The liver is an organ that is essential for the proper functioning of the body. There are many factors that contribute to its damage. This process can be inhibited and even reversed, provided that appropriate treatment is implemented in a timely manner, which will allow the liver to regenerate quickly.
The liver is the largest organ inside our body1and has many key functions: it removes harmful substances from the blood, and produces enzymes and bile that help digest food and assimilate essential substances .2
Compared to other organs, the liver is distinguished by the fact that it shows great regenerative capacity. However, it is slow. Additionally, there is a long list of damaging factors for its cells, namely hepatocytes. It includes, among others alcohol, viruses, certain medications.
The more and more frequently diagnosed overweight and obesity also have a negative impact on the functioning of the liver.3As the incidence of obesity increases, there is also an increase in the incidence of NAFLD, i.e. non-alcoholic fatty liver disease which is now one of the most common liver diseases in the world.4
What are liver diseases?
Nonalcoholic fatty liver disease (NAFLD)
Nonalcoholic fatty liver disease (NAFLD) is an excessive accumulation of fat (mainly triglycerides) in hepatocytes.3The liver is not fully adapted to the fat-storing function. If fatty acids are not oxidized and used as an energy source, they are accumulated in hepatocytes in the form of triacylglycerols.3This process leads to the development of fatty liver.
The disease is largely associated with the obesity epidemic (central obesity is of particular importance), type II diabetes and the metabolic syndrome3,4 . Most people suffering from NAFLD are obese, but thin people can also suffer from the disease.4The disease also occurs in people who suffer from hyperlipidemia, hypertension and hyperglycemia.3, 4
If NAFLD is left untreated it can cause inflammation. These in turn can lead to the development of a severe form of the disease callednon-alcoholic steatohepatitis (NASH), cirrhosis, and even hepatocellular carcinoma.4
Treatment of NAFLD mainly consists in changing the lifestyle: increasing physical activity and following an appropriate diet. A very important element in the treatment of NALFD is the reduction of excess body weight. However, weight loss must not be rapid, as the use of fasting diets and chronic starvation can aggravate the fatty tissue.5You should give up sweets and other high-calorie snacks. Animal fats (e.g. butter, lard, fatty milk and dairy products) are also not recommended. The diet recommends vegetable fats (e.g. rapeseed oil, olive oil and good quality soft margarines).
The diet should include carbohydrates with a low glycemic index, as they allow you to feel saturated longer and will not harm the liver. You should exclude foods with high GI, such as wheat bread, white pasta, white rice, and some cooked root vegetables, such as carrots, beets, and selected fruits: pears, grapes, bananas.5Recommended eat raw vegetables and fruits due to the high fiber content, which has a positive effect on the intestines, suppresses the appetite and lowers the caloric content of the diet.5Fried foods should be avoided. The permitted methods of food preparation are: steaming, baking in the oven, boiling in water, stewing.5
Good to know: a diet in liver diseasesNutrition is a very important element in the treatment of liver diseases. Of course, the diet should be adapted to the needs of the patient's organism, modified depending on the patient's condition and liver efficiency. However, it is always a variation of an easily digestible diet with reduced fat. This model of nutrition is most often used by patients with liver disease.
Alcoholic Liver Disease
Fatty liver can also be caused by chronic and excessive alcohol consumption, which causes the development of alcoholic liver disease. This term is used to describe the different stages of ALD: fatty liver, alcoholic hepatitis, and fibrosis and cirrhosis.6
The liver is an organ particularly exposed to the toxic effects of ethyl alcohol and its metabolites. It is here that the main transformations of alcohol take place.6As many as 90% of heavy drinkers, the liver reacts to excessive alcohol intake with steatosis, in 40% with inflammation, in 15-30% with fatty liver and finally cirrhosis.6
Alcoholic fatty liver is a process inlargely reversible and resolves when drinking is stopped.6Otherwise, it may lead to more stages of liver damage.
Viral Hepatitis
Viral hepatitis is most often associated with HAV, HBV, HCV, HDV, and HEV infection.7HAV infection occurs via the fecal-oral route (contaminated food, drinking water ). On the other hand, HBV, HCV and HDV viruses are transmitted parenterally, mainly as a result of the violation of tissue continuity by infected (e.g. occupational exposure) or poorly sterilized medical and non-medical equipment (tattoo needles, piercing), through transfusion of blood products and organ transplants from infected donors, vertically from mother to child.7
Treatment of viral hepatitis and its effectiveness depend primarily on the stage of the disease, accompanying diseases and the general he alth of the patient. The key is rest (lying down), adequate nutrition (2000 kcal / day, easily digestible diet) and hydration. It is absolutely contraindicated to consume alcohol and hepatotoxic drugs during the disease.7
In the case of type C infections, drugs are used to fight the virus. Until recently, it was an interferon, the effectiveness of which was 40%. Currently, a new interferon-free therapy, called 3D for short, is used, the effectiveness of which is almost 100%. It is worth knowing that you can protect yourself against infection with hepatitis A and B viruses by using a vaccine. We are still waiting for such protection against the hepatitis C virus.
Autoimmune Hepatitis
Autoimmune hepatitis (AIH) is an autoimmune disease. For unknown reasons, the immune system attacks the cells of the liver, causing damage to them. As a consequence, acute or chronic hepatitis may develop.8AIH is a rare disease with a frequency of 0.1-1.9 cases / 100,000 patients. Women are sick four times more often than men. The disease occurs at any age, but most often it affects people in the puberty period and between the ages of 40 and 60.8
The treatment uses corticosteroids (prednisone), and then other drugs with a strong immunosuppressive effect [weakening the immune system - editor's note] are added. red].
Drug-induced liver injury
More than 1,000 different substances, including drugs, have been identified that may contribute to liver damage. The drugs that most commonly cause liver damage are antibiotics, including anti-tuberculosis preparations and medicationsantidepressants, anticonvulsants, non-steroidal anti-inflammatory drugs and azathioprine.7Treatment of drug-induced liver injury begins with the immediate termination of treatment with drugs associated with liver damage.7If this occurs for acute liver failure, a liver transplant may be required.
Cirrhosis of the liver
Cirrhosis of the liver is a chronic disease of the liver that causes liver failure1 . The most common causes of cirrhosis are hepatitis viruses and alcohol. The list of factors that can lead to cirrhosis also includes some drugs, toxins, metabolic disorders (disorders of fat metabolism, iron and copper storage, etc.), diseases of the bile ducts, diseases of the hepatic veins and portal vein vessels.7
The main goal of treatment is to stop the disease progression, prevent and treat complications (such as portal hypertension, ascites) and treatment (if possible). Symptomatic treatment mainly includes dietary restrictions, correcting protein deficiencies, pharmacologically reducing portal hypertension.
Liver tumors
Liver tumors can be benign or malignant. Usually, a benign tumor is an angioma1 . Malignant tumors can be primary or metastatic. Primary liver tumors include, inter alia, hepatocellular carcinoma.1Tumors of other tissues can also metastasize to the liver.1Risk factors for developing liver cancer include hepatitis B (HBV) or C (HCV) infection, heavy alcohol use, cirrhosis, obesity and diabetes.2
Treatment options for patients with liver cancer include: surgical excision (in some situations - whole organ excision and liver transplantation), ablation and embolization of lesions, targeted therapy, radio-therapy and chemotherapy. The methods listed may be used singly or in combination.2
Genetic liver disease
- Wilson's disease - as a result of a genetic mutation, the excretion of copper from the body is disturbed, which causes its accumulation in various organs (mainly in the liver, brain, corneas and kidneys), causing their damage1, 9
- hereditary hemochromatosis - is a genetic disease, the essence of which is the excessive accumulation of iron in the body, causing damage to various tissues. The most common complications of iron malabsorption include liver cirrhosis, diabetes mellitus, skin discoloration, arthropathy andcardiomyopathy1
- Gilbert's syndrome - a genetic disease, the essence of which is the excessive accumulation of bilirubin in the blood (a yellow pigment formed from heme, a component of hemoglobin). The disease is characterized by recurrent bouts of jaundice (yellowing of the skin and whites of the eyes).1
- Crigler-Najjar syndrome - is a genetic disease caused by total or relative deficiency of glucuronyl transferase in liver cells - an enzyme that allows bilirubin to be removed from the body. Therefore, in the course of the disease, the concentration of bilirubin in the blood increases and, as a consequence, jaundice appears.1
- Dubin-Johnson syndrome - is an inherited disease with slight, mild jaundice. It is caused by the obstruction of bilirubin excretion from hepatocytes due to dysfunction of the ABC (ATP-binding cassette) family of proteins.1For obvious reasons, there is no causal treatment of genetic diseases. You can only stop the development of the disease. For example, in the course of Wilson's disease, drugs are used to reduce the absorption of copper from the gastrointestinal tract.9
The spectrum of symptoms of liver diseases is very wide - from asymptomatic states to various general symptoms. The most common are discomfort, abdominal pain on the right side, under the ribs (where the liver is). Liver enlargement is palpable.7Symptoms such as low-grade fever, easy fatigue, nausea, vomiting, loss of appetite, weight loss, pale stools, darkening of the urine may also appear. Skin symptoms may also occur: itching, jaundice, spider veins (stellate hemangiomas).7