The Liver

Your liver is crucial to your survival. Without a functioning liver you will die. That's because the liver does many functions that are essential to life.

Your liver is about the size of a football, weighs about three pounds and is tucked in behind your lower ribs on the right side of your abdomen. It is the largest organ inside our bodies. It is one of the few organs that can actually regenerate itself. That means if a portion is cut off, it grows back. That doesn't mean however, we can treat our liver badly and we won't suffer.

What it does

The American Liver Foundation (ALF) calls the liver the body's refinery. By acting like a filter, the liver takes things and converts them into other things that the body can use or into substances that can be safely disposed of. In fact, blood from your stomach and your intestines goes through the liver before heading out to other parts of the body. ALF says the liver also makes some substances on its own, like bile, which is sent to the gall bladder and then into the intestine to help with digestion.

Here's a list of some of the other things your liver does, according to ALF and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

• makes much of our blood before we are born
• stores iron
• stores certain vitamins, minerals and sugars in case of shortages (Read about "Vitamins & Minerals")
• controls the movement of fat stores
• regulates blood clotting
• metabolizes alcohol
• filters out and neutralizes poisons
• makes and helps regulate the amount of cholesterol in our bodies (Read about "Cholesterol")
• regulates the proper levels of many chemicals and drugs
• helps balance hormones
• produces certain immune factors (Read about "The Immune System")
• removes bacteria from the blood (Read about "Microorganisms")

Signs and symptoms of liver disease

Because of all that it does, a damaged liver can impact the rest of the body seriously. This can lead to a number of signs and symptoms. Not all of these may be present. In fact, some people with liver disease may have no symptoms. If symptoms are present, they can include:

• jaundice, a yellowing of the skin and eyes (Read about "Jaundice")
• fatigue
• abdominal pain or discomfort
• loss of appetite
• nausea, vomiting
• diarrhea (Read about "Diarrhea")
• low grade fever
• headache, fatigue
• enlarged liver
• itching, rashes (Read about "Skin Rash")
• joint pain
• spider angiomas (abnormal blood vessels) on the skin
• dark urine (Read about "The Urinary System")
• pale or gray colored stools
• peripheral neuropathy (Read about "Peripheral Neuropathy")

Liver diseases and some other digestive disorders can also result in damage to the brain. (Read about "The Brain") When the liver doesn't work the way it should to neutralize toxins in the body, those toxins can build up, resulting in encephalopathy. (Read about "Encephalopathy")

Diagnosing liver disease

When diagnosing liver disease, your doctor will consider your symptoms and conduct a physical examination. Additional tests may be done, including an ultrasound or a CT scan (Read about "CT Scan - Computerized Tomography" "Ultrasound Imaging"). Your doctor may also want a liver biopsy, in which a small sample of tissue is taken with a needle and then examined under a microscope (Read about "Biopsy"). Your doctor may also want to use a special endoscopic procedure called endoscopic retrograde cholangiopancreatography (ERCP). ERCP enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas.

Diseases and conditions

There are a number of diseases and conditions that can damage the liver, or result from damage to the liver. They include:

• Viral hepatitis - Hepatitis is inflammation of the liver. Several different viruses are known to cause viral hepatitis. They are the hepatitis A, B, C, D, and E viruses. All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong.
  • Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood. (Read about "Hepatitis A")
  • Hepatitis B can be spread through contact with infected blood, through sex with an infected person and from mother to child during childbirth. (Read about "Hepatitis B" "Childbirth")
  • Hepatitis C is spread primarily through contact with infected blood; less commonly, through sexual contact and childbirth. (Read about "Hepatitis C")
  • Hepatitis D is spread through contact with infected blood. Anyone infected with hepatitis B is also at risk of hepatitis D, especially if they are injection drug users, or if they live with or have sex with a person infected with hepatitis D. Also at risk, according to NIDDK, are people who received a transfusion of blood or blood products before July 1992 or clotting factors made before 1987. Chronic hepatitis D can be treated with alpha interferon. Preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person's personal items. (Read about "Hepatitis D")
  • Hepatitis E is spread through food or water contaminated by feces from an infected person. NIDDK says this disease is uncommon in the United States. International travelers are most at risk. Preventive measures include avoiding tap water when traveling internationally and practicing good hygiene and sanitation. Hepatitis E can resolve on its own over several weeks to months. (Read about "Hepatitis E")
  • Non A-E hepatitis is the term used for cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses.
• Toxic hepatitis and drug-induced hepatitis - Toxic hepatitis can result when the liver is exposed to toxins, such as certain poisons, chemical or drugs. For example, misuse or chronic use of acetaminophen can cause toxic hepatitis. Chronic use of certain medications or herbs can damage the liver. (Read about "Herbal Precautions" "Medicine Safety" "Medication & Digestion") Industrial chemicals, dry cleaning solvents and some poisonous mushrooms can also lead to this condition. The damage may result from a single exposure, or it may develop after repeated exposure. In some cases, ingestion of the toxin may have been accidental, such as a child taking medication from a bottle. (Read about "Poison Prevention") In many cases, the symptoms of toxic hepatitis will resolve when exposure to the toxin stops. Many people will recover once exposure to the contributing toxin is stopped. But sometimes, the damage is permanent and a liver transplant is the only option.
• Autoimmune hepatitis - Autoimmune hepatitis is a disease in which the body's immune system (Read about "The Immune System") attacks liver cells. This causes the liver to become inflamed (hepatitis). It can affect anyone, although women between the ages of 15 and 40 are affected most often. A genetic factor may be involved. (Read about "Genetics") It's usually chronic, meaning it can last for years, and can lead to cirrhosis (scarring and hardening) of the liver (Read about "Cirrhosis") and eventually liver failure. Type I occurs at any age, often in people with other autoimmune disorders, such as type 1 diabetes (Read about "Diabetes"), Sjögren's syndrome (Read about "Sjögren's Syndrome") or ulcerative colitis (Read about "Ulcerative Colitis"). Type II autoimmune hepatitis typically affects girls ages 2 to 14, although adults can have it too. With proper treatment, autoimmune hepatitis can usually be controlled. The primary treatment is medicine to suppress (slow down) an overactive immune system. NIDDK says that in about 7 out of 10 people, the disease goes into remission, with a lessening of severity of symptoms, within 2 years of starting treatment. Some people in remission will see the disease return within 3 years. Treatment may be necessary, on and off, for years if not for life.
• Cirrhosis - Cirrhosis is a progressive disease of the liver. In cirrhosis, scar tissue replaces normal, healthy liver tissue and blocks the flow of blood through the organ. (Read about "Cirrhosis")
• Jaundice - Jaundice is a symptom of other problems. Jaundice is caused by the orange-yellow pigment called bilirubin. It is formed when red blood cells break down. The liver extracts it from the blood and then puts it into the bile. Most of the time bilirubin leaves the body in the stool. Problems with the liver can result in bilirubin not being filtered out of the blood, resulting in jaundice. Likewise, a backup of bile can result in bilirubin not being flushed out of the body. Jaundice is quite common in newborns. The American Association of Pediatrics says most of the time it clears up on its own, but it can be a problem specifically for babies born before full-term. (Read about "Jaundice")
• Nonalcoholic steatohepatitis (NASH) - Nonalcoholic steatohepatitis or NASH is a common, often "silent" liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis (Read about "Cirrhosis"), in which the liver is permanently damaged and scarred and no longer able to work properly.
• Fatty liver or nonalcoholic fatty liver disease (NAFLD) - You can also have fat in the liver without inflammation or liver damage, a condition called "fatty liver." This problem is called nonalcoholic fatty liver disease (NAFLD). NIDDK says both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. (Read about "Obesity") Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. Diabetes and high blood cholesterol are also becoming more common among Americans. (Read about "Diabetes" "Cholesterol") NIDDK says the most important recommendations given to people with this disease are to lose weight or maintain a healthy weight (Read about "Losing Weight"), eat a healthy diet, exercise and avoid alcohol and unnecessary medication. (Read about "Alcoholism")
• Cancer - Liver cancer is relatively rare in the United States. There are different types, including hepatocellular, cholangiocarcinoma, angiosarcoma and hepatoblastoma. (Read about "Liver Cancer")
• Cysts - A cyst is a fluid-filled sac. It is not cancer. Many liver cysts cause no symptoms and need no treatment. Liver cysts usually grow slowly. But if they get large, they can cause pain and require drainage or removal. A cyst may also need to be removed if it can prevent bile from reaching the intestine. There is also a rare condition called polycystic liver disease, which is often associated with polycystic kidney disease. (Read about "Polycystic Kidney Disease")
• Hemochromatosis - Hemochromatosis is a hereditary disease, in which excess iron is stored in the pancreas, liver and skin. (Read about "Hemochromatosis")
• Alpha-1 antitrypsin deficiency (AAT) - ALF says this is the most common genetic cause of liver disease in children, but it may also appear in late childhood or adulthood. It is caused by the lack of a liver protein that blocks the destructive effects of certain enzymes. Symptoms in newborns include jaundice, swelling of the abdomen and poor feeding. Symptoms in adults include fatigue, poor appetite, swelling of the abdomen and legs or abnormal liver tests. It can lead to cirrhosis. (Read about "Cirrhosis")
• Bleeding disorders - bleeding disorders can sometimes be caused by liver disease. The liver produces proteins (or factors) that help blood coagulate. Liver disease may cause a deficiency of these blood factors, and thus may increase the risk of bleeding disorders in some people. (Read about "Bleeding Disorders")
• Gallstones - ALF calls gallstones a liver disease, and having liver disease can increase your risk of developing gallstones. Gallstones can block the bile ducts and cause a backup of bile into the body, resulting in jaundice. (Read about "Gallstones")
• Gilbert syndrome - Gilbert syndrome is a common, generally mild liver disorder. In Gilbert syndrome, the liver doesn't process bilirubin correctly. Bilirubin is produced by the breakdown of red blood cells. Gilbert syndrome is often discovered during a routine blood test (Read about "Laboratory Testing"), and usually doesn't require treatment. There are usually no symptoms other than the blood test results. If there are any symptoms, the most common is mild jaundice.

Children and liver disease

There are also many liver diseases that infants and children suffer from. Some of those are:

• Biliary atresia - Biliary atresia is caused by the abnormal development of the bile ducts. When the bile ducts are too small or not there at all, bile backs up and damages the liver. Surgical treatment is needed to correct the problem. This is a condition that can lead to cirrhosis. (Read about "Cirrhosis") Biliary atresia is the most common reason for liver transplantation in children, according to NIDDK. (Read about "Transplants")
• Galactosemia - This is an inherited condition where the body is unable to digest a milk sugar called galactose. Newborns can be screened for this at birth. Unless discovered, it can be fatal. The child must be taken off formulas with milk sugars. (Read about "Newborn Screenings")
• Wilson's disease - This is another inherited condition that leads to a build up of copper in the liver and nervous system. (Read about "Nervous System") It often appears first in childhood, though it can appear later on as well. The liver of a person who has Wilson's disease does not release copper into bile as it should. As the intestines absorb copper from food, the copper builds up in the liver and injures liver tissue. Eventually, the damage causes the liver to release the copper directly into the bloodstream, which carries the copper throughout the body. The copper buildup leads to damage in the kidneys, brain and eyes. If not treated, Wilson's disease can cause severe brain damage. (Read about "The Brain") Medications can be used to treat Wilson's disease. Liver transplantation may be indicated for those with very advanced disease.
• Reye's syndrome - This condition leads to a fat build up in the liver. It also impacts the brain and is often fatal. It is often connected with a case of chicken pox or a flu type illness. Taking aspirin with a fever by children has also been linked to Reye's. (Read about Chicken Pox and Aspirin Warning in "Childhood Illnesses")
• Alagille syndrome - This is an inherited disorder in which there is progressive loss of the bile ducts within the liver and narrowing of bile ducts outside the liver. Symptoms include jaundice, itchy skin, pale, loose stools and poor growth in the first three months of life. Treatment includes medications designed to increase the flow of bile, and dietary supplements. This is a condition that can lead to cirrhosis. (Read about "Cirrhosis")

Treat it well

If you have a healthy liver, taking care of it can help keep you healthy. Remember that just about everything that enters your body, food, medication, alcohol, even chemicals we absorb through our skin, passes through the liver. Send enough bad stuff there and you can expect problems. Megadoses of vitamins and herbal supplements (Read about "Herbal Precautions") can cause problems according to ALF so make sure you talk to your doctor before you start taking them.

Related Information:

    Digestive System

    Cholesterol