Liver (Hepato)
Liver is a unique organ in body. it is lies in right upper part of abdomen. Liver is divided into right and left lobes which is further divided into 8 segments. An adult liver weighs around 1.2 kg and is the largest organ of the body. Liver lies below the diaphragm and is related with gall bladder on undersurface and stomach on the left. The blood inflow to liver is around 1500 ml/min. which is the higher than any other organ of body and is through two main vessels namely -hepatic artery and portal vein. The outflow vessels known as hepatic veins carries blood away from liver into the inferior vena cava (IVC). Liver synthesize bile which leaves liver through bile ducts (hepatic ducts).
Functions of Livere
Liver carries important function of metabolizing food, removal of toxins from body, store house of nutrients and vitamins beside synthesis of key coagulation factors required for blood clotting. Thus it maintains body homeostasis and regulates our immune response.
The common liver diseases
- Alcohol induced liver cirrhosis- is most common cause of liver damage due to long-term consumption of alcohol.
- Acute liver failure- rapid progression of jaundice and complete liver failure in a short span of time. The most common cause is alcohol, viral hepatitis and liver toxic drugs. These patients require emergency liver transplantation if not improving by medical managements
- Hepatitis B/C induced liver cirrhosis- hepatitis B virus (HBV) and hepatitis C virus (HCV) is common cause of chronic liver cirrhosis leading to end stage liver disease. The most common pathway for transmission of these virus is through blood followed by sexual route.
- Non alcoholic fatty liver disease (NAFLD)- obesity and fatty liver is becoming a leading cause of end stage liver disease and liver cirrhosis worldwide. Early stage of fatty liver disease is reversal and prevents development of liver cirrhosis if treated on time.
- Liver cancers- most common liver cancer is hepatocellular carcinoma which usually develops in patients of underlying liver cirrhosis
- Primary biliary cirrhosis- is an immune mediated damage of bile ducts of liver leading to liver cirrhosis
- Biliary atresia- congenital malformation of bile duct leading to jaundice and damage of liver in children
- Budd chiari syndrome- obstruction of hepatic venous outflow, leading to ascites and damage of liver
- Wilsons disease- copper deposition in liver leading to liver failure
- Sclerosing cholangitis
Symptoms of Liver disease
In early stage of liver disease, the symptoms are nonspecific. Development of fatigue, pain abdomen, recurrent fever, anorexia (decrease appetite), dark colored urine, yellowish sclera of eyes or inability to concentrate can be few early signs of liver disease. Signs of advanced liver disease are-
- Bleeding (hematemesis) – through mouth or per rectum
- Jaundice- yellowish discoloration of skin and sclera of eyes
- Ascites- collection of fluid into abdomen leading to tense abdomen. It is a sign of advanced liver failure. Such patients are at risk of further kidney damage due to fluid removing (diuretic) medications
- Hepatic encephalopathy- the condition from inability to concentrate or sleep deprivation to end stage coma. It is a sign of advanced liver disease and such patients should be in regular follow up doctors. These patients should avoid constipation and sedative (sleep causing) drugs
Assessment of stage of liver cirrhosis
Assessment of stage of liver cirrhosis is done by 2 widely used scoring system
- Child score -CTP score includes serum bilirubin level, serum albumin, INR, ascites and hepatic encephalopathy. Usually a Child A patients do not require a liver transplant unless it is associated with hepatocellular carcinoma
- MELD score- is more commonly used scoring system. It includes serum bilirubin, serum creatinine and INR, besides sodium levels
