The liver plays an essential role in the functioning of the body. The organ which is located in the upper abdomen is the largest internal organ. Liver disease is a consolidated term describing the various acute or chronic conditions that may affect the normal liver physiology, leading to partial or total damage of the hepatocytes. Liver disease impairs its functions, which are clinically manifested as localized or disseminated symptoms. Damage to the liver causes lung, brain, and kidney problems since the body systems work in conjunction with each other. Liver disease, therefore, needs to be managed before getting to end-stage liver disease since it becomes irreversible ( Boyer & Zakim, 2015) . Individuals should maintain a healthy lifestyle and seek medical attention should they experience pain in the upper abdomen to avoid too late diagnoses. The liver performs hundreds of functions for different systems in the body; thus, liver disease impairs most systems, which may be felt immediately or take years.
Anatomy of the Liver
The liver is located in the right hypochondria and extends towards the left hypochondrium. The organ has two surfaces: the diaphragmatic and visceral surfaces. The diaphragmatic surface is convex and located under the diaphragm and in direct contact. The visceral surface is irregular and flat, as dictated by the surrounding organs. It is located next to the kidney and below the duodenum, gallbladder, and stomach. The liver is held in position by the falciform, coronary, lesser omentum, and triangular ligaments (Vernom et al., 2020). The falciform ligaments hold the anterior part of the liver to the abdominal wall. The coronary ligaments hold together the superior surface to the inferior surface. Simultaneously, the triangular ligaments are formed by conjoined anterior and posterior coronary ligaments and hold the liver to the diaphragm. The lesser omentum attaches the liver to the stomach. To protect the liver is a fibrous layer called the Glisson’s capsule (Vernom et al., 2020). The liver is also divided into quadrate and caudate lobes. The liver's anatomical structure and location are strategic, such that all most compounds affecting the body system pass through it for detoxification.
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Normal Physiology of the Liver
The liver performs multiple functions that support other systems. It regulates and balances nutrient and chemical content since all blood leaving the gastrointestinal tract passes through it. The organ filters the digestive system's contents before they are channeled into the vascular system; therefore, it forms a barrier that protects the rest of the body from harmful components absorbed into the circulatory system. The waste and toxins filtered by the liver are excreted as bile. Bile also aids in the emulsification of fats during digestion (Verom et al., 2020). Additionally, the liver synthesizes fatty acid transport proteins and cholesterol. Another essential role of the liver is the breakdown of drugs into a form that the body can absorb. During the same process, substances that are used as vehicles but play no pharmacological role are also removed to increase the drug's efficacy.
In addition, the liver also synthesizes proteins for blood plasma and iron. The organ, therefore, plays a crucial role in maintaining the correct functioning of the cardiovascular system. To keep blood sugar level low, the liver also converts excess glucose in the blood into glycogen and stores it. When sugar levels are low, it breaks down the stored glycogen into glucose. The balance is essential to ensure there is enough and not excess blood sugar in circulation. It also regulates amino acid levels in the blood, depending on the blood glucose in circulation (Vernom et al., 2010). When an individual is starved, the liver breaks down amino acids to provide energy. After the amino acids are broken down, the organ coverts ammonia, which is toxic to urea, a less toxic compound. The liver is also involved in the synthesis of ketone bodies, synthesized after going for hours without food.
The liver is also involved in the development of the immune system. It is strategically situated to capture pathogens before they enter into circulation. It produces innate immunity proteins for circulation and also has resident antibodies (Gao, 2016). Additionally, it excretes bilirubin that is formed from lysed red blood cells. The excretions of the liver enter the gastrointestinal tract and are excreted in feces and urine.
The Pathophysiology of Liver Disease
The term liver disease describes any disease that impairs the liver's functioning, which may be acute or chronic (Francis et al., 2015). In acute cases, the onset of symptoms is less than six months, while chronic cases involve symptoms lasting more than six months. Both types are fatal and may necessitate a liver transplant. Acute cases may heal by themselves as they are often caused by inflammation. However, sudden damage may affect the whole liver in some cases, causing liver failure (Francis et al., 2015).
Alcohol, viral infections, immunological disorders, structural abnormalities, and genetic disorders are the leading causes of liver disease. Although the relation between alcohol and liver disease is unclear, physicians have indicated increased liver disease cases among chronic alcoholics. Non-alcoholic fatty liver diseases can also occur when triglycerides accumulate in the liver hepatocyte, causing inflammation ( Boyer & Zakim, 2015). Viral infections such as hepatitis also make the liver susceptible to disease, although it can be managed. If the infections are untreated, they can cause cirrhosis and carcinoma. Inherited disorders can also cause liver disease. The disorders include hemochromatosis, in which the liver lacks a regulating mechanism for the absorption of iron. The iron is then stored in the body, which causes cirrhosis when in the liver (Francis et al., 2015). Wilson's disease, whereby copper accumulates in the brain and liver, also increases liver cirrhosis susceptibility. Alpha-1 antitrypsin deficiency also poses a danger of liver disease.
Immunological disorders such as autoimmune reactions increase the chances of developing the liver disease since the antibodies destroy hepatocytes. Autoimmune reactions destroy intrahepatic bile ducts, impairing the removal of bile from the liver. In cases where the patient has sclerosing cholangitis, the bile ducts decrease in size with time, causing an obstruction, which results in inflammation of the liver (Francis et al., 2015). After a prolonged time, the accumulated bile causes scarring, which is clinically manifested as cirrhosis. However, in some cases, the bile ducts' blockage is caused by a congenital disorder called biliary atresia. The condition is manifested by jaundice at birth that prolongs for more than two weeks and is corrected surgically. Failure to unblock the ducts leads to fibrosis (Francis et al., 2015). Since, in some cases, the surgery is not performed, the patient ends up getting a liver transplant due to liver failure.
Stages of Liver Disease
The first stage is inflammation, manifested as a tender and enlarged liver. In most cases, inflammation lasts a few days as the body is fighting an infection or healing damaged body tissues. It is the easiest stage to manage liver diseases. If the inflammation is not managed, the liver starts to scar ( Björnsson et al., 2019) . Fibrosis impairs blood flow and overworks the liver's healthy part since the scarred region is not functional. If treated at this stage, the liver can also heal and replace the scarred tissue with normal tissue. If untreated, but the liver develops cirrhosis and is extensively impaired in its function, such that the effects are felt due to the accumulation of toxins ( Björnsson et al., 2019 ). For instance, accumulating toxins in the brain is exhibited by sleeping problems, reduced concentration span, and memory loss. At this stage, treatment aims to prevent further damage and maintain the remaining healthy part's functioning. Toxins may also be signaled by itching of the skin and swelling of legs.
In some cases, individuals develop extra sensitivity to medication, and their side effects since the liver does not eliminate the toxins contained therein ( Björnsson et al., 2019) . Advanced cirrhosis develops into the end-stage of liver disease. Decompensating is common in this stage, and the only option is liver transplantation since the damage cannot be reversed.
Prevention of Liver disease
Prevention of liver disease is mainly based on a healthy lifestyle. Drinking alcohol moderately is advised to avoid straining the liver, as it will have more toxins to eliminate. Moderate drinking for men means fifteen drinks a week, and eight drinks a week for women. Viral infections such as hepatitis pose a risk of liver diseases; therefore, individuals must avoid exchanging fluids as the virus is found in body fluids ( Wiegand & Berg, 2016) . If one has to get a tattoo, the equipment must be sterilized. Having protected sex is also advisable since hepatitis is secreted into sexual fluids. Vaccines are also available to lower a person’s risk of being infected with hepatitis, but caution is better than relying on vaccinations.
Drugs add strain to the liver due to substances in them that are used as vehicles but have no pharmacological effect. The toxins add a burden to the liver; the medication should only be taken when prescribed. In case one is using over the counter drugs; they must adhere to the dose to avoid high toxicity ( Wiegand & Berg, 2016) . The medication also includes herbal concoctions and supplements. Medicines that are not approved by the Food and Drug Authority may contain levels of toxins higher that are higher than recommended for human consumption.
Aerosol sprays also contain toxins that distress the liver; thus, it is vital to use them only in well-ventilated spaces while wearing a mask. Fungicides and insecticides also have chemicals; therefore, they should be used per the manufacturer's instructions. Personal protective equipment should also be worn to ensure the chemicals do not contact the skin. While staying away from toxins, the individual must also eat healthily and maintain a healthy weight, as obesity is a risk factor for non-alcoholic fatty liver disease.
Treatment for Liver Disease
Different types and degrees of damage to the liver require different medication. While in some cases, lifestyle changes such as ceasing alcohol consumption, reducing protein intake, and weight loss may help, drugs and surgery are necessary for others ( Boyer & Zakim, 2015) . In incidences, where liver disease is caused by an underlying condition such as a viral infection, the condition is treated to free the liver of strain and allow it to heal. After non-invasive methods have failed, the individual has to undergo a liver transplant, especially in end-stage liver disease.
Conclusion
Liver disease impairs functions of the liver, which are clinically manifested as various symptoms. Damage to the liver also causes lung, brain, and kidney problems since the systems work in conjunction with each other. In acute cases, the onset of symptoms is less than six months, while chronic cases involve symptoms lasting more than six months. Both types are fatal and may necessitate a liver transplant. Acute cases may heal by themselves as they are often caused by inflammation. However, in some cases, sudden damage may affect the whole liver, causing liver failure. While in some cases, lifestyle changes such as ceasing alcohol consumption, reducing protein intake, and weight loss may help, drugs and surgery are necessary for others. Liver disease, therefore, needs to be managed before getting to end-stage liver disease since it becomes irreversible.
References
Björnsson, E., Verbaan, H., Oksanen, A., Frydén, A., Johansson, J., Friberg, S., & Kalaitzakis, E. (2019). Health-related quality of life in patients with different liver disease stages induced by hepatitis C. Scandinavian journal of gastroenterology , 44 (7), 878-887.
Boyer, T. D., & Zakim, D. (Eds.). (2015). Hepatology: a textbook of liver disease (3rd ed., pp. 572-615). Saunders.
Francis, S. A., Smith, F., & Malkinson, J. (2015). Integrated Pharmacy Case Studies . Pharmaceutical Press.
Gao, B. (2016). Basic liver immunology. Cellular & molecular immunology , 13 (3), 265-266.
Vernon, H., Wehrle, C. J., & Kasi, A. (2020). Anatomy, Abdomen and Pelvis, Liver. In StatPearls [Internet] . StatPearls Publishing.
Wiegand, J., & Berg, T. (2016). The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis. Deutsches Ärzteblatt International , 110 (6), 85.
