Contents

The Liver: Basic Facts

Resources on Liver Transplant Surgery

Treatment Locations for Liver Transplants


The liver is the second largest organ (the skin is the largest) in the human body, roughly the size of a football. It weighs about 1.2-1.6kg (around 3lbs), being slightly bigger in men than women. It is located in the upper, right side of the abdomen behind the lower ribs. The gall bladder is attached to the lower portion of the right side of the liver.

Dark reddish brown in colour, the liver is divided into a larger right lobe and a smaller left lobe. These are further divided into approximately 100,000 lobules which are connected to small ducts, which connect with larger ducts and which in turn form the hepatic duct. The hepatic duct transports the bile produced by the liver cells to the gallbladder and duodenum (the upper part of the small bowel).

The hepatocytes or the ‘liver cells’ which make up the majority of the liver, have an average life span of 150 days. There are approximately 202,000 cells in every milligram of liver tissue. These make up around 60% of the total liver. The remaining structure of the liver is mainly biliary tract.

Blood is supplied to the liver through two sources. The hepatic artery brings in oxygenated blood and the hepatic portal vein supplies nutrient rich blood from the stomach and intestines. The liver holds approximately 13% of the body’s blood at any given time. All the blood leaving the stomach and intestines passes through the liver via the portal vein.

What Does the Liver Do?

The liver is one of the most important organs in our bodies. It has many hundreds of functions which are essential for our survival and well being. Some of its major roles are summarised below;

  • storing fuel for the body in the form of glycogen which is made from sugars such as glucose. When glucose is required by body cells, the liver breaks down glycogen, releasing glucose into the bloodstream.
  • processing fats and proteins obtained from food.
  • the production of clotting factors. These are proteins which enable blood to clot.
  • the safe processing and removal of alcohol.
  • the safe processing of many poisons and toxins from the body.
  • the processing of many medicines.
  • the production of bile which is used to aid fat digestion in the gut.
  • the production of plasma proteins (mainly albumin) which are essential for fluid regulation within blood and the circulatory system.
  • the storage of elements and vitamins such as Vitamins A, D, E, K and iron.
  • the production of some antibodies to aid natural immunity.

What Makes the Liver so Unique

A normal and healthy liver has a very large reserve. It can recover and repair itself from many conditions such as infections, the effects of drugs, alcohol and other toxins and trauma. However, when this reserve is stretched too far due to disease or exposure to toxins, the liver gradually starts to fail as normal liver cells are destroyed. The liver may go through stages of damage from a reversible fatty change, to hepatitis (inflammation of the liver), to cirrhosis (an irreversible scarring of the liver) to cancer.

Because of its large reserve capacity, a large chunk of liver can be safely removed from a living being (a donor) and transplanted into a patient with a failing liver (recipient). This is what forms the basis for Living Donor Liver Transplantation. Without its extraordinary ability to regenerate and its reserve capacity, this would not be possible.

Symptoms And Signs Of Liver Disease

There are many causes of liver disease which may compromise liver function to a greater or lesser extent. Some of these conditions are discussed in detail in this guide. But, it is useful to know the symptoms and signs which may arise from liver disease of any type.

  • none: liver disease may be found incidentally,
  • a feeling of being unwell,
  • fatigue,
  • nausea,
  • vomiting,
  • diarrhoea,
  • weight loss,
  • dry eyes and mouth,
  • red or pink, blotchy, mottled patches on the palms of hands (palmer erythema),
  • abnormal small blood vessels on the surface of the skin, mainly on the face, chest and arms (spider naevi),
  • abdominal pain or discomfort,
  • itching of skin,
  • enlargement of the liver (hepatomegaly),
  • jaundice: yellowing of the skin and whites of the eyes,
  • passing dark urine: associated with jaundice,
  • passing pale or clay coloured stools: associated with jaundice,
  • bruising,
  • bleeding from any site e.g. gums, nose, wounds, rectum, vagina,
  • abdominal distension from fluid collecting in the abdomen (ascites),
  • vomiting of blood (haematemesis), from oesophageal varices,
  • confusion and an altered level of consciousness (hepatic encephalopathy),
  • coma,
  • death.

Biliary Disease

Biliary disease refers to any disease that affects the gall bladder and the bile duct system with carries bile between the liver, gallbladder and the small bowel. The nature of this disease may be inflammation, infection, stones, or obstruction of the gallbladder or any part of the duct system.

The gallbladder is a sac located under the liver. It stores and concentrates the bile produced in the liver, which aids in the digestion of fats. Bile is released from the gallbladder in response to food, especially fats, in the upper small intestine. Conditions which slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease.

Types of gallbladder disease include:

Cholecystitis (inflammation of the gallbladder)

Cholelithiasis (gall stones)

In most cases, prevention is not possible. Reducing intake of fatty foods and weight reduction may reduce symptoms in people with gallbladder disease.

Liver Blood Tests

A series of special blood tests can often determine whether or not the liver is functioning properly. These tests can also distinguish between acute and chronic liver disorders and between hepatitis and cholestasis. The most commonly performed blood tests include:

Serum Bilirubin Test

Elevated levels of bilirubin often indicate an obstruction of bile flow or a defect in the processing of bile by the liver. Bilirubin is produced by the liver and is excreted in the bile.

Serum Albumin Test

Below-normal levels of albumin, a protein made by the liver, are associated with many chronic liver disorders.

Serum Alkaline Phosphatase Test

Elevated levels of alkaline phosphatase, an enzyme found in the bile, usually indicate an obstruction of bile flow, liver injury, or certain cancers.

Alanine Transaminase (ALT) Test

This enzyme is released from damaged liver cells.

Aspartate Transaminase (AST) Test

This enzyme is released from damaged liver, heart, muscle, or brain cells.

Gamma-glutamyl Transpeptidase (GGT) Test

This enzyme is produced by the liver, pancreas, and kidneys and released into the blood when these organs are injured. It is particularly sensitive to alcohol related liver damage.

Lactic Dehydrogenase Test

This enzyme is released when organs such as the liver, heart, lung, or brain are injured.

5-Nucleotidase Test

This enzyme is released by the liver when the liver is injured due to bile duct obstruction or impaired bile flow.

Prothrombin Time (PTT) Test

This test measures the time it takes for blood to clot. Blood clotting requires vitamin K and a protein made by the liver. Liver cell damage and bile flow obstruction can both interfere with proper blood clotting.

Not all of these tests are useful for all patients. The attending physician will usually decide on which tests are required and how useful the results obtained are before a diagnosis can be made. Often, other tests are required to gauge other elements of liver structure and function. These are discussed below.

Other Liver Tests

Specific liver blood tests can be performed in order to assess liver function. However, often a more detailed assessment is required to assess the size, shape and nature of liver tissue and the surrounding organs. This can be done by using various scans and other investigations to directly or indirectly visualise the area in question. Examples of these tests are given below.

Abdominal X-rays

Plain radiographs (X-rays) which show many aspects of organs within the abdominal cavity.

Ultrasound Scans

These are used to visualise organs to show their size, shape and texture and to show the presence of masses and other structural abnormalities.

Nuclear or Radioisotope Scans

Radioactive markers or dyes are used to show changes in the liver structure and function.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

A thin tube called an endoscope is used to view various structures in and around the liver.

CT scan/MRI scan

Various types of 2 dimensional or 3 dimensional images can be obtain which show liver structure in great detail.

Some liver diseases can be diagnosed only by a liver biopsy.


About the Liver Guide

This guide consists of many pages written especially for those who need to know more about the liver and associated organs, illnesses and conditions which affect them, which tests might be useful and which treatments are available. Ultimately, a liver transplant may be the only long term solution. Therefore, this guide also has information on this subject specifically.

Resources on Liver Transplant Surgery

Treatment Locations for Liver Transplants

Retrieved from "http://www.globehealthtours.com/directory/Liver"

From Surgery abroad with Globe Health Tours.