Liver Disease Q&A

Ask the Consultant

Two of our leading liver specialists answer common questions on liver disease including signs and symptoms, the effects of alcohol and treatments options.

Dr Stephen Ryder
The commonest causes of liver disease in the UK are alcohol, fatty liver due to weight gain and viral hepatitis (hepatitis B and C). There are a number of other causes (autoimmune liver diseases and a number of inherited liver diseases).  Injury to the liver can result in the liver forming scar tissue which can end up distorting the liver (cirrhosis), it is this distortion of the liver by scar tissue which can cause liver failure.


Dr Rajaventhan Srirajaskanthan
There are many different causes of liver disease worldwide. The most common types of liver disease are dependent on where you live. In the UK the most common types of liver disease are non-alcoholic fatty liver disease and alcohol related liver disease. However, there are a number of other conditions including autoimmune and viral causes. 

Dr Stephen Ryder
During the time the liver is being injured there are usually no symptoms, the process of building up scar tissue in the liver may take 2-4 decades during which people appear well. Once cirrhosis is present the liver is at risk of failing, sign of liver failure are fluid retention (leg swelling and a build up of fluid in the abdomen called ascites), jaundice, confusion due to a bulid up of waste products in the blood which are removed by a healthy liver and a risk of internal bleeding from what are essentially internal varicose veins in the oesophagus. These are late signs and usually indicate a poor outlook. Early diagnosis before the development of cirrhosis is essential to prevent these happening. We can now assess people for the presence and amount of scar tissue in their liver both by blood tests and by a special form of ultrasound scan (fibroscan).


Dr Rajaventhan Srirajaskanthan
Often liver disease can have no symptoms and is identified incidentally on blood tests. However, in some people it can cause fatigue or some pain in the abdomen. In more advanced cases people can develop swelling of their abdomen and also become jaundice. 

Dr Stephen Ryder
People who are overweight and have type 2 diabetes are at high risk of fatty liver disease. If people drink too much alcohol over a time period (more than 14 units for for both men and women). Hepatitis B is an infection which is very common in many parts of the world and is usually caught in childhood, in the UK  people who were born in high risk countries such as China, Sub Saharan Africa and Eastern Europe are at risk. Hepatitis C is spread either by contaminated medical equipment (common in countries with poor health care systems) or by injecting drugs.


Dr Rajaventhan Srirajaskanthan
It depends on the cause of liver disease. In terms of developing non-alcoholic fatty liver disease this is more common in diabetics, people who are overweight or have high blood pressure. Alcohol related liver disease is usually due to too much alcohol intake, however, this can be a subtle excess over many years. 

Dr Stephen Ryder
If people drink more than the safe limits there is a risk of developing injury to the liver. This usually starts with a build up of fat in liver cells (which can be detected by abnormal liver blood tests or scans in many people). If this injury continues the liver attempts to repair the damage but may heal with scar tissue formation. A number of years of heavy drinking is usually required before cirrhosis develops with the risk then of developing liver failure. Alcohol causes 70% of liver deaths in the UK and around 12000 people die per year of liver disease. 


Dr Rajaventhan Srirajaskanthan
In moderation alcohol does not cause harm to the liver and that is when people follow the national guidance. However, if you exceed this level repeatedly over a long period of time it can cause scarring and damage to the liver. 

Dr Stephen Ryder
Not everyone who drinks too much will develop liver disease, there seem to be a number of genetic and environmental factors which protect some people. We know that is people have more than one risk factor for liver disease they are much more likely to run into problems-for example overweight heavy drinkers are much more prone to develop liver scar and cirrhosis. The key message really is that a healthy lifestyle is very good for your liver! 


Dr Rajaventhan Srirajaskanthan
It can cause permanent damage to the liver with continued excessive drinking. A condition called cirrhosis can occur where the liver becomes scarred and does not function as it should. Stopping alcohol at this point may not always lead to a full recovery of the liver, though usually there is some improvements. 

Dr Stephen Ryder
The main causes of liver disease are the ones referred to above. 


Dr Rajaventhan Srirajaskanthan
Genetic factors such as family history of liver disease. Gender females are more likely to suffer from conditions like autoimmune liver disease or primary biliary cirrhosis. 

Dr Stephen Ryder
There are now highly effective treatments for some liver diseases, for example we can cure almost everyone of hepatitis C now with drug treatments. There are now very good services which can help with weight loss and reduction in alcohol intake so liver disease should be viewed as a totally treatable thing as well as preventable with lifestyle change.


Dr Rajaventhan Srirajaskanthan

There are a number of very effective treatments for different types of liver disease. A lot of research is currently under way in many different types of liver disease. There have been some remarkable breakthroughs in treatment of viral hepatitis, specifically hepatitis B and C. 

Dr Stephen Ryder
I made the choice so long ago now I cant remember my original reasons! It was probably because it sounded high powered and looked good on the telly. In reality its far more rewarding than that and sad though it may seem I still enjoy it enormously. 


Dr Rajaventhan Srirajaskanthan
I thoroughly love medicine and find it fascinating. It is a great profession that allows you to help people and also advance science through working in collaboration with colleagues. 

Dr Stephen Ryder
Being part of the development of new treatments for hepatitis C. We have gone from discovery of this virus in 1989 through treatments which could cure people but not all and were very toxic and difficult to take to new drugs now with almost 100% cure rates and no significant side effects. This is a real showcase for modern medicine, from discovery to eradication of a disease in less than 30 years.


Dr Rajaventhan Srirajaskanthan
The highlights of my career to date have been becoming a consultant and being awarded my MD following completion of my research degree. 

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