Liver Health

Updated 12 October 2016

Causes of liver disease

Because there are so many different types of liver disease there are also many possible causes.


The liver is a complex organ that performs many different functions. Many different things can go wrong with the liver and there are over 100 different diseases that can affect the liver.

Some causes of liver disease are congenital (in other words you are born with them) while others are caused later in life by viruses, parasites, immune system abnormalities, cancer, chronic alcohol and/or drug abuse or fat accumulating in the liver.

If the damage to the liver is sudden and limited, the liver can commonly repair itself, according to the Merck Manual. However, if the liver is subjected to repeated damage, such as in the case of excessive long-term alcohol abuse, or the effects of hepatitis C, or fatty liver disease, the liver starts forming scar tissue. This can result in irreversible damage, called fibrosis (initial stages) and cirrhosis (irreversible) of the liver, because scar tissue prevents the normal functions of the liver.

This scar tissue destroys the liver’s internal structure, according to the Merck Manual, and also inhibits the liver’s ability to repair itself.

What’s more, cancer cells are most likely to develop in areas where the body has been damaged and is desperately trying to repair itself on a constant basis. The greater the cell replication in any part of the body, the greater the statistical chances of a rogue cancer cell finding a foothold, according to a Harvard University study published by the Genetics Society of America.

Genetic causes of liver disease

As the liver plays such a critical part in ridding the body of toxins and extracting and storing nutrients for the body to use, children born with a genetic liver disease usually become ill as young infants.

Some of the more common ones, according to the American Liver Foundation, are:

- Haemochromatosis (iron accumulates in the body)

- Wilson’s disease (it causes the body to retain copper)

- Gilbert’s disease (a metabolic disorder)

- Alpha 1- antitrypsin deficiency (causes liver damage)

- Glycogen storage disease type 2 (causes liver damage)

- Biliary atresia (a condition in which bile ducts are blocked or malfunctioning)

- Porphyria (a condition that affects, among other things, the skin and the liver)

These liver diseases are all fairly rare.

Acquired causes of liver disease

Accurate statistics on liver disease in South Africa are difficult to come by, but a large European study conducted at the behest of the European Association for the Study of the Liver and published in Journal of Hepatology revealed the four major causes of liver disease to be alcohol consumption, viral hepatitis B and C and metabolic syndromes related to obesity.

Liver cancer and medication-induced liver problems are also fairly common.

Alcoholic liver disease. Alcoholic liver disease is most prevalent in people who have genetic variations of certain enzymes, in women, in people who drink and also take drugs, who have certain types of hepatitis and who do not eat a healthy diet, according to an article by LK Mahani et al, published in 2011 in the American Journal of Clinical Nutrition.

There are three stages to this disease, namely hepatic steatosis (fatty liver), alcoholic hepatitis and alcoholic cirrhosis. Moderate drinking is considred to be one to two units of alcohol per day for men and one for women. What would constitute excessive alcohol consumption will vary from patient to patient.

2. Hepatitis A, B and C. Hepatitis basically means that the liver is inflamed.

Hepatitis A can be acquired from a virus found in the faeces of an infected person, while hepatitis B and C are blood-borne viruses. Hepatitis B is highly infectious, while hepatitis C is less so. Hepatitis B and C can be spread by means of sex, sharing of equipment such as toothbrushes, or coming into direct contact with the blood of an infected person.

Hepatitis A is not a chronic condition, while both hepatitis B and C can become chronic, and cause irreversible liver damage. 

3. Fatty liver disease (Non-alcoholic steatohepatitis). When there is fat build-up in the liver, often found in obese or overweight patients, not only is the functioning of the liver affected, according to the American Liver Foundation but it can lead to cirrhosis of the liver, and cardiovascular problems. Such patients often also have diabetes and high cholesterol. In its early stages, this disease can be arrested by severely reducing fat intake.

4. Medication-induced liver problems. Paracetamol is found in more than 600 different prescription and over-the-counter medicines. When used as directed, these are safe and effective, but taking more than the prescribed dose can lead to liver damage. Illegal drugs, including cocaine and inhalants, can also do serious damage to your liver.

5. Liver cancer. The most common primary liver cancer (one that originates in the liver) is hepatocellular carcinoma. Other primary liver cancers are relatively rare. Cancer can also spread to the liver from other organs. Liver tumours can be cancerous or non-cancerous. Liver cysts can also form, but these are mostly harmless.

Reviewed by Dr. Mark W Sonderup, B Pharm, MB ChB, FCP (SA). Senior Specialist, Division of Hepatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town (January 2015).

Read more:
Diagnosing liver disease
Treating liver disease
Preventing liver disease


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