Know your Liver, Dr S. Vivekanandan – October 8th, 2012
Senior Consultant, HPB & Liver Transplantation
How does the liver work?
The liver is the largest organ in the body (weighing about1.2 to 1.5kg).
It is located on the right side of the abdomen, directly beneath the right
lung, and is protected by the lower half of the rib cage. It performs many
complex functions that are essential to life and good health.
Functions of the liver
The liver performs a host of functions (well over 500) but the basic ones are:
Production of plasma proteins:
• Factor 1 and 2: Clotting proteins that are responsible for ensuring that the blood can clot following injury
• Plasma proteins namely the protein albumin which, amongst other things, keeps fluids within the blood vessels.
Storage of trace elements and vitamins:
• fats and fat soluble vitamins (A, D, E, K)
• Glycogen, a product made by the liver as a method of storing energy that can be converted back at time of need to maintain the bloods sugar levels
Metabolism (breaking down) of substances:
• Fats and fat soluble vitamins
• Certain trace elements e.g. copper
Detoxification (rendering harmless):
• steroid and thyroid hormones
Excretion (removal) of:
• Copper and iron
• Some drugs
• Lactate (a substance produced by the body during metabolism)
• The liver cells contribute towards natural immunity by producing some antibodies. A special type of cell found in the liver called ‘Kupffer’ cells also help to clear unwanted substances from the body.
Liver Diseases & Its Symptoms
Most patients are assessed for liver transplantation primarily because
the liver is no longer functioning well and this ‘liver failure’ can be
successfully treated by liver transplantation.
Liver failure most commonly occurs due to chronic insult or injury to the liver, this is called chronic liver disease. However occasionally liver failure can occur when the liver stops working due to severe or acute damage to the liver, this is called acute liver failure. In both situations Liver transplantation is usually recommended when liver failure worsens despite medical treatment.
Common indications for liver transplantation in adults include: chronic
hepatitis B, chronic hepatitis C, primary biliary cirrhosis (PBC), primary
sclerosing cholangitis (PSC), autoimmune liver disease and alcoholic
liver disease. Other indications include wilson’s disease (copper overload) haemochromatosis (iron deposition in the liver), alpha 1 anti-trypsin and acute liver disease. Sometimes it is not possible to identify an exact cause of liver failure.
Some people who do not have liver failure may benefit from liver
transplantation. In particular, patients with primary liver cancer may
be considered. In rare cases some patients with normal liver function,
but with a metabolic disease which causes symptoms elsewhere in
the body, would benefit from liver transplantation.
Signs and Symptoms of Liver disease
The symptoms of chronic liver disease vary slightly due to the cause
of the original disease.
People may suffer from the following symptoms:-
• Increased feeling of fatigue and lethargy.
• Jaundice (yellowing of the eyes and skin).
• Dark coloured urine / Pale, clay coloured stool.
• Ascites – an abnormal accumulation of fluid in the abdomen.
• Oedema – an abnormal accumulation of fluid in the tissues,
most noticeable in the legs.
• Vomiting blood or passing of dark, tarry stools.
• Tendency to bleed or bruise easily.
• Mental confusion or coma (encephalopathy), when the liver disease is severe.