The functions of the normal liver

The liver is the largest internal organ in the body. It is located mainly in the upper right side of the abdomen, situated mostly under the lower ribs. It weighs about three pounds and is roughly the size of a football.

The normal liver is soft and smooth and is connected to the small intestine by the bile duct which carries the bile formed in the liver to the intestines. Nearly all of the blood that leaves the stomach and intestines must pass through the liver. Acting as the body's largest chemical factory, it has thousands of functions including:

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  The production of clotting factors, blood proteins, bile, and more than a thousand different enzymes


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  The breakdown of old red blood cells


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  The metabolism of cholestrol

• The storage of energy (glycogen) to fuel muscles
  
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  Maintenance of normal blood sugar concentration


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  The regulation of several hormones


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  Detoxification of drugs and poisons, including alcohol

The relationship of the liver to the blood is unique. Unlike most organs in the body, only a small amount of blood is supplied to the liver by arteries. Most of the liver's supply of blood comes from the intestinal veins as the blood returns to the heart. The main vein that returns blood from the intestines is called the
portal vein. As the portal vein passes through the liver, it breaks up into increasingly smaller and smaller veins. The tiniest veins (called sinusoids because of their unique structure) are in close contact with the liver cells. In fact, the liver cells line up along the length of the sinusoids.

This close relationship between the liver cells and blood from the portal vein allows the liver cells to remove and add substances to the blood. Once the blood has passed through the sinusoids, it is collected in increasingly larger and larger veins that ultimately form a single vein, the hepatic vein that returns the blood to the heart.

Under normal circumstances, the liver has the ability to heal itself by repairing or replacing damaged cells. With cirrhosis, the healing process is altered.

Other complications associated with liver cirrhosis

• Osteoporosis - decreased bone mass and density

Cirrhosis interferes with the liver’s ability to produce vitamin D and calcium, which promote bone growth, density and health.

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  Hepatocellular carcinoma - Liver cancer

Cirrhosis increases the risk of developing primary (originates in the liver) liver cancer. A secondary liver cancer is one that originates elsewhere in the body and spreads (metastasizes) to the liver.

The most common symptoms and signs of primary liver cancer are:

• Abdominal pain and swelling
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  Enlarged liver
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  Weight loss
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  Fever

In addition, liver cancers can produce and release a number of substances, including ones that cause:

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  Increased red blood cell count (erythrocytosis)
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  Low blood sugar (hypoglycemia)
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  High blood calcium (hypercalcemia)

• Liver failure

This occurs when damage to the liver becomes so extensive that the liver cannot function.

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  Kidney failure - Hepatorenal syndrome.

Hepatorenal syndrome is the progressive failure of the kidneys to clear substances from the blood and produce adequate amounts of urine even though some other important functions of the kidney, such as retention of salt, are maintained.

Reduced function of the kidneys is the result of the accumulation of toxic substances in the blood when the liver fails. There are two types of hepatorenal syndrome. One type occurs gradually over months. The other occurs rapidly over a week or two.

If liver function improves or a healthy liver is transplanted into a patient with hepatorenal syndrome, the kidneys usually begin to work normally.

• Hypersplenism

The spleen normally acts as a filter to remove older red blood cells, white blood cells, and platelets (small particles that are important for the clotting of blood.). The blood that drains from the spleen joins the blood in the portal vein from the intestines. As the pressure in the portal vein rises in cirrhosis, it increasingly blocks the flow of blood from the spleen. The blood “backs-up” and accumulates in the spleen, and the spleen swells in size, a condition referred to as splenomegaly. Sometimes, the spleen is so swollen that it causes abdominal pain.

As the spleen enlarges, it filters out more and more of the blood cells and platelets until their numbers in the blood are reduced.

Symptoms include:

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  Anemia - low red blood cell count
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  Leucopenia - low white blood cell count
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  Thrombocytopenia - low platelet count

The anemia can cause weakness, the leucopenia can lead to infections, and the thrombocytopenia can impair the clotting of blood and result in prolonged bleeding.

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  Hepatopulmonary syndrome

Rarely, some patients with advanced cirrhosis can develop the hepatopulmonary syndrome.

Symptoms include:

• Shortness of breath, particularly with exertion – due to certain hormones being released which causes the lungs to function abnormally.

The problem is that not enough blood flows through the small blood vessels in the lungs that are in contact with the alveoli (air sacs) of the lungs. Blood flowing through the lungs is shunted around the alveoli and cannot pick up enough oxygen from the air in the alveoli.

What is liver cirrhosis?

Cirrhosis is a term that refers to a disease in which normal liver cells are damaged and replaced with scar tissue, decreasing the amount of normal liver tissue which results in disruption of normal liver function. There are many diseases that injure and kill liver cells, which lead to cirrhosis. It’s the inflammation and repair that is associated with the dying liver cells that cause’s scar tissue to form.

The scar tissue interferes with the flow of blood through the liver and the loss of normal liver tissue, leads to the failure of the liver to perform some of its critically important functions.

Cirrhosis is a term that refers to a disease in which normal liver cells are damaged and replaced with scar tissue, decreasing the amount of normal liver tissue which results in disruption of normal liver function. There are many diseases that injure and kill liver cells, which lead to cirrhosis. It’s the inflammation and repair that is associated with the dying liver cells that cause’s scar tissue to form.

The scar tissue interferes with the flow of blood through the liver and the loss of normal liver tissue, leads to the failure of the liver to perform some of its critically important functions.

For example, liver cells are responsible for the production of bile. Bile has two important functions: to aid in digestion and to remove and eliminate toxic substances from the body. In cirrhosis, the canaliculi are abnormal and the relationship between liver cells and canaliculi is destroyed, just like the relationship between the liver cells and blood flow. As a result, the liver is not able to eliminate toxic substances normally, and they can accumulate in the body. To a minor extent, digestion in the intestine also is reduced.

For example, liver cells are responsible for the production of bile. Bile has two important functions: to aid in digestion and to remove and eliminate toxic substances from the body. In cirrhosis, the canaliculi are abnormal and the relationship between liver cells and canaliculi is destroyed, just like the relationship between the liver cells and blood flow. As a result, the liver is not able to eliminate toxic substances normally, and they can accumulate in the body. To a minor extent, digestion in the intestine also is reduced.

Symptoms of (latter stage) liver disease (cirrhosis)

Evidence of cirrhosis may not develop until the patient experiences complications of the disease. These include:

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  Abnormal nerve function (peripheral neuropathy)
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  Enlarged breasts in men (gynecomastia)
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  Shrinking (atrophy) of testicles in men
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  Itching of the hands and feet that spreads to other parts of the body - due to bile products that are deposited in the skin
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  Spider-like veins (spider angiomas) that develop under the skin
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  Abdominal pain – due to enlargement of the liver
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  Jaundice - yellowing of the skin and whites of the eyes

This is caused by inability of the liver to remove the bile pigment bilirubin from the blood. Bilirubin is formed from the breakdown of red blood cells that gives bile its colour.

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  Gallstones - caused by not enough bile reaching the gallbladder

• Bruising easily

This is caused by the decreased production of blood clotting factors by the diseased liver. Liver damage interferes with the liver’s absorption of vitamin K and the production of proteins that help the blood clot. As a result, patients may bruise easier and bleed more frequently.

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  Dark, cola-coloured urine
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  Portal hypertension

Blood from the intestines, spleen and pancreas enter the liver through a large blood vessel called the portal vein. When scar tissue in the liver impedes blood flow it can result in increased pressure in the vein.

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  Ascites - fluid in the abdominal cavity

Cirrhosis can cause large amounts of fluid to build up in the abdominal cavity. This accumulation of fluid causes swelling of the abdomen, abdominal discomfort, and increased weight. The fluid may also interfere with breathing or become infected (spontaneous bacterial peritonitis).

Spontaneous bacterial peritonitis (SBP)

Fluid in the abdominal cavity (ascites) is the perfect place for bacteria to grow. Normally, the abdominal cavity contains a very small amount of fluid that is able to resist infection, and bacteria that enter the abdomen (usually from the intestine) are killed or find their way into the portal vein and to the liver where they are killed.

In cirrhosis, the fluid that collects in the abdomen is unable to resist infection as normal. In addition, more bacteria find their way from the intestine into the ascites.

This complication may be life- threatening, and whereas some patients with this complication have no symptoms, others have fever, chills, abdominal pain and tenderness, diarrhea, and worsening ascites.

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  Edema - swelling of the legs and feet

This is caused by signals that are sent to the kidneys to retain salt and water in the body. The excess salt and water accumulates in the tissue beneath the skin of the ankles and legs because of the effect of gravity when standing or sitting.

This accumulation of fluid is called edema or pitting edema. Pitting edema is the result of any pressure (e.g. fingertip; sock) that causes an indentation in the skin which persists for some time after the release of the pressure. The swelling tends to be worse at the end of a day after standing or sitting and may lessen overnight as a result of the loss of the effects of gravity when lying down.

• Encephalopathy

Some of the protein in food that escapes digestion and absorption is used by bacteria that are normally present in the intestine. While using the protein for their own purposes, the bacteria make substances that they release into the intestine. These substances then can be absorbed into the body. Some of these substances can have toxic effects on the brain. Ordinarily, these toxic substances are carried from the intestine in the portal vein to the liver where they are removed from the blood and detoxified.

In addition, some of the blood in the portal vein bypasses the liver through other veins, increasing the accumulation of toxic substances in the blood.

Symptoms of encephalopathy may include:

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  Mental confusion, such as forgetfulness or difficulty concentrating
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  Irritability
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  Mood changes
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  Abnormal sleep patterns - Sleeping during the day rather than at night. Reversal of the normal pattern is among the earliest symptoms of hepatic encephalopathy.
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  Drug sensitivity - The toxic substances also make the brains of patients with cirrhosis very sensitive to drugs that are normally filtered and detoxified by the liver. Doses of many drugs that normally are detoxified by the liver have to be reduced to avoid a toxic buildup in cirrhosis, particularly sedatives and drugs that are used to promote sleep.
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  Loss of memory
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  Delirium and coma
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  Hepatic encephalopathy Infection

The decreased immune system function from liver damage may lead to increased bacterial infections.

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  Varices - esophageal vein bleeding

When blood flow (returning to the heart from the intestines) in the portal vein is blocked due to scar tissue, it can raise the pressure in the portal vein (portal hypertension). When pressure in the portal vein becomes high enough, it causes blood to flow around the liver through veins with lower pressure to reach the heart. The most common veins through which blood bypasses the liver are the veins lining the lower part of the esophagus and the upper part of the stomach.

The abnormally increased blood flow and the resulting increase in pressure, in nearby blood vessels may cause veins to become stretched and dilated (varices). Because the walls of the blood vessels are thin, this can lead to bleeding. The higher the portal pressure, the larger the varices and the more likely a patient is to bleed from the varices into the esophagus or stomach. Bleeding from varices is usually severe and, without immediate treatment, can be fatal.

Symptoms of bleeding from varices include:

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  Vomiting blood - red blood mixed with clots
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  Black stools - due to changes in the blood as it passes through the intestine (melena)
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  Dizziness or fainting - caused by a drop in blood pressure especially when standing up from a lying position

Bleeding also may occur from varices that form elsewhere in the intestines, for example, the colon, but this is rare. For reasons yet unknown, patients hospitalized because of actively bleeding esophageal varices have a high risk of developing spontaneous bacterial peritonitis.

Symptoms of (early stage) Liver disease (cirrhosis)

Because cirrhosis takes years to develop, patients may have few or no symptoms (in the early stages) of liver disease. Some of the symptoms may be nonspecific (indicating that the liver may not be the cause). However, as the disease progresses and the liver function deteriorates, other symptoms may develop.

The most common signs and symptoms of the early stages of cirrhosis include:

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  Loss of appetite
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  Weight loss
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  Nausea
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  Weakness and exhaustion
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  Fatigue or exhaustion
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  Loss of interest in sex

Welcome to my blog!

Hi

After first hand experiance of dealing with a loved one with cirrhosis of the liver, I want to do as much as humanly possible to help other people come to terms with and deal with the condition in a positive way! Knowledge is power! with this knowledge you can deal with anything that comes your way!

If you or a member of your family, or loved one has or overcome liver cirrhosis, please add your comments and views. Any help would be gratefully received.