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Liver Disease

Overview :

The liver is a large, solid organ located in the upper right-hand side of the abdomen. Most of the liver lies under the rib cage, which helps protect it from physical injury. The liver is made up of two main lobes and two minor lobes and has a total weight in adults of about 3.5 lb (1.6 kg).

Within the liver are tiny ducts (tubes) that collect bile, a product secreted by the liver. Bile is stored in to the gall bladder and then released into the intestines after meals to help in the digestion of fats and the absorption of certain vitamins. This system of bile production by the liver, transport through the bile ducts, and storage in the gall bladder is called the biliary system. Damage to this system is called biliary disease.

The liver receives blood that comes directly from the intestines. At any given time the liver contains about 13% of the blood circulating in the body. This blood is rich in nutruents (food, vitamins, and minerals) that the body needs to function. Some of the most important functions of the liver are to process these nutrients.

Important functions of the liver include:

  • manufacturing and regulating the production of proteins. The most important proteins made in the liver are albumin, which helps maintain blood volume, and clotting factors to help regulate blood clotting.
  • making and storing fatty acids and cholesterol.
  • forming and releasing bile
  • processing and storing sugars in the form of glycogen, which can then be re-converted into energy
  • Storing iron, an important element in blood formation
  • Breaking down (detoxifying) alcohol, drugs, and environmental poisons so that they can be removed from the body.
  • Processing and removing bilirubin, a product released when red blood cells break down, and ammonia, a toxic waste product of protein breakdown.
  • Defending against infection by removing bacteria from the blood and making chemicals necessary to the functioning of the immune system.

Although the liver is the only organ that has the capacity to grow back, or regenerate, after injury or damage, sometimes the damage is too great for it to heal. The American Association for the Study of Liver Disease estimates that about 25 million Americans experience a liver-related disease each year. Individuals cannot live without a functioning liver. The ability to transplant livers is improving, liver transplantation is not nearly as common or successful as kidney transplantation.

Because the liver has many vital functions, there are many types of liver disease. The American Liver Foundation estimates that over 20,000 Americans die of chronic liver disease each year and another 360,000 are hospitalized. Individuals cannot live without a functioning liver.

Congenital Liver Diseases

Congenital liver diseases are disorders that are present at birth. Inherited liver diseases and disorders include:

  • Alagile syndrome, a disorder that causes withering of the bile ducts. This disease occurs in less than 1 in 100,000 individuals.
  • Alpha 1-antitrypsin deficiency, an inborn error in metabolism and the most common type of genetic liver disease.
  • Galactosemia, a hereditary metabolic disease in which the liver is unable to break down the sugar galactose found in milk. It occurs in about one in every 20,000 births.
  • Hematochromatosis, a hereditary metabolic disorder in which too much iron is absorbed from the diet and stored in the liver. This disease affects over one million Americans.
  • Porphyria, a disorder in which the component of blood that contains iron is not correctly formed.
  • Tyrosinemia, a rare inherited error in metabolism that causes severe liver disease in infants and children. It affects fewer than 200,000 individuals in the United States.
  • Type I glycogen storage disease, a lack of the enzyme that helps regulate blood glucose (sugar) levels.
  • Wilson's disease, an inherited disorder in which copper is accumulated in the liver and nervous system.

Acquired Liver Diseases

Many liver diseases are acquired from infection and exposure of the liver to toxic substances such as alcohol or drugs. In some areas of the world (although not the United States) liver parasites are a common cause of liver disease. In the United States, the most common acquired liver diseases are hepatitis A, B, and C and cirrhosis. Hepatitis A causes an acute (short-term) illness and is caused by a virus found in food or drinking water contaminated with feces. Hepatitis A infects between 125,000 and 250,000 people in the United States each year and causes about 100 deaths annually.

Hepatitis B is a viral infection spread by blood exchange and sexual contact with an infected person. It can be passed from an infected mother to her fetus. In most people hepatitis B is a short-term illness that causes mild symptoms such as fatigue, but in 2-6% of people, the disease lasts a long time and causes permanent liver damage. More than 75,000 people in the United States become infected with hepatitis B each year. Chinese Americans have a hepatitis B infection rate five times that of Caucasian Americans.

Hepatitis C is caused by a virus spread mainly through contact with the blood of an infected person, such as through sharing needles to inject drugs or from a mother to a fetus. Individuals infected with hepatitis C virus may not feel sick or know that they are infected for many years, but the disease can increase the likelihood of developing liver cancer of cirrhosis. The American Liver Foundation estimates that 4 million Americans are infected with hepatitis C, resulting in 10,000-12,000 deaths each year. About 70% of individuals who are infected do not know that they have the virus. African Americans have the highest rate of hepatitis C infections and are twice as likely to be infected with hepatitis C as Caucasian Americans.

Cirrhosis of the liver involves the formation of permanent scar tissue in the liver and loss of liver function. It is often caused by chronic alcohol abuse (alcoholic liver disease), but it can also be caused by diseases such as hepatitis. Cirrhosis interferes with blood flow through the liver and can raise pressure in blood vessels supplying the liver and decrease the absorption of nutrients from the blood, leading to malnutrition. The liver of individuals with cirrhosis is also less effective in removing toxic wastes from the blood. Cirrhosis can be fatal.

Over 800 over-the-counter and prescription drugs, as well as illicit street drugs, can cause liver damage. One of the most common drugs to cause liver damage is acetaminophen (Tylenol) when taken at high doses or by individuals who already have some liver damage. Exposure to toxic chemicals, physical injury, and blockage of the bile ducts call also cause liver damage.

Liver cancer can either develop first in the liver (primary liver cancer) or spread there from another site (metastasized cancer). About 16,000 new cases of primary liver cancer are diagnosed each year, most commonly in middle age and older men. Although the cause of liver cancer is unclear, it appears to be associated with chronic infections of hepatitis B and C.

Causes & symptoms

The causes of liver disease are many and varied. Leading causes are viral infection, alcohol abuse, and inherited disease. A common symptoms of liver disease are jaundice. With jaundice, the skin and the whites of the eyes take on a yellowish color as a result of the accumulation of bilirubin and bile pigments in the blood. This is a sign that the liver or the biliary system is not functioning properly. Other symptoms of liver disease include an enlarged liver and swollen abdomen, nausea, vomiting, weight loss, and fatigue. Some infections cause flu-like symptoms of fever, headache, and weakness.

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