VERIFIED CONTENTAuthor: Dominika Wilk

The liver is the largest of our organs, it weighs almost two kilograms. No other organ has as many functions as the liver. This is why when it becomes sick, the whole body suffers. Liver diseases are asymptomatic, so you need to be checked regularly to find them. In some cases, liver enzymes and ultrasound alone are not enough. Sometimes an MRI is necessary, and other times a CT scanner will be better.

The liveris one of the heaviest organs in our body - it weighs 1.5 kilograms. It is located primarily on the right side of the abdominal cavity, namely: in the upper right quadrant of the abdomen. However, the end of its left lobe reaches the area of ​​the left nipple (area 6 intercostal space).

Structure of the liver

The liver consists of the right, left, quadrilateral and caudate lobe, which in turn are mainly composed of hepatocytes, and the lobules are the smallest structural unit of the liver.

About 65% of the weight of the entire liver is made up of hepatocytes, and 35% - cells of the reticuloendothelial system. The latter include Browicz-Kupffer cells, stellate cells, and endothelial cells that line the sinus vessels. They all play a very important role in detoxifying and detoxifying the body.

Blood flows to the liver from two different sources:

  • from the hepatic artery (makes up 20-30% of the blood supply)
  • and from the portal vein (70-80%).

The portal vein supplies blood from various organs, including the intestines, pancreas, and that is why the liver stores excess nutrients from individual sections of the digestive system, e.g. glucose in the form of glycogen. For this reason, the liver is the main source of the removal of toxins from the entire body.

Functions performed by the liver in the body

The liver is an extremely important organ because it has over 500 different functions in our body. The most important of them are:

  • storage of glucose in the form of glycogen,
  • removal of excess toxins,
  • Is bile production necessary for digestion
  • and fat absorption.

In addition, a properly functioning liver is necessary for the proper conversion of thyroid hormones, namely the conversion of T4 into T3, which isactive hormone.

It is also necessary for the production of cholesterol. Although it has a bad reputation because it is associated with sealing veins and strokes, it also plays an extremely important role, e.g. it is necessary for the production of sex hormones and cell membranes.

More than 80% of cholesterol is produced in the liver, which means it is an important element in maintaining the hormonal balance in the body. The liver also helps to fight off various types of microorganisms that cross the digestive system and enter it through the portal vein.

Releases macrophages against them, which destroy pathogens, thus protecting the body against the development of infection.

Symptoms of a sick liver

Paradoxically, almost 90% of cases of liver diseases are asymptomatic or these symptoms are non-specific and also characteristic of other diseases - e.g. greater feeling of fatigue, itching of the skin or pain in the right shoulder.

For this reason, liver diseases are usually detected by accident, during routine examinations, e.g. in occupational medicine, when changes in morphology or elevated liver tests are noticeable.

Also, during prophylactic abdominal ultrasound, one of the most common liver diseases can be detected - that is fatty liver disease. On ultrasound, you can see an enlarged liver. However, the liver will not show any signs as it is innervous.

Occasionally, when it is really big, patients may feel the expansion in the right hypochondrium, which is caused by the liver pushing up against the peritoneal capsule that is already innervated.

More characteristic symptoms will be advanced and acute forms of liver diseases, such as:

  • cirrhosis of the liver, where we can see yellowing of the skin associated with jaundice,
  • ascites
  • Is the visibility of the veins on the abdomen a consequence of the expansion of the peripheral circulation.
  • With cirrhosis, muscle atrophy and hair loss may also be visible (in men, e.g. on the chest).

Diagnosis of liver diseases

When diagnosing the liver in terms of its he alth and efficiency, we should follow a certain sequence of actions. At the beginning, we perform the simplest and the easiest (but also the safest) blood tests or ultrasound, and only later we move on to more specialized tests, such as tomography or magnetic resonance imaging (if there are medical indications for this).

The most common blood tests are:

  • morphology,
  • ALT (alanine aminotransferase),
  • AST (aminotransferaseaspartate),
  • GGTP (gamma-glutamyltranspeptidase),
  • ALP (alkaline phosphatase),
  • bilirubin.

In morphology, for example, attention is paid to the number of white blood cells or platelets, as their reduced values ​​may suggest cirrhosis of the liver (however, the entire clinical picture of the patient is taken into account, not only these tests).

In turn, ALT and AST are popular liver tests, the relationship of which may indicate ailments, e.g. much higher AST than ALT occurs in alcoholic liver diseases or cirrhosis. In turn, an increase in both liver tests may appear in viral hepatitis B and C.

When reading test results, you should always bear in mind that ALT and AST are not just indicators of liver disease. For example, a higher AST may indicate muscle damage, including the heart muscle. On the other hand, ALP, which we also test to assess the condition of the bile ducts, may be elevated as a result of bone damage.

GGTP is a much less sensitive factor in liver related diseases, however when it is elevated it indicates that something is going on with the gland. Bilirubin, in turn, is a parameter used to assess liver pathology, e.g. in the diagnosis of Gilbert's syndrome, or severe damage to the organ itself.

In addition to laboratory tests, we also have imaging tests, which include:

  • USG,
  • computed tomography with contrast
  • and magnetic resonance imaging with contrast.

The basic examination is ultrasound, which is safe enough that it can be performed every day without harm to the body. It is also a sensitive test that sometimes it is better at assessing some liver-related pathologies than a CT scanner. This is the case, for example, in the case of cysts or fatty liver.

When there are medical indications, computed tomography with contrast or magnetic resonance imaging is performed. However, it should be remembered that the contrast used for the tomography is nephrotoxic, so it can damage the kidneys, so in some cases it is better to perform more detailed MRI scans.

Liver disease

Fatty liver

Fatty liver disease is one in which droplets of fat accumulate in the center of hepatocytes, causing the liver to gradually become fatty.

The reasons for this state of affairs are most often:

  • alcohol,
  • obesity,
  • diabetes,
  • insulin resistance,

but also:

  • protein malnutrition,
  • rapid weight loss,
  • Wilson's disease,
  • toxic actionsome drugs,
  • long-term parenteral nutrition,
  • hemochromatosis,
  • HCV virus.

Due to the fact that fatty liver was once thought to be mainly caused by excessive alcohol consumption, this disease is now divided into:

  • alcoholic fatty liver
  • and non-alcoholic steatosis due to the factors mentioned above.

Fatty liver is usually diagnosed on an ultrasound scan, where the liver is distinguished by a significant echogenicity of the organ (the so-called white liver) and enlargement of its size.

The examination of liver enzymes does not contribute much to the diagnosis, because they do not always have to be elevated in this disease.

The liver biopsy helps to verify the condition of this organ. If it is common in 85% of patients (i.e. mild, with no changes in the direction of fibrosis), the recommendation is a proper diet, giving up alcohol, as well as an attempt to eliminate the underlying cause of the disease (if it is obese, e.g. body weight).

However, when the condition is acute, becomes inflamed, and begins fibrosis, the patient must be treated by a hepatologist to prevent the development of cirrhosis.

Hepatitis A, B, C, D and E

Hepatitis is an inflammation of the liver caused by viruses type A, B, C or E, which can progress from an acute stage to a chronic stage.Most often you can get infected with type B and C viruses, as well as D . The way of infection in this case is sexual contact and contact with the patient's blood (you can get infected, for example, at a beautician or a dentist who disinfected the tools badly from previous clients). These viruses can also be passed from mother to child during childbirth.

In turn,viruses type A and Einfects when it enters the human body through the alimentary tract. In Europe, however, it is rare, it occurs rather in countries with a very warm climate and a low level of general hygiene.

The process of infection with type B viruses and Cand its replication can be similar. Up to 6 months after infection, when we are dealing with acute inflammation, the virus can replicate, and the patient may (but does not have to) experience symptoms:

  • weakness,
  • nausea,
  • abdominal pain,
  • jaundice may sometimes occur.

However, after 6 months, either the patient recovers or the infection turns into a chronic state.

In the case oftype B , the chronic condition affects approximately 5% of peopleinfected, while witha Cvirus it is as much as 80%. Over time, chronic hepatitis can severely damage the hepatocytes and then lead to cirrhosis of the liver. The type D virus, on the other hand, cannot replicate without the presence of the type B virus. So if a person is vaccinated with the type B virus, it will prevent the development of an infection.

Type A virus does not become chronic and has a negligible mortality rate. The course of the infection can be mild. In turn, the type E virus, which can be infected most often in Asia, may become chronic.

Diagnostic tests for liver virus infection are blood tests that detect a specific antigen:

  • anti-HCV,
  • anti-HDV
  • or e.g. anti-HBs.

Except that in order to check, for example, whether the infection is in the acute or chronic phase, different classes of these antibodies are tested. For example, in the acute phase of the B virus, blood is tested for HBeAg, which occurs within one week of HBsAg onset (which is indicative of infection and lasts up to 4-6 months).

HBeAg remains in the acute phase for 3-9 weeks. It is an indicator of intense viral replication.

In turn, anti-HBc IgG antibodies prove that the patient was infected with type B virus at all, because they persist throughout life after infection (they do not appear in the acute phase).

In addition, if the acute phase of the virus is suspected, liver enzymes such as ALT or AST are tested, as they are significantly elevated during this period.

Autoimmune hepatitis

Autoimmune hepatitis (AZW), like any autoimmune disease, is when the body attacks its own tissues - in this case, the liver. This leads to the development of chronic inflammation, which in turn leads to cirrhosis of the liver. The underlying cause of this disease is unknown.

As with other autoimmune diseases, it is influenced by both genetic predisposition and infectious, toxic or medicated factors. The diagnosis of autoimmune hepatitis is based on the exclusion of other inflammatory diseases of the liver and specific tests.

Symptoms of the disease are not characteristic (or there are no symptoms at all) and therefore the patient usually learns late that he has something.

In order to identify autoimmune hepatitis, tests for characteristic antibodies, e.g. ASMA, ANA, are performed, as well as blood tests to check whether the patient has an elevated level oftransaminases and hypergammaglobulinemia that would indicate AZW.

In addition, his pathological examinations are performed, as the infiltration of lymphocytes and plasmocytes in the portal spaces and bite necrosis are characteristic of this disease.

The diagnosis of autoimmune hepatitis antibodies includes:

  • anti-mitochondrial antibodies (AMA),
  • organ-nonspecific antinuclear antibodies (ANA),
  • anti-smooth muscle antibodies (SMA),
  • hepatorenal anti-microsomal antibodies (anti-LKM1),
  • antibodies against liver-specific membrane antigens (anti-LSP),
  • antibodies reactive with liver and pancreatic antigens (anti-LC1).

Antibody research allows for dividing AZW into different subtypes.

Hepatic encephalopathy

Hepatic encephalopathy is not strictly a liver disease, but the consequence of acute or chronic liver injury that causes changes in the CNS (central nervous system). It is a syndrome of neuropsychiatric disorders resulting from poor liver function and insufficient removal of toxins by it.

Impairment of hepatocytes, resulting from their death or malfunction, causes that the liver is unable to effectively detoxify the body, which results in the accumulation of neurotoxins in the circulating blood, such as, for example :

  • fatty acids,
  • phenols,
  • or ammonia.

Too high their concentration leads to increased diffusion of toxins on the blood-brain border, which leads to changes at the CNS level, especially the brain. This is why liver failure, which disrupts the work of the central nervous system, results in behavioral disorders, e.g.

  • feeling anxious,
  • with impaired memory,
  • slower reactions to stimuli,
  • slow reflex,
  • or disturbances of consciousness manifested as excessive sleepiness.

The diagnosis of hepatic encephalopathy mainly includes testing the ammonia level in the blood. Doctors also use neurophysiological and neuropsychometric tests. Magnetic resonance imaging may also be helpful in this case, thanks to which the metabolism of nerve cells can be assessed.

Cirrhosis of the liver

Cirrhosis of the liver is a consequence of liver inflammation and fibrosis, which results in the displacement of he althy liver parenchyma by fibrotic tissue.

Tissue fibrosis is caused by the inflammatory process mentioned, which mayroll as a result:

  • viral infection,
  • autoimmune hepatitis,
  • alcohol toxic damage,
  • or as a consequence of chronic fatty liver.

Fibrous, dead tissue changes the circulation through the liver, which is why complications include in the form of a collateral circulation.

The criteria for the classification of liver cirrhosis are different. If we take into account the morphological changes that occur in the liver as a result of this disease entity, we can distinguish cirrhosis:

  • small bump,
  • multi-tubular
  • and mixed form.

In turn, taking into account the activity of the disease process, we can divide it into:

  • active
  • or inactive,

and also on:

  • aligned
  • or ragged.

These divisions are clinically important when a physician needs to decide if a patient is already in a condition requiring liver transplantation.

The symptoms of cirrhosis are usually ambiguous. Patients may or may not have the symptoms listed below. And they include:

  • salivary gland enlargement,
  • diarrhea,
  • enlargement of the liver and spleen,
  • pulmonary hypertension,
  • recurring nosebleeds,
  • bruises on the skin,
  • thick-wavy hand tremors,
  • hepatorenal syndrome,
  • hepatopulmonary syndrome,
  • hepatocardial syndrome,
  • loss of muscle mass,
  • spider veins on legs,
  • yellowing of proteins and skin integuments,
  • palmar and plantar erythema,
  • itchy skin,
  • ascites,
  • gastrointestinal bleeding,
  • fatigue,
  • weight loss.

Liver cancer

Liver cancer can be primary and secondary in nature - it is a metastatic disease from other organs. Contrary to appearances, the latter situation is not uncommon.

Vascularized liver collects blood from various organs, so it is easy to metastasize - in particular from the large intestine. It very often happens that the tumor in the large intestine does not make itself felt, and the accidental ultrasound of the abdomen reveals changes in the liver. After more detailed research, it turns out that the main source of the disease is in the large intestine.

The first symptoms of liver cancer may be:

  • abdominal gas,
  • colic,
  • dyspepsia,
  • stool irregularities
  • or stomach pains.

Then it is worth doing an ultrasound that will help in the initialdiagnostics. The next step is to do a blood test, especially checking the level of platelets, clotting time, bilirubin, and sugar levels.

Apart from that, the following examinations are performed: magnetic resonance imaging and computed tomography. Chest X-ray is also a good idea. If a neuroendocrine tumor is suspected, a blood test is performed to check the levels of chromogranin A, a protein released from neuroendocrine cells. If it is elevated, it indicates the presence of this type of tumor.

Treatment of liver diseases

When we are dealing with the most popular disease, i.e. fatty liver, then, depending on the cause - the patient is eliminated from drinking alcohol, changing the diet to one with a restriction of simple carbohydrates, especially fructose, it is recommended to consume anti-inflammatory acids omega-3, encourages increased physical activity, which helps to reduce excess body weight.

In addition, herbal medicines based on milk thistle are used, which have a protective effect on hepatocytes, the patient is supported by supplementation of B vitamins, which help in the processes of transformation taking place in the liver.

Various forms of treatment are used in viral hepatitis. In the case of type B virus, the patient is administered e.g. interferons and nucleoside analogs (e.g. telbivudine) and nucleotide analogs (e.g. adefovir).

The main goal of therapy is to inhibit viral replication. For the type C virus, two- or three-drug therapy is used.

  • In dual therapy, for example, pegylated interferon and ribavirin are used.
  • Boceprevir is attached to the three-drug.

Acute A and E infections are not treated unless there are complications that force the patient to be hospitalized.

Autoimmune hepatitis is treated primarily with immunosuppressants and corticosteroids.

If the patient has hepatic encephalopathy, the patient is given, for example, ornithine aspartate. The dosage depends on the stage of the disease.

For example:

  • Grade 1 encephalopathy uses an oral dose of 6-9 g daily,
  • at stage 2: 9-18g a day,
  • a step 3 and 4: 10-40g a day.

An important element in the treatment of hepatic encephalopathy is the treatment of constipation, as they lead to an excessive accumulation of toxins in the body. In order to improve defecation, patients are given lactulose or macrogols.

In addition, it is important to diagnose for hidden gastrointestinal bleeding, which may lead to excessive amounts of protein in thethe body, and therefore increase the amount of harmful ammonia. If detected, patients are on a protein-restricted diet.

The best form of treatment for liver cancer is surgery. You can also use radiation therapy or administer isotopes to the liver that will destroy the lesions.

In the case of metastases from other organs, such as the large intestine, the lesion in the intestine, liver is removed. Later, chemotherapy, radiotherapy, and thermal ablation can be used. Liver transplantation is also performed in neuroendocrine neoplasms or in primary cell carcinoma of the liver.

Liver diet

Diet for fatty liver

There is no one common liver diet for all diseases related to the liver. Nutritional recommendations vary depending on the patient's clinical condition, symptoms, tolerance of certain foods, and body weight. A patient with decompensated cirrhosis and nutrient deficiencies will eat differently, and a person with obesity and fatty liver will eat differently.

In the case of people with fatty liver and accompanying obesity, a reduction diet is used. However, the diet is not cut by more than 500 kcal, because the excess of suddenly released fatty acids would promote fatty liver.

The purpose of the reduction type of nutrition is the elimination of excess fatty tissue, the excess of which promotes inflammation and causes insulin resistance - which is the main cause of non-alcoholic fatty liver disease. In case of fatty acid, which is based on an excessive amount of alcohol, it is necessary to completely stop drinking.

In addition, both in the NFLD (non-alcoholic fatty liver) and the alcoholic version, the supply of simple carbohydrates, mainly sweets, as well as fats is limited. Fat restrictions usually apply to processed, trans.

It is good to eat fats in reasonable amounts, such as: omega-9, omega-3, omega-6, because they have a positive effect on the lipid metabolism.

In fatty liver, the reduction of fructose is also very important, especially in the form of additives to juices and processed foods.

With this disease, the recommendations are very similar to those used in patients with dyslipidemia: the supply of fiber is increased, products that reduce excess cholesterol and foods with phytosterols are introduced, as well as soy protein. The recommended forms of diet here are the Mediterranean diet and the DASH diet.

Diet for hepatitis

In viral hepatitis, nutrition will depend on whether we are dealing with an acute or chronic condition. In the former, the patients do not tolerate fats, so there is a significant reduction in fatty foods. The source of energy is then carbohydrates, and the protein remains in an amount similar to that consumed by a he althy person, i.e. 1 gram of protein per 1 kg of body weight. It should be added that such a diet is short-lived and it should not be prolonged, because it is a deficient diet.

When liver inflammation becomes chronic, the patient follows a varied, richly nutritious diet, similar to that used by he althy people. However, the amount of protein in the diet is increased to 1.2 grams to 1.5 grams per 1 kg of body weight per day. The source of such a protein should be:

  • lean meat,
  • good quality cold cuts,
  • eggs,
  • reduced-fat dairy products.

However, fats, depending on the tolerance, should constitute 30-35% of the energy from the provided diet.

Diet for cirrhosis

Nutrition in cirrhosis depends on whether it is misaligned or even. In the first case, the patient is malnourished, so you need to increase the caloric value of his diet and provide more nutrients. In addition, due to accompanying ailments, e.g. ascites, esophageal varices, the food often has to have a different consistency.

It should also have an increased frequency of meals - even up to 7. It is important that you eat the last small meal just before going to bed, as it prevents morning hypoglycaemia.

Due to such a large number of meals, they should be small and in the form of a snack. In patients with compensated cirrhosis, no dietary restrictions are applied, but their diet should be highly nutritious, often also with increased caloric content.

Supplementation

To support liver regeneration, it is worth taking advantage of supplementation. However, it should always be done under the supervision of a doctor or dietitian, because improperly selected vitamins or minerals can harm more than help a sick liver.

For example, an excess of fat-soluble vitamins A, D or E can accumulate in the liver, and iron added to supplements will be a real threat to people with hemochromatosis or HCV.

Safe vitamins that will support the functioning of the liver are all B vitamins. They are soluble in water, so there is no risk of overdosing them, and they support important processes, e.g. vitamin B6 is necessary for the proper functioning of the liver.protein metabolism and the proper metabolism of homocysteine ​​(vitamin B12 plays a similar role), and vitamin B2, i.e. riboflamin, protects hepatocytes against oxidative stress.

An important ingredient in supplements that improve liver function is L-ornithine aspartate, which helps convert toxic ammonia (produced by the liver through protein metabolism) into less harmful urea.

If the liver is overloaded and the mechanism of conversion of ammonia into urea fails - poisoning occurs, excess toxins accumulate, and the risk of hepatic encephalopathy increases. Therefore, with the help of a dietitian, it is worth choosing a product with the right dose of l-ornithine.

Herbal support for the liver is also recommended, as it supports the production of bile - for example, dandelion has such an effect or has hepaprotective effect on liver cells - here milk thistle is the most recommended. Milk thistle is a well-known herb with a proven protective effect on liver cells that it is even used in some toadstool poisoning.

The substance that has the most beneficial effect on hepatocytes, and which is contained in milk thistle, is silymarin. It is distinguished by anti-inflammatory, antioxidant and immunomodulatory properties, therefore it is used in both toxic liver damage and inflammation of this organ.

A herb with proven beneficial effects on the liver is Phyllantus niruri, which is found in tropical climates, including Africa, South America. It has been proven in animal studies that it has a protective effect on liver cells when exposed to toxic substances such as alcohol.

In vivo and in vitro studies have also shown that it is able to inhibit replication of type B virus (HBV).

Category:

Gastrology