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Liver disease is the fifth commonest cause of death in the UK, and is growing at one of the fastest rates of any disease process.

A whole variety of problems can cause liver problems, not just alcohol. It can be caused by viral infections, inherited conditions, autoimmune diseases, medications and in association with obesity and diabetes.

Liver problems are often picked up by routine screening liver tests. In the earlier stages liver problems usually do not cause any symptoms. Once symptoms do occur the liver disease is usually very significant.

All liver diseases are treatable, and some curable, if the problem is picked up relatively early. By recognising problems or potential problems with the liver future health can be greatly improved by employing the correct treatments and lifestyle measures.

Advanced liver disease, or cirrhosis, requires careful monitoring to detect and treat potential problems such as liver cancer and internal bleeding.

Liver Disease and Treatment at The Princess Grace Hospital Liver specialists from London teaching hospitals see patients at The Princess Grace.

There are close links with the X-ray department with experienced liver radiologists performing ultrasound, CT and MRI scanning.

There is a dedicated nurse specialist, who in close liaison with the consultants has experience in treating and monitoring patients with viral hepatitis.

There are close links to a service specialising in dietary and lifestyle modifications for assisting in the treatment of some liver diseases

For a complete list of our Consultants, click here to use our Consultant Directory

Hepatitis B

Worldwide over 400 million people are infected with hepatitis B.

The majority of infections in the UK are acquired early in life particularly individuals born in the developing world. Some countries have a prevalence of over 10%.

Acute hepatitis B is less common than chronic (long standing) disease, but can be fatal. There is an effective vaccine which can prevent transmission of hepatitis B

The term 'carrier' is no longer correct; as many people assumed to have insignificant hepatitis B go on to develop cirrhosis and liver cancer.

Hepatitis B can undergo periods of being inactive and then reactivate after many years, even in people assumed to be healthy 'carriers'. Lifelong follow up and monitoring is required for this condition as effective treatments exist.


Anyone infected with hepatitis B should undergo routine liver tests at least once a year, and often more frequently.

New tests have been developed which accurately measure the level of the virus in the blood - the viral load. Monitoring the viral load over time is vital to predicting the course of the infection.

Ultrasound examination helps to determine the degree of damage to the liver and to assess for development of liver cancer. Hepatitis B is by far the commonest cause of hepatitis worldwide, and certain infected individuals need regular surveillance for liver cancer, as this can be cured if picked up in its early stages.

Liver biopsy helps to confirm the diagnosis and assess the degree of scarring (fibrosis) in the liver.

Non-invasive tests of liver fibrosis such as 'fibroscan' and blood test markers of fibrosis will be used with increasing frequency in the future.


Treatment of hepatitis B has radically changed over the past 5 years with several new drugs becoming available.

Treatment consists of either pegylated interferon or oral antivirals such as lamivudine, adefovir, telbivudine or entecavir.

Hepatitis C

400 - 500,000 people in the UK are infected with hepatitis C, and more than 80% are unaware.

Hepatitis C causes progressive inflammation in the liver which can lead to cirrhosis, liver failure and cancer. Most people infected have no symptoms until very late in the disease process.

The diagnosis is often prompted by the discovery of abnormal liver function tests, although up to 30% of individuals with hepatitis C actually have normal liver function tests.

The initial antibody test identifies people who have been exposed to the virus, the majority remain infected, which is detected by a PCR test to detect the virus itself.

Of all people infected with hepatitis C 30% will develop cirrhosis 30 years after initial infection, though some people will have significant disease after a much shorter period.

Common sources of infection include a history of injecting drug use, a blood transfusion prior to routine screening in 1991 and being born in the developing world, especially in countries such as Pakistan and Egypt.


Screening blood tests can identify the presence of the virus and look at the subtype or genotype, which influences the treatment.

Ultrasound of the liver is a good screening test to look for advanced liver disease.

Liver biopsy is still believed to be the gold standard for assessing the degree of scarring (fibrosis) that has occurred in the liver.

Non-invasive tests of liver fibrosis such as 'fibroscan' and blood test markers of fibrosis will be used with increasing frequency in the future.


Over 50% of hepatitis C is now cured with antiviral therapy

Treatment consists of combined pegylated interferon and ribavirin.

Fatty Liver Disease

Fat in the liver (steatosis) can be caused by a variety of factors such as diabetes, alcohol, certain medications and the metabolic syndrome. It is very common occurring in up to 5% of the population.

In some individuals the fat is associated with inflammation (steatohepatitis). In such cases inflammation may lead to progressive scarring and even the development of cirrhosis.

Fat in the liver is predictive of an increased risk of developing diabetes, heart disease and strokes.

Recognition of fatty liver and its health consequences at an early stage can lead to prevention of future cardiovascular disease.

As with other forms of liver disease, it is often asymptomatic until substantial damage has been done to the liver.


Fatty liver is often picked up incidentally as abnormal liver function tests on health screening, or during ultrasound examination of the abdomen.

Measures of pre-diabetic states using markers of insulin resistance, and of serum cholesterol and lipids are important in addressing risks of developing diabetes or cardiovascular disease.

Liver biopsy helps to confirm the diagnosis and assess the degree of scarring (fibrosis) in the liver.

Non-invasive tests of liver fibrosis such as 'fibroscan' and blood test markers of fibrosis will be used with increasing frequency in the future.


Diet, exercise and lifestyle issues are the main focus of treatment and prevention of associated complications.

Lipid lowering drugs and tablet treatments for insulin resistance may have a role in preventing progressive liver disease.

Antioxidants may have a role in treatment.

Hepato-pancreatico-biliary surgery

Hepato-pancreato-biliary surgery (HPB surgery) focuses on diseases that affect the liver, pancreas and biliary system, both malignant and benign.

Acute and Chronic Pancreatitis

Inflammation of the pancreas can be as a result of reflux of bile into the pancreatic duct, or pancreatic duct obstruction. The pancreas secretes enzymes that play an important role in digestion and metabolism. Pancreatic inflammation causes these enzymes to become blocked and instead attack the pancreas. Symptoms include nausea and vomiting, fever, rapid pulse, with severe pain in the upper abdomen radiating into the back

Surgical Treatment – Pancreatic necrosectomy

Most patients respond well to conservative treatment which involves hydration, close observation and antibiotic therapy. Some patients develop dead pancreatic tissue which becomes infected which would have to be removed surgically.

Pancreatic cancer

Often not detected until the late stages of disease. Symptoms resemble that of pancreatitis as well as loss or appetite and unintentional weight loss, jaundice, itching and digestive problems.

Surgical Treatment - Whipple's procedure (pancreatoduodenectomy)

This procedure involves removing the head of the pancreas, along with duodenum, gall bladder and top of the common bile duct, and possibly part of your stomach if required. The remaining pancreas, end of the bile ducts are connected to the small intestine.

Surgical Treatment - Distal Pancreatectomy

A procedure that can be performed as open or laparoscopic surgery. This removes the tail and if necessary some of the body of the pancreas in order to resect the tumour growth. In order to eradicate all traces of disease, often the spleen is also removed at the time of surgery.


The spleen is used to fight infections in the body and filter the blood. There are a number of reasons why the spleen would need to be removed. The commonest of which is ITP (Idiopathic Thrombocytopenia (low platelets)).

Surgical Treatment - Laparoscopic splenectomy

On occasion it may be necessary to surgically remove the spleen. This can be performed as a laparoscopic procedure. In chronic cases, this is often the best treatment. Although you can live quite normally without your spleen, it can mean that you are more prone to infections it the future.

Liver Cancer

Cancer found in the liver is most often a secondary cancer, with a primary cancer located elsewhere in the body (most commonly the large bowel). Symptoms don’t often appear until late stages of disease. These can include jaundice, ascities (abdominal swelling), an enlarged liver, nausea and vomiting, weight loss and abdominal pain.

Surgical Treatment - Liver Resection

Surgery can remove (resect) the area of affected liver. Depending on which part or segment of the liver that is affected surgery may be able to be performed using a laparoscopic technique.

Surgical Treatment – Laparoscopic or Percutaneous Radio Frequency Ablation

On occasions, instead of removing the diseased part of the liver, radio frequency (RF) ablation can be used to burn the tumour insitu to destroy the tumour cells.

Chemotherapy may be used before surgical resection or RF ablation (to reduce tumour size) or after to ensure complete eradication of disease.

Gall Bladder and Bile Duct Cancer

These cancers are rare but when they occur affect the bilary tract and often not detected until late stages of disease. If caught early, surgical removal can remove all cancerous cells. Late stage cancer surgical intervention is palliative not curative.

Surgical Treatment – Radical Cholecystectomy

In early stages a cholecystectomy, often performed laparoscopically, can remove all the diseased tissue. However, with disease spread, an extended cholecystectomy may be necessary. This will remove some liver tissue along with lymph nodes.

Surgical Treatment – Excision of bile duct

Tumours near the liver and hepatic ducts can be surgically resected along with the gallbladder, liver and surrounding tissue and lymph nodes. Distal tumours may also involve removing the head of the pancreas.