Understand

The liver

my liver exan question-ANG

Where is it in the body?

It is located on your right side, midway between your waist and your arm pit.

Composition and how it works

The liver is composed of a left and right lobe. The gallbladder  is located at the right lobe and stores the bile.

Two distinctive sources bring blood to the liver: the hepatic artery, which brings blood coming from the heart, and the portal vein that brings blood from the intestines. Then the hepatic veins eliminate/drain that blood.

The liver under the microscope

If we look closer, the liver is composed, of lobules where we find blood vessels, canals and cords interposed by liver cells, hepatocytes , which act as exchange zones.

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What is the use of the liver?

As the largest organ in our body, our liver has 3 vital functions, essential to our body: detoxification, synthesis and storage.

Detoxification

Real filter, the liver recovers and eliminates many toxins. Those toxins can be naturally present in the waste generated by our organism, like ammonia, or in the ones we eat or drink, like alcohol.

Synthesis

Our liver assures the metabolism of the carbohydrates, the fat and the proteins while producing bile, essential element for our digestion. Our liver also avoids hemorrhages via the coagulation process.

Storage

The liver stores vitamins (A, D, E, and K) and glycogens (carbohydrates) meaning it stores energy like sugar and makes it available to our organism when needed.

Fibrosis, cirrhosis, and steatosis: what is it?

Fibrosis

Any chronic aggression of the liver will cause a fibrous scar of the hepatic tissue. This hepatic fibrosis constitutes a healing process replacing the damaged liver cells.

This is reversible if the reason of the disease is treated and if the injuries are not too severe. Then, the liver can regain a normal structure. Therefore, it is essential to know the level of fibrosis of someone’s liver in order to establish a diagnosis, and an appropriate treatment to ensure follow-up and efficiency.

This fibrosis prevents the proper functioning/operation of the liver and does not exhibit any particular symptoms.

Cirrhosis

At the beginning, cirrhosis is often asymptomatic, even when it reaches the cirrhosis level. In that case we call it compensated cirrhosis, meaning not that your body has found ways to able to adapt to the liver disease.

It can be discovered during a routine exam. With the evolution of the cirrhosis, we can go from a compensated cirrhosis to a decompensated one and then there will might be complications:

  • Portal hypertension hampers the venous circulation, causing increased pressure in the portal vein. It can also be responsible for hemorrhages via the rupture of esophageal varicose.*
  • Ascites is the appearance of an excess of liquid in the abdominal cavity and it can get infected.
  • Icterus, more commonly known as jaundice, is a yellowing of the skin and other tissues due to increased bilirubin in the blood.
  • Hepatic encephalopathy is a neurological disorder related to non-eliminated toxic accumulation.
  • The primary liver cancer, also called “hepatocellular carcinoma”, is a final complication of cirrhosis and can stay asymptomatic for a long time.

Steatosis

Hepatic steatosis is an accumulation of fat in the liver. It is an augmentation of fat in the hepatic cells and can cause complications in cases of obesity, alcohol intoxication (due to an excessive consumption of alcohol) or hepatic disorders (like diabetes Type 2). Steatosis can be isolated and we call it « pure steatosis » or it can be associated with hepatitis: non-alcohol related hepatic steatosis (SNHA or NASH

Usually, people suffering from those do not show any symptoms. In some cases, steatosis can evolve into fibrosis that may transform into cirrhosis due to obesity and overweight in our occidental societies.

Key ideas:

What about liver diseases?

Alcohol related diseases

Fibrosis: with an alcohol consumption of more than 30 grs per day over several years.

Athletic couple jogging in nature in good spirit

A glass of wine (10 cl) = A glass of Porto (6 cl) = A glass of champagne (10 cl)

Half a beer (25 cl) = A glass of whisky (3 cl) = A glass of pasties («3 cl) = ONE ALCOOL UNIT

Hepatitis B

This is a DNA virus whose infection happens mainly through blood (substance abuse, intravenous, tattoo, piercing), sexual contact and through “vertical transmission” (mother to child) during birth. Transmission through blood transfusion and non-sterile equipment remains relatively rare in industrialized countries.

The Hepatitis C

HCV is an RNA virus that is transmitted through blood-to-blood contact.  Historically, most patients with this virus were infected through blood transfusions.  Now that the blood supplies are screened for HCV, the most common cause for new cases is intravenous drug use.  While sexual transmission of the virus can occur, it is very rare as the virus is not transmitted in semen or saliva.  Given that the virus can exist in the body for a long time, many people infected with HCV are unaware of how they contracted it.

NASH (non-alcohol related steatosis)

NASH is the association of steatosis and liver inflammation with fibrosis development.

 Autoimmune diseases

There are two liver related autoimmune diseases:

  • PBC is an inflammatory disease of the intrahepatic bile ducts that can turn into cirrhosis in the most severe cases. PBC is mostly diagnosed among women over 40.
  • Autoimmune hepatitis is an inflammatory disease of the liver characterized by the elevation of specific blood markers and the presence of autoantibodies. It can happen at all ages but mainly among women.

Liver “storage” diseases

There are two « storage » diseases:

  • Genetic hemochromatosis is a genetic disorder caused by a defect in the regulation of intestinal iron absorption. Iron accumulates in tissues, including in the liver, causing /generating fibrosis then cirrhosis. The disease is much more common in men than in women and occurs around 40-60 years. The treatment of this disease intends to reduce iron deposits in the body tissues.
  • Wilson disease, still scarce, is a genetic disorder caused by the accumulation of copper in the liver. Cornea and nervous central system can also be affected.
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