A ROUGH GUIDE TO THE LIVER

Where is it and what does it do?

The liver is by far the largest organ in your body and weighs approximately 1.25 KG or 3 lbs.

If you want to know where your liver is, hold out your left hand and spread your fingers as if you were holding a large melon.  Keep your hand like that and place your left thumb on your right nipple and your little finger along the bottom of your ribs.  Your left hand is roughly where your liver lies inside your body, protected by your ribs.

A healthy liver feels smooth and firm, just like an uncooked pig’s liver your might see in a butcher’s shop.

People often describe the liver as the body’s chemical processing factory.  It performs hundreds of immensely complicated functions varying from continuously cleaning the blood of possible poisons, to manufacturing bile to assist in the digestion of fat in your diet.

What can go wrong with it?  

       Fatty Liver              Cirrhotic Liver         Liver Cancer

During chronic liver disease, the structure of the cells in your liver can change.  The damaged cells are replaced by scar tissue called fibrosis.  Your doctor can only be certain if your have fibrosis by doing a liver biopsy (see section on Tests you might have).

Anything that results in severe damage to your liver can cause fibrosis.  This includes alcohol abuse, hepatitis and other viruses.

Some chemicals, many poisons, too much iron absorbed from your diet, a severe reaction to drugs and obstruction of the bile duct can also cause fibrosis.

If the damage to your liver continues, scar tissue progressively accumulates and blood flow through it diminishes.

This can cause even more liver cells to die.  A lot of scarring makes your liver stiff and, combined with the loss of liver cells, is known as cirrhosis.

Your doctor can only diagnose cirrhosis by carrying out a biopsy.

There is treatment for types of cirrhosis, but often there is no cure.

Currently, treatment is mainly supportive and about making sure it does not get any worse.

Treatment may include a strict diet, diuretics, vitamins, and abstinence from alcohol.

However, a lot of progress has been made in managing the major complications of cirrhosis, such as fluid retention in the abdomen, bleeding and changes in mental function.

How do I know if something is wrong with my liver?

Most people with liver damage have physical signs at first.

It is common for people to appear healthy and well nourished during the early stages of liver damage.  Even those with cirrhosis can appear well.  However, as cirrhosis progresses, several major problems will eventually cause symptoms.

An undamaged liver produces and processes certain necessary substances for the body.  The liver processes nutrients from foods and gets rid of toxins.  If your liver is cirrhotic, it is unable to produce and process these substances correctly.  So, you may feel tired and weak or generally unwell.  You may lose your appetite or feel sick.  You may also lose weight.

One of the waste products that a damaged liver cannot process in bilirubin.  Bilirubin is the waste product left after the breakdown of haemoglobin (the chemical that carries oxygen around the body in red blood cells).  If the level of bilirubin builds in your body, it can make your skin and the white of your eyes go yellow.  This is called jaundice.  Your urine may be dark because it has more bilirubin in than usual.  And your faeces may be light in colour because they contain less bilirubin than usual.

Other physical signs of cirrhosis include little red veins – called vascular spiders or spider naevi, on the face, arms, and upper trunk; accumulation of water in the legs and abdomen; and an enlarged liver.  Water accumulating in the abdomen is called ascites.  Another sign of cirrhosis is intense itching as bile products are deposited in the skin.

If the blood cannot pass through the main vein from the intestines to the liver, then further complications can happen.  Enlarged (varicose) veins in the oesophagus and haemorrhoids may appear.  These are called varices.  Sometimes they rupture, which can cause severe and therefore your might vomit varying amounts of blood: one in three cirrhotic's bleed in this manner.

Liver Function Test (LFTs)

Your doctor may test your blood to see how your liver is functioning.  This Liver Function Test looks for several different things.

Synthetic Function

One of the functions of your liver is to make protein.  One of these proteins is called albumin.  A lower level of albumin in your body indicates that the liver is having problems making proteins.

Prothombin Time

Another function of your liver is to make clotting factors.  A test called Prothombin time is used to test if the liver is successfully making certain clotting factors.

Conjugation and Excretion of bile

A major function of the liver is to make bile, which aids digestion.  Bilirubin is usually incorporated into the bile by the liver.

Bilirubin is a product of the ‘breakdown’ of haemoglobin.  Haemoglobin is the substance in red blood cells that carries oxygen around the body.  When any number of liver cells are damaged, bilirubin incorporation into bile fails, instead it accumulates in the blood.  If you have high levels of bilirubin in your blood it shows there is some damage to your liver and can cause jaundice.

Liver Cell Integrity

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are enzymes usually present within health liver cells.   When the liver cells are damaged, these enzymes leak into the blood at higher than normal levels.  Blood tests can measure levels of these enzymes.

ALT and AST are sometimes referred to as the ‘transaminases’ – if they are raised, then you are said to have ‘transaminitis’.

Another enzyme usually found in the cells that line the bile ducts in the liver – alkaline phosphatase (alk phos or ALP – may also be measured, but this enzyme is not as frequently raised in hepatitis C.

In hepatitis C, however, the transaminases may or may not be elevated, and unfortunately, they have been shown to be poor markers of the stage of liver disease.  Some people may have raised transaminases, but have little or no liver damage. Others may have normal transaminases, but have some liver damage.  So no-one of these tests, although relatively non-invasive, accurately reflect the stage of liver damage.

Liver Biopsy

A liver biopsy involves a special needle to remove tissue from your liver that a doctor can then examine under a microscope.  Looking at liver tissue itself is the best way to determine how healthy your liver is.

A liver biopsy is a good method of assessing the extent of liver damage.  Blood tests can usually measure the extent of inflammation in your liver.  However, no blood tests currently are able to reveal the extent to which your liver is damaged by cirrhosis or scarring.

Having a Liver Biopsy can help.

Many disorders can affect your liver and some of these your doctor can diagnose using specific blood tests, e.g. the different forms of viral hepatitis discussed in the first chapter.  However, sometimes the results of these blood tests are inconclusive and it is necessary to have a liver biopsy.