Non-neoplastic Liver Disease - Types, Symptoms, Diagnosis, Treatment, and Prognosis

Introduction:

Non-neoplastic liver diseases affect the liver cells and intrahepatic bile ducts, and they are not harmless. Non-neoplastic liver diseases are cirrhosis (scarring of liver tissues), hepatitis (inflammation of the liver), and cholangitis (swelling of the bile duct). They are the abnormal growth of cells, but they are non-malignant. Non-neoplastic liver lesions are focal nodular hyperplasia, nodular regenerative hyperplasia, compensatory hyperplasia of the liver, pseudonodule of the liver, partial nodular transformation, and focal fatty change. The non-neoplastic diseases occur as a result of an increase in the number of cells due to disruption in the intrahepatic blood supply, infections, hormonal imbalances, pre-neoplastic characteristics (conditions that cause cancer), abnormal metabolic disruption caused by the presence of abnormal chemicals that prevent normal metabolic functions, and focal necrobiotic process (physiological cell death).

The non-neoplastic disease of the liver is a benign disease that does not spread to other organs. Instead, they are caused by abnormal growth of liver cells due to some triggering factors like alcohol consumption, medication overdose, hormonal imbalances, reduced blood supply to the liver, and infections like viral hepatitis.

What Are the Types of Non-neoplastic Diseases?

1. Cirrhosis- Cirrhosis is a chronic liver disease that causes scarring of the healthy liver tissues. The healthy liver cells are instated with scar tissues due to continuous damage to the liver cells. The main reason for cirrhosis is heavy alcohol consumption.

2. Hepatitis- Hepatitis is a liver condition where the liver cells are inflamed. It can occur due to viral infections, autoimmune disorders (when the immune system attacks the body's healthy organs or tissues), or due to certain medications like Acetaminophen (painkiller and fever medicine), NSAIDs (non-steroidal anti-inflammatory drug) for painful conditions, herbal medicines, and birth control pills.

3. Cholangitis: Cholangitis is defined as inflammation or swelling of the bile duct. The bile duct is tubular in shape and carries bile from the liver and the gallbladder to the small intestine. If there is any obstruction or narrowing of the bile duct due to bile stones or blood clots, it results in inflammation. This further disrupts liver function.

What Are the Types of Non-neoplastic Nodules?

1. Focal Nodular Hyperplasia- This is another prevalent benign lesion but less common than hemangiomas.Focal nodular hyperplasia (FNH) comprises liver cells, connective tissue cells, and bile duct cells. They are prevalent in women between the ages of 20 and 30. When the diagnosis is unclear, these lesions are often excised since they mimic malignant lesions.

2. Nodular Regenerative Hyperplasia (NRH)- NRH results when the normal liver cells form into many small nodules with liver cells that regenerate (form new cells). It is common in people of all ages, but is more prevalent in older people.

3. Compensatory Hyperplasia of the Liver- Compensatory hyperplasia is an increase in the number of cells in a rapid way as they maintain their structure and function. However, they are different from one another. This happens as a compensatory mechanism when the organ is damaged or injured.

4. Pseudonodule of the Liver- Hepatocellular pseudotumor is seen in patients with cirrhosis. It resembles hepatocellular carcinoma. The clinical features, imaging results, and needle biopsy help in finding the pseudotumor.

5. Partial Nodular Transformation- Partial nodular transformation involves the replacement of a part of the liver's parenchymal cells (functional cells of the liver different from the supporting tissues) with nodules containing hepatic cells (cells of the liver). This is a rare condition, and the causes are unclear.

6. Focal Fatty Change- Focal fatty change is the fat deposition as patches in the liver. It occurs due to disruption in the blood flow or decreased absorption of lipoproteins (a substance that contains fat and protein and channels cholesterol throughout the blood), or reduced oxygen in the tissues.

What Are the Symptoms of Non-neoplastic Diseases?

• Pain in the right upper region above the abdomen.

• Jaundice- yellowish discoloration of the skin and eyes.

• Loss of appetite.

• Stomach fullness.

• Feeling weak and tired.

• Lump or mass felt in the abdomen.

Non-neoplastic nodules do not show symptoms. However, if the lesion size is large, it might pressure the adjacent structures and create symptoms.

How Are Non-neoplastic Diseases Found?

• Complete Blood Count- This blood test screens all the components like red blood cells, white blood cells, platelets, and hemoglobin. A discrepancy in the normal levels of these parameters points out an infection.

• Liver Function Tests (LFT)- Liver enzymes like alanine transaminase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LD), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) are checked. Also, albumin and globulin, which are proteins, are also tested. The bilirubin and prothrombin tests are performed. If there are mismatches in the routine levels, then there is an infection.

• Ultrasound Scan- In an ultrasound, liver abnormalities are detected by capturing images via high-frequency sound waves transmitted through an ultrasound probe.

• CT Scan- Computerized tomography (CT) covers abnormalities in the bony structures and the organs surrounding them. It uses computer technology to obtain printed images captured using X-rays at multiple angles.

• MRI Scan- Magnetic resonance imaging (MRI) gives a detailed and clear view of the internal organs and their nearby structures to make a diagnosis and plan the treatment.

• Liver Biopsy- In a liver biopsy, a tiny portion of the suspected lesion or the organ is removed with forceps and viewed under a microscope to detect pathological changes. This test gives a confirmatory result about the disease or the lesion.

How Are Non-neoplastic Diseases Treated?

• Treatment is not required for non-neoplastic nodules unless they cause symptoms.

• If the nodule size is large or if it becomes symptomatic, surgical removal of the nodule will be recommended.

• Non-neoplastic diseases are treated by surgical removal of the damaged liver portion.

• Avoid external factors like alcohol consumption and taking medications without a doctor's advice.

• A liver transplant will be recommended if the liver is severely damaged.

What Is the Prognosis of Non-neoplastic Disease?

Since these diseases are not life-threatening, the prognosis is good for non-neoplastic diseases. However, if the damage to the liver by the disease is beyond repair, for example, in cirrhosis, the prognosis will be poor.

Conclusion:

Non-neoplastic liver diseases do not cause significant symptoms. The symptoms appear if the lesions enlarge and press on the nearby organs. Treatment usually is limited to surgical procedures. If the liver damage is severe and leads to liver failure, a liver transplant will be recommended for cirrhosis. Though these lesions generally do not require treatment, close monitoring of the disease with liver function tests and imaging studies should be followed, and the worsening of the disease can be prevented.