What Is Liver Inflammation and How Is It Treated?

James Myhre & Dennis Sifris, MD
·15 min read

Medically reviewed by Jay N. Yepuri, MD

Liver inflammation describes a condition known as hepatitis. While people tend to associate hepatitis with viral hepatitis (hepatitis A, hepatitis B, and hepatitis C), there are also nonviral causes, such as alcoholic hepatitis, autoimmune hepatitis, and fatty liver disease.

Whenever your liver is suddenly inflamed, you may experience the classic symptoms of hepatitis, including dark urine, upper abdominal pain, and yellowing of the eyes and skin. If the inflammation persists, it can cause scarring that gradually diminishes the function of the liver, leading to cirrhosis and, in some cases, liver failure or liver cancer.

This article describes the causes, symptoms, and complications of liver inflammation. It also explains how liver inflammation is diagnosed and treated and ways to reduce your risk of hepatitis in any of its many forms.

<p>Boris Jovanovic / Getty Images</p>

Boris Jovanovic / Getty Images

What Causes Liver Inflammation?

Inflammation is the body's natural response to anything that it considers harmful. In the presence of infection, injury, or disease, the body will launch an immune response by triggering the dilation (widening) of blood vessels in the affected tissues. This allows larger immune cells access to the site to help neutralize the attacker and start repairing damaged tissues.

When the inflammation occurs in the liver, it is known as hepatitis. Many infectious and nonnoninfectious conditions can cause liver inflammation.

Viral Hepatitis

Arguably, the most recognized cause of liver inflammation is viral hepatitis. Viral hepatitis is a highly contagious disease that targets and attacks cells of the liver.

Five types of viral hepatitis are:

  • Hepatitis A: Mainly transmitted by food and water contaminated with hepatitis A virus

  • Hepatitis B: Mainly transmitted by sex and blood transmission of hepatitis B virus

  • Hepatitis C: Mainly transmitted by shared needles and blood transmission of hepatitis C virus

  • Hepatitis D: A type that can only be transmitted when you are infected with hepatitis B virus

  • Hepatitis E: A type mainly constrained to southern Asia, northern Africa, and Mexico

Read Next: How Viral Hepatitis Is Transmitted

Parasitic Infections

Several different parasites also target the liver. Some enter the body through the mouth or breaks in the skin, while others can penetrate mucosal tissues or enter the body through insect bites.

These include:

Bacterial Infections

While less common, certain bacteria can also trigger liver inflammation, either directly or by causing abscesses (pus-filled pockets) or granulomas (clumps of white blood cells) in the liver.

The causes can be broadly categorized as:

Fatty Liver Disease

Fatty liver disease—also known as nonalcoholic fatty liver disease (NAFLD) and, more recently, metabolic dysfunction-associated steatotic liver disease (MASLD)—is the accumulation of fat in the liver due to metabolic conditions like:

The deposit of fat, called hepatic steatosis, can trigger inflammation that remains largely asymptomatic (without symptoms) for many years.

Over time, the inflammation can start to damage the liver and lead to a more serious condition known as metabolic dysfunction-associated steatohepatitis (MASH).

Related: Do I Have a Fatty Liver?

Alcoholic Liver Disease

Alcohol liver disease (ALD) is a form of fatty liver disease caused by the excessive use of alcohol over many years. As with MASLD, this can lead to hepatic steatosis and the gradual onset of alcoholic hepatitis. It is at this later stage that symptoms start to show.



How Fast Does Alcohol Damage the Liver?

ALD is a slowly progressive disease but one that can be at least partially reversed once drinking is stopped. Alcohol hepatitis, an advanced stage of ALD, tends to affect people who drink large quantities of alcohol daily for at least 10 to 20 years.



Autoimmune Hepatitis

Autoimmune hepatitis is a chronic condition in which the immune system mistakenly attacks cells of the liver. In 25% to 34% of cases, the inflammatory reaction will be asymptomatic and only be identified on blood tests.

When symptoms do develop, they can range from subclinical (barely noticeable) to fulminant (severe to the point of life-threatening). As with all autoimmune diseases, autoimmune hepatitis tends to affect females more than males.

Related: How Autoimmune Hepatitis Is Diagnosed

Genetic Disorders

Several genetic disorders can cause liver inflammation. These conditions are passed from parents to a child via aberrant gene mutations.

The three most common of these are:

  • Alpha-1-antitrypsin deficiency: A condition that causes a protein called A1AT to become backed up in the liver, triggering inflammation and progressive liver damage

  • Hereditary hemochromatosis: A genetic disorder that causes the overload of iron in the body, causing damage to multiple organs, including the liver

  • Wilson's disease: A genetic disorder that causes the overload of copper in the body, most profoundly in the liver and brain

Medications and Toxins

Hepatoxicity, also known as liver poisoning, can be caused by medications and other substances that either directly damage the liver or place undue stress on the liver as it breaks them down.

Hundreds of substances can cause liver inflammation, some of which are dose-dependent (only causing toxicity at higher doses) or idiosyncratic (affecting some people but not others).

Medications and supplements of special concern include:

Related: How Tylenol Causes Liver Damage

Biliary Diseases

The liver, along with the gallbladder and bile ducts, is part of the biliary system. This is the system that transports bile (a fluid containing digestive enzymes) from the liver to the gallbladder, where it is stored and secreted to break up fat into the small intestine.

Any condition that affects the gallbladder or bile ducts can trigger liver inflammation, usually by obstructing the flow of bile from the liver.

These include:

Related: How to Tell Gallbladder and Liver Pain Apart

Shock Liver

Ischemic hepatitis, also known as "shock liver," is caused by any condition that severely reduces blood flow to the liver. Shock describes the sudden drop in blood pressure that deprives organs of the blood and oxygen they need to survive. Left untreated, this can lead to organ failure.

Causes of shock liver include:

  • Cardiac tamponade: A potentially life-threatening condition in which fluid compresses the heart and makes it hard to pump blood

  • Hypovolemic shock: Usually caused by blood loss from an injury or internal bleeding

  • Malignant arrhythmia: A severely abnormal heart rhythm that can severely reduce blood flow

  • Portal vein thrombosis: The blockage of a major blood vessel of the liver by a blood clot

  • Sepsis: A potentially deadly immune reaction to an infection that has entered the bloodstream



What Is Idiopathic Hepatitis?

Idiopathic hepatitis is when liver inflammation occurs for no known cause. It is a condition most commonly seen in newborns, either affecting the liver (idiopathic neonatal hepatitis) or the gallbladder (idiopathic neonatal cholangitis).

The condition is diagnosed when all other causes are excluded. It usually resolves on its own without complications.



Symptoms of Liver Inflammation

Liver inflammation can be described in one of two ways:

  • Acute inflammation is when inflammation develops suddenly and severely and usually resolves quickly once the underlying cause is treated.

  • Chronic inflammation is inflammation that persists or recurs for long periods, often with minimal symptoms until extensive organ damage is done.

Acute liver inflammation has more overt symptoms and is caused by the derangement (disturbance) of normal liver function.

One example is hemolysis, the otherwise normal breakdown of red blood cells by the liver. With acute hepatitis, hemolysis speeds up, causing the excessive production of a yellow pigment called bilirubin from destroyed cells. High bilirubin can affect the skin, urine, and even the brain.

Acute hepatitis also slows bile secretion, reducing the amount released into the small intestine and changing the color of stools.

Symptoms of acute liver inflammation include:

Related: Signs and Symptoms of Hepatitis

Complications of Liver Inflammation

Although acute liver inflammation can sometimes damage the liver, the liver has the remarkable ability to regenerate itself and will often reverse the damage. Even so, severe cases have been known to lead to acute liver failure and death.

Arguably, the greater concern is when liver inflammation is chronic. Even at low levels, chronic inflammation can cause changes in liver cells that lead to fibrosis (scarring). Common causes of this include hepatitis B and C, fatty liver disease, and alcoholic liver disease.

While fibrosis itself doesn't cause any symptoms, the damage it causes over the course of years can lead to potentially life-threatening complications like:

  • Cirrhosis: The progressive loss of liver function due to severe scarring and liver damage

  • Liver cancer: Caused when damaged liver cells mutate and grow out of control

  • Liver failure: The end stage when the liver is no longer able to sustain bodily functions, often requiring a liver transplant to survive

Related: 17 Complications of Cirrhosis

How Is Liver Inflammation Diagnosed?

The diagnosis of liver inflammation typically starts with a physical exam and a review of your medical history. Based on the initial findings, lab tests, imaging studies, and other procedures may be ordered to narrow the possible causes.

Initial Assessment

The physical exam typically involves palpation (light touch) of the upper-right abdomen to check for signs of swelling or discomfort. Your healthcare provider will look for other signs of hepatitis, including jaundice, bruises, or a mild fever.

A review of your medical history can help identify risk factors for liver disease and may involve questions about:

  • Your diet

  • Your alcohol consumption

  • Medications you take (including over-the-counter drugs and herbal remedies)

  • Your sexual history (a risk factor for hepatitis B)

  • Injecting drug use (a risk factor for hepatitis B and C)

  • Blood transfusions before 1992 (a risk factor for hepatitis C)

  • Recent travels to countries where diseases like malaria are common

Lab Tests

Based on the suspected causes of your symptoms, your healthcare provider will order different lab tests, including:

Imaging Studies

Different imaging tests can provide clues as to the cause of your symptoms, including the blockage of blood vessels or bile ducts, abnormal growths or masses, or signs of fibrosis.

Four common imaging studies include:

  • Abdominal ultrasound: A noninvasive device that generates images by bouncing high-frequency sound waves off of the liver

  • Computed tomography (CT): An imaging technology that composites multiple X-rays to create a three-dimensional (3D) visualization of your liver

  • Magnetic resonance imaging (MRI): An imaging technique that generates highly detailed images of soft tissues using powerful magnetic and radio waves

  • Transient elastography: A newer form of ultrasound, also known as FibroScan, that can detect and measure the amount of fibrosis in your liver

Liver Biopsy

A liver biopsy involves the extraction of a small amount of liver tissue for evaluation in the lab. The sample may be obtained by inserting a needle through your abdomen into a diseased part of your liver. The sample can also be taken during exploratory surgery.

A liver biopsy can provide a definitive diagnosis for diseases like liver cancer, autoimmune hepatitis, MASLD, and Wilson's disease. It can also help determine how advanced cancer or cirrhosis is to help direct the course of treatment.

Related: How Hepatitis Is Diagnosed

Treatment of Liver Inflammation

Generally speaking, the best way to treat liver inflammation is to resolve the underlying cause. However, this is not always an option, particularly with incurable chronic liver diseases like hepatitis B or autoimmune hepatitis.

But even if a condition is not curable, the correct treatment can slow disease progression, preserve liver function, and ease pain and other symptoms. Examples include taking daily antiviral drugs for chronic hepatitis B or using statins and calcium channel blockers to manage MASLD.

Lifestyle and Home Remedies

Certain changes in your diet and lifestyle can help ease liver inflammation when paired with simple, at-home remedies. Some of the more effective interventions include:

  • Avoiding alcohol in any form

  • Eating a diet low in fat, sugar, and salt

  • Eating small meals every three or four hours to avoid pressure from an overfull stomach

  • Drinking plenty of water to help your liver work better

  • Applying a cold compress to your upper abdomen for 10 to 15 minutes to ease swelling

  • Avoiding slouching or sitting too long as this can compress the liver and cause pain

  • Wearing an elastic rib belt available online and at drugstores to support and stabilize the liver

  • Sipping ginger tea or turmeric tea, which studies suggest may help reduce inflammation

Related: What to Eat If You Have Fatty Liver Disease

Medications

Certain over-the-counter (OTC) and prescription medications may help reduce liver inflammation and pain.

As contradictory as it may seem, Tylenol can be useful for people with chronic liver inflammation. Studies suggest that taking no more than 2,000 milligrams per day is safe for treating occasional liver pain. However, it should not be used if you have acute hepatitis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) should also be avoided if you have acute or chronic liver inflammation, as they can cause potentially severe gastrointestinal bleeding.

Among the prescription drugs commonly used to ease inflammation in people with cirrhosis are:

Related: Natural Remedies for Fatty Liver Disease

How to Prevent Liver Inflammation

You can't always prevent liver inflammation, but there are things you can do to reduce your risk. Some of the more effective measures include

  • Maintaining a healthy weight and losing weight if necessary

  • Eating a balanced diet rich in whole grains, fresh vegetables, and fresh fruits

  • Limiting alcohol to more than two drinks per day if you are male and one drink per day if you are female

  • Seeking alcohol treatment if you can't control your drinking

  • Getting the Twinrix vaccine to protect against hepatitis A and B

  • Following safer sex practices to reduce your risk of hepatitis B

  • Avoiding imported Chinese or herbal medications that may be contaminated with heavy metals or pesticides

  • Using medications like Tylenol correctly and only for occasional relief

When to Contact a Healthcare Provider

The classic signs of hepatitis—jaundice, dark urine, and light stool—are difficult to miss, but there are times when the symptoms are subtle and easily overlooked. This is a big problem given that most cases of liver disease are only diagnosed when the condition is advanced and harder to treat.

According to the Centers for Disease Control and Prevention (CDC), of the estimated 4.5 million people currently living with liver disease in the United States, only 1.8% have been diagnosed.

To this end, it is important to recognize the signs of liver inflammation and identify if you are at high risk of liver disease.

The American Association for the Study of Liver Diseases (AASLD) revised its guidelines in 2022 and now recommends annual screening for people at high risk of MASLD. This includes:

Even if you don't have overt (or any) symptoms of liver inflammation, it may be in your best interest to seek screening for liver disease if you fall within these two high-risk groups.

Summary

Liver inflammation describes a condition called hepatitis. The most common cause is viral hepatitis. but other conditions like fatty liver disease, alcoholic liver disease, bacterial hepatitis, autoimmune hepatitis, and hepatotoxic drugs can also cause inflammation.

Acute liver inflammation can be mild or severe depending on the underlying cause. Chronic liver inflammation can lead to progressive scarring of the liver, resulting in complications like cirrhosis, liver cancer, or liver failure.

The treatment of liver inflammation can vary by the cause. To reduce your risk, you should maintain a healthy weight, limit your alcohol intake, avoid fatty foods, use medications as prescribed, and get vaccinated against hepatitis A and B.

Related: Facts About Liver Disease and COVID-19

Read the original article on Verywell Health.