- Symptoms – Alcohol-related liver disease
- When to seek medical advice
- Signs Your Liver Needs A Detox
- Five Way to Support Your Precious Liver
- How to Know When Your Liver is Overtaxed
- How to Cleanse and Rejuvenate Your Liver
- Improve bile flow with bitter botanicals
- Support the Liver with Pure Phosphatidylcholine
- Support Glutathione Levels
- Mop up Toxins With a Comprehensive Blend of Binders
- Support the Gut with Soothing Natural Pre-Biotic Gums and Fibers
- Krones-Herzig A, Diaz MB et al. The Glucocorticoid Receptor Controls Hepatic Dyslipidemia through Hes1. Cell Metab. 2008 Sep;8(3):212-23 View Abstract
- Swain, MD. Fatigue in Liver Disease: Pathophysiology and Clinical Management Canadian Journal of Gastroenterology. 2005 Oct;(20):181-188 View Abstract
- Bradl H, editor. Heavy Metals in the Environment: Origin, Interaction and Remediation Volume 6. London: Academic Press; 2002.
- Chang LW, Magos L, Suzuki T, editors. Toxicology of Metals. Boca Raton. FL, USA: CRC Press; 1996
- Kaplowitz N. The importance and regulation of hepatic glutathione. Yale J Biol Med. 1981 Nov-Dec; 54(6): 497–502.
- Ziem G, McTamney J. Profile of patients with chemical injury and sensitivity. Environ Health Perspect. 1997 Mar; 105(Suppl 2): 417–436. View Abstract
- Gittlen SD, Schulman ES. Raised histamine concentrations in chronic cholestatic liver disease. Gut. 1990 Jan; 31(1): 96–99. View Full Paper
- Zhao X, Wong P. Managing Sleep Disturbances in Cirrhosis Scientifica (Cairo). 2016; 2016: 6576812. View Full Paper
- Islam KB, Fukiya S, Hagio M, et al. Bile acid is a host factor that regulates the composition of the cecal microbiota in rats. Gastroenterology. 2011 Nov;141(5):1773-81. View Abstract
- Tremblay S, Romain G, Roux M, et al. Bile Acid Administration Elicits an Intestinal Antimicrobial Program and Reduces the Bacterial Burden in Two Mouse Models of Enteric Infection. Infect Immun. 2017 May 23;85(6). pii: e00942-16. View Full Paper
- Lian LH, Wu YL, et al. Gentiana manshurica Kitagawa reverses acute alcohol-induced liver steatosis through blocking sterol regulatory element-binding protein-1 maturation. J Agric Food Chem. 2010 Dec 22;58(24):13013-9. View Abstract
- Valenzuela A, Aspillaga M, et al. Selectivity of silymarin on the increase of the GSH content in different tissues of the rat. Planta Med. 1989 Oct;55(5):420-2. View Abstract
- Rui YC. Advances in pharmacological studies of silymarin. Mem Inst Oswaldo Cruz. 1991;86 Suppl 2:79-85. View Full Paper
- Shah R, Gulati V, et al. Pharmacological properties of guggulsterones, the major active components of gum guggul. Phytotherapy Research. 2012 Nov;26(11):1594-605. View Abstract
- Hişmioğullari AA, Bozdayi AMet al. Biliary lipid secretion. Turk J Gastroenterol. 2007 Jun;18(2):65-70. View Abstract
- Karaman A, Demirbilek S, et al. Protective effect of polyunsaturated phosphatidylcholine on liver damage induced by biliary obstruction in rats. J Pediatr Surg. 2003 Sep;38(9):1341-7. View Abstract
- Stremmel W, Ehehalt R, et al. Mucosal protection by phosphatidylcholine. Dig Dis. 2012;30 Suppl 3:85-91. View Abstract
- Cook GC, Sherlock S. Results of a controlled clinical trial of glutathione in cases of hepatic cirrhosis. Gut, 1965, 6, 472 View Full Paper
- D’Ettorre G, Douek D. Microbial Translocation and Infectious Diseases: What Is the Link? International Journal of Microbiology Vol 2012, Article ID 356981. View Full Paper
- Similar Articles:
- 9 Signs your liver may be damaged
- 8 Questions You Should Be Able to Answer About Your Liver
- 2. How can I keep my liver healthy?
- 3. What’s the best diet to follow?
- 4. What else can I do to keep my liver healthy?
- 5. What symptoms will I notice if my liver isn’t working right?
- 6. Which tests can tell me if something is wrong?
- 7. Should I be tested for hepatitis C?
- 8. What’s my prognosis if I’m diagnosed with some type of liver disease?
- 13 Ways to a Healthy Liver
- Liver Tests
- Common Characteristics of Liver Disease
- What are some common liver disease symptoms?
- What is jaundice?
- What is cholestasis?
- What is liver enlargement?
- What is portal hypertension?
- What are esophageal varices?
- What is ascites?
- What is liver encephalopathy?
- What is liver failure?
- Pale Stools: Possible Causes and When to Seek Help
- Facts About Liver Disease
- Non-Alcoholic Liver Disease
- Alcoholic Liver Disease
- Liver Spotting
- Non-Alcoholic Liver Damage
- Alcoholic Liver Damage
- Help for Signs of Early Liver Disease
When to seek medical advice
ARLD does not often cause symptoms until it’s reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of the symptoms above.
Read about alcohol misuse (drinking too much).
Contact your GP for advice if you have a history of regular alcohol misuse.
A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4 questions:
- Have you ever thought you should cut down on your drinking?
- Have people annoyed you by criticising your drinking?
- Have you ever felt guilty about your drinking?
- Have you ever drunk an “eye-opener”, which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves?
If you answer “yes” to one or more of the questions above, you may have an alcohol problem and are advised to see your GP.
See your GP as soon as possible if you have symptoms of advanced ARLD.
Read more about how ARLD is diagnosed.
Signs Your Liver Needs A Detox
Five Way to Support Your Precious Liver
Every day, your three-pound liver saves your life. The second largest organ in your body (after the skin), your liver works tirelessly to keep you healthy—performing a stunning array of tasks. This workhorse filters everything you eat and drink, helps usher toxins safely out of the body, regulates blood sugar levels, stores extra sugar in the form of glycogen, and converts extra carbohydrate and protein into forms that can be stored for later use. Your liver also produces the body’s “liquid gold”—bile—which breaks down fats so they can be absorbed, and carries wastes out in the stool. Your liver even breaks down old or injured blood cells. It stores iron. It stores clotting molecules for the blood.
It’s versatile, your liver. But it is not invulnerable. Even this remarkable organ can be excessively burdened by the onslaught of toxicants so common in everyday life—chemicals, poor food, sweet snacks and sodas, excess alcohol, pollution and the constant stress we all face today. We are routinely exposed to over 84,000 chemicals (many untested for safety because they were grandfathered in by the Toxic Substances Act). Then there is our “obesogenic” food environment, which tempts us to eat high-fat, sugary, refined foods that seem to beckon from every television commercial, store, and restaurant, and place a significant burden on the liver’s detoxification system. Finally, the liver is impacted by chronic stress, a feature of contemporary life—which can lead to chronic high levels of cortisol, and contribute to fatty liver. According to the Mayo Clinic, nonalcoholic fatty liver disease is common in the United States, affecting an estimated 80 to 100 million people.
Liver rejuvenation supports better health in the body – from cholesterol and hormone metabolism to detoxification, energy and even cognitive function.
How to Know When Your Liver is Overtaxed
What are the early signs and symptoms of an overtaxed or stressed liver? Are there telltale warning signals that your liver could benefit from a little loving care and extra detox? Here are seven tips your liver may indeed need some attention.
Fatigue is a common complaint the world over, and is often experienced when the liver is under stress. The liver converts glucose into glycogen, a form of sugar that can be stored, and then later released as glucose when the body needs a burst of energy. By storing and supplying the body with glucose, the liver helps provide energy and combat fatigue. If the liver is stressed it may become less efficient at regulation of blood glucose. Fatigue and sugar cravings may pop up.
Hormone Imbalances and Premenstrual Syndrome
The liver detoxifies more than chemicals and pollutants. It also detoxifies our own hormones, including excess estrogen. Not surprisingly, when liver function is impaired, excess estrogen may not be adequately bound and excreted. Signs of excess estrogen in women can include PMS, fibrocystic breasts, moodiness, weight gain, menstrual disturbances, fibroids and more.
Belly Bloat and Excessive Gas
When the flow of bile is stagnant or slowed, the gut shifts towards a state of dysbiosis, where unfriendly flora dominate, and constipation is common. The toxins from pathogenic bacteria then block detoxification pathways in the liver as well. With the resulting imbalance of flora and dysbiosis, excessive gas and bloating may be experienced after eating.
High Levels of Heavy Metals
Human exposure to heavy metals has soared, due to an exponential increase of metals in industrial, agricultural, and technological applications. From coal burning power plants to plastics, textiles, electronics, wood preservation, and paper processing, metals are ubiquitous in everyday life. Heavy metals can cause DNA damage and contribute to a variety of human illnesses. When the liver’s detoxification pathways are impaired, heavy metals can accumulate in the body. In particular, the liver’s stores of glutathione, which safely and effectively binds to toxins and metals, can be depleted.
A comprehensive tri-test that assesses urine, blood, and hair levels of mercury can give a realistic picture of an individual’s mercury burden. Other tests can look at glutathione levels, and levels of other metals in hair.
Chemical sensitivities and allergies
When the liver is under stress, individuals may find themselves more reactive to chemical exposures, including gasoline, kerosene, natural gas, pesticides, solvents, new carpet, adhesives, glues, fabric softener, formaldehyde, cleaning agents, medications and more.
Seasonal pollen allergies may worsen, and food sensitivities may increase. The liver is responsible for breaking down excess histamine, and if it is sluggish, histamine may build up in the body. In individuals with chronic cholestasis and impaired bile flow, blood levels of histamine have been found to be significantly greater than normal.
Nearly 60 million Americans are affected by the sleep disorders every year. Sleep problems run the gamut, taking too long to fall asleep (called sleep latency), waking up too early, fitful and poor sleep quality, frequent nocturnal awakening, or early morning awakening. The solutions range from sleeping medications to cognitive reframing techniques, relaxation tapes, meditation, sleep hygiene, and more. But one simple solution may be to improve liver function. Sleep disturbances have long been observed in chronic liver conditions, and one mechanism may be impaired hepatic melatonin metabolism. Melatonin is the “circadian rhythm” hormone—the hormone our bodies naturally release as darkness falls, and which readies us for a good night’s sleep.
How to Cleanse and Rejuvenate Your Liver
Your liver is the only visceral organ in your body that can actually regenerate itself. If even a mere quarter of your original liver is left, it can regenerate back to its full size. Your liver’s capacity for repair is immense. It just needs a little extra care and attention. Here are some tips for improving your liver function.
Improve bile flow with bitter botanicals
Bitter botanicals have been used for hundreds of years as both medicine and as aperitifs. They promote proper drainage of the liver, kidneys, lymph, and help support intestinal health. First and foremost, they support healthy bile flow, which is critical for digestive function, and helps balance your gut flora, since bile acids are antimicrobial., Remember, toxins and their metabolites are eliminated from the liver into the bile, and out of the body via the stool.
The classic bitter botanicals are potent yet gentle. They include gentian, milk thistle, goldenrod, myrrh, and dandelion. Gentian is often called our most bitter bitter, offering digestive support and liver protection. Gentian has been shown to increase levels of our most potent endogenous antioxidant, glutathione. It also improves bile flow., Milk thistle (Silybum marianum) has a reputation as a potent liver protector, also with bitter properties. Its most active molecule, silymarin, has been shown to enhance glutathione levels in the liver and gut., Dandelion is widely known for its tonic function on the liver, gallbladder, and kidneys. Goldenrod helps the flow of bile. Myrrh is antimicrobial, and improves bile flow as well. Guggulsterones are the molecules in myrrh responsible for its cholesterol-lowering effect.
Support the Liver with Pure Phosphatidylcholine
Phosphatidylcholine (PC) makes up 90% of the phospholipids in bile. Increased intake of PC has been shown to enhance prevent liver stagnations and subsequent liver damage. Phosphatidylcholine also is essential for the health of the gut, and is a primary building block for the gut’s protective mucus layer.
Support Glutathione Levels
Your liver’s ability to transform toxic molecules into less toxic ones, and then help your body excrete them, depends on two phases of detoxification. Phase I liver detoxification utilizes specialized enzymes to help neutralize innumerable substances. Phase II detoxification goes even further, and neutralizes the byproducts of Phase I. Then the toxins are removed from the body. To detoxify, your liver relies on many enzymes and molecules, but the most important may be glutathione. Levels of glutathione are naturally higher in the liver than the rest of your body. However, low levels of glutathione have been found in chronic liver disease.
Mop up Toxins With a Comprehensive Blend of Binders
Many toxins are reabsorbed after excretion into the bile. In addition, endotoxins from unfriendly gut bacteria, as well as bacteria themselves, can actually move through an inflamed gut lining directly into the bloodstream. This is known as microbial translocation and is associated with immune activation and inflammation. This puts more stress on the liver.
There is no universal binder that has an equal affinity for all toxins. However, a blend of natural molecules that effectively bind a wide array of toxins can help lessen the load on our bodies. Binders to consider include bentonite clay, activated charcoal, chitosan, and thiol-functionalized silica. Because each has a special affinity for certain types of toxins, a blend will offer broader protection.
Support the Gut with Soothing Natural Pre-Biotic Gums and Fibers
Because binders can be constipating, consider soothing supplements such as acacia gum, which serves as a prebiotic fiber, and aloe vera, which has long been used in traditional medicine to soothe inflamed tissues. These support the health of the intestinal lining, normal gut motility and the growth of friendly flora, all of which can help improve liver function.
Chang LW, Magos L, Suzuki T, editors. Toxicology of Metals. Boca Raton. FL, USA: CRC Press; 1996
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9 Signs your liver may be damaged
Your liver is a key part of your digestive system, responsible for cleaning out toxins from your blood, processing medicines, producing bile, helping you digest fat, storing glucose and producing proteins for clotting your blood, among many other things.
It’s also a fairly forgiving organ, able to regenerate cells up to a point, but repeated damage to the liver leads to inflammation, scarring and cirrhosis. This causes it to shrink and harden, and changes the structure of the liver, preventing it from functioning well. A high intake of alcohol or toxins, a diet high in fat, and some viral infections, such as hepatitis, can cause damage to the liver.
Liver disease doesn’t usually cause any symptoms until the damage to the liver is fairly advanced.
Some signs your liver may be struggling are:
- Fatigue and tiredness. Doctors are not sure exactly how liver damage causes tiredness, but it’s a common symptom.
- Nausea (feeling sick). Nausea occurs because toxins build up in the bloodstream, due to the liver’s decreased ability to do its job of filtering out toxins.
- Pale stools. Stools are given their dark colour by the bile salts that the liver normally releases. If the stools are pale, it may indicate a problem with the liver or other part of the biliary drainage system. Black tarry stools can happen in advanced liver disease and are caused by blood passing through the gastrointestinal tract – this needs urgent medical attention.
- Yellow skin or eyes (jaundice). Jaundice is due to the build-up of bilirubin (a bile pigment) in the blood, because it can’t be processed effectively. The skin may also be itchy for the same reason.
- Spider naevi (small spider-shaped arteries that appear in clusters on the skin). Spider naevi look like a red dot with blood vessels radiating out from the centre like spider’s legs. They can be common in healthy women, but when they are found in larger numbers on the upper half of the body or in men they may suggest liver disease.
- Bruising easily. You may bruise easily due to your liver’s reduced ability to produce clotting factors.
- Reddened palms (palmar erythema). Roughly a quarter of people with liver cirrhosis develop palmar erythema – a reddening of the skin on the palms.
- Dark urine. Urine that is dark orange, amber, cola-coloured or brown can be a sign of liver disease. The colour is due to too much bilirubin building up because the liver isn’t breaking it down normally.
- Swollen abdomen (ascites). Ascites happens because fluid is retained in the abdomen. The legs and ankles may also become swollen due to fluid retention.
Last Reviewed: 07/04/2016
8 Questions You Should Be Able to Answer About Your Liver
2. How can I keep my liver healthy?
Eat a healthy diet. Because your liver processes foods and liquids and changes them into stored energy and nutrients, a bad diet — for example, one that includes chronic alcohol consumption — can damage the liver over time. In contrast, a healthy diet keeps your liver functioning properly.
3. What’s the best diet to follow?
The American Liver Foundation recommends eating regular, balanced meals that include foods from all food groups (grains, proteins, dairy, fruit, vegetables, and fats). Some more diet tips:
- Choose high-fiber foods, including fresh fruit and vegetables, whole-grain breads, and rice and cereals.
- Load up on healthy protein, which is vital for fighting infections and healing damaged liver cells. Your best bets: low-fat or fat-free dairy products, lean meats, and plant-based sources like beans, legumes, and lentils.
- Skip trans-fats found in processed foods. Instead, opt for healthy fats found in nuts and seeds, avocados, flaxseed, olive oil, and fish oils (or fatty fish).
- Drink plenty of fluids.
- Avoid consuming high amounts of salty and sugary foods.
Note, however, that you may need to follow a different diet if you have a liver disease. If you have hepatitis C, for example, you should avoid foods that contain high levels of iron or salt.
RELATED: The Common Infection Many People Don’t Know They Have
4. What else can I do to keep my liver healthy?
Although diet is key, so, too, is keeping your weight in check by controlling your portion sizes and exercising regularly. One reason: Obesity is linked to fatty liver disease, which, in turn, can lead to scarring, or cirrhosis of the liver (especially if you have hepatitis C), and even liver cancer or liver failure. If you’re overweight, set a goal to steadily lose 10 percent of your current weight — just be sure to avoid fad diets that cause you to lose weight too fast, which may strain your liver.
You should also limit alcohol, which can cause cirrhosis, to one drink a day for women and two for men. Even if you were once a heavier drinker and have since cut or eliminated alcohol intake, the damage may not show up until years later. (If you drank heavily in the past, be sure to tell your doctor about it; your provider might want to test you for underlying liver damage, says Dr. Decker.)
Also avoid other risky behaviors such as abusing over-the-counter drugs like acetaminophen, a pain reliever that can cause damage if taken in large amounts over a short period of time. The Food and Drug Administration recommends adults take no more than 4,000 milligrams (mg) a day.
Finally, you can decrease your risk of liver damage from hepatitis C and hepatitis B by limiting your number of sexual partners and avoiding intranasal and IV drug abuse and getting a body piercing or a tattoo with unsterilized needles.
5. What symptoms will I notice if my liver isn’t working right?
If there’s a problem with your liver, you may experience the following:
- Chronic fatigue
- Gastrointestinal issues like nausea and vomiting
- Decreased appetite
- Dark-colored urine
- Jaundice (yellowing of the skin and eyes)
6. Which tests can tell me if something is wrong?
You’ll start with a blood test called the liver function test, which can detect whether your liver is leaking abnormal levels of enzymes — a sign that something is awry, Decker says.
But “having a normal function test is no guarantee that your liver is healthy, especially if you have a history that raises concerns about your liver,” Decker says. The opposite may also be true: Abnormal test results don’t necessarily mean that you have liver issues. Even temporary conditions — like severe infections, pregnancy, and muscle trauma, among many other things — can alter the results of the test. Depending on your history and symptoms, your doctor may decide to do more tests, including an ultrasound, CT scan, or MRI.
7. Should I be tested for hepatitis C?
It’s important to know your hepatitis C risk, especially because the prevalence of cases seems to be increasing, Decker says, adding that this may be a result of better testing. In fact, new cases of hepatitis C have nearly tripled over the past five years, according to the Centers for Disease Control and Prevention (CDC). Hepatitis C is a contagious liver disease spread mainly through contact with the blood of someone who’s infected with the virus. The CDC estimates that up to 3.9 million people have chronic hepatitis C, meaning that the virus has progressed to a long-term illness. Roughly 75 to 85 percent of people who become infected with the hepatitis C virus will develop a chronic infection.
Factors that increase your hepatitis C risk include:
- Using intranasal or intravenous drugs at any point in life
- Receiving a blood transfusion or organ transplant before 1992
- Being treated for a blood-clotting problem before 1987
- Being on long-term hemodialysis treatment
- Having multiple sexual partners
If you fall into any of these categories, your doctor will recommend a blood test to screen for the virus. The CDC also recommends that all people born between 1945 and 1965, or baby boomers, get tested at least once.
8. What’s my prognosis if I’m diagnosed with some type of liver disease?
There are many types of liver diseases, such as nonalcoholic fatty liver disease, viral hepatitis (including hepatitis C), and genetic diseases like Wilson’s disease and hemochromatosis. In general, all of these diseases have good long-term outcomes if managed and treated properly, either with weight loss, medication, or dietary changes. In fact, all of the viral hepatitis diseases are treatable, and because treatments for hepatitis C are so effective, most people may be able to completely eliminate the virus from their body.
Additional reporting by Joseph Bennington-Castro
13 Ways to a Healthy Liver
Liver Awareness Month Feature
The best way to fight liver disease is to avoid it, if at all possible. As we observe Liver Awareness Month in 2013, here are 13 ways to achieve liver wellness. Appropriately, that’s one useful tip for each year of the new century!
- Maintain a healthy weight. If you’re obese or even somewhat overweight, you’re in danger of having a fatty liver that can lead to non-alcoholic fatty liver disease (NAFLD), one of the fastest growing forms of liver disease. Weight loss can play an important part in helping to reduce liver fat.
- Eat a balanced diet. Avoid high calorie-meals, saturated fat, refined carbohydrates (such as white bread, white rice and regular pasta) and sugars. Don’t eat raw or undercooked shellfish. For a well-adjusted diet, eat fiber, which you can obtain from fresh fruits, vegetables, whole grain breads, rice and cereals. Also eat meat (but limit the amount of red meat), dairy (low-fat milk and small amounts of cheese) and fats (the “good” fats that are monounsaturated and polyunsaturated such as vegetable oils, nuts, seeds, and fish). Hydration is essential, so drink a lot of water.
- Exercise regularly. When you exercise consistently, it helps to burn triglycerides for fuel and can also reduce liver fat.
- Avoid toxins. Toxins can injure liver cells. Limit direct contact with toxins from cleaning and aerosol products, insecticides, chemicals, and additives. When you do use aerosols, make sure the room is ventilated, and wear a mask. Don’t smoke.
- Use alcohol responsibly. Alcoholic beverages can create many health problems. They can damage or destroy liver cells and scar your liver. Talk to your doctor about what amount of alcohol is right for you. You may be advised to drink alcohol only in moderation or to quit completely.
- Avoid the use of illicit drugs. In 2012, nearly 24 million Americans aged 12 or older were current illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 9.2 percent of the population aged 12 or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics (pain relievers, tranquilizers, stimulants, and sedatives) used non-medically.
- Avoid contaminated needles. Of course, dirty needles aren’t only associated with intravenous drug use. You ought to follow up with a medical practitioner and seek testing following any type of skin penetration involving sharp instruments or needles. Unsafe injection practices, though rare, may occur in a hospital setting, and would need immediate follow-up. Also, use only clean needles for tattoos and body piercings.
- Get medical care if you’re exposed to blood. If for any reason you come into contact with someone else’s blood, immediately follow up with your doctor. If you’re very concerned, go to your nearest hospital’s emergency room.
- Don’t share personal hygiene items. For example, razors, toothbrushes and nail clippers can carry microscopic levels of blood or other body fluids that may be contaminated.
- Practice safe sex. Unprotected sex or sex with multiple partners increases your risk of hepatitis B and hepatitis C.
- Wash your hands. Use soap and warm water immediately after using the bathroom, when you have changed a diaper, and before preparing or eating food.
- Follow directions on all medications. When medicines are taken incorrectly by taking too much, the wrong type or by mixing medicines, your liver can be harmed. Never mix alcohol with other drugs and medications even if they’re not taken at the same time. Tell your doctor about any over-the-counter medicines, supplements, and natural or herbal remedies that you use.
- Get vaccinated. There are vaccines for hepatitis A and hepatitis B. Unfortunately, there’s no vaccine against the hepatitis C virus.
- Liver function panel: A liver function panel checks how well the liver is working and consists of many different blood tests.
- ALT (Alanine Aminotransferase): An elevated ALT helps identify liver disease or damage from any number of causes, including hepatitis.
- AST (Aspartate Aminotransferase): Along with an elevated ALT, the AST checks for liver damage.
- Alkaline phosphatase: Alkaline phosphatase is present in bile-secreting cells in the liver; it’s also in bones. High levels often mean bile flow out of the liver is blocked.
- Bilirubin: High bilirubin levels suggest a problem with the liver.
- Albumin: As part of total protein levels, albumin helps determine how well the liver is working.
- Ammonia: Ammonia levels in the blood rise when the liver is not functioning properly.
- Hepatitis A tests: If hepatitis A is suspected, the doctor will test liver function as well as antibodies to detect the hepatitis A virus.
- Hepatitis B tests: Your doctor can test antibody levels to determine if you have been infected with the hepatitis B virus.
- Hepatitis C tests: In addition to checking liver function, blood tests can determine if you have been infected with the hepatitis C virus.
- Prothrombin Time (PT): A prothrombin time, or PT, is commonly done to see if someone is taking the correct dose of the blood thinner warfarin (Coumadin). It also checks for blood clotting problems.
- Partial Thromboplastin Time (PTT): A PTT is done to check for blood clotting problems.
- Ultrasound: An abdominal ultrasound can test for many liver conditions, including cancer, cirrhosis, or problems from gallstones.
- CT scan (computed tomography): A CT scan of the abdomen gives detailed pictures of the liver and other abdominal organs.
- Liver biopsy: A liver biopsy is most commonly done after another test, such as a blood test or ultrasound, indicates a possible liver problem.
- Liver and spleen scan: This nuclear scan uses radioactive material to help diagnose a number of conditions, including abscesses, tumors, and other liver function problems.
Common Characteristics of Liver Disease
What are some common liver disease symptoms?
When diagnosing liver disease, the doctor looks at the patient’s symptoms and conducts a physical examination. In addition, the doctor may request a liver biopsy, liver function tests, an ultrasound, a computed tomography (CT) scan, and/or a magnetic resonance imaging (MRI) scan.
Some common liver disease symptoms include the following, each of which are described briefly below:
- Jaundice. A yellowing of the skin and eyes.
- Liver enlargement
- Portal hypertension
- Esophageal varices
- Ascites. A fluid buildup in the abdominal cavity.
- Liver encephalopathy
- Liver failure
What is jaundice?
Jaundice is a yellow discoloration of the skin and whites of the eyes due to abnormally high levels of bilirubin (bile pigment) in the bloodstream. Urine is usually dark because of the bilirubin excreted through the kidneys. High levels of bilirubin may be attributed to inflammation, or other abnormalities of the liver cells, or blockage of the bile ducts. Sometimes, jaundice is caused by the breakdown of a large number of red blood cells, which can occur in newborns. Jaundice is usually the first sign, and sometimes the only sign, of liver disease.
What is cholestasis?
Cholestasis means any condition in which bile flow is reduced or stopped. “Chole” refers to bile and “stasis” means “not moving.” Bile flow may be blocked inside the liver, outside the liver, or in both places. Symptoms may include:
- Dark urine
- Pale stool
- Easy bleeding
- Pain from the biliary tract or pancreas
- Enlarged gallbladder
Some causes of cholestasis include the following:
- Alcoholic liver disease
- Primary biliary cirrhosis
- Drug effects
- Hormonal changes during pregnancy
- A stone in the bile duct
- Bile duct narrowing
- Bile duct cancer
- Pancreatic cancer
- Inflammation of the pancreas
What is liver enlargement?
Liver enlargement is usually an indicator of liver disease, although there are usually no symptoms associated with a slightly enlarged liver (hepatomegaly). Symptoms of a grossly enlarged liver include abdominal discomfort or “feeling full.”
What is portal hypertension?
Portal hypertension is high blood pressure in the portal vein, which supplies the liver with blood from the intestine and spleen. Portal hypertension may be due to increased blood pressure in the portal blood vessels, or resistance to blood flow through the liver. Portal hypertension can lead to the growth of new blood vessels (called collaterals) that connect blood flow from the intestine to the general circulation, bypassing the liver. When this occurs, substances that are normally removed by the liver pass into the general circulation. Symptoms of portal hypertension may include:
- Development of varicose veins. Varicose veins (esophageal varices) develop most commonly at the lower end of the esophagus and in the stomach lining, although they can develop anywhere from the mouth to the anus.
What are esophageal varices?
Esophageal varices are dilated blood vessels within the walls of the lower part of the esophagus that are prone to bleeding. They can appear in people with severe liver disease. A diseased liver can cause portal hypertension, which is high blood pressure in the portal vein. The portal vein supplies the liver with blood. Over time, this pressure causes blood vessels to grow, called collateral blood vessels. These vessels act as channels to divert the blood under high pressure. The extra pressure in these vessels causes them to dilate and become tortuous. These vessels can eventually reach the lower esophagus and stomach and are prone to rupture. The rupture can lead to significant blood loss from vomiting or from lost blood passing through the gastrointestinal tract. Symptoms of esophageal varices may include:
- Painless vomiting of blood
- Black, tarry or bloody stools
- Decreased urine output
- Excessive thirst
- Anemia. A condition that indicates a low red blood cell count.
What is ascites?
Ascites is fluid buildup in the abdominal cavity caused by fluid leaks from the surface of the liver and intestine. Ascites due to liver disease usually accompanies other liver disease characteristics, such as portal hypertension. Symptoms of ascites may include a distended abdominal cavity, which causes discomfort and shortness of breath. Causes of ascites may include the following:
- Liver cirrhosis (especially cirrhosis caused by alcoholism)
- Alcoholic hepatitis
- Obstruction of the hepatic vein
Ascites can also be caused by nonliver disorders.
What is liver encephalopathy?
Liver encephalopathy is the deterioration of brain function and damage to the nervous system due to toxic substances building up in the blood, which are normally removed by the liver. Liver encephalopathy is also called portal-systemic encephalopathy, hepatic encephalopathy, or hepatic coma. Symptoms may include:
- Impaired consciousness
- Changes in logical thinking, personality, and behavior
- Mood changes
- Impaired judgment
- Sluggish speech and movement
- Loss of consciousness
- Seizures (rare)
- Muscle stiffness or tremors
- Uncontrollable movement
What is liver failure?
Liver failure is severe deterioration of liver function. Liver failure occurs when a large portion of the liver is damaged due to any type of liver disorder. Symptoms may include:
- Tendency to bruise or bleed easily
- Impaired brain function
- General failing health
- Loss of appetite
Pale Stools: Possible Causes and When to Seek Help
There are many possible causes of pale stools. Some of the common causes include:
Certain medications, such as the nonsteroidal anti-inflammatory drugs ibuprofen (Advil) and naproxen (EC-Naprosyn), birth control pills, some antibiotics, and anabolic steroids can cause drug-induced hepatitis. Drug-induced hepatitis is a swelling or inflammation of the liver caused by medications.
Drug-induced hepatitis and the related discolored stools usually go away within a few weeks after the medications are discontinued in the majority of people.
Viral hepatitis is a swelling or inflammation of the liver caused by viruses such as the hepatitis A, B, or C viruses. Hepatitis C often leads to liver disease.
Your doctor can diagnose the type of hepatitis virus you have and help you figure out the best treatment plan for you.
Alcoholic hepatitis is swelling or inflammation of the liver caused by drinking excessive amounts of alcohol. Alcoholic hepatitis can lead to liver disease or liver failure.
To treat this form of hepatitis, you’ll have to stop drinking alcohol. Your doctor can help you if you’ve become dependent on alcohol. Alcoholic hepatitis can also cause malnutrition, so you may also need to be put on a special diet to get the vitamins and other nutrients you need.
Medications such as prednisone (RAYOS) and pentoxifylline (Pentopak) can also treat liver inflammation.
In severe cases, a liver transplant may be needed.
Biliary cirrhosis is an inflammation or irritation of the bile ducts in the liver. The inflammation or irritation blocks the flow of bile to the intestines. The exact cause of biliary cirrhosis is unknown. There is no cure for biliary cirrhosis, and the disease can be fatal.
Treatment can help manage your symptoms and prevent complications. Commonly prescribed medications include cholestyramine (Questran) to treat itching and ursodiol (Urso Forte), which aids in removing bile from the bloodstream.
Your doctor may also suggest taking vitamins A, K, E, and D, to replace the nutrients that are lost in the fatty stools. Calcium supplements can also help prevent loss of bone density.
In severe cases, your doctor may suggest a liver treatment.
Gallstones are hardened deposits in the gallbladder that can block the flow of bile.
Medications can sometimes dissolve gallstones. You may need surgery to remove your gallstones if they’re large or medication isn’t effective.
Sclerosing cholangitis is an inflammation or scarring of the bile ducts, which are the tubes that carry bile throughout the body. The exact cause of this disease is unknown, but genetic factors may be partially responsible.
Both medications and surgeries are possible treatments for sclerosing cholangitis. Commonly prescribed medications include:
- cholestyramine (Questran)
- prednisone (RAYOS)
- ursodiol (Urso Forte)
- azathioprine (Azasan)
- cyclosporine (Sandimmune)
Your doctor may also prescribe supplements for vitamins A, D, E, and K to replace what the body has lost. Your doctor may also prescribe antibiotics.
Common surgeries used to treat sclerosing cholangitis include:
- endoscopic balloon: inserting a balloon at the end of a long tube into the bile ducts to open any narrowing
- biliary drainage catheter: placing a drain in the narrowing of the bile ducts
- removal of the colon and rectum in severe cases
- liver transplant
Structural defects in the biliary system
You may have been born with structural defects in your biliary system that prevent the flow of bile.
After a physical exam, your doctor may order several tests to determine if you have structural defects. These tests include blood tests, scans, and X-rays.
Your doctor may be able to surgically repair the defects. The type of defect will determine the type of surgical procedure the doctor will use.
Gallbladder removal surgery can result in the narrowing of the bile ducts. This condition is known as biliary stricture.
Your doctor may be able to correct the problems using surgery or a stent. A stent is a small tube that a surgeon places inside the ducts to keep them open so that bile can flow freely.
Benign (noncancerous) or malignant (cancerous) tumors in the biliary system can interfere with bile flow or inflame the liver.
Your doctor may be able to remove the tumor surgically. If the tumor is cancerous, you may need radiation, a therapy that uses X-rays or gamma rays to destroy cancerous cells. Chemotherapy can also be used. This is the use of powerful drugs to kill cancer cells.
Cysts on the bile ducts can prevent the flow of bile.
The cysts may go away without treatment, or your doctor may perform surgery to remove them. The surgery is done laparoscopically and with small incisions and less discomfort that common surgery.
There are many types of diseases that can affect the liver and its functions. Some have successful treatments while others do not. Examples of common conditions that affect the liver include:
This condition causes the body’s immune system to attack itself and destroy healthy liver tissue. Autoimmune hepatitis can lead to cirrhosis and other liver damage.
Biliary atresia is a condition that adversely affects a person’s bile ducts and bile flow when they’re an infant. If left untreated, the condition can cause liver scarring and affect liver tissue. Fortunately, there are treatments available for the condition.
Cirrhosis is a condition where scar tissue replaces healthy liver tissue. A number of conditions can cause cirrhosis. These include long-term excessive alcohol use, chronic hepatitis, or rare genetic disorders, such as Wilson’s disease.
This condition causes an excess of iron to build up in the body. Too much iron can damage the liver.
Viral hepatitis refers to a viral infection that causes liver inflammation. The hepatitis types have different letters, including A, B, C, D, and E. Each has different causes and severity.
Hepatitis A is more common in developing countries that lack clean drinking water and have poor sanitation systems. Most people can recover from hepatitis A without liver failure or long-term complications.
Hepatitis B can cause a short- or long-term infection. In U.S. adults, the disease is most commonly spread through sexual contact. However, a person can also get it through sharing needles or accidentally injecting themselves with a contaminated needle. The condition can cause serious complications, including liver failure and cancer. There’s a vaccination against the disease to prevent it.
Hepatitis C can be an acute or chronic infection. It’s most commonly spread by coming in contact with blood containing the hepatitis C virus, such as through sharing unclean needles to inject drugs or apply tattoos. Less commonly, unprotected sexual contact with an infected person can transmit the infection, too. This condition can cause inflammation that can lead to cirrhosis, liver failure, and liver cancer.
Nonalcoholic fatty liver disease and NASH
These are conditions where fat builds up in the liver. An excess of fat can damage the liver, causing inflammation. Nonalcoholic steatohepatitis (NASH) is a form of nonalcoholic fatty liver disease that causes scarring or fibrosis. People who are obese and have conditions related to obesity, such as type 2 diabetes, are more likely to have this disease.
If people on the street were asked to name the most important organ of the human body, the organs cited most frequently would likely be the heart, brain, and lungs. The liver, however, is considered the most important organ according to some experts, including well-known medical personality Dr. Oz. It is not surprising that the liver ranks so high in importance among medical professionals, given its detoxifying, infection-fighting, energy-storing, and digestive abilities.
The hard-working liver labors tirelessly in the right upper quadrant of our abdomen, and given its low-key nature (no throbbing, pulsing, or breathy sounds), it’s easily forgotten. In fact, the liver rarely causes pain in the absence of a serious condition. Knowing the earliest signs and symptoms of liver disease is imperative in seeking timely medical treatment and intervention.
Facts About Liver Disease
According to the American Liver Foundation, at least 10 percent of Americans have some form of liver disease. Additionally, the American Liver Foundation reports that hepatitis C, non-alcoholic fatty liver disease, and liver cancer are all occurring with greater incidence.
Alcohol abuse, hepatitis viruses, and obesity – all considered highly preventable – are the leading three risk factors for death from liver disease. Other causes of liver disease include cancer, autoimmune diseases, and genetic or metabolic disorders.
Sadly, symptoms of many liver disorders do not manifest until serious – sometimes irreversible – damage has occurred. A population-based study found that 69 percent of adults with cirrhosis were unaware of having liver disease. Another study found that Hispanic Americans and African Americans are at greater risk for developing liver disease than Caucasians.
Hispanic Americans have greater risk due to heavier drinking and higher prevalence of obesity and diabetes, while African-Americans have a higher prevalence of obesity, diabetes, and hepatitis B or C.
Non-Alcoholic Liver Disease
When people refer to liver diseases or damage not caused by excessive alcohol use, they’re usually referring to a non-alcoholic fatty liver disease, also known as NAFLD. This condition leads to excess fat gathering in the liver.
Damage caused by NAFLD presents signs and symptoms similar to liver disease by alcohol abuse. Non-alcoholic fatty liver disease is an umbrella term, with the most common form simply named fatty liver. Causes of fatty liver include:
- High levels of fat in the blood
Fatty liver usually does not have symptoms and is reversible with lifestyle changes.
A more advanced NAFLD condition is non-alcoholic steatohepatitis (NASH). In this condition, the fat growth is associated with liver cell inflammation and varying degrees of scarring to the organ. NASH is a serious condition, and may lead to severe scarring of the liver as well as cirrhosis.
Alcoholic Liver Disease
Many people have heard of signs and symptoms of alcoholic liver disease such as jaundice (yellowing of the skin and whites of the eyes), fatigue and digestive issues.
Less commonly known signs and symptoms of alcoholic liver disease include:
- Skin conditions such as itchiness, eczema and psoriasis
- Bad reactions to medications such as antibiotics or pain relievers
- Frequent heartburn and acid reflux
Additionally, alcohol abusers might notice significant decreases in their alcohol tolerance, becoming inebriated more quickly than usual. Alcohol abusers might also suffer more severe hangovers than usual as liver disease develops.
Stages And Early Symptoms Of Liver Disease Among Alcoholics
The American Liver Foundation names three types of alcoholic liver disease. These are – in order of most to least severe – alcoholic cirrhosis, alcoholic hepatitis and alcoholic fatty liver disease. The signs and symptoms of these may overlap.
Alcoholic Fatty Liver Disease
This disease happens when fat builds up in the liver, which causes swelling and impairs liver function. Alcoholic fatty liver disease can occur even after a short period of heavy drinking. Symptoms are not usually present in this stage, though the American Liver Foundation reports some may feel weak or fatigued, or notice discomfort in the right upper abdomen.
With cessation of alcohol use, drinkers can usually reverse liver disease in this stage. If drinking continues, damage to the liver will not subside and will result in irreversible disease.
This condition can manifest after long-term drinking. This involves inflammation and scarring of the liver, which prevents blood flow in the organ, slowing its essential functions. Even though alcoholic hepatitis might be diagnosed as “mild,” it is a serious condition requiring abstinence from adult beverages. Severe alcoholic hepatitis can be life-threatening.
The mildest forms of alcoholic hepatitis might not present any signs or symptoms. As the condition advances, signs and symptoms might include:
- Low-grade fever
- Loss of appetite
- Tenderness in the right upper abdomen
- Weight loss
Liver function tests will also reveal elevated liver enzymes. Severe alcoholic hepatitis may lead to abdominal fluid accumulation, cognitive and behavioral changes, and liver or kidney failure. It is imperative you seek medical advice and intervention at this stage.
This condition is not reversible, though abstinence from alcohol may prevent further damage and improve some signs and symptoms. In this type of liver disease, severe scarring of the liver is present. People with alcoholic cirrhosis will almost certainly be dependent on alcohol and require medical treatment and a great deal of support. A person suffering from alcohol-related cirrhosis who continues to drink has less than a 50 percent chance of living for five more years.
You cannot live without your liver.
The liver is a crucial organ most of us never think about … unless it fails. By the time a liver stops functioning, it’s too late and the only real option is hoping you draw the golden ticket for a transplant.
Alcoholic liver disease is a serious and potentially fatal disease. Non-alcoholic liver disease can have the same prognosis.
Whether liver disease develops from alcoholic or non-alcoholic causes, it is important to be aware of the early signs and symptoms. Early detection is the best chance of stopping damage before the organ stops functioning completely.
One sunny Tuesday morning Sonya woke up yellow.
Like normal Tuesday mornings, she put her kids on the school bus and dressed herself for work. But as she began to apply her light-beige foundation, she abruptly stopped. What she saw in the mirror was anything but normal. Her face, arms and neck were yellowed.
Jaundice is just one of the many symptoms of liver damage. And it can come on suddenly.
Since we can’t see when ugly liver spots develop, or the organ discolors or shows abnormalities, we must rely on other methods to spot trouble.
Symptoms and Signs To Be Wary
New research is finding new molecules that may offer new treatments in a cure for liver disease. Experiments, tests and treatments are continually being explored. Still, the best treatment is early detection.
Your quiet liver does more than you might think, like fighting infection and storing energy.
Some of the signs of early liver damage include:
- Irregular sleep
- Low or fluctuating energy levels
- Skin and eyes developing a yellowish tint
- Skin conditions appear, such as eczema, psoriasis, acne, and itching
- Drinking minimal amounts of alcohol inebriates quickly and causes intense hangovers
- The impact of caffeine becomes acute
- Flushing from the trunk rising up to the head
- Experiencing severe reactions and side effects to common medications
When early liver damage creeps up, the body can no longer protect against harmful chemicals. The body stops being able to digest food, remove impurities, filter toxins from the blood and send nutrients where they need to go.
The declining liver also presents with these signs:
- Bleeding or bruising easily
- Stomach problems after eating, such as bloating, gas and nausea
- Frequent headaches, heartburn and acid reflux
- Difficulty losing weight or inexplicable weight gain
- A strange urinary smell after eating asparagus
- Chemicals (bleach, perfume, gasoline, paint, cleaning products) cause a severe reaction
In addition to the symptoms of non-alcoholic liver damage, those with alcoholic liver damage often experience tremors.
Amazing Regrowth of the Liver
Bob has an old army injury in his knee that developed arthritis. He took pain medicine for years until, suddenly, he got very sick. After a year’s journey of illness and treatments, Bob received a liver transplant.
Since the human liver regenerates and can return to its original size, Bob’s partial liver failure meant he could receive a partial liver transplant from a living donor.
Bob’s lifespan potential has been increased due to receiving a transplant and the amazing regenerative properties of the liver. However, liver transplants are not easy to come by. There are currently thousands of people on the national waiting list for a hepatic transplant.
The liver has the ability to grow back when damaged, and the body can heal itself in small ways. Lifestyle changes like eliminating alcohol, drugs (including too much Tylenol-containing medications), tobacco, and seeking nutritional therapy can enhance the liver’s natural healing abilities.
Only people who have abstained from all alcohol for a period of at least six months can be considered for a transplant. In addition, all other organs must be healthy and the individual able to undergo surgery. Since alcohol dependency can affect other organs, this may affect an alcoholic’s ability to be considered for a liver transplant as well.
Even with a hepatic transplant, the rate of survival after one, three, and five years declines respectively.
Non-Alcoholic Liver Damage
Non-alcoholic fatty liver disease is unrelated to alcohol and refers to excess fat gathering in the liver.
Non-alcohol-related liver disease can be brought on by:
- Inflammation due to an injury or infection
- Medication overdose
- Genetic disorders
- Autoimmune failure
Non-alcoholic liver damage goes through the same stages as an alcohol-damaged liver. It is the cause of the disease that differs.
Alcoholic Liver Damage
Wanting to give up alcohol? Advanced medical tests, research studies and scientific knowledge put together a picture of what quitting alcohol can do for avoiding or halting liver damage.
Alcohol abuse is one of the primary causes of liver damage. Alcohol-associated liver disease is the main cause of chronic liver disease in Western countries.
Once you are diagnosed with alcoholic liver damage, there is one key factor:
Abstaining from alcohol is the only chance a person has of recovery.
Stages of Alcoholic Liver Disease
Alcohol drains the body of nutrients, affects many organs and damages tissues.
There are four main stages of alcoholic liver disease, each one worse than its predecessor.
Alcohol Fatty Liver Disease
Heavy drinking can cause fatty acids to collect in the liver, in some cases in less than a week.
After years of heavy drinking or acute periods of binge drinking, the liver can develop inflammation and swelling. This swelling and inflammation of the liver is called hepatitis.
Other types of hepatitis can cause non-alcoholic liver disease.
The third stage of liver disease is fibrosis, a buildup of proteins in the liver. Instead of filtering toxins and breaking down proteins, the liver accumulates too many proteins, resulting in fibrosis.
The newest research indicates gut microbiota play an influential role in liver injury. As we learn more and more about gut-brain health and gut-liver health, researchers point out the abilities of alcohol cessation and dietary and supplement improvements to slow the progression of liver disease.
Cirrhosis of the liver is scarred tissue that takes over healthy tissue.
When the liver has been inflamed for a long time, cirrhosis occurs. This is the stage where loss of function happens. Cirrhosis can lead to liver cancer and end-stage liver disease.
Alcohol use speeds up the destruction of the liver and reduces its ability to compensate for damage. Cirrhosis damage is irreversible; however the patient can prevent further damage by stopping alcohol use.
Consequences of Drinking Too Much
Noteworthy, anything that jeopardizes the amazing regenerative ability of the liver puts your life in danger.
The further liver disease progresses, the more dangerous it becomes.
A 29-year-old Californian, Brandon didn’t think he was an alcoholic. After his family held an intervention, Brandon realized his weekend binge drinking was a serious problem. When he went to rehab, his medical team found signs of liver disease and tests confirmed the diagnosis.
Thankfully, Brandon’s condition was discovered early enough that the holistic and medical treatments he received arrested the damage. Two years later the young man’s scans showed significant improvement, and thanks to the support he received, Brandon has stayed sober.
Out of mind while chugging down beers and liquors, a developing alcoholic liver disease can quickly become life-threatening for anyone.
According to the American Liver Foundation, between ten and twenty percent of heavy drinkers will develop alcoholic liver cirrhosis from repeated and excessive alcohol use.
Help for Signs of Early Liver Disease
The recommended daily limits for alcohol consumption are no more than one drink per day for women and two for men.
If you or someone you know regularly exceeds these recommended daily limits, or is experiencing some early signs of liver disease, it is important to intervene early.
Medical treatment for addiction is vital. Quitting alcohol is a formidable challenge and withdrawing from alcohol at home can be life-threatening.
Getting a professional intervention early on is a person’s best chance of reversing the strain alcohol puts on the liver. Let us help today.
This was originally posted on October 19, 2016 and was updated and republished February 11, 2019
As a Certified Intervention Professional (CIP), member of NAATP, NAADAC, and accredited by the Pennsylvania Certification Board, Mike Loverde knows first-hand what it’s like to live life with addiction. By overcoming it, he had a calling to work with others who struggle with drug and alcohol addictions—the people who use and the families who feel helpless watching them decay.
With thousands of interventions across the United States done and many more to come, Loverde continues to own the intervention space, since 2005, by working with medical doctors, psychiatrists, psychologists and others who need expert assistance for their patients who need intervention. To further his impact on behavioral health and maximize intervention effectiveness, Loverde is near completion of a Masters in Addiction Studies (MHS) accreditation, as well as a Licensed Independent Substance Abuse Counselor (LISAC), and is committed to attaining the designation of a Licensed Professional Counselor (LPC).
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