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Liver Functioning and Dysfunction - An Overview

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The functions of the liver are to remove the toxins from our body, maintain the blood sugar level, help in digestion, and help in blood clotting.

Written by

Dr. Janani R S

Medically reviewed by

Dr. Ghulam Fareed

Published At September 14, 2022
Reviewed AtMarch 15, 2023

Introduction:

The liver is the largest internal organ in our human body. The liver performs many functions like removing toxic (harmful) wastes from the blood, removing old red blood cells, helping in digestion by breaking down fats, helping in controlling and storing blood sugar, it produces proteins needed for the body and helping in blood clotting. If any of the function is not carried out by the liver properly, it can be due to liver disease.

Liver diseases can be due to a viral infection, too much alcohol intake, due to side effects of taking certain medicines beyond the desired or prescribed time, autoimmune disease (when the immune system attacks its own body or organs), cancer, genetically acquired liver diseases like hemochromatosis (too much iron stored in the body), hyperoxaluria (when oxalate, a chemical is present excessively in the urine) run in the family and non-alcoholic fatty liver disease (NAFLD- when excess fat is deposited in the liver).

Liver diseases can be diagnosed by performing blood tests like liver function tests (LFT) and a genetic blood test to rule out any genetic disease (a disease that runs in the family). Treatment of the liver problem depends on the type of the disease. Some liver diseases can be treated by bringing some changes in lifestyle, like recommending stopping the habit of drinking alcohol and losing weight. Other liver problems may require medications or surgery. A liver transplant will be considered when there is liver failure.

What Is a Liver?

  • The liver is a large reddish-brown color, spongy organ, and it is rubber-like in texture. It weighs around 3.17 to 3.66 pounds.

  • It is located in the right upper part of the stomach, just below the rib cage and above the right side of the stomach, right kidney, and intestine.

  • The liver is also called a gland because it produces chemicals (like bile) needed for the body.

  • The liver produces a dark green-yellowish-brown fluid called bile. This bile is released by the liver into the gallbladder for storage. Bile contains cholesterol, water, salts like potassium and sodium, metals like copper, bile salts, and bilirubin (a yellow pigment produced as a result of red blood cell breakdown). Bile helps in the digestion of food by breaking down fats into fatty acids. It is then carried to the digestive tract to help in further digestion.

  • The liver is the only organ in the human body that can regrow from its remaining part after surgery or damage to the liver by chemical exposure. Chemicals like carbon tetrachloride used for dry cleaning and plastic-making chemicals like vinyl chloride cause damage to the liver.

  • The diseases of the liver are called hepatic diseases, and the problems in the liver due to any external or internal factor are called hepatic disorders.

  • A doctor who is a specialist in finding and treating liver diseases is called a hepatologist.

What Is the Structure of the Liver?

  • Shape: The liver is a rough triangle in shape.

  • Lobes: The liver has four parts or lobes, the right larger lobe, the left lobe, the small caudate lobe, and the quadrate lobe. These lobes are set apart by a band of tissue called the falciform ligament, which helps the liver to stay tight to the stomach or abdominal wall.

  • Bile Duct: These lobes contain numerous lobules (smaller lobes) and connect with many small bile ducts. These small ducts join with larger ducts and form the common hepatic duct. Common hepatic ducts carry bile from the liver to the gallbladder and duodenum (the first part of the small intestine). The other parts of the liver are peritoneum which forms an outer covering for the liver. Gilson’s capsule is a connective tissue (a tissue that protects other organs or tissues in the body) that covers the liver, arteries, and hepatic ducts.

  • Blood Supply: The liver receives blood from two types of blood vessels (small tubes that carry blood). The hepatic artery is a blood vessel that carries pure blood or oxygenated blood from the heart to the liver; this is the liver's main artery. The hepatic portal vein is also a blood vessel that brings blood to the liver from the spleen, gallbladder, pancreas, and gastrointestinal tract (together called the digestive system).

What Are the Functions of the Liver?

  • Blood Filtration: The liver filters the blood from the digestive system as it passes through the liver and removes the waste products and toxins (harmful wastes) from drugs and alcohol byproducts (unwanted products that the body releases after using it up). These waste products leave the body through the kidney in the urine.

  • Bile Secretion: Bile helps break down large fat globules into smaller droplets during digestion so that it is taken up or absorbed by the body easily.

  • Bilirubin Production and Excretion: Bilirubin is produced as a result of the breakdown of hemoglobin (a protein in the red blood cells that carries oxygen to other parts of the body). This hemoglobin releases iron which is stored in the liver or bone marrow (a spongy substance present in the center part of a bone that helps produce bone marrow stem cells and substances that form new blood cells). It also removes bilirubin from the circulation, as excess bilirubin can cause jaundice - yellowish discoloration of the skin and eyes.

  • Processes Hemoglobin: The liver processes hemoglobin and stores iron.

  • Helps in Blood Clotting: Coagulants (a substance that causes a liquid to thicken) help the blood clot. Vitamin K is important for producing these coagulants. Bile is necessary for vitamin K absorption. When the liver does not produce bile, clotting factors cannot be formed.

  • Metabolizing Carbohydrates: Carbohydrates are broken down into glucose (sugar in the blood) and released into the blood to maintain a normal blood sugar level. The carbohydrates are stored in the liver as glycogen and are released when the body demands energy.

  • Vitamins and Mineral Storage: The liver stores large amounts of vitamins A, D, E, K, and vitamin B12 and releases them into the blood. Vitamins are essential for normal growth and development, the development of red blood cells, and the nervous system. The liver also stores copper and iron and releases them when there is a lack of any of these elements in the blood.

  • Protein Synthesis: The liver produces plasma proteins like albumin (maintains minimal fluid pressure), globulin (takes part in immune system problems), and fibrinogen (helps in blood clotting). Albumin is an important protein in the bloodstream. It channels fatty acids and hormones to create a healthy blood flow and maintains minimal fluid pressure to prevent inward blood flow within the blood vessel.

  • Amino Acid Regulation: Protein production relies on amino acids. The liver regulates the amino acids flow in the blood.

  • Excretion: The liver converts the dangerous ammonia to urea, which leaves the body through urine. Urea is the final product of protein synthesis.

  • Removes Infection: During filtration of blood, the liver eliminates bacteria, thus removing the infection from the body.

What Happens if the Liver Does Not Function Properly?

If the liver does not function properly, one of the following diseases might be ruled out:

  • Hepatitis: An infection of the liver where the liver is inflamed or swollen. It can be caused by a viral infection. It is called viral hepatitis if it is caused by a viral infection. Viral hepatitis can easily spread from one person to another. Hepatitis A, B, C, D, and E are types of hepatitis.

  • NAFLD (Non-alcoholic Fatty Liver Disease): Excess fat deposition in the liver due to obesity or type II diabetes.

  • AFLD (Alcoholic Fatty Liver Disease): Fat deposition in the liver due to drinking too much alcohol.

  • Autoimmune Hepatitis: When the immune system attacks the body's healthy organs and causes the liver to swell.

  • Genetic Hepatic Disease: Genetic diseases like hemochromatosis (excess deposition of iron in the liver) or Wilson's disease (too much copper stored in the liver) are examples of genetic liver disease.

  • Drug-induced Liver Disease: Due to consumption of certain medications like painkillers or energy supplementary medications beyond a prescribed time.

  • Cirrhosis: Cirrhosis is the scarring of the liver. The healthy liver tissues will be replaced by scar tissues.

  • Liver Failure: If the liver does not function properly due to damage to the liver, liver failure happens.

  • Liver Cancer: Cancerous tumor in the liver.

How to Find Out the Liver Disease?

  • Liver Function Tests: This test reveals the liver status. It shows the levels of different enzymes like alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT), proteins like albumin (a protein made in the liver), prothrombin time (PT), total protein, bilirubin (a waste product made by the liver) and lactate dehydrogenase (LD). The difference in the levels of any of these parameters indicates liver disease.

  • Complete Blood Count: In order to rule out any infection, complete blood count tests are done. Any changes in the components like red blood cells, white blood cells, platelet count, and hemoglobin from their normal range indicate an infection or disorder.

  • Ultrasound: An imaging technique that uses sound waves to capture the image of internal organs and other structures.

  • CT Scan and MRI: Computerized tomography (CT) uses a computer linked to an X-ray to capture detailed pictures of internal organ structures in a 3-dimensional view. The magnetic resonance imaging (MRI) technique uses magnetic fields and radio waves to capture images of internal structures or organs in a detailed way.

  • Liver Biopsy: In a liver biopsy, a small portion of the liver is cut and viewed under a microscope to rule out the pathological changes (changes in the tissue of an organ) or the severity of a disease.

How to Improve Liver Function?

  • Follow a healthy and balanced diet. Include equal amounts of proteins, fibers, probiotics, and carbohydrates in your food chart. Avoid eating red meat.

  • Exercise regularly.

  • Reduce weight if you are obese.

  • Avoid using or sharing needles used by another person. Use sterile needles.

  • Do not have sex with multiple partners or unprotected sex; this can increase the risk of getting hepatitis B and hepatitis C. Follow safety precautions like using condoms while having sex.

  • Do not share personal items like toothbrushes, razor blades, and nail cutters, as infections can easily spread.

  • Wash hands regularly before eating food and after coming from the restroom.

  • Limit alcohol drinking.

  • Make sure your space is well-ventilated if you are using aerosol cleaning products, pesticides, and any form of chemicals. These are toxins that can damage your liver gradually.

  • Get immediate medical care if you come in contact with another person's blood.

  • Get vaccinated, as vaccinations are available for hepatitis A and hepatitis B.

Conclusion:

The liver is an important organ for our entire body's function and regulation. It helps remove toxins from the body and regulates other metabolic functions. It also plays an important role in producing proteins that take part in various metabolic activities and also promote bleeding. Hence maintaining a healthy lifestyle and following medical advice can improve liver function and help one live a healthy life.

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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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