About liver disease

 There are many kinds of liver diseases and conditions, the most common are hepatitis viruses, nonalcoholic fatty liver disease (NAFLD), autoimmune diseases, genetic conditions, cancer, and others. Liver disease has many causes such as:

• Infections: Viruses and parasites can infect the liver. The most common infections are hepatitis viruses. Liver-damaging viruses can be spread through contaminated food or water, unscreened blood transfusions, sexual contact, exposure to blood/body fluids, and other ways.

• Immune system abnormalities: Your immune system protects your body from germs and toxins. But that system can attack certain parts of your body (autoimmune), including your liver. Examples of autoimmune liver diseases include autoimmune hepatitis; primary biliary cholangitis; primary sclerosing cholangitis.

• Genetics: An abnormal gene inherited from one or both of your parents can cause liver damage. Genetic liver diseases include hemochromatosis; Wilson's disease; alpha-1 antitrypsin deficiency.

• Cancer and other growths: Examples include liver cancer; bile duct cancer; liver adenoma.

• Other causes of liver disease: long-term alcohol use; fat accumulation in the liver (NAFLD; nonalcoholic fatty liver disease); obesity; some prescription or over-the-counter medications; some herbal compounds.

Stages of Liver Disease

• Stage 1 is inflammation of your liver, caused by your immune system reacting to a foreign substance, like toxins. Chronic inflammation can lead to an enlarged liver. Inflammation can result from fatty liver, hepatitis, and other causes.
• Stage 2 is liver fibrosis or liver scarring, caused by chronic inflammation. Scarred tissue begins to replace healthy tissue, which reduces how well your liver functions. Liver scar tissue also reduces blood flow to your liver.
• Stage 3 is cirrhosis of your liver, caused by severe liver scarring. At the cirrhosis stage, you may experience more symptoms of liver damage including jaundice, weakness, fatigue, appetite and weight loss, abdominal bloating, and edema in your extremities.
• Stage 4 is liver failure, which means your liver can no longer function or heal itself. In liver failure, the liver can no longer process toxins or drugs, and they build up in your body. Symptoms grow worse and can include mental and physical impairment, appetite and weight loss, diarrhea, and other problems.

What does the liver do?

Your liver is essential to your life. It is the largest solid internal organ in the body. It is about the size of a football and weighs about 3 to 3.5 pounds (1.36–1.59kg). It is located on your right side, just under your rib cage.

Your liver’s biggest role is to filter your blood all day, every day. A healthy liver gets its color, a deep reddish brown, because it is so drenched in blood. At any given moment, your liver contains about a pint of blood, or 13% of the body’s total blood supply. Your liver filters more than a liter of blood every minute which is about 22 gallons of blood per hour and more than 250 gallons of blood in a 24-hour time period. There are two sources that supply your liver with all that blood: the hepatic artery and the hepatic portal vein. The hepatic artery brings oxygen-rich blood to your liver. Blood coming from your digestive system enters the liver through the hepatic portal vein carrying nutrients, medications, or toxins. 

Unlike the lungs or heart, we cannot feel our liver working. Many people don’t think about their liver unless or until there is something wrong with it. Your liver is an incredibly hard-working organ with more than 500 different vital functions. Only your brain has more functions than the liver. Many of the liver’s functions are related to your metabolism. These metabolic functions allow you to convert food to energy, break down food to basic building blocks needed by your body and eliminate waste.

The liver…

• Produces bile
  • Bile is a yellow-green acidic liquid that helps carry away waste and break down fats in the small intestine during digestion
• Produces proteins for blood plasma
  • Blood plasma is a fluid which transports blood components (red and white blood cells and platelets), nutrients, hormones, proteins, and waste products
• Produces cholesterol and special proteins to help carry fats through the body
• Converts unused glucose into glycogen for storage
  • When needed, glycogen can be converted back to glucose for energy
  • Balances blood sugar and makes glucose as needed
• Regulates levels of amino acids in blood
  • Amino acids form the building blocks of proteins
• Stores iron processed from hemoglobin
  • Hemoglobin is the protein in your red blood cells that carries oxygen
• Converts poisonous ammonia, made during digestion, to urea
• Processes drugs and other poisonous substances to your body
• Regulates blood clotting (or our ability to stop bleeding)
• Fights infections by making immune factors and removing bacteria from the bloodstream
• Removes bilirubin from red blood cells

The liver removes harmful substances from our body often by breaking them down to smaller byproducts. These byproducts leave the liver through bile or blood – byproducts in bile are removed from the body through feces while those in the blood are filtered out by the kidneys and removed through the urine.

Courtesy of the American Liver Foundation

Some general ways to treat liver disease are a combination of the following:

• Lifestyle changes: avoiding alcohol, losing weight, eating a healthy diet, and exercising regularly can help prevent or reduce liver damage.
• Medications: some drugs can treat specific causes of liver disease, such as antivirals for hepatitis or steroids for autoimmune hepatitis.
• Surgery: some procedures can remove or destroy damaged parts of the liver, such as a liver resection or ablation.
• Liver transplant: a surgery that replaces a diseased liver with a healthy one from a donor.

The best treatment option for each person depends on their individual situation and medical history. Therefore, it is important to consult with a doctor who can diagnose the type and stage of liver disease and recommend the most appropriate treatment plan.

If you’re a liver patient, your diet is adjusted to meet your individual needs. Talk to your doctor about what’s best for you. Still, here are some general food tips for a healthy or healthier liver:

• What to avoid: Don’t eat foods high in fat, sugar and salt. Stay away from a lot of fried foods including fast food restaurant meals. Raw or undercooked shellfish such as oysters and clams are a definite no-no.
• Talk to your doctor about alcohol and your liver health: Depending on the state of your liver, you should avoid alcohol. If you’re allowed alcohol, limit it to no more than one drink a day if you’re a woman and two drinks a day if you’re a man.
• Eat a balanced diet: Select foods from all food groups: Grains, fruits, vegetables, meat and beans, milk, and oil.
• Eat food with fiber: Fiber helps your liver work at an optimal level. Fruits, vegetables, whole grain breads, rice and cereals can take care of your body’s fiber needs.
• Drink lots of water: It prevents dehydration and it helps your liver to function better.

Exercise or really any physical activity has many well-known benefits for the liver. Regular physical activity can:

• improve blood flow to the liver,
• change the composition of bacteria in your body,
• decrease liver inflammation,
• change how your blood vessels dilate,
• reduce fat in your liver,
• and reduce body fat.

A healthy body weight and regular physical activity can even improve scar tissue (fibrosis) in your liver.

Historically, many healthcare providers have been reluctant to advise their patients with cirrhosis and complications of end-stage liver disease to exercise. However, emerging evidence now supports recommending regular physical activity for patients who have cirrhosis. Importantly, this can lower elevated pressures in the liver, which are responsible for most liver-related symptoms patients with cirrhosis experience. Furthermore, regular physical activity is important for any patient who is under evaluation for liver transplantation and physical performance and physical frailty are predictors of poor outcomes before and after going to the operating room.

The American College of Sports Medicine and their Exercise Is Medicine program suggest that patients with chronic liver disease engage in moderate-intensity aerobic activity, (e.g., walking at a pace where you can maintain a conversation with the person next to you), for at least 150 minutes per week. This should be coupled with at least two days of resistance training, which can include body weight exercises. With that said, the bottom line here is any physical activity is good and having a conversation with your patients about what they enjoy as physical activity can help improve adherence to and encourage long-term success with living a healthy, active life.

*Courtesy of Penn State Liver Center

 The treatment for liver disease depends on the diagnosis, the severity of the damage, and the underlying cause. Some liver problems can be managed with lifestyle changes, such as quitting alcohol, losing weight, eating a healthy diet, and exercising regularly2. Other liver problems may require medications or surgery.

Some of the medications that are used to treat different types of liver disease are:

• Antiviral drugs: These are used to treat chronic hepatitis B or C, which are viral infections that can cause liver inflammation and scarring. Antiviral drugs can help reduce the viral load, prevent further damage, and lower the risk of complications3.
• Immunosuppressants: These are used to treat autoimmune hepatitis, which is a condition where the immune system attacks the liver cells. Immunosuppressants can help suppress the immune response and reduce inflammation3.
• Ursodeoxycholic acid: This is used to treat bile acid synthesis disorders and progressive familial intrahepatic cholestasis, which are rare genetic conditions that affect the production or flow of bile from the liver. Ursodeoxycholic acid can help dissolve gallstones, improve bile flow, and protect the

Living liver donor transplantation is a surgery that removes a diseased liver from one individual and replaces it with a portion of a healthy liver from a living donor. The liver is able to regrow to full size in both donor and recipient.

What is a living donor liver transplant?

During a living liver donation, a living donor will provide a single lobe of their liver for transplantation into the recipient. A fully functioning liver will grow in the recipient, and the donor’s liver will regrow to its original size.

The donor and recipient of a living liver transplant might be family members or have a close association. This is what medical professionals call a directed

donation.

If an individual wants to donate a portion of their liver to someone they do not know, the medical community refers to it as a nondirected donation. A

transplant hospital would need to guide the process in either case.

How does it work?

Surgical teams usually conduct both surgeries for living liver transplants in

nearby operating rooms. One surgeon removes a portion of the liver, usually

the right side, from the donor.

They may take anywhere from 25–65% of the liver. Surgeons then transplant

this portion of the liver into the recipient in the other operating room. Teams

may perform these surgeries with open incisions or use an imaging instrument called a laparoscope that shows what is inside the body. Doctors call this type of procedure keyhole surgery. However, keyhole surgery for liver transplants is very new, and not all facilities may offer it.

The doctor will provide the donor and recipient with enough liver to maintain

bodily functions. Over the next several months, both livers will regrow to full

size.