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Liver Disease is any disturbance of liver function that causes illness. The liver is responsible for many critical functions within the body and should it become diseased or injured, loss of those functions can cause significant damage to the body. Liver disease is also referred to as hepatic Disease. Liver Disease is a broad term that covers all potential problems that cause the liver to fail to perform its designated functions. Usually, more than 75% or three quarters of liver tissue needs to be affected before a decrease in function occurs. The liver is the largest solid organ in the body; and is also considered a gland because, among its many functions, it makes and secretes bile. The liver is located in the upper right portion of the abdomen protected by a rib cage. It has two main lobes that are made up of tiny lobules. Liver cells have two different sources of blood supply. Hepatic artery supplies oxygen rich blood that is pumped from the heart, while portal vein supplies nutrients from the intestine and spleen. Normally, veins return blood from body to heart, but portal veins allow nutrients and chemicals from the digestive tract to enter the liver for processing and filtering prior to entering general circulation. Portal vein also efficiently delivers chemicals and proteins that liver cells need to produce proteins, cholesterol, and glycogen required for normal body activities. As part of its function, liver makes bile, fluid that contains, among other substances, water, chemicals, and bile acids. Bile is stored in the gallbladder and when food enters the duodenum, bile is secreted into the duodenum, to aid in digestion of food. The liver is the only organ in the body that can easily replace damaged cells, but if enough cells are lose, liver may not be able to meet the needs of the body. Liver can be considered a factory; and among its many functions include: production of bile that is required in digestion of food, in particular fats Storing of extra glucose or sugar as glycogen, and then converting it back into glucose when the body needs it for energy Production of blood clotting factors Production of amino acids, including those use to help fight infection processing and storage of Iron necessary for red blood cell Production manufacture of cholesterol and other chemicals require for fat transport conversion of waste products of body metabolism into urea that is excrete in urine Metabolizing medications into their active ingredient in body Cirrhosis is term that describe permanent scarring of Liver. In Cirrhosis, normal liver cells are replaced by scar tissue that cannot perform any liver function. Acute Liver failure may or may not be reversible, meaning that on occasion, there is a treatable cause and the liver may be able to recover and resume its normal functions.
Embryologically, liver grows as ventral diverticulum from the junction of foregut and midgut into the ventral mesogastrium. The same diverticulum forms gallbladder and bile ducts as well. Ligamentum teres hepatis is an obliterate umbilical vein, which joins the left portal vein; ligamentum venosum is obliterate ductus venosus, which joins the left portal vein to the left hepatic vein. The upper surface of the liver is percuss at the level of fifth intercostal space. Superior, anterior, posterior and right surfaces of the liver are continuous with each other and are related to the diaphragm and anterior abdominal wall. The anterior surface is separate from the inferior surface by a sharp anterior border that is clinically palpable on deep inspiration. Inferior surface is related to hepatic flexure, right kidney, transverse colon, duodenum and stomach. The Gallbladder straddles the undersurfaces of liver segments IVB and V. There is an H - shaped fissure on the inferior surface of the liver. The right vertical arm of H is formed by gallbladder anteriorly and inferior vena cava posteriorly; it is incomplete, with Caudate process between the two. The vertical arm of H is formed by ligamentum teres hepatis in front and ligamentum venosum behind. Transverse limb of H is porta hepatis, 5 - cm transverse fissure on the undersurface of liver with quadrate lobe in front and Caudate lobe behind. It contains common hepatic duct in front and to right, proper hepatic artery in front and to left, and portal vein behind, enclose in hepatoduodenal ligament, composed of 2 layers of lesser omentum. Anatomically, liver is divided into a larger right lobe and a smaller left lobe by falciform ligament. This division, however, is of no use surgically. From a surgical point of view, liver is divided into right and left lobes of almost equal size by a major fissure running from gallbladder fossa in front to IVC fossa behind. This division is based on right and leave branches of hepatic artery and portal vein, with tributaries of bile ducts following. The middle hepatic vein lies in Cantlie's line. Leave pedicle has a longer extrahepatic course than right. Each lobe is divided into 2 sectors. Right hepatic vein divides the right lobe into anterior and posterior sectors; leave hepatic vein divides the left lobe into medial and lateral sectors. While falciform ligament and umbilical fissure mark division between leave lateral and leave medial sectors on surface of liver, no surface marking is observed between right anterior and right posterior sectors. The posterior sector of right lobe and caudate lobe are not seen on frontal view of the liver; anterior sector of the right lobe forms the right lateral border in this view.
Livers control most chemical levels in the blood. It also secretes clear yellow or orange fluid called bile. Bile helps to break down fats, preparing them for further digestion and absorption. All of the blood leaving the stomach and intestines passes through the liver. The liver processes this blood and breaks down, balances, and creates nutrients for the body to use. It also breaks down medicines in blood into forms that are easier for the body to use. Livers do many important things, including: making bile, which helps carry away waste and break down fats in small intestine during digestion, making certain proteins for blood plasma, making cholesterol and special proteins to help carry fats through body stores and release glucose as needed to process hemoglobin to use its iron content changes harmful ammonia to urea Clears blood of medicines and other harmful substances regulate blood clotting Fights infections by making immune factors and removing bacteria from bloodstream Clears bilirubin when liver has break down harmful substances, they are excrete into bile or blood. Bile by - products enter the intestine and ultimately leave the body in bowel movements. Blood by - products are filtered out by kidneys and leave the body in the form of urine.
Many conditions can affect your liver. Here look AT some of the main ones. Hepatitis is a viral infection of your liver. It causes inflammation and liver damage, making it difficult for your liver to function as it should. All types of hepatitis are contagious, but you can reduce your risk by getting vaccinated for types and B or taking other preventive steps, including practicing safe sex and not sharing needles. Hepatitis is typically spread through contact with contaminated food or water. Symptoms may clear up without treatment, but recovery can take a few weeks. Hepatitis B can be acute or chronic. Its spread through bodily fluids, such as blood and semen. While hepatitis B is treatable, there is no cure for it. Early treatment is key to avoiding complications, so it is best to get regular screenings if youre AT risk. Hepatitis C can also be acute or chronic. It often spread through contact with blood from someone with hepatitis C. While it often does cause symptoms in its early stages, it can lead to permanent liver damage in its later stages. Hepatitis D is a serious form of hepatitis that only develops in people with hepatitis B. It ca be contracted on its own. It can also be either acute or chronic. Hepatitis E is usually caused by drinking contaminated water. Generally, it clears up on its own within a few weeks without any lasting complications. Fat buildup in the liver can lead to fatty liver disease. Alcoholic fatty liver disease, which is caused by heavy alcohol consumption, and nonalcoholic fatty liver disease, which is caused by other factors experts are still trying to understand left unmanaged, Both types of fatty liver disease can cause liver damage, leading to cirrhosis and liver failure. Diet and other lifestyle changes can often improve symptoms and reduce your risk of complications. Autoimmune conditions involve your immune system mistakenly attacking healthy cells in your body. Several autoimmune conditions involve your immune system attacking cells and your liver, including: autoimmune hepatitis. This condition causes your immune system to attack your liver, resulting in inflammation. Left untreated, it can lead to cirrhosis and liver failure. Primary biliary cirrhosis. This results from damage to bile ducts in your liver, causing buildup of bile. Pbc can lead to eventual cirrhosis and liver failure. Primary sclerosing cholangitis. This inflammatory condition causes gradual damage to your bile ducts. They eventually become blocked, causing bile to build up in your liver. This can lead to cirrhosis or liver failure. Several genetic conditions, which you inherit from one of your parents, can also affect your liver: hemochromatosis causes your body to store more iron than it need.Sss This iron remains in your organs, including your liver. This can lead to damage over long periods of time if not manage. Wilsons disease causes your liver to absorb copper instead of releasing it into your bile ducts.
Chronic liver failure develops more slowly than acute liver failure. It can take months or even years before you exhibit any symptoms. Chronic liver failure is often the result of cirrhosis, which is usually caused by long - term alcohol use. Cirrhosis occurs when healthy liver tissue is replaced with scar tissue. During chronic liver failure, your liver becomes inflame. This inflammation causes formation of scar tissue over time. As your body replaces healthy tissue with scar tissue, your liver begins to fail. Alcoholic fatty Liver disease: Alcoholic fatty liver disease is result of fat cells deposited in the liver. It generally affects those who drink a lot of alcohol and those who are obese. Alcoholic hepatitis: Alcoholic hepatitis is characterized by fat cells in the liver, inflammation, and scarring. According to the American Liver Foundation, up to 35 percent of people who drink heavily will develop this condition. Alcoholic cirrhosis: Alcoholic cirrhosis is considered the most advanced out of the three types. The American Liver Foundation says that some form of cirrhosis affects 10 to 20 percent of people who drink heavily.
Bile is an important fluid as it helps excrete material not excreted by kidneys and aids in absorption and digestion of lipids via secretion of bile salts and acids. Bile is produced by hepatocytes and is mainly composed of water, electrolytes, bile salts, bile acids, cholesterol, bile pigment, bilirubin, and phospholipids in addition to other substances. Bile is secreted from hepatocytes into bile canaliculi where it travels from smaller ducts to larger ducts, eventually ending up in the duodenum or being stored in the gallbladder for storage and concentration as determined by duct and sphincter of Oddi pressures. Following secretion of bile into the duodenum, it undergoes enterohepatic circulation, where it performs its job in the bowel, and bile components that are not excreted are recycled by conversion into bile acids by gut bacteria for reuse by absorption in ileum and transport back to the liver. Most fat - soluble vitamins reach the liver via intestinal absorption in form of chylomicrons or VLDL. Liver stores and / or metabolizes fat - soluble vitamins. As discussed earlier, vitamins are stored in Ito cells. It can undergo oxidation into the retinal followed by retinoic acid for phototransduction, or retinoic acid can be conjugated into glucuronide for secretion into bile. Whether vitamin D3 comes from skin, animal products, or plant products, it must undergo 25 - hydroxylation by hepatic CYP - 450 system, which is further hydroxylated in the kidney to achieve its functional form. The Hepatic CYP - 450 system then hydroxylates carbon 24 to render vitamin D inactive. Livers receive vitamin E in its alpha and gamma - tocopherol forms. Alpha - tocopherol is integrated with VLDL or HDL in the liver and is then secreted back into circulation while the liver metabolizes gamma - tocopherol form for excretion. While vitamin K is not stored or metabolized in the liver, its presence is essential as the liver enzyme, gamma - glutamyl carboxylase requires it for gamma - carboxylation of coagulation factors II, VII, IX, X, and protein C and protein S. Another critical function of the liver is metabolism and / or detoxification of xenobiotics. Livers use lysosomes for some of these substances, but the major route of metabolism and detoxification is through biotransformation. Liver functions to transform xenobiotics mainly by converting them from lipophilic form to hydrophilic form through 2 reactions: phase I and phase II. These reactions mainly take place in smooth endoplasmic reticulum of hepatocytes. Phase I reactions create more hydrophilic solute via oxidation, reduction, and hydrolysis using primarily cytochrome P450 family of enzymes. Product of phase I has oxygen species that react better with enzymes involved in phase II reactions. Phase II reactions conjugate metabolites created in phase I to make them more hydrophilic for secretion into blood or bile. There are three main avenues for conjugation performed in phase II reactions: conjugation to glucuronate, glutathione, or sulfate. Conjugation to glucuronate, such as with bilirubin, takes place in smooth endoplasmic reticulum.
Because of the importance of the liver and its functions, evolution has ensure that it can regrow rapidly as long as it is kept healthy. This ability is seen in all vertebrates, from fish to humans. The liver is the only visceral organ that can regenerate. It can regenerate completely, as long as a minimum of 25 percent of tissue remain. One of the most impressive aspects of this feat is that the liver can return to its previous size and ability without any loss of function during the growth process. In mice, if two - thirds of the liver is remove, remaining liver tissue can regrow to its original size within 5 to 7 days. In humans, process takes slightly longer, but regeneration can still occur in 8 to 15 days - an incredible achievement, given the size and complexity of the organ. Over the following few weeks, new liver tissue become indistinguishable from the original tissue. This regeneration is helped by a number of compounds, including growth factors and cytokines. Some of the most important compounds in the process appear to be: hepatocyte growth factor insulin transforming growth factor - alpha epidermal growth factor interleukin - 6 norepinephrine
Despite multiple studies of liver regeneration, many aspects of this phenomenon remain to be further understood. Changes associated with PHx that constitute first trigger are still not clear, but it is inevitable that large hemodynamic alterations seen after in remnant liver after PHx must play a role. Equally unclear but slightly better understood are signaling pathways leading to the end of regeneration at the right time. In skin, intestine and blood, tissue restoration occurs by proliferation of stem cells, and it is a local affair. Wound healing and associated phenomena, with which liver regeneration has many similarities, is also local affair. With liver, this is not the case. Liver function affect the entire body and the consequences of liver failure are anything but local. Fully differentiated hepatocytes continue to carry the burden of maintaining homeostasis for the entire body and, at the same time, restoring liver mass. Many recent studies have focused on signaling pathways that allow hepatocytes to maintain most of their homeostatic functions and proliferate at the same time. This aspect of liver regeneration, as well as events of very beginning and end of regeneration can be better study, now that a solid framework of growth factors, cytokines and cellular events regulating regeneration has been laid out.
Liver function panel is a blood test to check how well the liver is working. This test measures blood levels of total protein, albumin, bilirubin, and liver enzymes. High or low levels may mean that liver damage or disease is present. Livers serve several important functions in the body, including changing nutrients into energy for the body and breaking down toxic substances. Your doctor may order a liver function panel if you have symptoms of liver disease. These symptoms include fever, vomiting, abdominal pain, yellowing of your eyes or skin, dark yellow urine, and feeling very tired. This blood test also may be do if you have recently been exposed to hepatitis virus or are taking medicine that may cause liver damage.
The liver is an organ located in the upper right part of the belly. It is beneath the diaphragm and on top of the stomach, right kidney, and intestines. Liver has many functions. There are 2 distinct sources that supply blood to the liver: oxygenate blood flows in from the hepatic artery. Nutrient - rich blood flows in from the hepatic portal vein. The liver has 2 main sections. Both are made up of 8 segments. Segments are made up of thousand small lobes. Lobules are connected to small ducts that connect with larger ducts to ultimately form common hepatic duct. The Common hepatic duct transports bile made by liver cells to the gallbladder and first part of the small intestine. Bile is clear yellow or orange fluid that helps digest food.
Serum measurements of various liver - derive enzymes and Bilirubin are frequently measured in clinical practice. This review focuses on associations between abnormal levels of liver function tests and the risk of cardiovascular disease. Mildly elevated - glutamyltransferase levels are independently associated with future CVD events in most published studies. The association between serum aminotransferases and CVD Risk seems somewhat weaker than that observed for For - glutamyltransferase. Increased levels of alkaline phosphatase are modestly associated with first - ever CVD outcomes in some studies. Lower levels of total Bilirubin are independently associated with increased risk of CVD events. It is unclear whether abnormal levels of these liver function tests are simply markers or causal risk factors for CVD. Recent data from population - base studies suggest that addition of information on either - glutamyltransferase or other liver function test concentrations to traditional risk factors provides no improvement in CVD risk prediction.
In most cases, fatty liver disease doesnt cause any serious problems or prevent your liver from functioning normally. But for 7% to 30% of people with the condition, fatty liver disease gets worse over time. It progresses through three stages: your liver becomes inflame, which damages its tissue. This stage is called steatohepatitis. Scar tissue forms where your liver is damage. This process is called fibrosis. Extensive scar tissue replaces healthy tissue. At this point, you have cirrhosis of the liver. Cirrhosis of the liver is a result of severe damage to the liver. Hard scar tissue that replaces healthy liver tissue slows down liver functioning. Eventually, it can block liver function entirely. Cirrhosis can lead to liver failure and liver cancer.
Liver is a half - moon shaped organ that is fairly straight on bottom. It tilted slightly in the body cavity, with the left portion above the stomach and the right portion above the first part of the small intestine. Liver has two main portions, or lobes. Each lobe is further divided into eight segments. Each segment has an estimated 1 000 lobules, or small lobes. Each of these lobules has a small tube that flows toward a common hepatic duct. Compared to the rest of the body, liver has a significant amount of blood flowing through it. Estimate 13 percent of bodys blood is in the liver at any given time.
The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, liver is reddish - brown in color and feels rubbery to touch. Normally you can't feel the liver, because it's protected by a rib cage. Liver has two large sections, called right and left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver's main job is to filter blood coming from the digestive tract, before passing it to the rest of the body. Liver also detoxifies chemicals and metabolizes drugs. As it does so, liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.
Aminotransferase includes AST and ALT. They are markers of hepatocellular injury. They participate in gluconeogenesis by catalyzing transfer of amino groups from aspartic acid or alanine to ketoglutaric acid to produce oxaloacetic acid and pyruvic acid respectively. Ast is present in cytosolic and mitochondrial isoenzymes and is found in the liver, cardiac muscle skeletal muscle, kidneys, brain, pancreas, lungs, leucocytes, and red cells. It is not as sensitive or specific for liver, and elevation in AST may be seen as secondary to nonhepatic causes as well. Alt is a cytosolic enzyme that is found in high concentrations in the liver. Hepatocellular injury and not necessarily cell death is trigger for release of these enzymes into circulation. Both AST and ALT values are higher in normal males than in females. They also correlate with obesity, with the normal reference range higher in those with higher body mass index. Alkaline phosphatase is part of the family of zinc metalloenzymes that are highly concentrated in microvilli of bile canaliculus as well as several other tissues. During growth, due to increased osteoblastic activity, elevated levels of ALP are seen in children and adolescents. Normal reference range levels also increase with age in females. Glycoprotein gamma - glutamyltransferase is located on membranes of cells with high secretory or absorptive activities. Its main function is to catalyze transfer of gamma - glutamyl group from peptides to other amino acids. It is also abundant in many other sources of the body but is more specific for biliary disease when compared to alkaline phosphatase because it is not present in bone. Levels of GGT are higher in infants. Bilirubin is the end result of heme catabolism, with 80% being derived from hemoglobin. Unconjugated Bilirubin is transport to Liver loosely bind to albumin. Bilirubin is water - insoluble and cannot be excreted in urine. Bilirubin that is conjugate is water - soluble and appears in urine. It conjugates in Liver To Bilirubin glucuronide and is subsequently secreted into bile and gut respectively. Albumin is synthesize in the liver, producing approximately 10 grams per day. With any liver disease, there is a fall in serum albumin, reflecting a decrease in synthesis. If liver function is normal and serum albumin is low, this may reflect on poor protein intake or protein loss. Prothrombin time measures the rate of conversion of prothrombin to thrombin. Except for factor VIII, all other coagulation factors are synthesize by liver. Prothrombin time requires factors II, V, VII, and X and, as these are made in the liver, liver's function is crucial in coagulation. If synthetic function of the liver is normal and prothrombin time is delayed, this may indicate treatment with warfarin, consumptive coagulopathy, or deficiency of vitamin K.
Levels of LFTs can point to differentials. Many disease processes have very distinct abnormalities in liver enzymes. Further investigation is warranted if repeated tests confirm an abnormality. In patients with alcoholism, AST to ALT ratio is generally at least 2: 1, showing a high level of AST activity in alcoholic liver disease. Elevate GGT along with AST also suggests alcohol abuse. Ggt should be used alone since it is not very specific for alcohol. Several medications are known to cause liver damage. Many of these are commonly used in daily practice, including but not limited to NSAIDs, antibiotics, statins, anti - seizure drugs, and drugs for tuberculosis treatment. Acute hepatocellular injury can be seen secondary to several drugs including but not limited to acetaminophen, allopurinol, NSAIDs, alcohol, anti - tuberculosis medications such as isoniazid, pyrazinamide, and rifampin, statins, antifungals such as ketoconazole, antibiotics such as tetracyclines, anti - seizure medications such as valproic acid and phenytoin, antidepressants such as fluoxetine, antipsychotics such as risperidone and antivirals such as valacyclovir and ritonavir. Acute cholestasis can be seen secondary to drugs including anabolic steroids, NSAIDs, tricyclic antidepressants, alcohol, antibiotics such as azithromycin, amoxicillin, nafcillin, rifampin, and trimethoprim - sulfamethoxazole. Long - term use of these agents can also lead to chronic hepatocellular and / or cholestatic liver damage. Methotrexate, commonly used medication for rheumatoid arthritis and other inflammatory arthritis, can cause mild transient elevation in LFTs, and can also cause permanent liver damage in liver fibrosis and cirrhosis, especially with higher cumulative doses. Liver fibrosis can also be seen as secondary to chronic alcohol intake or methyldopa. Ergot alkaloids can result in ischemic necrosis. Oral contraceptives can result in hepatic venous outflow obstruction. Herbal medications can also cause elevation in LFTs. Viral illnesses are common cause of hepatitis and elevation in LFTs. Viral hepatitis B, C, and D can cause chronic hepatitis, while hepatitis and E cause acute viral hepatitis. Several other viruses, including HIV, Epstein - Barr and Cytomegalovirus can also cause hepatitis. Autoimmune hepatitis is a chronic disease that is characterized by continuing hepatocellular inflammation and necrosis and a tendency to progress to cirrhosis. It is more common in young women than men with a 4: 1 ratio. Patients usually present with high LFTs without apparent cause. These patients can have positive autoantibodies including antinuclear antibody, anti - smooth muscle antibody, anti - liver / kidney microsomal antibodies, and antibodies to liver antigen. Fatty liver disease, aka nonalcoholic steatohepatitis has gained more attention recently because of its ability to cause chronic hepatic disease as well as hepatocellular carcinoma. The typical patient with this disease is overweight, has type II diabetes, or has dyslipidemia and no evidence of clinically significant alcohol use. Ast and ALT are usually both elevated with a ratio of 1: 1, with other liver function tests being normal. Hemochromatosis is abnormal accumulation of iron in parenchymal organs, leading to organ toxicity. It is the most common autosomal recessive genetic disorder and the most common cause of severe iron overload. Clinical manifestations include diabetes, liver disease, and cutaneous hyperpigmentation.
Liver Function Tests are one of the most commonly ordered laboratory tests. Mild isolated elevations in LFTS can be seen as normal fluctuations and should not trigger expensive and extensive workup. However, physicians should be aware of various conditions that can lead to elevation in LFTS. Thorough history taking and physical examination can provide clues to differential diagnosis. Drug and medication history is of utmost importance. Nursing team will help with medication reconciliation. Pharmacists can also assist in identifying potentially hepatotoxic agents. Referrals to specialists such as hepatologists may sometimes be indicate. Interprofessional team approach can help identify underlying etiology with appropriate management.
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