Specialist's Corner
Let your liver lead a healthy life
The liver plays an important role in many bodily functions from protein production and blood clotting to cholesterol, glucose (sugar), and iron metabolism. Many diseases and conditions can affect the liver, for example, certain drugs like excessive amounts of acetaminophen, and acetaminophen combination medications, as well as statins, cirrhosis, alcohol abuse, hepatitis A, B, C, D, and E, infectious mononucleosis (Epstein Barr virus), nonalcoholic fatty liver disease (NASH), and iron overload (hemochromatosis). Symptoms of liver diseases include weakness and fatigue, weight loss, nausea, vomiting, and yellow discoloration of the skin (jaundice). The treatment of liver disease depends on its cause.
What is liver disease?
Liver disease is any disturbance of liver function that causes illness. The liver is responsible for many critical functions within the body and should it become diseased or injured, the loss of those functions can cause significant damage to the body. Liver disease is also referred to as hepatic disease. Liver disease is a broad term that covers all the potential problems that cause the liver to fail to perform its designated functions. Usually, more than 75% or three quarters of liver tissue needs to be affected before a decrease in function occurs. The liver is the largest solid organ in the body; and is also considered a gland because among its many functions, it makes and secretes bile. The liver is located in the upper right portion of the abdomen protected by the rib cage. It has two main lobes that are made up of tiny lobules. The liver cells have two different sources of blood supply. The hepatic artery supplies oxygen rich blood that is pumped from the heart, while the portal vein supplies nutrients from the intestine and the spleen. Normally, veins return blood from the body to the heart, but the portal vein allows nutrients and chemicals from the digestive tract to enter the liver for processing and filtering prior to entering the general circulation. The portal vein also efficiently delivers the chemicals and proteins that liver cells need to produce the proteins, cholesterol, and glycogen required for normal body activities.
What is the function of the liver?
As part of its function, the liver makes bile, a fluid that contains among other substances, water, chemicals, and bile acids (made from stored cholesterol in the liver). Bile is stored in the gallbladder and when food enters the duodenum (the first part of the small intestine), bile is secreted into the duodenum, to aid in the digestion of food. The liver is the only organ in the body that can easily replace damaged cells, but if enough cells are lost, the liver may not be able to meet the needs of the body. The liver can be considered a factory; and among its many functions include: Production of bile that is required in the digestion of food, in particular fats; Storing of the extra glucose or sugar as glycogen, and then converting it back into glucose when the body needs it for energy; Production of blood clotting factors; Production of amino acids (the building blocks for making proteins), including those used to help fight infection; The processing and storage of iron necessary for red blood cell production; The manufacture of cholesterol and other chemicals required for fat transport; The conversion of waste products of body metabolism into urea that is excreted in the urine; Metabolizing medications into their active ingredient in the body. Cirrhosis is a term that describes permanent scarring of the liver. In cirrhosis, the normal liver cells are replaced by scar tissue that cannot perform any liver function. Acute liver failure may or may not be reversible, meaning that on occasion, there is a treatable cause and the liver may be able to recover and resume its normal functions.
What are the symptoms of liver disease?
Classic symptoms of liver disease include nausea, vomiting, right upper quadrant abdominal pain, and jaundice (a yellow discoloration of the skin due to elevated bilirubin concentrations in the bloodstream). Fatigue, weakness and weight loss may also occur. However, since there are a variety of liver diseases, the symptoms tend to be specific for that illness until late-stage liver disease and liver failure occurs. Examples of liver disease symptoms due to certain conditions or diseases include: A person with gallstones may experience right upper abdominal pain and vomiting after eating a greasy (fatty) meal. If the gallbladder becomes infected, fever may occur. Gilbert’s disease has no symptoms, and is an incidental finding on a blood test where the bilirubin level is mildly elevated. Cirrhosis of the liver will develop progressive symptoms as the liver fails. Some symptoms are directly related to the inability of the liver to metabolize the body's waste products. Others reflect the failure of the liver to manufacture proteins required for body function and may affect blood clotting function, secondary sex characteristics and brain function. Symptoms of cirrhosis of the liver include the following: Easy bruising may occur due to decreased production of clotting factors; bile salts can deposit in the skin causing itching; gynecomastia or enlarged breasts in men may occur because of an imbalance in sex hormones, specifically an increase in estradiol; impotence (erectile dysfunction, ED), poor sex drive and shrinking testicles are due to decrease in function of sex hormones; confusion and lethargy may occur if ammonia levels rise in the blood stream (ammonia is a waste product formed from protein metabolism and requires normal liver cells to remove it); ascites (fluid accumulation within the abdominal cavity) occurs because of decreased protein production; and muscle wasting may occur because of reduced protein production. Additionally, there is increased pressure within the cirrhotic liver affecting blood flow through the liver. Increased pressure in the portal vein causes blood flow to the liver to slow down and blood vessels to swell. Swollen veins (varices) form around the stomach and esophagus and are at risk for bleeding.
When should you call your doctor for liver disease?
Often, the onset of a liver disease is gradual and there is no specific symptom that brings the affected individual to seek medical care. Fatigue, weakness and weight loss that cannot be explained should prompt a visit for medical evaluation. Jaundice or yellow skin is never normal and should prompt an evaluation by a health care professional. Persistent fever, vomiting, and abdominal pain should also prompt medical evaluation as soon as possible. Acetaminophen or Tylenol overdose, whether accidental or intentional, can cause acute liver failure. Emergent evaluation and treatment is required. Antidotes to protect the liver can be provided, but are effective only when used within a few hours. Without this intervention, acetaminophen overdose can lead to liver failure. Symptoms only occur after potential liver damage has occurred.
Alcohol abuse and liver disease: Alcohol abuse is the most common cause of liver disease in North America. Alcohol is directly toxic to liver cells and can cause liver inflammation, referred to as alcoholic hepatitis. In chronic alcohol abuse, fat accumulation occurs in liver cells affecting their ability to function.
How to diagnose the cause of liver disease?
The precise diagnosis of liver disease involves a history and physical examination performed by a health care professional. Understanding the symptoms and the patient’s risk factors for liver disease will help guide any diagnostic tests that may be considered. Liver disease can have physical findings that affect almost all body systems including the heart, lungs, abdomen, skin, brain and cognitive function, and other parts of the nervous system. The physical examination often requires evaluation of the entire body. Blood tests are helpful in assessing liver inflammation and function. Specific liver function blood tests include AST and ALT (ransaminase chemicals released with liver cell inflammation), GGT and alkaline phosphatase (chemicals released by cells lining the bile ducts), bilirubin, and protein and albumin levels. Other blood tests may be considered, including: Complete blood count (CBC). Patients with end stage liver disease may have bone marrow suppression and low red blood cells, white blood cells and platelets. As a result, patients with cirrhosis may have bleeding. Lipase to check for pancreas inflammation. Electrolytes, BUN and creatinine to assess kidney function; and ammonia blood level assessment are helpful in patients with mental confusion to determine whether liver failure is a potential cause. CT scan (computerized axial tomography), MRI (magnetic resonance imaging), and Ultrasound (sound wave imaging, which is especially helpful in assessing the gallbladder and bile ducts. Liver biopsy may be considered to confirm a specific diagnosis of liver disease. Each liver disease will have its own specific treatment regimen.
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