Introduction: Fatty Liver, Cirrhosis, and Related Disorders: Merck Manual Home Edition

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	Introduction

Section		Liver and Gallbladder Disorders

Subject		Fatty Liver, Cirrhosis, and Related Disorders

Topics		Introduction· Cirrhosis· Fatty Liver· Primary Biliary Cirrhosis· Primary Sclerosing Cholangitis

Introduction

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primary biliary cirrhosis

tamoxifen

Most liver diseases, including fatty liver, cirrhosis, primary biliary cirrhosis and primary sclerosing cholangitis, result from injury to the liver. If damage is acute (sudden) and limited, the liver commonly repairs itself by regenerating new liver cells onto the scaffolding (internal structure) left when liver cells die. Repair and full recovery occur if the person can survive long enough to allow this renewal. However, repeated damage, particularly with disruption of the liver scaffolding, leads to scarring (fibrosis) and erratic attempts at regenerating, resulting in cirrhosis.

Injury to the liver can follow exposure to any of the following:

Alcohol (a common cause)
Toxins in the environment and as contaminants in foods
Certain drugs, such as aspirinSome Trade Names
ECOTRIN
ASPERGUM
(given to infants), corticosteroids, tamoxifenSome Trade Names
NOLVADEX
, and tetracyclineSome Trade Names
ACHROMYCIN V
TETRACYN
SUMYCIN
Some medicinal herbs (for example, “bush tea” containing pyrrolizidine alkaloids)
Metabolic problems
Infection (eg, certain viruses)
Inflammation from malfunction of the immune system, causing the body to attack its own tissues (an autoimmune reaction—see Autoimmune Disorders)

Sometimes the exact cause of liver injury is not known.

Medicinal Herbs and the Liver

Some medicinal herbs (plant parts taken for medicinal purposes) contain substances that can damage the liver. These substances may also be consumed in contaminated foods. The liver is a prime target for damage because it processes everything that enters the mouth and is swallowed.

Herbs, for example, that contain pyrrolizidine alkaloids may damage the liver. Hundreds of herbs contain pyrrolizidine alkaloids. These herbs include borage, comfrey, and certain Chinese herbs, such as zi cao (groomwell), kuan dong hua (coltsfoot), qian li guang (liferoot), and pei lan (Eupatorium). Some of the herbs that contain pyrrolizidine alkaloids are used to make teas. Sometimes milk, honey, and cereals are contaminated with pyrrolizidine alkaloids, which are then consumed unknowingly.

Pyrrolizidine alkaloids can damage the liver gradually if small amounts are consumed for a long time or more quickly if a large amount is consumed. They may cause the hepatic vein to become clogged, blocking the blood supply to the liver. Affected people have abdominal pain and may vomit. Fluid accumulates in the abdomen and legs. Eventually, scar tissue in the liver (cirrhosis), liver failure, and even death may result.

Other herbs that can damage the liver include Atractylis gummifera, Camellia sinensis (used to make black tea), celandine (greater), chaparral, germander, jin bu huan, kava, ma huang (Ephedra), mistletoe, pennyroyal oil (used to make teas), and syo-saiko-to (a mixture of herbs).

Last full review/revision September 2007 by Eldon A. Shaffer, MD

Next: Cirrhosis

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