Liver Parenchymal Disease: Conditions, Symptoms, And Treatment

The global prevalence of parenchymal liver disease is around 25% and is set to increase, with the highest prevalence in the Middle East and South America.¹

As a result, it is vital to understand who is at risk, how to prevent it, and what treatment options are available. Let’s check out everything you need to know.

What is the liver, and what does it do?

The liver is a large organ found in the upper right-hand side of your abdomen, beneath your lungs and diaphragm, and above your stomach. It plays a crucial role in the body, as all blood leaving your stomach and intestines first passes through the liver. 

Your liver is a control hub for blood volume regulation, immune system support, macronutrient metabolism, and lipid and cholesterol balance.

The liver also helps to filter toxic substances out of your system. It produces a substance called bile, which assists in excreting material your kidneys haven’t excreted. Bile also breaks down fats into fatty acids, which your body absorbs via the digestive tract. 

Causes and symptoms of parenchymal liver disease

Signs and symptoms of liver problems can be general and non-specific. These can include loss of appetite, tiredness, weight loss, and jaundice. Jaundice is a yellow discoloration of the eyes and skin due to over or underproduction of bile.

Causes of liver disease can vary, but a common shared cause is alcoholism. The liver is responsible for the breakdown of alcohol, so constant alcohol use leads to the build-up of toxic substances.

Some related conditions include:

Hepatic steatosis

Hepatic steatosis is when excess fat builds up in the liver, and various factors or conditions can cause it. It has two types: Alcoholic fatty liver disease (AFLD) and nonalcoholic fatty liver disease (NAFLD). 

You’ll be asymptomatic, and your doctor will discover the presence of fatty liver incidentally while imaging the abdomen for other purposes. 

Some symptoms that can occur include discomfort in the abdomen in the upper right side, where the liver is located. 

There are a few potential causes of fatty liver, including: 

• Certain medications

• Alcohol consumption

• Over and undernutrition

• Metabolic conditions

Fibrosis

Liver fibrosis occurs when your liver tissue becomes scarred and cannot work as well. It can develop into cirrhosis, a more severe pattern of scarring, which has a higher chance of complications. Causes include hepatitis C virus infection and alcoholism.

Hepatitis

Hepatitis refers to inflammation of the liver, often caused by a virus. Hepatitis A and E viruses are common in travelers and contaminated water and food sources. Usually, symptoms include jaundice and vomiting. 

Contaminated needles from drug use or tattoos can cause hepatitis B and C. Hepatitis B and C can also be sexually transmitted. 

Hepatitis D does not arise independently; rather, it develops from hepatitis B. 

Other common causes of hepatitis are drugs, alcohol, and an overactive immune system resulting in autoimmune hepatitis.

Cirrhosis

Cirrhosis refers to scarring of the liver. Initially, scar tissue forms (fibrosis) without losing its function. Following ongoing injury, most of the liver becomes scar tissue, leading to loss of function and cirrhosis. 

Hepatitis C virus and alcoholic liver disease are the most common causes. Other causes are viral infection, autoimmune conditions, genetic conditions, and toxins. 

Hepatitis C cirrhosis can lead to hepatocellular carcinoma in 1–2% of cases. 

Metabolic diseases

A few metabolic diseases involve the liver and can lead to chronic liver disease. The three most common causes are: 

Wilson disease

This genetic condition results in abnormal copper accumulation. Symptoms include:

• Weakness

• Jaundice

• Itching

• Coordination problems

• Leg swelling

Hereditary hemochromatosis

This is another genetic condition where the body has disrupted iron regulation. Men are affected around two to three times more than women, generally presenting at around 50–60 years of age. 

Women typically present peri-menopausal when they stop having regular periods. Symptoms are varied but involve fatigue, joint pain, cardiac problems, and diabetes.

Alpha-I antitrypsin (AAT) deficiency 

This genetic condition affects the production of the AAT protein, resulting in excessive elastase enzymes in the body. This causes damage to the lungs and the liver. Breathing difficulties are generally the first symptom to appear.

Risk factors

Hepatic steatosis, or fatty liver disease, tends to present in people who are obese and have insulin resistance or type 2 diabetes. 

Other risk factors for liver disease include: 

• Using certain medications

• Excessive alcohol consumption

• High-risk behaviors, such as unprotected sex or sharing needles

• Exposure to other people's blood and body fluids

• Having blood transfusions before 1992

Diagnosis of parenchymal diseases of the liver

Diagnosis of liver disease depends on the cause and complications of the liver disease. If you’re experiencing any symptoms described or have a family history of liver complications, talk to your doctor about potential causes and treatment. 

Your doctor will start by asking about the symptoms you're experiencing and whether you have a family history of a liver condition. They’ll also likely take note of your medications and your dietary and drinking habits. 

Your doctor can use ultrasound, CT, and MRI to diagnose liver disease. They can also use blood tests to measure the levels of different proteins and enzymes.  

A liver biopsy may be necessary for some liver conditions, where a doctor removes a piece of the liver for examination. This helps to assess if there is inflammation in the liver and the stage of the disease progression.

Parenchymal liver disease treatment

In viral hepatitis, your doctor may administer antiviral agents. In the case of autoimmune hepatitis, they may administer steroids and immunosuppressants. 

In alcoholic cirrhosis, abstinence from alcohol is necessary.

In the case of fatty liver, people often present with elevated triglycerides and hypertension, risk factors for cardiovascular diseases. This highlights the need to treat such conditions with a multidisciplinary approach to reduce heart complications. 

Lifestyle changes often improve nonalcoholic fatty liver disease. 

The earlier signs and symptoms are identified, the better the prognosis and long-term outcomes.

Keeping your liver healthy

Even if you’re not experiencing any liver complications, taking preventative steps is a good idea. This will preserve the functioning of your liver, helping you stay healthy and respond to the challenges and demands of your life.

Some ways to do this are:

• Maintain a healthy weight

• Eat a balanced diet

• Limit your alcohol consumption

• Avoid illicit drugs 

• Get vaccinated against hepatitis A and B

• Regular screening for hepatitis B and C, especially in an occupation where you may have exposure to people or blood with these conditions

The lowdown

Liver parenchymal disease is a common condition that can present in several ways and has a variety of causes. Alcoholism is a common cause of liver complications, alongside genetic conditions and viral infection. 

While some liver damage is reversible, ongoing injury to the liver can eventually result in permanent liver disease. Removing an offending substance like alcohol or treating an underlying infection like a hepatitis virus is key to preventing further injury. 

Talk to your doctor about any potential symptoms you are experiencing—the earlier diagnosis occurs, the better the prognosis.

Frequently asked questions

Is liver parenchymal disease dangerous?

Liver disease can become dangerous if liver function is severely impaired. Death rates are around 15.7 per 100,000 in the United States. 

Liver parenchymal disease often occurs alongside other conditions, putting you at higher risk. Common comorbidities include chronic kidney disease, sleep apnea, heart disease, type 2 diabetes, and obesity. 

Around 80–90% of people with obesity have nonalcoholic fatty liver disease. As a result, it’s vital to address all the symptoms and potential complications of liver disease, with regular screening and follow-ups to minimize the risk of comorbidities.²