Liver Diseases

Liver Care at UVM Health

As the largest internal organ in your body, your liver performs hundreds of functions. It helps with digestion, immune activity and blood clotting. It also stores energy and vitamins and removes toxins from your blood. Liver diseases can affect these important processes and cause serious illness.

At University of Vermont Health, we provide skilled, compassionate care for liver diseases. Our network of gastroenterologists gives you access to advanced therapies, no matter where you live in Vermont or northern New York. When possible, we offer digital health services to bring care to you.

A medical provider conducts an ultrasound of a patient's liver.

Why Choose UVM Health?

As a leading gastroenterology program in the region, we offer:

Coordinated approach: Our board-certified gastroenterologists and hepatologists coordinate with specialists across many disciplines to meet your individual needs. Your team may include surgeons, radiologists, pathologists and cancer experts. We also collaborate with primary care providers to manage some liver diseases.
Leading-edge treatments: As a health system anchored by an academic medical center, you’ll find diagnostic and therapeutic procedures not widely available in the region. Offerings include endoscopic ultrasounds and advanced cancer therapies.
Support services: When you need to make changes to your lifestyle to improve your health, we offer a wide range of counseling and support services.

Types of Liver Diseases

Diseases that affect the liver include:

Alcoholic liver disease: Heavy alcohol use causes fat buildup in the liver that can result in inflammation and scarring.
Autoimmune liver diseases: Occur when your immune system attacks your liver. Examples include primary biliary cholangitis and autoimmune hepatitis.
Bile duct diseases: Conditions affecting the ducts that drain bile (a digestive enzyme produced in your liver) into your small intestine. Bile ducts can become narrowed or blocked, which can damage your liver.
Congenital liver diseases: Genetic conditions inherited from your parents. Hemochromatosis and Wilson’s disease are two types of congenital liver diseases.
Liver cancer: Develops when abnormal cells in your liver grow uncontrollably. Liver cancer can start in your liver (primary liver cancer) or spread to the liver from somewhere else in your body (secondary liver cancer).
Metabolic dysfunction-associated steatotic liver disease: A buildup of fat in the liver in people who drink little or no alcohol. This condition is associated with metabolic syndrome, a group of conditions (including obesity, type 2 diabetes, high cholesterol and high blood pressure) that often occur together.
Portal hypertension: High pressure in the portal vein, the main blood vessel in your liver, caused by advanced liver disease. This pressure can lead to other health issues.
Viral hepatitis: A viral infection most often caused by hepatitis viruses A, B and C. Hepatitis is spread from person to person through contact with infected body fluids (such as blood or semen) or contaminated food or water.

Your liver has the unique ability to regenerate when it becomes damaged. But over time, liver disease may cause permanent scarring (cirrhosis) and liver failure.

Diagnosing Liver Diseases

To make an accurate diagnosis, your provider will review your symptoms and medical history and perform a physical exam. Your provider may ask you about your lifestyle (diet, alcohol use, sexual practices) and order tests, such as:

Blood Tests

A liver function panel is the most common blood test to measure how well your liver is working. Your provider may order other blood tests to detect inflammation or problems with blood clotting that could indicate liver disease.

Imaging Tests

Ultrasound, CT and MRI scans help your provider see the structure of your liver. They can also assess your liver using specialized imaging tests, such as:

FibroScan®: This ultrasound imaging test that detects cirrhosis by measuring the stiffness of your liver tissues.
Liver and spleen scan: A test that uses a small amount of radioactive tracer injected into a vein in your arm. We follow the tracer into your liver and spleen (a small organ located to the left of your stomach) with a special camera. This scan helps your provider detect cysts, tumors and other liver conditions.

Biopsy

A biopsy is a procedure to collect a sample of tissue for laboratory analysis. We may perform a liver biopsy by inserting a fine needle through your abdomen into your liver.

We also use endoscopic ultrasound (EUS) for biopsies. An endoscope is a thin, lighted tube equipped with an ultrasound probe and camera. Your provider inserts the endoscope through your mouth and into your stomach. Using ultrasound guidance, your provider passes a fine needle from the endoscope into the liver to collect a sample of abnormal tissue.

Portal Pressure

We use endoscopic ultrasound (EUS) to measure portal pressure and diagnose portal hypertension. This procedure is similar to an EUS biopsy but involves guiding a pressure-sensing instrument into the portal vein.

Treating Liver Diseases

Your provider will listen to your needs and preferences to develop a personalized treatment plan. Treatment strategies for liver disease typically focus on:

Easing symptoms
Preventing and treating complications of the disease
Preventing other conditions that could cause more liver damage

Your treatment plan may include:

Lifestyle Changes

Changes to your diet and lifestyle are often key treatments to reverse the effects of liver disease or prevent further damage. Your provider will work with you to help you:

Avoid medications that can damage your liver, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen
Eat a healthy diet
Eliminate alcohol and drug use
Manage other health conditions, such as high blood pressure, high cholesterol, obesity and diabetes
Protect yourself from viral hepatitis through vaccinations, good hygiene and safe sex practices
Quit smoking

We know lifestyle changes can be difficult to make on your own and we are here to help. Our Addiction Treatment Center offers outpatient treatment and support for alcohol and drug addiction. We also offer nutrition counseling and tobacco cessation resources.

Medications

Medications can be an effective treatment for some types of liver disease. Your providers may prescribe:

Antifibrosis drugs: To prevent scarring that leads to cirrhosis
Antiviral therapy: For viral hepatitis
Corticosteroids and immunosuppressants: For autoimmune diseases

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiology procedure to treat portal hypertension. Your provider inserts a thin tube (catheter) through a blood vessel in your neck and guides the tube to your liver. Your provider then inserts a hollow tube (stent) to redirect blood flow, which lowers pressure in the portal vein.

Multidisciplinary Cancer Care

If you are diagnosed with liver cancer, you want an experienced team on your side. At UVM Health, we bring together a group of specialists to provide team-based gastrointestinal cancer care for people with liver cancer. The team, called a tumor board, includes gastroenterologists, surgeons, medical oncologists, radiation oncologists, radiologists and pathologists. They work together to deliver advanced treatments, such as:

Ablation: Ablation therapy applies heat, cold or a chemical directly to the tumor. We may deliver this treatment using an image-guided needle or probe, or surgically.
Embolization: This treatment uses real-time imaging and thin tubes (catheters) threaded through blood vessels to block blood flow to the tumor. At the same time, we may place beads coated with chemotherapy drugs or radioactive substances next to the tumor to destroy the cancer cells.
Medication therapy: Our medical oncologists are experts in selecting and managing cancer medications to treat liver cancer. Your treatment may include chemotherapy, immunotherapy and/or targeted therapy.
Radiation therapy: In this treatment, high-energy rays are directed at the tumor from outside your body. Precise radiation therapy technology allows us to target the tumor while limiting damage to surrounding tissue.
Surgery: When possible, a partial hepatectomy to remove the tumor and surrounding tissue is often the best treatment option for liver cancer. If you have cirrhosis, removing all the cancer while leaving enough tissue for good liver function can be challenging. Our physicians will determine your eligibility for surgery and may recommend other treatments if necessary.

Liver Transplant

If you have severe liver disease, you may require a liver transplant. At UVM Health, we offer pre- and post-transplant care and partner with premier centers in the United States to perform liver transplant surgery.

Wellness & Prevention

Evidence shows that proactive health care focused on preventing illness leads to better outcomes. We're here to help you live a healthier, happier life. We offer wellness and prevention services to empower you to take control of your health.