Many liver diseases start at a certain point in time. When this happens, they are called acute because they start all of a sudden.

This is the point at which many people will start to have symptoms, including:

• Tiredness or weakness
• Jaundice (yellowing of the eyes and skin)
• Fever
• Nausea and vomiting
• Dark urine or very pale colored stools
• Pain under the ribs on the right side

Up to half of all people with liver disease have no symptoms at all. Some types of liver disease get better without treatment, and the liver heals itself entirely.

Other liver diseases, however, continue to cause damage even when the symptoms are gone. These diseases are then called chronic and can go on for many years.

The word "hepatitis" means inflammation or swelling of the liver. Many things can trigger this, and the hepatitis C virus is just one of them. Medications, alcohol, and even some genetic diseases can cause inflammation. (Genetic diseases are ones that are passed down from your biological parents.)

Sometimes liver inflammation gets better on its own, but sometimes, as in the case of chronic hepatitis C, treatment with medications is required to stop the inflammation.

If you have hepatitis, you need to be very careful not to do things that might irritate your liver even more. Alcohol irritates the liver, even in someone who doesn't have any other liver problems.

Summary:

"Hepatitis" means inflammation of the liver. It can be caused by:

• Genetic diseases
• Medications (including over-the-counter drugs)
• Alcohol
• Viral hepatitis (see next section)

Hepatitis A

The hepatitis A virus is usually spread through water and food (particularly raw shellfish) that is contaminated with human waste. If you hear about people getting hepatitis from a visit to a restaurant or cafeteria, or after a picnic, it is probably hepatitis A. If you get hepatitis A, you may feel like you have the flu. You may notice a yellowish color (called jaundice) in your skin or in the whites of your eyes. You may feel sick or tired for a month or so, but hepatitis A never leads to chronic liver disease. In rare cases, a person may get so sick from hepatitis A that he or she may die. There is a vaccine to prevent hepatitis A. People with a chronic liver disease should receive the vaccine to be protected from hepatitis A, unless they are already immune (determined by blood tests). Immunity means that a person already has been exposed to the virus, and their immune system will protect them from getting it again. It is important that people with chronic liver disease who are not immune to hepatitis A receive the vaccine to protect themselves from it, since they can get quite sick if they contract the infection.

Hepatitis B

The hepatitis B virus is spread through blood, semen, and vaginal fluid. You can get hepatitis B if you have sex with an infected person, or if you share needles or works to inject drugs with someone who is infected. As with hepatitis A, hepatitis B can make you feel sick for a short time. After that, most people with hepatitis B get rid of the virus. A small number (2% to 6%) of people who get hepatitis B infection fail to get rid of it, and go on to have chronic infection. This often leads to liver damage over time. Once you have come into contact with hepatitis B, and the virus is no longer active in your body, you cannot become infected with it again. There is a vaccine to prevent hepatitis B. People with a chronic liver disease should receive the vaccine to be protected from hepatitis B, unless they are already immune (determined by blood tests). It is important that people with chronic liver disease who are not immune to hepatitis B receive the vaccine to protect themselves from it, since they can get quite sick if they contract the infection.

Hepatitis C

Hepatitis C is spread mainly through the blood. If you share needles or works to inject drugs, you have a high chance of getting infected. People who had a blood transfusion before 1992 also might find out that they are infected with hepatitis C. Unlike the other hepatitis viruses, the virus that causes hepatitis C may not make you feel very sick. In fact, you can be infected and not even know it. Hepatitis C can be a serious illness. Most people who get hepatitis C never get rid of the virus completely. Over time, it can cause permanent liver problems. There is no vaccine to prevent it. If you have hepatitis C, you can still get hepatitis A and B.

Anything that damages the liver over many years leads the liver to form scar tissue. Fibrosis is the first stage of liver scarring.

When scar tissue builds up and takes over most of the liver, this is a more serious problem called cirrhosis (pronounced "sir-o-sis"). Scar tissue cannot perform any of the jobs of normal liver cells, and this causes a person with cirrhosis to slowly become ill.

There is no way of predicting who is going to get cirrhosis. Cirrhosis does not happen overnight. Many people who have cirrhosis for 5 to 10 years or more do not show clear signs of illness.

Cirrhosis can be caused by anything that damages the liver after years of irritation, not just alcohol. However, heavy alcohol use and having the hepatitis C virus for a long time (such as 20 to 30 years) increases your risk.

Scroll over image to see the liver change from a healthy liver to a liver with cirrhosis.

Over time, cirrhosis can lead to advanced liver disease. Symptoms can include fatigue, difficulty thinking clearly, fluid in the abdomen, bleeding in the intestines, and poor blood clotting.

Alcoholic liver disease is a common form of liver disease in the United States. People get alcoholic liver disease by drinking large amounts of alcohol for many years. It doesn't matter whether the alcohol comes from hard liquor, beer, or wine. Any type of alcohol can cause liver damage.

One unit of an alcoholic beverage contains 10 grams of alcohol. A unit is roughly equivalent to:

• one 12-ounce bottle of beer (5% alcohol)
• one 4-ounce glass of wine (12% alcohol)
• one 1-ounce shot of hard liquor (40% alcohol)

So how much alcohol is too much? It depends on whether you're a man or a woman. Studies have shown that women experience liver disease at lower levels of alcohol intake than men.

Many liver specialists would agree that liver disease is likely at these levels:

• For women: 4 or more units of alcohol daily for at least a year
• For men: 6 or more units of alcohol daily for at least a year

Some people will experience liver damage even if they drink much less. The good news is that the livers of heavy drinkers can improve if they stop drinking entirely.

Fatty liver is the buildup of fat in liver cells. It is probably the most common type of liver disease in the United States. Fatty liver by itself rarely leads to severe liver damage.

Fatty liver can result from drinking too much alcohol. It can also happen in people who rarely drink. In this case, it is called "nonalcoholic steatohepatitis," or NASH. ("Steato-" means fat.) With NASH, a patient's liver shows some inflammation that in some cases can lead to liver damage and cirrhosis (scarring of the liver tissue).

It is not clear why fat builds up in the liver, but people are more likely to develop the condition if they have diabetes, are overweight, or have high levels of cholesterol or blood fats (called "triglycerides"). The amount of fat in the liver may decrease when overweight people lose weight, when diabetics have well-controlled blood sugars, and when cholesterol and triglyceride levels are lowered.

Like all other body organs, your liver can get cancer. Liver cancer is a disease in which some of the cells in your liver begin to reproduce faster than they should. This can lead to liver tumors, which are generally diagnosed by taking pictures of the liver with ultrasound, computerized tomography (CT) scan, or magnetic resonance imaging (MRI).

Having hepatitis B or hepatitis C can increase your chances of getting liver cancer, particularly a type of cancer called hepatocellular carcinoma (or "HCC").

Most people with liver cancer do not have any symptoms from it. Those who do have symptoms often have some pain in the area of their liver (right side of the abdomen, under the ribs), or they may have a build-up of fluid in their abdomen (called "ascites").

Liver cancer can be deadly. If you find out that you have liver cancer, you need to get treated as soon as possible.

For more information, go to Liver Cancer (http://www.hepatitis.va.gov/cancer-00-00) .

Some genetic disorders cause the liver to build up toxic substances. These include:

• Hemochromatosis (too much iron)
• Wilson's disease (too much copper)

Other less common liver diseases include:

• Autoimmune hepatitis (the body attacks its own liver cells)
• Primary sclerosing cholangitis (the liver's large bile ducts become blocked, leading to infection, jaundice, and eventual cirrhosis)
• Primary biliary cirrhosis (liver's small bile ducts become inflamed and bile backs up, leading to itchy skin, jaundice, and eventual cirrhosis)

Here are some things to remember about keeping your liver healthy if you have hepatitis C:

• Don't drink alcohol. Alcohol can cause further swelling and irritation of your liver, and drinking increases your chances of cirrhosis. No one knows if there is a safe amount of alcohol for patients with liver disease.
• Get tested for hepatitis A. A blood test can tell if you are already immune to hepatitis A. If you have hepatitis C, and you are not immune to hepatitis A, you should get vaccinated for it. If you have hepatitis C, you have a higher chance of getting very sick if you get hepatitis A.
• Get tested for hepatitis B. The test can tell if you have ever been exposed to hepatitis B. If you haven't been exposed, you should get vaccinated if:
  • you belong to a group at risk for hepatitis B (such as health care workers)
  • you have been involved in high-risk sexual behavior
  • there is any chance of your using or sharing needles for illegal drug use
  If you are already immune to hepatitis B, you should be protected from getting it again.
• Be careful with medications. Occasional use of low-dose acetaminophen (commonly known as Tylenol) is OK. A general rule is to take half the dose recommended on the bottle. It is also OK to take ibuprofen (Motrin or Advil) if you do not have cirrhosis. Regular aspirin is fine if it doesn't bother your stomach.
• Be careful about vitamins and minerals. Avoid iron supplements unless prescribed by your doctor (as long as your doctor knows you have hepatitis C). Iron might speed up the process of liver scarring, particularly when taken in large doses.
• Be careful about herbal remedies. Some patients ask to take the herb "milk thistle," believing it can reduce swelling in the liver. Whether milk thistle works or not is unknown. However, be cautious when taking any herb. U.S. regulations do not require that these products be tested for quality.

Click on an underlined letter to find the terms that start with that letter.

Acquired Immune Deficiency Syndrome (AIDS): A severe disorder caused by the HIV retrovirus. It effects your immunity by making you more susceptible to infections and to certain rare cancers. It is mostly transmitted by exposure to contaminated blood and semen.

Alanine aminotransferase (ALT): An enzyme released from liver cells. A blood test that reveals ALT levels above normal may indicate liver damage.

Alanine aminotransferase (ALT): levels and aspartate aminotransferase (AST) levels rise during periods of liver damage, when these enzymes leak out of broken cells. The actual numbers are not as important as how much they increase over time. Many patients with hepatitis C have raised ALT and AST levels, and many patients have normal ALT and AST levels. For those with elevations, one goal of treatment is to get the levels back to normal.

Albumin: A group of proteins made in the liver, and which play an important role in ensuring the maintenance of a normal blood volume.

Albumin (Alb): is a protein made by the liver to keep body fluids in balance. Low levels can indicate poor health and nutrition or a failing liver.

Alkaline phosphatase (AlkPhos): is an enzyme made in the liver's bile ducts and also in bone, kidneys, and intestines. High levels can indicate liver or bone disease.

Alpha-fetoprotein (AFP): is a test used to help diagnose liver cancer.

Anemia: is a shortage of red blood cells that can cause fatigue and other symptoms. Anemia may occur in people on interferon treatment.

Antibodies: are proteins produced by the body to fight infections. The presence in the blood of an antibody to hepatitis C means that the virus is present as well.

Antibody: A protein molecule produced by cells of the immune system in response to a foreign body, such as a virus or bacteria. Antibodies circulate in the blood to protect against infection.

Anti-HCV: (antibody to hepatitis C virus) The antibody directed against the hepatitis C virus (HCV). Its presence in the bloodstream often indicates HCV infection. This antibody has not been shown to protect people against hepatitis C.

Ascites: Fluid within the abdomen, often caused by cirrhosis.

Ascites: is fluid buildup in the abdomen due to high blood pressure in the liver.

Aspartate aminotransferase (AST): An enzyme released from liver cells. A blood test that reveals AST levels above normal may indicate liver damage.

Assay: A test or analysis.

bDNA (branched DNA) assay: One of the two tests that reveal the presence in the bloodstream of minute quantities of DNA and RNA, such as RNA fragments from hepatitis C virus.

Biochemical response (BR): Refers to patient's response to interferon therapy by normalization of ALT.

Bilirubin: A bile pigment that is also created by the breakdown of heme pigments. Usually collected by the liver cells, its presence in blood or urine is often a sign of liver damage.

Bilirubin (T bili): is produced by the liver when it recycles red blood cells. Normally it is processed for removal from the body, so high bilirubin is usually a bad sign. At very high levels, your skin can actually turn yellow (jaundice).

Blood-borne substances: Those substances that are present in the blood and are carried by it throughout the body. Blood-borne substances, such as viruses, can be passed on to others through blood transfusions, needle sharing, and even sharing a toothbrush if both people have bleeding gums.

Breakthrough response: A "breaking through" of the virus while on therapy. Detection of virus during therapy in those who had initially lost virus during treatment.

Carrier: A person in apparent good health, who has been infected with an organism and is capable of infecting and/or causing disease in others. Individuals persistently infected with hepatitis B and C without evidence of liver injury are considered "carriers."

Chronic infection: An infection that persists and that returns after it had seemed to be cured. Disease is defined as evidence of liver injury by abnormality in serum ALT and/or liver histology.

Cirrhosis of the liver: The result of long-standing inflammation and damage in the liver, such as may be caused by a hepatitis C infection or alcohol. It is characterized by excess formation of scar tissue, also called fibrosis, and results in the loss of liver cells and increased resistance of blood flow.

Cirrhosis: is the condition of having extensive scar tissue in the liver (see fibrosis). Permanent damage may have been done as a result of infection or alcohol abuse, and healthy liver cells have been replaced with scar tissue.

Concomitant event: An event, such as a medical condition, that occurs at the same time as another.

DNA (deoxyribonucleic acid): A component in cells of all living matter that carries hereditary genetic information. DNA helps determine what an organism will be as it develops to maturity, i.e. a virus, a human.

Edema: The puffiness that occurs from abnormal amounts of fluid in the spaces between cells in the body, especially just below the skin.

ELISA (enzyme-linked immunosorbent assay): This is a test that provides information on the presence or amount of antibodies in the bloodstream. This test is sometimes referred to as an "EIA."

Encephalopathy: A variety of brain function abnormalities experienced by some patients with liver disease. These most commonly include confusion, disorientation, and insomnia, and may progress to coma.

Encephalopathy: is damaged brain function caused by cirrhosis. It can lead to coma.

End treatment response (ETR): Refers to response to medications at the end of therapy regime.

Enzymes: Naturally occurring chemical substances in the human body that help a chemical reaction take place. High levels of these enzymes in blood may be a marker of disease.

Enzyme immunoassay (EIA): A test that provides information on the presence or amount of antibodies in the bloodstream. This test is sometimes referred to as an "ELISA."

Epidemiology: Investigation of the causes of, and ways to control, diseases.

False-positive: A test result that mistakenly gives a positive reading.

Fibrosis: is the first stage of scar formation in the liver. Scar tissue is an attempt to contain areas of the liver that have been damaged by alcohol, hepatitis C, or other factors.

Flavivirus: A group of related viruses, including the viruses that cause yellow fever. Hepatitis C is a hepacivirus related to flavivirus.

Genotype: A pattern of genetic information that is unique to a group of organisms or viruses. Doctors may determine the genotype of hepatitis C to help decide the best treatment.

Hepatic: Related to the liver.

Hepatitis: Inflammation (swelling) of the liver.

HCV RNA (hepatitis C virus ribonucleic acid): Fragments of the replicating hepatitis C virus (HCV). These can be detected using sophisticated testing to determine the level of hepatitis C virus present in the serum.

Hepatocellular carcinoma (HCC): Cancer of the liver cells that has progressed into a tumor.

Hepatocellular carcinoma (HCC): is liver cancer.

Interferons (IFN): are a group of proteins made by the body that have antiviral, antitumor, and immune system activity. They are also produced synthetically for treatment of medical conditions.

Intravenous drug abuse (IVDA): Acquiring an addiction to narcotic-type drugs that require intravenous administration. The intravenous use and abuse of recreational and other illegal drugs is a common route of transmission for hepatitis C infection.

Jaundice: A condition characterized by yellowness of the skin and eyes. Jaundice is a symptom of many disorders, including: obstruction of bile passageways by a gallstone; disease of the liver due to viral infection, alcoholism, or poisons; or breakdown of red blood cells.

Neutropenia :means a decreased number of a type of white blood cells that fight infections in the body. Interferon treatment can cause neutropenia.

Polymerase chain reaction (PCR): is a test used to determine the number of virus particles in the blood.

Portal hypertension: is high blood pressure in and around the liver. It is often caused by cirrhosis, and it can result in variceal bleeding and ascites.

Prothrombin time (PT): is a test that measures how long your blood takes to clot. Prothrombin helps the blood to clot, so time increases if the liver is not making enough of it.

Quasispecies: One or more sub-populations of a virus occurring within a single genotype in an individual.

Recombinant DNA: Genetic material that has been altered and recombined through insertion of new DNA sequences using bioengineering. Many drugs are now produced using recombinant DNA methods.

Recreational drugs: Illegal drugs, such as marijuana, cocaine, and heroin that are used by people addicted to the drugs, or, if not addicted, who feel the effects of the drugs outweigh the risk factors associated with them.

Remission: Partial or complete disappearance - or a lessening of the severity - of symptoms of a disease. Remission may happen on its own or occur as a result of a medical treatment.

RIBA (recombinant immunoblot assay): A test that confirms the presence of HCV antibodies in the bloodstream.

Risk factors: Certain behaviors (such as intravenous drug use or transfusions) linked to the development of an infection such as hepatitis.

RNA (ribonucleic acid): Molecules, found in all cells, that translate DNA genetic information into proteins.

Serology: A branch of medical testing that focuses on serum, particularly immune factors in serum.

Seronegative: When the suspected substance being searched for, such as the antibody to hepatitis C virus, does not show up in a blood test.

Seropositive: When the suspected substance being searched for, such as the antibody to hepatitis C virus, does show up in a blood test.

Seroprevalence: The frequency of a seropositive substance in a group of people.

STD (sexually transmitted disease): A communicable disease transmitted by sexual intercourse or genital contact.

Sustained response (SR): A response to therapy that continues over a long time period.

Sustained viral response: Means that six months after the end of interferon treatment, the virus is no longer detectable in the blood.

Thrombocytopenia: is a low level of platelets in the blood, sometimes caused by interferon treatment.

Transaminase: A term for alanine aminotransferase (ALT) and aminotransferases (AST).

Transmission: Passing an infection or disease from one person to another.

True-positive: A test result that accurately gives a positive reading.

Variceal bleeding: is bleeding from enlarged veins in the esophagus (called varices). Varices form as a result of high blood pressure in the liver.

Viral load: is the amount of virus particles in a milliliter of blood.

Viral load: The measurement of the amount of a given virus in the bloodstream.

Viremia: The presence of a given virus in the bloodstream.

Virologic Response (VR): Refers to patients' loss of detectable HCV RNA during or after medication therapy.

White blood cell count (WBC), hematocrit (HCT), and platelets (PLT): are all components of the blood. A low WBC count is called leukopenia. A low HCT count is called anemia and represents a lack of red blood cells. A low platelet count is called thrombocytopenia. These abnormalities can develop as complications of liver disease or as side effects of HCV treatments. A complete blood count (CBC) tests all of these types of blood cells.