's me!

  5. Avatar Melody says:

    Thank-you for the info. cannot believe my daughters Dr. did not give this to us. She was dia. with end liver failure. We are trying to find info on this condition, info is on web. but we need support to find out what is next, or I should say next step we should do. Its the waiting, that’s what is the hardest as time is the killer–or lack of it. Find a
    hepatologist, gotta go shes calling

  6. Avatar Melody says:

    I’m back, it was time for Lactulose, an Meds. She has Good Ol Hep C too, from sweet boyfriend. I will be watching an learning from your site, Thank You so much. See you at the monthly meeting [ LASH ]