GENERAL INFORMATION ON LIVER DISEASE

The six most common causes of chronic liver disease in the United States are alcohol, hepatitis
viruses (especially hepatitis B and hepatitis C), fatty liver, medications and hemochromatosis
(too much iron in the liver).

Other causes of liver disease and cirrhosis include autoimmune hepatitis (condition in which a
patients immune cells attack the liver); primary biliary cholangitis (an autoimmune disease in
which the bile tubes that drain bile from the liver are attacked); primary sclerosing cholangitis
(a disease in which the bile tubes become blocked); alpha-1 antitrypsin deficiency (this enzyme
protects the lung from destruction) and Wilson disease (too much copper in the liver).

Terminology
The liver is a factory and filter system. Two categories of blood tests are used to analyze the
activity of this system and determine how a patients liver is working:

Liver enzymes: AST (SGOT), ALT (SGPT), Alkaline Phosphatase, GGT (GammaGT) all
indicate liver injury or inflammation; these tests do not indicate bad liver function
Liver function tests: Protime or INR (a clotting test), cholesterol, ammonia, albumin (a protein in
the blood) and bilirubin (the substance that makes a person yellow) all indicate a problem with
the liver function if abnormal as well as creatinine which is a direct kidney function test and
indirectly a liver function test.

Medications and Alcohol
If you have liver disease, you should not drink alcohol (less is better, none is the best). Pain
relievers such as Tylenol

(acetaminophen) are safe if you take less than six 325 mg tablets per
day (2 gms). Ibuprofen and Naprosyn is liver safe if you have no ulcers, no cirrhosis and normal
kidneys Do not use nasal decongestants/antihistamines terfenidine (Seldane) and astimazole
(Hismanal) if cirrhosis is present. Patients who are taking the medications: 1) isoniazid 2)
Voltaren 3) valproic acid or 4) flutamide; must undergo liver enzyme testing at one and three
months of therapy. Ask for the drug and herbal toxicity sheets.

Patients should always carry a list of medications and the names, telephone numbers and
addresses of their doctors in a wallet or purse.

Diet
Patients with liver disease should monitor their diet, especially if cirrhosis is present. If you do
not have cirrhosis, a low-fat, low-cholesterol, low-sodium diet is advised. Patients should watch
their diet to maintain an ideal body weight (overweight patients have too much fat in their liver
and may develop liver damage from fat). If you have cirrhosis, you should adhere to the
CIRRHOSIS DIET a low sodium and 80- to 100-gram protein diet is advised, with most protein
coming from vegetable sources such as soybeans or beans, or white meat (fish or chicken). Red
meat should be avoided. Raw shell fish should not be consumed. Five to six meals per day are
recommended, with an emphasis on complex carbohydrates such as rice, potatoes, pasta and
bread. Although caffeine will not harm your liver, caffeine intake should be minimized. A low
General Information on Liver Disease
Page 2 of 2
fat diet is also advised and you should exercise at least 20 minutes per day for your diet to have
the maximum effect.

Vaccines
Because patients with liver disease are at increased risk of acquiring infections and having a
more severe disease if infection occurs, it is necessary to discuss the need for vaccines with your
doctors. Inquire about vaccination for hepatitis B, hepatitis A and pneumonia.

Signed

Robert G. Gish MD
www:\Robertgish.com
rgish@robergish.com