Liver Diseases: Comprehensive Overview from Fatty Liver to Cancer

Major Categories

Disease	Key Features	Major Causes
Cirrhosis	Irreversible fibrosis → nodular regeneration → portal hypertension, synthetic failure	Alcohol, HBV/HCV, NAFLD/NASH, autoimmune, genetic (Wilson, hemochromatosis)
Alcoholic Liver Disease (ALD)	Spectrum: Steatosis → Steatohepatitis (ASH) → Cirrhosis	Chronic heavy alcohol (>30g/day women, >50g/day men)
NAFLD / NASH	Steatosis >5% hepatocytes without alcohol; NASH = inflammation + ballooning ± fibrosis	Metabolic syndrome (obesity, T2DM, dyslipidemia, HTN)
Viral Hepatitis	A/E: acute, fecal-oral; B/C/D: blood/sexual, vertical; B/C → chronic → cirrhosis/HCC	HBV, HCV, HDV (requires HBV), HEV
Autoimmune Hepatitis	Female predominance; high IgG, autoantibodies (ANA, SMA, LKM1); responds to steroids	Genetic + environmental trigger
Primary Biliary Cholangitis (PBC)	Anti-mitochondrial antibody (AMA+); middle-aged women; cholestatic	Autoimmune bile duct destruction
Primary Sclerosing Cholangitis (PSC)	IBD association (UC); multifocal strictures; cholangiocarcinoma risk	Immune-mediated; genetic susceptibility
Drug-Induced Liver Injury (DILI)	Intrinsic (dose-dependent) vs. Idiosyncratic; RUCAM causality scale	Acetaminophen, antibiotics, herbals, TB drugs
Acute Liver Failure (ALF)	Coagulopathy (INR ≥1.5) + encephalopathy <26 wks in no prior liver disease	Acetaminophen, viral, DILI, ischemia, Wilson
Hepatocellular Carcinoma (HCC)	Most common primary liver cancer; arises in cirrhosis (80–90%)	HBV, HCV, ALD, NASH, aflatoxin, hemochromatosis
Wilson Disease	ATP7B mutation → copper accumulation; neuro + hepatic; treat with chelation	Autosomal recessive
Hemochromatosis	HFE C282Y homozygosity → iron overload; cirrhosis, diabetes, cardiomyopathy	Autosomal recessive

Silent Progression

Most chronic liver diseases are asymptomatic until decompensation (ascites, variceal bleed, encephalopathy, jaundice).

Screening & Surveillance

• At-risk: LFTs, FIB-4, ELF, FibroScan q1–3yr.
• Cirrhosis: HCC surveillance (US ± AFP q6mo); variceal screening (EGD).
• Viral hepatitis: HBV/HCV serology; treat to cure/suppress.

Prevention

• Alcohol moderation/abstinence.
• Metabolic health (weight, glucose, lipids).
• Vaccination (Hep A/B).
• Safe injection, safe sex.
• Medication review (hepatotoxins).

Early detection reverses fibrosis; late detection manages complications.