The Liver And How It Works
Why is the liver important?
The liver is the largest organ in the body weighing about 3 pounds and is the largest solid organ in the body and plays an important role, performing many difficult functions that are essential for life. Your liver serves as your body’s internal chemical power plant. It is impossible to live without the liver and the health of the liver is a major factor in the quality of one’s life. Some important functions of the liver are:
· Manufacturing blood proteins that aid in clotting, oxygen transport, and immune system function.
· To convert the food we eat into stored energy, in the form of glycogen, and chemicals necessary for life and growth.
· To break down saturated fat and producing cholesterol.
· To act as a filter to remove alcohol and toxic substances from the blood and convert them to substances that can be excreted from the body;
· To process drugs and medications absorbed from the digestive system, enabling the body to use them effectively and ultimately dispose of them;
· To create and export important chemicals used by the body.
What are some of the symptoms of liver disease?
The most important thing to recognize about liver disease is that up to 50 percent of individuals with underlying liver disease have no symptoms. The most common symptoms are very non-specific and they include fatigue or excessive tiredness, lack of drive, occasionally itching. Signs of liver disease that are more prominent are jaundice or yellowing of the eyes and skin, dark urine, very pale or light colored stool or bowel movements, bleeding from the GI tract, mental confusion, and retention of fluids in the abdomen or belly.
Can liver damage be reversed?
The liver is a unique organ. It is the only organ in the body that is able to regenerate… that is completely repair the damage. With most organs, such as the heart, the damaged tissue is replaced with scar, like on the skin. The liver, however, is able to replace damaged tissue with new cells. An extreme example is a patient who suffers an overdose from Tylenol. In this example up to 50 – 60 percent of the liver cells may be killed within 3 – 4 days. However, if no other complications arise, the patient’s liver will repair completely, and a liver biopsy after 30 days will appear completely normal with no signs of damage and no scar. However, the long-term complications of liver disease occur when regeneration is either incomplete or prevented by progressive development of scar tissue within the liver. This occurs when the damaging agent such as a virus, a drug, alcohol, etc., continues to attack the liver and prevents complete regeneration. Once scar tissue has developed it is very difficult to reverse that process. Severe scarring of the liver is the condition known as cirrhosis. The development of cirrhosis indicates late stage liver disease and is usually followed by the onset of complications.
What tests and/or procedures are performed to diagnose ALD (Alcoholic Liver Disease)?
Blood tests are useful in the determination of ALD. Blood tests can establish alcohol as the cause of the disease but cannot determine the seriousness of the illness. Aminotransferase abnormalities are usually indicative of ALD. These are AST, ALT, and AST/ALT ratios. There is increased serum activity of gamma glutamyl transpeptidase (GGTP) in chronic alcohol users. Sixty percent of alcoholics have elevated GGTP in combination with elevated AST levels. Serum electrolytes, mean corpuscular volume (MCV) and serum uric acid levels are also indicative of ALD in combination with results from other tests. Prothrombin time (ability of the blood to clot) may be indicative of mild hepatic disease, but may be present in hepatic failure.
Liver biopsy is not always necessary to confirm the diagnosis of ALD, but is the most sensitive measure of disease stage and is useful in predicting the disease course.
Abdominal ultrasound and CT scanning may also be performed. Abdominal ultrasound is useful in the assessment of fatty content of the liver. CT scanning detects cirrhosis, portal hypertension and tumors.
Diet And Nutrition
Why is the liver so important in nutrition?
Nutrition and the liver are connected in many ways. Since most of what we eat, breathe, and absorb through our skin must be refined and detoxified by the liver, special attention to nutrition and diet can help keep the liver healthy. Approximately 85–90 percent of the blood that leaves the stomach and intestines carries important nutrients to the liver where they are converted into substances the body can use.
Can poor nutrition cause liver disease?
Poor nutrition is not generally a cause, with the exception of alcoholic liver disease, and liver disease found among starving populations. It is much more likely that poor nutrition is the result of chronic liver disease, and not the cause. Good nutrition with a balanced diet can actually help the damaged liver regenerate new liver cells. In fact, in some liver diseases, nutrition becomes an essential form of treatment. Ask your doctor.
Are “high protein diets” bad for my liver?
High protein diets are generally well-tolerated by healthy adults. But a dramatic increase in protein-rich foods may be dangerous for people with severe liver or kidney disease for the following two reasons:
· Such individuals may lack the ability to get rid of the waste products left from protein metabolism.
· These diets may also limit intake of other important foods, such as fruits, vegetables, and whole grains.
You may not know if you have liver disease. For this and other reasons, ask your doctor before starting any diet.
How does liver disease affect nutrition?
Many chronic liver diseases are associated with malnutrition. The most common is cirrhosis, which is the scarring of the liver. Cirrhosis can occur by repeated injury to liver cells, which can be caused by excessive alcohol intake, chronic viral hepatitis, exposure to certain drugs or toxic substances, and a variety of other causes.
People with cirrhosis often experience loss of appetite, nausea, vomiting, and weight loss, giving them a thin appearance. Diet alone does not contribute to the development of this liver disease generally, although non-alcoholic fatty liver, associated with obesity, can lead to cirrhosis. People who are well-nourished but drink large amounts of alcohol are also at risk for alcoholic disease.
What is Fatty Liver Disease and is it caused by eating too much fat?
Fatty liver is an abnormal accumulation of fat (small or large droplets) in the cytoplasm of liver cells and may often be accompanied by fibrosis. Fatty liver is present in approximately 90-100% of heavy drinkers (who consume more than 80 grams of alcohol per day over a 5 year period). Palpable liver enlargement is also characteristic of fatty liver and is present in about 90%of these patients. Conditions other than heavy alcohol consumption may also cause fatty liver.
Fatty Liver Disease, also known as “fatty infiltration of the liver,” is not caused by excessive eating of fats, although obesity is a risk factor for fatty liver. In some patients, the fat is associated with inflammation and scarring and may lead to cirrhosis. Nutritional causes of fat in the liver include alcohol, starvation, obesity, protein malnutrition, and intestinal bypass operation for obesity. Diabetes is another factor associated with fatty liver.
Chemicals And Drugs
Can exposure to chemicals or certain drugs cause permanent damage to my liver?
Yes, chemicals can cause chronic liver disease and cirrhosis. Usually, chronic liver disease develops only after long-term use of a drug. Excessive exposure to certain drugs and chemicals may cause tumors of the liver as well.
Can illegal drugs damage the liver?
Yes, liver damage is common in people who are regular illegal drug users. Most instances of liver damage in these individuals result from viral hepatitis caused by sharing contaminated needles and using alcohol.
Alcohol
Does alcohol cause liver disease?
Yes, but it is only one of the many causes, and the risk depends on how much you drink and over how long a period. Some causes include viruses, hereditary defects, and reactions to drugs and chemicals.
What quantity of alcohol usage should be seen as being a risk to the liver?
First, it should be understood that alcohol is a poison. Any amount of alcohol can produce damage to the liver. In an otherwise healthy person with no underlying liver problems, the general rule of thumb is different for men and women. Men metabolize and are able to clear alcohol more efficiently than women due to body size, body fat and certain enzymes. Because of this the maximum “safe” daily intake of alcohol for a woman is 1 – 2 drink per day; for the male it is 3 – 4 over a 24-hour period. It is also important to recognize the body and the liver in particular does not distinguish between different forms of alcohol. Beer and wine are not “safer” than whiskey or spirits. One drink is defined as one shot (1 and 1/4 ounces) of whiskey or spirits, one four-ounce can of wine or one 12-ounce can of beer. If an individual has an underlying liver condition such as hepatitis B or C, or prior damage from alcohol or other diseases, the liver is very sensitive to any amount of alcohol. In those conditions, the only safe dose of alcohol is zero.
Are there dangers from alcohol besides the amount that is consumed?
Yes. Even moderate amounts of alcohol can have toxic effects when taken with over-the-counter drugs containing acetaminophen. If you are taking over-the-counter drugs, be especially careful about drinking and don’t use an alcoholic beverage to take your medication. Ask your doctor about precautions for prescription drugs.
What kinds of liver diseases are caused by too much alcohol?
Alcoholic hepatitis is an inflammation of the liver that lasts one to two weeks. Symptoms include loss of appetite, nausea, vomiting, abdominal pain and tenderness, fever, jaundice, and sometimes, mental confusion. It is believed to lead to alcoholic cirrhosis over a period of years. Cirrhosis involves permanent damage to the liver cells. “Fatty Liver” is the earliest stage of alcoholic liver disease. If the patient stops drinking at this point, the liver can heal itself.
Can “social drinkers” get alcoholic hepatitis?
Yes. Alcoholic hepatitis is mostly found in alcoholics, but it also occurs in people who are not alcoholics.
Do all alcoholics get alcoholic hepatitis and eventually cirrhosis?
No. Some alcoholics may suffer seriously from the many physical and psychological symptoms of alcoholism, but escape serious liver damage. Alcoholic cirrhosis is found among alcoholics about 10–25 percent of the time. If alcoholic hepatitis is detected and treated early, cirrhosis can be prevented. However, if untreated for a long period of time, it may be fatal, especially if the patient has had previous liver damage.
What is cirrhosis?
Cirrhosis is the scarring of the liver caused by long-term alcohol abuse or chronic viral hepatitis. In children, the most frequent causes are biliary atresia, which often requires a liver transplant.
What are the complications of ALD (Alcoholic Liver Disease)?
Complications of ALD are usually caused by the systemic complications of hepatic injury. These include: portal hypertension, an obstruction of the normal blood flow through the liver and reduction in functional hepatocyte mass. These conditions may occur in those with alcoholic hepatitis or alcoholic cirrhosis and in other non-alcohol related liver diseases.
Portal hypertension results in an elevation in pressure throughout the vascular tree above the portal vein. This elevation in pressure may cause the formation of ascites (accumulation of serous fluid in the abdomen) and increased blood flow through alternative pathways resulting in the development of varices and hypersplenism. Spontaneous bacterial peritonitis may occur in the acutely ill cirrhotic patient.
Reduction in functional liver mass causes hepatic encephalopathy (mental dysfunction caused by an accumulation of nitrogenous wastes in the blood and brain), coagulopathy (dysfunctional clotting mechanism due to decreased synthesis of clotting factors) and hypoalbuminemia (decreased synthesis and hepatic secretion of albumin, a protein responsible for maintaining serum osmotic pressure). When albumin content is decreased, the water tends to move out of serum into the tissues (edema or swelling) or into the peritoneal space (area surrounding organs in the abdomen) or ascites.
What is Nonalcoholic Steatohepatitis (NASH)?
Nonalcoholic steatohepatitis (NASH) is characterized by histopathological features of alcoholic hepatitis in patients drinking insignificant amounts of alcohol. Up to 20 per cent of patients with elevations of transaminases of unknown significance have been reported to have NASH. In about 80 per cent of cases NASH is associated with obesity and type 2 diabetes mellitus, especially in middle aged women. Hepatic steatosis, hyperinsulinemia, endotoxins, proinflammatory cytokines, oxidative stress and genetic factors are pathogenetically important. In its strict form NASH is characterized by steatosis, signs of
hepatocellular injury, necroinflammation and fibrosis. Most patients are asymptomatic or have mild, noncharacteristic right upper quadrant complaints. Transaminase values are below 100 U/l, alanine aminotransferase is higher than aspartate aminotransferase. In most patients long term prognosis is good, however, in some patients NASH is progressive and may lead to cirrhosis. Management includes careful weight reduction and treatment of diabetes. Therapy with ursodeoxycholic acid, vitamin E and insulin sensitizing agents has yielded promising initial results.
Viral Hepatitis
How does the Hepatitis Virus damage the Liver?
Viruses have either RNA (Hepatitis C) or DNA (Hepatitis B), and being non-living they are referred to as viral particles. They multiply within the host’s cell by using the host cells’ DNA or RNA. As the number of virus particles / virions increase inside the liver cell, the infected Liver Cells rupture and each Virion that comes out is capable of invading another healthy Liver Cell. This rapid viral multiplication causes the death of millions of healthy Liver Cells.
I think I’ve heard of other forms of hepatitis aside from A, B, and C. Are there other kinds of hepatitis?
There are various other viruses known to cause liver disease: hepatitis A, B, C, D, and E, which vary in their severity and characteristics.
Hepatitis C can lead to serious, permanent liver damage and, in many cases, death.
Hepatitis A: Is a liver disease caused by the hepatitis A virus (HAV). Hepatitis A can affect anyone and can occur in situations ranging from isolated cases of disease to widespread epidemics due to contaminated food or water.
Hepatitis B: Is a serious disease caused by a virus that attacks the liver. The virus, which is called the hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. HBV is transmitted by body fluids and blood.
Hepatitis C: Is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have the disease. HCV is spread by contact with the blood of an infected person.
Hepatitis D: Is a liver disease caused by the hepatitis D virus (HDV), a defective virus that needs the hepatitis B virus to exist. (HDV) is found in the blood of persons infected with the virus.
Hepatitis E: Is a liver disease caused by the hepatitis E virus (HEV) transmitted in much the same way as the hepatitis A virus. Hepatitis E, however, does not occur often.
What causes hepatitis?
Hepatitis is a generic term. It indicates inflammation and damage to liver cells. This damage can be caused by drugs, toxins, alcohol, inherited diseases, certain metabolic diseases and viruses. Commonly, however, hepatitis refers to viral hepatitis. There are a wide variety of viruses that can cause hepatitis, but again most commonly the term refers to the viruses designated A, B, C, D, E, and G. In the World, the most common causes are hepatitis A, B, and C.
How important are hepatitis vaccines?
There are vaccines to prevent hepatitis A and B. Hepatitis B is a disease that could be completely eradicated with universal vaccination. It is now one part of the newborn vaccination series. Attempts are ongoing to vaccinate all children by the time they reach junior high age. Adults who are in high-risk occupations such as the health care field or carry out high-risk activities, such as IV drug use and multiple sexual partners should also be vaccinated. Hepatitis A vaccine is recommended in a number of child-care settings and should be discussed with your pediatrician. Adults or children traveling to areas of the world where hepatitis A is very common, including all underdeveloped or poorly developed countries, should be vaccinated before they go. Any individual with underlying chronic liver disease that is not due to hepatitis B, particular those with hepatitis C or cirrhosis should be vaccinated against both Hepatitis A and Hepatitis B, unless they are already immune.
Liver Transplant
Is liver transplantation a treatment of last resort, when everything else has failed?
Yes and no. If medical treatment is likely to allow prolonged survival with good quality of life, transplantation would be reserved for the future. However, ideally the surgery is undertaken before the terminal stage of the disease when the person is too ill to withstand major surgery and will not survive until a suitable donor is available.
What are the major risks?
Before surgery, the risks are mainly the development of some acute complication of the disease which might render the patient unacceptable for surgery. With transplantation there are risks common to all forms of major surgery, as well as technical difficulties in removing the diseased liver and implanting the donor liver. One of the major risks for the patient is not having any liver function for a brief period. Immediately after surgery, bleeding, poor function of the grafted liver, and infections are major risks. The patient is carefully monitored for several weeks for signs of rejection of the liver.
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