Internal Medicine

Liver and gallbladder diseases

The liver is the central metabolic organ in the human body.
Liver diseases therefore often have far-reaching consequences, as impairments of liver function can affect the whole body. The "cardinal symptom" of liver disease is jaundice (Jaundice), i.e. the yellowing of the skin. This occurs because the liver can no longer adequately convert and break down the resulting pigment bilirubin and this can e.g. deposited in the skin.
Below you will find a clear explanation of the most important diseases of the liver and gallbladder.

Classification of diseases of the liver and gallbladder

You will find the diseases of the liver and gallbladder classified according to:

Inflammation of the liver
Structural diseases of the liver
Gallbladder diseases
Other diseases of the liver and gallbladder

Inflammation of the liver

Hepatitis C.

Liver inflammations are divided into hepatitis A - E.
Hepatitis C is caused by a specific virus, the hepatitis C virus (HCV). The virus is mainly transmitted via the bloodstream, most commonly to drug addicts who reuse needles or who share needles. Sexual transmission of the virus plays a minor role. Acute hepatitis C remains asymptomatic in 75% of patients. The problem with hepatitis C, however, is that the acute infection turns into chronic liver inflammation in about 80% of cases, which in turn can turn into cirrhosis and liver cancer. So the course of a hepatitis C infection can be fatal. The virus can be fought with modern aggressive drugs and a cure is possible.

For details, see Hepatitis C.

Hepatitis B.

Hepatitis B is in turn triggered by the hepatitis B virus (HBV). It is the most common form of hepatitis. The hepatitis B virus is contained in various body fluids of those affected, and sexual transmission plays a far more important role than in hepatitis C. The transmission from mother to child during childbirth or while breastfeeding is also important is possible and is the most common source of infection in developing countries. Compared to hepatitis C, hepatitis B is usually not chronic, only 10% of those infected develop chronic hepatitis. Another big difference is that there is a vaccine against hepatitis B that is administered in Germany as part of the "6-fold vaccination" in early childhood and protects against infection.

For details, see Hepatitis B.

Hepatitis A / D / E

Hepatitis A, D and E are rarer and more prognostically progressing liver inflammations.
Hepatitis A is a typical travel sickness and is common in holiday destinations with low hygiene standards, e.g. transmitted through contaminated water. Typical symptoms include fever, diarrhea, and vomiting.
Hepatitis D is caused by the hepatitis D virus. An infection with this virus is only possible if the person affected already suffers from hepatitis B! Therefore, overall, hepatitis D is very rare, as the majority of the population cannot develop the disease.
In Germany, hepatitis E is mainly transmitted through raw (game) pork (e.g. ground meat). It is important that the risk of infection increases significantly during pregnancy and that the course of the disease in pregnant women is also less favorable! Therefore, pregnant women should definitely avoid raw meat!

For more detailed information, see Hepatitis A, Hepatitis D and Hepatitis E..

Structural diseases of the liver

Fatty liver

If there is excessive fat storage in the liver tissue, one speaks colloquially of a fatty liver. As part of this restructuring of the liver, inflammation can also occur, which is then called Steatohepatitis are designated. The most common cause of obesity in the liver is excessive alcohol consumption, which is why one generally has an alcoholic fatty liver (alcoholic steatohepatitis, ASH) from a non-alcoholic fatty liver (non-alcoholic steatohepatitis, NASH) differs. Patients usually only notice the disease when an inflammation of the liver develops. The presence of fatty liver also increases the risk of developing cirrhosis or liver cancer very drastically.

For details, see Fatty liver.

Cirrhosis of the liver

Cirrhosis of the liver is a nodular remodeling of the liver tissue that massively restricts liver function. The most common cause of liver cirrhosis is alcohol abuse (50%), followed by liver inflammation hepatitis C and B (25%). The disease has far-reaching consequences for the whole body, for example varicose veins develop on the abdominal wall and in the esophagus because the blood flow through the liver is restricted. Liver cancer develops comparatively often from cirrhosis of the liver over the years. There is no cure for liver tissue damage; patients can only be saved with a liver transplant.

You can find detailed information at:

Cirrhosis of the liver
Stages of cirrhosis of the liver

Liver cancer / HCC

Liver cancer is also called Hepatocellular carcinoma (HCC). Liver cancer often develops over the years from cirrhosis of the liver or from fatty liver. Chronic alcohol abuse and infections with hepatitis B or C are therefore the most important risk factors for the development of the tumor. If the tumor has not yet spread to other parts of the body, patients can be cured with partial liver removal or a liver transplant.
Furthermore, the liver is the place where metastases of other tumor diseases (e.g. lung / breast cancer) occur most frequently.

For details, see Liver cancer.

Wilson disease

Wilson's disease is a congenital genetic metabolic disorder. The patient has a disorder in the copper metabolism, which is why copper is stored primarily in the liver tissue and brain. The copper deposition leads to tissue damage to the liver and patients often develop cirrhosis of the liver. The deposits in the brain can cause symptoms such as dementia and muscle twitching (tremor). A lifelong low-copper diet and the use of copper-binding drugs can control the disease relatively well, but in some cases a liver transplant may be necessary.

For details, see Wilson disease.

Liver fibrosis

Liver fibrosis is the displacement of healthy liver cells by connective tissue. This causes the liver to lose its function. Overall, liver fibrosis can be understood as a preliminary stage of liver cirrhosis, because if the nodular remodeling of the liver takes over, we speak of liver cirrhosis. To determine the progression of the connective tissue change, an ultrasound examination or a tissue sample (biopsy) help.

For details, see Liver fibrosis.

Gallbladder diseases

Gallstones

Gallstones are deposits of certain parts of the bile in the gallbladder or bile ducts. Most of the cases (approx. 90%) are cholesterol stones. Cholesterol is excreted with the bile, but if the cholesterol concentration in the blood is too high, the bile acid can no longer completely bind it and cholesterol stones fall out. Risk factors for gallstones include women, obesity, and age over 40. In patients with gallstones, one can first try not to dissolve the stones surgically, for example with shock wave therapy or certain drugs. If this is unsuccessful, the gallbladder can be surgically removed.

For more information, see Gallstones.

Inflammation of the gallbladder

If gallstones clog the bile ducts, gallbladder inflammation usually develops. It is usually the first symptom of gallstones that previously remained asymptomatic. In 95% of the cases, gallstones are the basis of a gallbladder inflammation, but there are also "stone-free" inflammations. Symptoms of gallbladder inflammation are usually severe pain in the upper right abdomen, which can radiate into the shoulder, as well as nausea and vomiting. Jaundice can also develop. Treatment of a gallbladder infection usually consists of surgical removal of the gallbladder.

For details, see Inflammation of the gallbladder.