Most Common Liver Problems

If you ever wondered how your drugs, medications and other ingested products get detoxified in the body, ask the liver. And if you ever asked yourself where our body assembles amino acids to make proteins when needed, check the liver. And in the event that you were wondering how your blood sugar remains controlled even when you fast or spend several hours or days without eating, you should again ask your liver.

It plays a central role in digestion (with the emulsification of fats (with the secretion of bile), drugs and toxin metabolism (with the function of the microsome P450 system), formation of proteins with amino acids and regulation of blood sugar with processes such as gluconeogenesis and glycogenolysis.  Henceforth, diseases that affect the liver would impair more than that single organ: they would affect the entire body in general.

The most common types of liver diseases include:

• Fatty liver disease
• Portal hypertension
• Hepatitis
• Liver cirrhosis
• Liver cancer

Interestingly enough, although those diseases can be considered as individual entities, more often than not they can also progress from one state to the other.

Fatty Liver disease

Fatty liver disease is a metabolic state of temporary damage in which large vacuoles of fat (triglycerides) accumulate within the hepatocytes (liver cells) secondary to a toxic stimuli. Generally, this state of disease is reversible as the cellular architecture and the most important components are not damaged. With that said, removal of the toxic stimulus causes reversal of the metabolic state and return of the cells to normal. At a cellular level, the problem that causes fatty liver disease is a defect in fatty acid metabolism.
This can be due to either decreased energy consumption and combustion (maybe because there is not enough energy to process the fatty acids or we consume more fatty acids that can be processed at a time), or because of increased peripheral resistance to insulin, which also plays a crucial role in fatty acid metabolism. Fatty liver diseases has several causes, ranging from drugs and toxins, infections, nutritional or inflammatory states.

See Also: Fatty Liver: Treatment for Fat Accumulation in Liver Cells

However, the two most common causes (which we will discuss here) are alcoholism and obesity. In alcoholism for instance, the excess alcohol consumption causes toxic damage to the mitochondria which are the energy source of the cells, causing decreased energy for the metabolism of fats. In obesity, there is peripheral resistance to the effects of insulin, which also leads to increased fat storage. In both instances, the neutral fats first start to accumulate in the cytoplasm, around the nucleus, forming small vacuoles. This is called microvesicular changes. As the extent of the damage advances, more and more fats accumulate, thus occupying a larger surface area and eventually pushing the cellular nuclei at the periphery, giving the entire cell a characteristic appearance called “signet ring”. This is referred to as “macrovesicular changes”.  Fatty liver disease on its own is asymptomatic, but if it progresses to another stage, you could start experiencing symptoms of liver damage.

Portal Hypertension

Portal hypertension is a condition in which there is increased hydrostatic pressure in the portal venous system (elevation of pressure of more than 5 mmHg).

The portal vein is a vein like no others. It carries oxygenated blood from the gastrointestinal tract and the spleen to the liver (instead of the heart, like other normal veins). By doing so, the portal vein ensures that the liver is supplied with metabolites to function, and also that all ingested substances are processed and detoxified (if needed) before being redistributed to the entire body). This thus ensures that all the blood and nutrients dispatched to the entire body have been checked first in the liver.

Prehepatic causes include portal vein thrombosis or congenital atresia of the portal vein. In these conditions, the portal vein is directly occluded before its entrance in the liver, thus causing a pressure build-up and fluid build-up. Intrahepatic causes of portal hypertension stem from the liver, and liver cirrhosis is the most common one. In this condition, the liver tissue has become fibrotic as a result of sustained injury, and the portal vein is unfortunately trapped in the fibrotic tissue, causing pressure. Post hepatic causes occur between the liver and the right heart, and include any condition that could affect the inferior vena cava.

Because of increased pressure in the portal system, blood is forced to be shifted in the systemic circulation and at the sites where the portal system and the systemic circulation join. These include the esophagus (the patient could present with vomiting blood), the umbilicus (the patience could present with engorged blood vessels around the navel, giving it a “spider web” appearance), the anus (the patient could present with hemorrhoids, also known as “piles”). Additionally, because the liver is no more able to produce proteins (due to damage of its tissue), systemic edema occur, with fluid buildup in the abdomen (ascites), the legs peripheral edema) and even in the lungs (pleural effusion).

Hepatitis

Hepatitis is defined as inflammation of the liver (“heap” = related to liver, and “it is” = inflammation). This is a multifactorial disease, and can result from a wide variety of injuring agents.

Non alcoholic hepatitis can result from viral infections (hepatitis A, B, C, D, E), parasitic infections (schistosomiasis), drug use, just to name a few. Medically, the symptoms and clinical presentation are the same in both cases. The only clue that your physician could have to determine whether hepatitis is alcoholic or not are your social history (which highlights your alcohol intake) and your liver function tests: in alcoholic hepatitis, the AST/ALT ratio is 2:1 (which means AST is higher than ALT). AST (Aspartate Transaminase) and ALT (Alanine Transaminase) are two liver enzymes located intracellularly, and that leak into the plasma with liver damage. AST is locate in the mitochondria, and given that alcohol intake causes damage to the mitochondria, you will have higher levels of AST in the blood compared to ALT (which is located in the cytoplasm).

Liver Cancer

Chronic hepatitis and liver cirrhosis can result into liver cancer. IN fact, the leading cause of liver cancer is cirrhosis secondary to viral hepatitis caused by hepatitis viruses B and C. Here, the pathogenesis is simple: because of chronic and continuous inflammation of the liver, the cells are constantly dividing in attempt to achieve cellular repair, which leads to an increased rate of errors during mitosis and increased risk of cancer. Also, the hepatitis B and C viruses themselves cause direct modification of the cellular genetic material, increasing the risk of cancer. Liver cancer can also be secondary from metastases from other tissues (breast, lung, renal, bone, colon or prostate cancers).  In that case, the chances of survival are much lower, because metastasis is a red flag for disease progression.

See Also: Alternative Liver Cancer Treatments

Common Symptoms of liver disease

Common symptoms of liver disease include: sweating, jaundice, abdominal pain, weight loss and hepatomegaly (liver enlargement). In addition to these, liver cancer is generally associated with abdominal mass, abdominal pain, emesis, anemia, back pain, jaundice, itching, weight loss and fever.