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Liver explained
Theliverissituatedontheupperrightsideoftheabdomen,justbelowthediaphragm.Itisthe largestinternalorganofthehumanbodyandweighsaround1.5kgintheaverageadult.Blood fromthedigestivesystemmustfirstfilterthroughtheliverbeforeittravelsanywhereelseinthe body. Theprincipalrolesoftheliverincluderemovingtoxinsfromthebody,processingfoodnutrients andhelpingtoregulatebodymetabolism.Arangeofconditionscanpreventtheliverfrom performingitsvitalfunctions.Culpritsincludefataccumulation,alcoholmisuse,viralinfection,iron orcopperaccumulation,toxicdamageandcancer. Themostcommoncauseofliverdiseaseisnon-alcoholicfattyliverdisease(fattyliver).Cirrhosis istheend-resultofmanyliverconditionsandinvolvesseverescarringoftheliver(withlivernodule formation).Itisassociatedwithaprogressivedeclineinliverfunctionresultinginliverfailure. Functions of the liver Someofthemanyfunctionsoftheliverinclude: Drugs,includingalcohol,arefilteredthroughtheliverandneutralisedorconvertedinto otherformsbyspecialenzymes. Bile,producedbytheliver,isstoredinthegallbladderandusedtohelpbreakdown dietaryfats. FatsolublevitaminsA,D,EandKneedbileinordertobeabsorbedbythebody. Theliverconvertscarbohydratesintoglucoseforinstantlyavailableenergyandconverts glucoseintoitsstorableform(glycogen).Whenbloodsugarlevelsdrop,glycogenis convertedbackintoglucose. Aminoacidsfromproteinaresenttotheliverfortheproductionofbodyproteinssuchas hormones. Theliverchangesammonia(atoxicby-productofproteinmetabolism)intourea,whichis thenexcretedinurine.

Ima ge des crip

Symptoms of disease Symptomsofliverdiseasedependonthedisorder,butcaninclude: Jaundice(theskinorwhitesoftheeyeturnyellow) Darkurine Nausea Vomiting Diarrhoea Appetiteloss Weightloss Generalmalaise Fever Bloatedabdomen,swollenankles Abdominalpainintheupperrightside Anaemia,vomitingbloodorpassingblackstools(denotingalteredblood) Changesinmentalstatealteredsleeppattern(awakeatnight),confusion,drowsiness.

A range of causes Someofthecausesofliverdiseaseinclude: Non-alcoholicfattyliverdisease(fattyliver) Hepatitisvirusinfections Alcohol-relatedliverdisease

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Toxiceffectofmedications,herbalmedicines Congenitalorinheritedabnormalitiesoftheliverinvolvingaccumulationofironand copperinthebodyandsomerareenzymedisorders Conditionsleadingtolivercelland/orbileduct(theplumbingsystemoftheliver) damage.

A range of disorders Somedisordersoftheliverinclude: Fatty liverthisisthemostcommonofthealcohol-inducedliverdisorders.Fat accumulatesinsidethelivercells,causingcellenlargement(steatosis)andsometimescell damage(steatohepatitis),andcanleadtocirrhosis.Similarchangesarealsoseenin peoplewhodonotdrinkexcessiveamountsofalcoholbutareoverweight,obeseorhave diabetes.Theliverbecomesenlarged,causingdiscomfortontheupperrightsideofthe abdomen. Cirrhosisthishasmanycausesbutiscommonlyduetohepatitisinfectionorexcessive alcoholintake.Thecellsoftheliverareprogressivelyreplacedbyscartissue,which seriouslyimpairsliverfunctioning. Hepatitisageneraltermmeaninginflammationoftheliver.Itisalsousedtoreferto infectionsoftheliverbyspecificviruses(hepatitisAtoE). Haemochromatosisthisinheriteddiseasemakesthebodyabsorbandstorehigherthan normalamountsofiron.Thisdamagesmanyorgansincludingtheliver,pancreasand heart. Autoimmune liver disorders anabnormalincreaseinimmunecellsdamagestheliver cells.Theserareconditionsincludeautoimmunehepatitisandprimarybiliarycirrhosis (mostlywomenaffected)andprimarysclerosingcholangitis(morecommoninmen). Cancerprimarycancerscanariseintheliver,mostoftenfromchronichepatitiswith cirrhosis.Straycancercellsfromatumourelsewhereinthebodymaycauseasecondary tumourintheliver. Galactosaemiathebodysreactiontoparticularmilksugarsdamagestheliverand otherorgans.Thisisarareinheriteddisorder. Alpha 1-antitrypsin deficiencyanotherrareinheriteddisorderthatcancausecirrhosis oftheliver. Wilsons diseasethelivercantexcretecopper.Variousorgansofthebody,including theliverandbrain,areaffectedbytheexcessivelyhighcopperlevels.

Complications of liver disease Withouttreatment,apersonwithliverdiseaseissusceptibletoawiderangeofcomplications, including: Hepatic encephalopathyscartissuepreventstheproperflowofbloodthroughthe liver,sothattoxinsremain.Thesecirculatingtoxins,particularlyammonia,affectbrain functioningandcanleadtoacoma. Ascitesliverdiseasecancauseabuild-upofbodysodium(salt),whichleadstofluid retentionintheabdominalcavity(ascites)andinthelegs,feetandback(oedema). Liver failurethelivercellsaredestroyedfasterthanthelivercanreplacethem,until theorgancannolongerfunctionadequately. Cancercirrhosisorsomeformsofhepatitiscanmakethelivermoresusceptibleto primarycancer(cancerthatoriginatesintheliver). Gastrointestinal bleeding theveinsthatnormallytravelthroughthelivermaybe blockedbecauseofcirrhosis.Theseveinsthenbypasstheliverandmaytravelalongthe stomachoroesophaguslining,wheretheymayruptureandbleed.

Diagnosis Liverdiseaseisdiagnosedusinganumberoftests,including: Physical examinationthelivermaybeenlarged. Medical historyincludingmedicationsandlifestylefactorssuchasdietandalcohol consumption,exposuretohepatitisviralinfections,bloodtransfusions,tattoosorfamily historyofliverdisease. Blood teststocheckthelevelsofliverenzymesandjaundice(yellowness)andto assesstheproteinproductioncapabilityoftheliver). Ultrasound scan of the abdomen (belly)athree-dimensionalx-rayusingsound waves.Thisisusedtolookattheliverandotherorgans,includingchecktheirsizeand shape,checktheliverforabnormallumpsandassessfluidaccumulation.

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Other scansincludingcomputedtomography(CT)scanandmagneticresonance imaging(MRI). Biopsyasmallpieceoflivertissueisremovedandexaminedunderthemicroscopeina laboratory.

Treatment Treatmentdependsonthecause,butmayinclude: Rest Avoidingalcoholandanydrugsthatmightdamagetheliver Awell-balanced,nutritiousdietsomepeoplerequireamodifieddiet(forexample,low salt) Medications,suchasantiviraldrugstotreatviralinfections SpecificmedicationstomanageWilsonsdisease Periodicremovalofbloodtobringironlevelsdowntonormal(inpatientswith haemochromatosis) Surgery,chemotherapyandradiotherapy,orlivertransplantationaretheusualtreatments forlivercancer Incaseswheretheliverisfailing,alivertransplantisanoption.

Where to get help Yourdoctor

Things to remember

Theprincipalrolesoftheliverincluderemovingtoxins,processingfoodnutrientsand regulatingbodymetabolism. Importantcausesofliverdisordersarefattyliver,hepatitisvirusinfectionsandalcohol. Cirrhosis(liverscarring),theend-resultofmanyliverdisorders,canleadtoliverfailure.

This page has been produced in consultation with, and approved by:

CanberraHospital-GastroenterologyUnit

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

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