Know Your Liver: Types Of Liver Problems, Symptoms, and Causes
- Known as an organ, the liver is a gland, and that, too, is the largest gland in the human body.
- It performs more than 500 functions; prime among them being producing bile, making albumin, helping in blood filtration, and, being a frontline immunity warrior.
- The liver can be damaged by 5 types of problems: genetically inherited problems, immunity-related problems, viral infections, cancers, and other problems such as the fatty liver.
- Symptoms of the liver being damaged/scarred include jaundice, loss of appetite, nausea, and edema.
- People consuming excessive alcohol, practicing unsafe sex, staying in unsanitary conditions, or suffering from obesity are at most risk for liver diseases.
- Liver damage is diagnosed through blood tests, imaging tests, or biopsies.
- Treatment may include lifestyle changes, medicines, blood transfusion, or liver transplant, depending on the severity of the damage.
If you’ve seen the iconic medical show House M.D., then you’d know what the mercurial genius Dr. Gregory House says about the liver: “It helps you live, that’s why it’s called the liver.” And yes, that’s exactly what the liver does: it acts as the body’s filtering system, processing and breaking down toxins and other materials that need to be secreted through the kidney. It also generates good cholesterol, an essential component of cellular structure.
That’s why everyone must get to know their liver, how it works, symptoms of liver disease, types of liver disease, and causes of liver problems. It’s only by understanding liver problem signs and their reasons that you can figure out how to make your liver healthy.
First, here’s a look at a few liver health facts:
- The liver is the largest gland (also known as the largest solid organ) in the human body.
- The common liver-related diseases are Hepatitis A, Hepatitis B, Hepatitis C, cirrhosis, liver cancer, liver failure, gall stone, and fatty liver (alcoholic and non-alcoholic). Then there are genetic diseases like Wilson’s disease and hemochromatosis.
- According to research by World Life Expectancy, Egypt ranks the highest in mortality by liver disease, followed closely by Nigeria, where alcohol consumption, Hepatitis B virus infection, smoking, and the use of herbs and roots have been noted as the main causative culprits.
- Latest studies done in 2021 show that hepatocellular carcinoma (HCC), a common form of liver cancer, is the 3rd highest cause of death globally, 2nd highest cause of death for men in the sub-Saharan Africa region, and 4th highest cause of death for women of the same region.
- The prevalence of chronic HBV (hepatitis B virus) infection in East Africa is around 5-7%. The prevalence of HCV (hepatitis C virus) infection in the same region is 1.5-3.5%.
- Liver disease is also widely prevalent in the Asia-Pacific region, which saw almost 66% of all global deaths from liver diseases in 2015, according to research published in The Lancet in December 2019.
- The liver is the largest gland (and also the largest solid internal organ) in the human body
- Most liver disease cases are linked to either alcohol, obesity or viral hepatitis.
What is the liver and how does it work?
The liver is an exceptional organ because it can grow to its full size from a portion as small as 25% of its normal size. This is very important in living-donor liver donation because the donor doesn’t have to sacrifice their liver, unlike in a living-donor kidney transplant, where the donor gives up one kidney permanently.
If all other donation criteria are satisfied, the donor can give a portion of their liver, and wait until it grows back. The recipient gets a liver portion that also grows to its full size. In this way, through its power of regeneration, one liver becomes two!
While the liver is mainly credited for its prominent role in digestion, it performs around 500 functions, including filtering the blood.
Situated between the stomach and the lungs, the liver is primarily responsible for producing chemicals to digest the food we eat, carry out protein synthesis, and help in detoxification of the system.
Blood supply to the liver
The liver gets nutrient-rich blood from the digestive system through the portal vein, and it gets oxygenated blood from the heart through the hepatic artery. It holds around 13% of the entire body’s blood at any point in time. Three hepatic veins remove blood from the liver.
When the liver cells are damaged for any reason, unless the damage is too severe and irreversible, the organ can repair and regenerate itself through cytokines and growth factors (collectively called “compounds”). The process of regeneration is quite quick — it depends on the amount of healthy liver tissue left — and the regenerated liver continues to function as before.
Some of the compounds that play a significant role in this regeneration process are the hepatocyte growth factor, interleukin-6, norepinephrine, epidermal growth factor, transforming growth factor-alpha, and insulin.
What does the liver do?
The following are some of the most essential functions that a liver carries out:
- Producing bile: In what could perhaps be classified as its most important function, the liver produces bile (made up of bilirubin, bile salts, cholesterol, electrolytes, and water) to help the small intestine break down and absorb the circulating blood cholesterol, fats, and vitamins.
- Blood filtration: Another very important liver function is to clean the blood circulating in our body. The liver removes internal compounds such as hormones, as well as external ones like medicinal chemicals and alcohol.
- Frontline immunity warrior: The liver is on the frontline of maintaining the body’s immunity. It is the first to detect any harmful bacteria, viruses, and macromolecules that enter the system via the gut.
- Breakdown of fats and proteins:The bile in the liver helps to break down proteins and fats for easy digestion.
- Carbohydrate metabolization: The liver breaks down the carbohydrates stored within itself to produce blood sugar (glucose), which is released into the bloodstream to provide energy to the body. It also converts excess glucose into glycogen, to be used in case of emergencies.
- Producing proteins for blood plasma: The liver produces some plasma proteins that are required to transport hormones, lipids, minerals, and vitamins for the functioning of the immune system.
- Regulating blood levels of amino acids: Amino acids are the building blocks of proteins; the liver regulates the blood levels of these amino acids.
- Metabolization and absorption of bilirubin: Hemoglobin, the main component of the red blood cells, breaks down to form bilirubin. The iron released in the process is tucked away in the liver and the bone marrow to make new blood cells.
- Making albumin: Albumin, a common blood protein, is necessary to prevent blood vessels from bursting or leaking, and to maintain the correct blood pressure. It does this through transporting steroidal hormones and fatty acids. Albumin is produced by the liver.
- Clotting of blood: Liver bile is essential for the absorption of Vitamin K, which creates coagulants for the clotting of blood. The liver is thus an important facilitator for blood clotting and hence preventing excessive blood loss.
- Storing essential vitamins and minerals: The liver can store a huge quantity of essential vitamins and minerals, which the body can rely upon in times of shortage.
Types of liver disease
There are several types of liver disease, depending on the underlying causes of liver problems. These include:
- Genetically inherited liver disease
- Immunity-related liver disease
- Liver problems caused by infections
- Liver cancers/tumors
- Other liver problems and/or diseases
Genetically inherited liver disease
- Wilson’s disease: This is a liver problem that usually shows up in the teenage years to the early 30s. Wilson’s disease leads to excessive build-up of copper in the liver and other organs, thus leading to problems in the liver, nervous system, or even psychiatric disorders.
- Hyperoxaluria: This is caused by a genetic mutation that prevents the liver from creating the enzyme that stops excessive production of oxalate, which then combines with calcium to cause kidney stones and other renal problems.
- Alpha-1 antitrypsin deficiency: This causes a mix-up in the chemical produced by the liver to help prevent lung infections, thus making the lungs susceptible to infections.
- Hemochromatosis: This causes a build-up of excessive iron (absorbed from food) in the liver and other organs, thus making the body susceptible to various liver problems, heart ailments, diabetes, etc.
Immunity-related liver disease
- Autoimmune hepatitis: Four times more common in females than in males, this chronic, inflammatory condition damages healthy liver cells and leads to several disorders or finally, liver failure.
- Primary biliary cholangitis: It injures the bile ducts, leading to the bile retracing into the liver and scarring it.
- Primary sclerosing cholangitis: It scars and blocks the bile ducts, thus causing a build-up of bile inside the liver. This disease can eventually lead to liver cancer.
Liver problems caused by viral infections
- Hepatitis A: This is caused by eating or drinking something contaminated with polluting agents (especially excretory matter). This virus can also spread by oral or anal sex with an infected person.
- Hepatitis B: This is caused by the transfer of infected fluids from one person to another via sexual contact, sharing of injectable needles, or from a mother to a baby. This disease can turn fatal if allowed to go untreated beyond 6 months.
- Hepatitis C: This is caused by sharing injectable needles for any purpose, be it blood transfusion, having tattoos or piercings, or using the same razors, nail-cutters, or any such equipment that can come in contact with infected blood.
- Liver cancers: These include hepatocellular carcinoma, which is more common and starts in the main liver cell i.e., hepatocyte; and two not-so-common ones, namely, intrahepatic cholangiocarcinoma and hepatoblastoma. Hepatocellular carcinoma happens due to hepatitis, or excessive alcohol consumption.
- Liver cell adenoma: It starts as a tumor, which may or may not develop into cancer. Women taking contraceptive pills are seen to be more prone to getting this tumor.
- Bile duct cancer: More common in elderly people, this cancer affects the ducts that carry the bile from the liver to the small intestine, for digesting food.
- Metastatic cancer: It is more common for cancers to start elsewhere in the body and travel to the liver, rather than starting in the liver itself. Hence, metastatic liver cancers are a commoner occurrence than the above three.
Other liver problems
- Non-alcoholic fatty liver disease (NAFLD): This happens when there’s too much fat build-up in the liver, which causes inflammation. Non-alcoholic steatohepatitis (NASH) is a type of NAFLD, wherein along with fat deposits, there’s also inflammation and cell damage in the liver. This condition can lead to liver scars and even cirrhosis.
- Acute liver failure: This is a condition brought about by sudden triggers when the liver just stops functioning even when you don’t have any prior problems with the liver. Infections, wrongly taken prescription drugs, or overdose of acetaminophen can lead to this problem.
- Cirrhosis: The development of scars on the liver is called cirrhosis. More the scars, less the ability of the liver to function properly. Metabolic disorders, excessive alcohol consumption, less blood flow to the liver, and Hepatitis C are some of the cauofhind liver cirrhosis.
Symptoms of liver disease
Early symptoms of liver disease are not always visible or conspicuous, especially in conditions like NAFLD. If you see anyone or some of the following signs crop up repeatedly, consult a doctor and conduct primary diagnostic tests for ascertaining your liver health.
- Jaundice (which is characterized by yellowing of skin, eyes, and nails; and also, loss of appetite)
- Loss of appetite for a long time (without yellowing of skin, eyes, nails)
- Abdominal pains, especially on the right side
- Edema, i.e. swelling of legs and ankles
- Urine turning dark in color
- Stools turning pale in color
- Getting bruises easily
Be especially cautious if you’re prone to the risk factors that commonly lead to liver damage.
Risk factors for liver health
Since the symptoms of an unhealthy or damaged liver may show up quite later, or may not even show up in some cases, it’s best to keep track of any intermittent changes, especially if you’re vulnerable to the following risk factors:
- Genetic factors / hereditary liver problems
- Excessive alcohol consumption
- Being very overweight or obese
- Exposed to others’ body fluids
- Unprotected sex
- Having tattoos or piercings
- Having metabolic disorders like Wilson’s disease
- Drinking contaminated water
- Staying in unsanitary conditions
Prevention, diagnosis, and treatment of liver problems
Since early symptoms of liver disease may be inconspicuous, there may be an undesirable delay in diagnosis and treatment.
Therefore, primary prevention (preventing any disease from arising in the first place) is better than secondary prevention (early detection and treatment). The adage “prevention is better than cure” is more applicable to liver problems than others.
- Get vaccinated: There are a series of vaccines for children and adults that are to be taken to prevention against varied liver problems. These include Hepatitis A and Hepatitis B vaccine series. Follow the schedule according to your/your child’s age and get vaccinated.
- Practice safe sex: Since a lot of liver-related problems spread through the exchange of human fluids, it’s wise to practice safe sex with condoms, and also restrict physical contact with strangers whose sexual history is not known.
- Avoid drugs: Narcotics can be fatal for life in multiple ways, but speaking about liver health, in particular, many drugs are taken intravenously. In such scenarios, sharing of needles can cause liver disease.
- Limit or avoid alcohol intake: Any kind of alcohol consumption puts the liver strain under pressure, but if the consumption is limited and spaced out, then the liver gets time to recover. Daily consumption of alcohol or even weekly consumption of large amounts of alcohol is one of the worst things one can do to their liver. As the liver cells struggle to recover, it can eventually lead to cirrhosis and liver failure.
- Avoid self-medication: Always take medicines as per a doctor’s prescription, in the recommended dosage. Excessive and wrong medication can cause liver disease. The damage is more fatal when medication and alcohol are mixed.
- Be careful about hygiene and sanitation: Liver diseases are often caused by drinking unsafe, polluted water, or using someone else’s toiletries. Be careful about maintaining personal hygiene, as well as keeping your surroundings and food/water clean to prevent ailments like Hepatitis A.
- Maintain your weight: Avoid putting on excessive weight through the consumption of unhealthy food. Excessive fat deposits, especially in the visceral area, lead to inflammation and problems like NAFLD.
In case liver damage is suspected, a doctor will prescribe various tests to ascertain the level of liver damage or to detect liver disease.
To start with, liver function blood tests are recommended to measure the level of liver enzymes in the blood. Sometimes, an INR blood clotting test may also be suggested.
If the doctor suspects liver scarring, he or she may prescribe imaging tests like MRI, ultrasound, or CT scan. A specialized type of ultrasound, known as fibroscan, is suggested to see the level of scarring as well as fat deposits in the liver.
Suspected lesions, tumors, and cancers are best examined through a biopsy.
While genetically passed-on liver problems require medicinal treatment, other problems are usually treated with a mixture of medicines and lifestyle changes to prevent a relapse.
These lifestyle changes may include everything from maintaining personal hygiene to losing weight, to practicing safe sex.
If the problem is graver, or in cases of acute liver failure or liver failure, the person is subjected to intravenous fluids, prescribed medicines, blood transfusion, or liver transplant.
The liver may seem like a tiny organ tucked in one niche of the human body, but it carries out more than 500 functions!
That alone gives an idea of the far-reaching effects that any problems or damage to the liver may have on various parts of the body. From the kidney, to the brain, to the heart – liver damage can have adverse effects on many parts of the body. Hence, it is prudent to keep in mind the risk factors and eliminate risky behaviors to prevent oneself from getting diseases of the liver.
In case any symptom of liver damage is noticed, it is best to consult a doctor without wasting time so that the damage can be arrested in time via medicines or lifestyle changes without surgical intervention.
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