2012: Issue 26

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2012 > Digestive Threats > Liver Diseases

Liver Diseases

Digestive system depends on a healthy liver

Cancer and other diseases of the liver represent dangerous threats to health. Many develop gradually without any noticeable symptoms; by the time symptoms appear, the disease may have reached a life-threatening stage.

Sometimes, numbers speak volumes: Liver cancer accounts for one in four cancer deaths in Thailand, more than any other cancer. The most recent statistics from Thailand’s Ministry of Public Health revealed that liver cancer killed more than 14,000 Thais in 2010 alone. The number of new cases continues to grow; on a typical day, 30 patients in Thailand will be diagnosed with liver cancer.

 causes of liver diseases

The liver’s importance is hard to overstate. “The liver is the body’s largest internal organ, and it’s involved in many  important body functions,” says Dr. Nusont Kladchareon,  a UK-board certified gastroenterologist and hepatologist at Bumrungrad. “The liver synthesizes many important proteins and other essential substances including blood-clotting helpers. It also produces certain hormones and digestive juice or bile.”

The liver converts and stores nutrients, vitamins and minerals, and it breaks down foreign chemicals and toxins from the body through the waste removal process. “It’s also the only organ capable of repairing itself by generating new cells to replace damaged cells,” Dr. Nusont notes. “If it becomes impaired by disease, the liver’s function may decline to the point where a patient’s life is in danger.”

Cancer is far from being the only threat to a healthy liver; a number of liver diseases are growing in prevalence due to unhealthy lifestyle choices, namely heavy alcohol consumption, unsafe sex and sedentary living. The most serious liver threats include:


Hepatitis is the general term describing inflammation of the liver and has several possible causes, including;

Hepatitis viruses A, B and C: Viral hepatitis is a major public health problem in Thailand, where hepatitis A and B are common while hepatitis C is relatively rare. The hepatitis A virus is transmitted through contaminated foods and beverages while hepatitis B and C are transmitted through contact (including sexual contact) with infected blood or body fluids. Hepatitis B and C can also be spread through razor sharing and during cosmetic procedures such as tattooing, body piercing, and even manicures and pedicures.

“People need to be aware of their personal risk factors,” cautions Dr. Nusont. “Risky behaviors, such as having multiple sex partners or sharing personal care items like razors and tweezers, promote the spread of such viral infections. Mothers carrying the hepatitis B virus may pass the infection to their babies during childbirth. Some newborns fight off the infection and develop lifetime immunity; babies who can’t clear the virus become hepatitis B carriers and may eventually suffer chronic hepatitis, putting them at a greater risk for liver cirrhosis and liver cancer.”

Fatty Liver: Fatty liver disease, the abnormal accu-mulation of fat in the liver, is another leading cause of liver disease. “Inflammation can be related to fatty liver and can damage liver cells,” says Dr. Nusont. 


dr-Nusont-Kladchareon Digestive center Bumrungrad Bangkok Hospital Thailand

“Without proper care and treatment, the condition can become chronic and, in some cases, may progress to liver cirrhosis or life-threatening liver cancer later in life.”

While the precise cause of fatty liver disease is not fully understood, evidence has linked excessive alcohol consumption to fatty liver, which eventually leads to liver inflammation. Abstaining from alcohol doesn’t fully protect against fatty liver; Non-alcoholic fatty liver disease (NAFLD) tends to strike people who have dia-betes, are overweight and/or have high cholesterol. 

Alcohol abuse: Long-time heavy drinkers face a high risk for developing alcoholic hepa-titis. Drinkers already diagnosed with fatty liver disease, hepatitis B or hepatitis C may compound the damage to their liver if they continue abusing alcohol. Doing so makes it easier for the condition to progress to cirrhosis and, eventually, to liver cancer.

“The leading causes of hepatitis can vary significantly from one community or group to another,” says Dr. Nusont. “In Thailand, alcoholic hepatitis and viral hepatitis are highly prevalent. Viral hepatitis and hepatitis related to fatty liver disease are very prevalent in urban communities and among more affluent groups.

“What’s most concerning about these liver disorders is their lack of early warning signs,” notes Dr. Nusont. “During the early stages of chronic liver inflammation and fatty liver disease, most patients have no obvious symptoms – or symptoms are so subtle that patients simply dismiss them as insignificant. Most people are totally unaware they have a liver disease until it has progressed significantly to the point where symptoms are too obvious to ignore – for example, when jaundice turns their skin and the whites of their eyes to a yellowish tint.”

Liver cirrhosis

During the early stages of liver disease, most of the liver’s tissues remain healthy, and the liver continues functioning normally. As the disease progresses further without treatment, healthy tissues begin to undergo slow but progressive scarring, known as fibrosis. Slowly but surely, scarring affects more liver tissues, and liver function begins to decline.

“Damage from liver fibrosis eventually affects enough liver tissue to impair the liver’s capacity to heal itself,” Dr. Nusont explains. “At this point, treatment can only slow the rate of further damage and reduce the severity of symptoms. Patients with liver cirrhosis will require close monitoring as they’re at greater risk for liver cancer. Earlier cancer detection improves the effectiveness of treatments. In cases of severe liver cirrhosis, liver transplantation may be the only effective treatment option.”


Liver cancer

The liver is susceptible to both primary and secondary (or metastatic) liver cancer. Primary liver cancer originates in the liver, usually as a result of chronic hepatitis and cirrhosis. Secondary liver cancer refers to cases where cancer originates in another organ –  the colon, stomach or pancreas, for example – and eventually spreads to the liver.

“Years ago, liver cancer was difficult to treat successfully,” recalls Dr. Nusont. “Sadly, most liver cancer patients didn’t survive very long in those days. With recent and rapid medical advances, liver cancer is now much more treatable at every stage. Survival rates have improved greatly; many more patients experience a remission or even a cure of their cancer.”

Healthy lifestyle choices are critical to preventing liver diseases and to limiting their severity. Despite all that we know, too many people turn feeling fine today into skipping their next health check-up or putting off those plans to start exercising or eat healthier. “Where the liver is concerned, we can’t simply wait for symptoms to give us fair warning,” says Dr. Nusont. “A lot of liver tissue can be saved by earlier intervention. See your doctor on a regular basis, get vaccinated, and lower your risk factors. That’s a mantra that delivers great protection from life-threatening liver diseases.”

A message from your liver

“As your liver, I will do my utmost to withstand all of the challenges and threats I face without protest. Whenever you hear something coming from me, don't ignore it. Take it seriously, because we may not have much time left."


Protect your liver starting today

  • Limit alcohol consumption. The safest amount of alcohol is none at all;
  • Practice safer sex;
  • Avoid sharing personal items (e.g. razors, nail clippers, tooth brushes). Keep ‘personal’ items to yourself;
  • Know your hepatitis immunity status, have it checked and/or get vaccinated;
  • Check with your healthcare professional before starting any new herbal or dietary supplement regimens;
  • Wear a mask and gloves to protect yourself from exposure to chemicals;
  • Follow your doctor’s recommendation for periodic check-ups and health screenings.



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