"Ask the Doctor": Liver Disease

April 18, 2000

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Whirlygig: Can you give me some general information on maintaining good liver health?

Dr Woods: The number one cause of liver damage in the US is alcohol abuse. It's important to understand that each patient has a different tolerance to alcohol; therefore, the amount of alcohol necessary to cause liver damage varies from patient to patient. Females are especially vulnerable to liver injury from alcohol. So by far, the number one health tip is to avoid alcohol, or certainly to only take alcohol in moderation. Other things that can injure the liver include obesity, or poorly controlled diabetes. In these diseases, fat can be deposited in the liver, leading to significant liver injury. Certain herbal medicines can be toxic to the liver, and we always caution our patients to make sure that they are using products that are at least somewhat standardized. There is a variety of other things that can lead to liver injury, including excessive use of even such good drugs as Tylenol. Even normal doses of Tylenol in patients who already have liver injuries, especially when combined with alcohol use, can lead to serious liver injury. The other factor that you can do to protect your liver is to receive the vaccinations to protect you from Hepatitis A and B infections. This requires two different vaccines, but it's especially important for patients travelling to underdeveloped areas of the world. Unfortunately, we don't yet have a vaccine to protect against Hepatitis C. Certainly, if you have any questions about the status of your liver, liver screening tests are fairly inexpensive, and certainly worth while.

Larry184: What are the chances of getting hepatitis in a hospital?

Dr Woods: The chances of getting hepatitis in a hospital are probably very low, but certainly not zero. Any time you need to receive blood or blood products, there is a risk involved. All potential blood donors are very thoroughly screened, but obviously no screening is perfect. In reality, the only truly safe blood is your own blood, and we encourage patients who are undergoing any type of elective surgery to do what we call autologous transfusions-that is, to donate one or two units of blood to themselves. The risk of obtaining Hepatitis A or other forms of hepatitis, I believe, is very low in the hospital setting. The exception is employees who are in the setting of the operating room, or dialysis units, where there is a high risk of exposure to blood and body fluids.

Jabrake: Can you tell me anything about Primary Biliary Cirrhosis?

Dr Woods: Primary Biliary Cirrhosis is what is called an auto-immune liver disease. Basically, the body has become confused, and no longer recognizes its own liver as not being a foreign liver, and begins to attack its own liver. If the attack continues over a long enough period of time, patients will go on to develop significant liver injury and perhaps even cirrhosis of the liver. Many patients may eventually need a liver transplant. The disease primarily occurs in older females, and presently is being treated with many of the same medications that are used in patients who received a liver transplant. I tell the patients who have PBC that they are basically experiencing the phenomenon of rejection that we see after transplant.

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