Liver Disease

The liver is one of the largest organs in our body. It performs many vital functions, including:

• Breaking down fats and converting them into energy.
• Maintaining appropriate blood sugar levels, either by removing excess sugar from the blood and storing it, or by releasing stored sugar back into the bloodstream.
• Storing and releasing vitamins and minerals such as iron and copper.
• Producing proteins that are essential for blood to clot.
• Filtering toxic substances, such as alcohol or medications, from our blood and then helping the body eliminate them through solid or liquid waste.

The liver can become damaged for a variety of reasons. These include:

• Infections caused by a virus or parasite.
• Autoimmune disorders, which occur when your immune system attacks part of your own body.
• Genetic conditions that you’ve inherited from a parent.
• Complications from an existing medical condition, like diabetes or obesity.
• Cancer.
• Lifestyle choices, including chronic alcohol abuse, intravenous drug use and unprotected sex.

Long term damage to the liver can result in scarring — a condition called cirrhosis — and an increased risk of liver failure, which means the liver has partially or completely stopped working.

In 1990, in response to a growing need for high quality and life-saving liver disease care, Scripps launched two programs: San Diego’s first liver transplant service, known today as Scripps Center for Organ & Cell Transplantation, and the Scripps Clinic Liver Disease Center.

More than 25 years later, both of these robust programs continue to deliver the most advanced treatments available, including access to emerging therapies through clinical trials.

In addition to earning its status as one of the largest referral centers in the country for chronic viral hepatitis, Scripps Clinic’s Liver Disease Center is internationally recognized for its research into new treatments for chronic liver disease, particularly Hepatitis B and C.

Scripps gastroenterologists and hepatologists have extensive experience diagnosing and managing a variety of medical conditions that affect the liver, including:

• Autoimmune hepatitis, a disorder that causes your immune system to attack your liver. This can lead to chronic inflammation, scarring and eventual liver failure.

• Cirrhosis is the formal name for scarring that occurs in the liver. This scarring is caused by long term liver damage, and results in reduced liver function.

• Cholestatic liver diseases occur when the liver cannot adequately produce or release a substance called bile, which helps break down fats. A healthy liver constantly produces bile, which is passed through bile ducts into the gallbladder (for storage) and the small intestine (where it breaks down and absorbs fats). There are two main types of cholestatic liver disease, described below – primary biliary cirrhosis (PBC) and primary sclerosing cholangitis.

• Primary biliary cirrhosis, also known as PBC, is an autoimmune disorder that causes inflammation of the bile ducts within the liver. When these ducts are damaged, bile cannot flow properly and builds up in the liver, causing cirrhosis (scarring) and impaired liver function.

• Primary sclerosing cholangitis is similar to PBC, however it causes inflammation of bile ducts both within and outside of the liver. When these ducts are damaged, bile cannot flow properly and builds up in the liver, causing cirrhosis (scarring) and impaired liver function.

• Hemochromatosis, a condition where your body absorbs and retains too much iron. The excess iron causes damage to several organs, including the liver.

• Hepatitis B, a viral infection that causes short- or long-term inflammation of the liver. Most people with this condition were exposed to blood or bodily fluids from someone who was infected with the Hepatitis B virus. If your body cannot fight the virus on its own, and it’s left untreated, hepatitis can eventually lead to cirrhosis and liver failure.

• Hepatitis C is an infection caused by the Hepatitis C virus, and usually leads to long-term liver inflammation. Similar to Hepatitis B, it’s transmitted through contact with blood; however, most people with Hepatitis C are not aware they are infected until the liver is already damaged.

• Primary liver cancer is often called hepatocellular carcinoma, or HCC for short. The two terms are used interchangeably because most people who have liver cancer have HCC. This type of cancer starts in the liver, as opposed to cancer that starts in another organ and then spreads to the liver. Learn more about liver cancer treatment at Scripps.

• Liver failure, or end stage liver disease, occurs when the liver loses most or all of its function. Depending on how much liver function is left, your doctor may be able to manage your symptoms with medication or strict dietary changes. For patients with complete liver failure, a liver transplant is the only treatment option.

If your doctor suspects you have a liver disorder, he or she will confirm their diagnosis using one or more of the following tests:

• Endoscopic retrograde cholangiopancreatography, or ERCP, is an endoscopic procedure that allows doctors to examine the bile ducts. It can be useful in diagnosing bile duct cancer.

• Imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI) can confirm liver damage.

• Liver function tests are blood tests that can assess how well your liver is functioning by measuring levels of proteins, enzymes and other substances in your bloodstream.

• Liver biopsy, a procedure where your doctor removes a sample of tissue from your liver and examines it for signs of disease.

For some people, living with chronic liver disease means a lifetime of managing symptoms. Our hepatologists work closely with each patient, to ensure you receive the safest and most effective care available – for as long as you need it.

Liver disease treatment options at Scripps include:

• Medication including steroids, antiviral drugs and immunosuppressants, can be used to manage a variety of liver disorders including autoimmune hepatitis and Hepatitis B and C.

• Liver transplant, a surgical procedure that removes the diseased liver and replaces it with a healthy donor liver. Scripps Center for Organ & Cell Transplantation has performed more than 640 liver transplants since it was founded in 1990, with success rates that are routinely higher than the national expected average.

• Liver resection, also known as partial hepatectomy, is a surgical procedure used to remove cancerous tumors from the liver.

• Ursodeoxycholic acid (UDCA) is a medication doctors may prescribe to treat primary biliary cirrhosis.

• Regular blood removal is often an effective treatment for people with hemochromatosis (excess iron stored in the body). By giving blood, you can help reduce your iron levels. If you’re not eligible to give blood due to a medical condition like anemia, your doctor may be able to prescribe a medication that helps your body get rid of excess iron through your urine or stool. This is called chelation therapy.

• If you have liver cancer, your hepatologist will work closely with Scripps cancer specialists to create a customized treatment plan. Learn more about liver cancer treatment options at Scripps.

Scripps gastroenterologists and hepatologists offer liver disease consultations or care at the following locations:

• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital (San Diego and Chula Vista)
• Scripps Green Hospital
• Scripps Clinic Carmel Valley
• Scripps Clinic Encinitas
• Scripps Clinic Rancho Bernardo
• Scripps Clinic Rancho San Diego