Liver is a large essential organ located in the right upper quardant of our abdomen and involved in many metabolic processes like detoxifying chemicals, metabolizing drugs, making of proteins and blood clotting factors, manufacturing cholesterol and triglycerides, synthesis of glycogen and production of bile and a host of many other functions combined with other organs.
Liver weighs about 1.6 kg. It measures about 8 inches horizontally, 6 inches vertically and is 4.5 inches thick.
Liver is located in the upper right quadrant of abdominal cavity, below the diaphragm on top of the stomach, intestines and right kidney. It is reddish brown in color.
Liver Anatomy & Structure
Liver is a reddish brown wedge shaped organ. Liver is largest gland in the body and heaviest internal organ. Liver is connected to 2 large blood vessels namely hepatic artery and portal vein. Falciform ligament divides liver into right and left lobes. It looks 2 lobes from the above and 4 lobes from the below. It consists of four unequal lobes in which 2 are main lobes, right and left, each made up of 8 segments. The segments are made up of lobules.
Lobules are the functional units of liver; each is made up of millions of hepatic cells or hepatocytes that are basic metabolic cells. Lobules are held together by dense, irregular, fine connective tissues that cover entire liver known as Glisson’s capsule. The lobules connect with small ducts which together form the common bile duct which transports bile from the liver to the gallbladder and duodenum. The right lobe of the liver is further divided into anterior and posterior segments by the right hepatic vein. Except bear area of liver, the entire part of liver is cover with serous coat called peritoneum.
Surface Of The Liver
Based on adjacent structures and location, external surface of the liver is described. Liver surfaces are
- Diaphragmatic surface
- Visceral surface
1. Diaphragmatic Surface – It is an anterosuperior surface of liver which is convex in shape, smooth and fits closely beneath the diaphragm curvature. Liver is covered by double layered membrane called as peritoneum that reduces friction between organs. Peritoneum folds back and form falciform ligament and left and right triangular ligaments. The posterior part of diaphragmatic surface does not have the cover of visceral peritoneum which has direct contact with diaphragm, called as bare area.
2. Visceral Surface –Posteroinferior surface of the liver is called as visceral surface. Visceral surface is covered with serous layer called peritoneum and is irregular, uneven, flat or concave in shape. It is in contact with right kidney, gallbladder, first part of duodenum, oesophagus, right adrenal gland, transverse colon and stomach.
Ligaments Of Liver
Fibrous tissue connecting bones or cartilage is called ligaments which attach the liver to surrounding structures. There are five ligaments of which four are peritoneal folds -falciform, coronary, two lateral ligaments (triangular) and the fifth one is round ligament which is a fibrous cord, an obliterated umbilical vein.
- Falciform Ligament : It attaches anterior part of liver to the anterior abdominal wall and divides right and left lobe of liver.
- Triangular Ligaments (right and left) – The right triangular ligament attach the right lobe of liver to diaphragm. The left triangular ligament attach the left lobe of the liver to the diaphragm.
- Coronary Ligament (anterior and posterior folds) – It attaches the superior portion of the liver to the inferior surface of the diaphragm that demarcates the bare area of liver.
- Lesser Omentum attaches liver to first part of duodenum and lesser curvature of stomach.
The posterior surface of the liver is held to the inferior vena cava by the fibrous tissue and hepatic veins.
Anatomical spaces lying between liver and surrounding structures are called as hepatic recesses which have clinical importance as infection collect in this area and becomes abscess.
- Subphrenic spaces – It is between diaphragm and anterior and superior aspects of liver
- Morison’s pouch – It is a space between visceral surface of liver and right kidney. Abdominal fluid may collect in this pouch as it is the deepest part of peritoneal cavity when lying flat.
- Subhepatic spaces – It is between inferior surface of the liver and transverse colon
Blood And Nerve Supply Of Liver
Blood supply of liver is through hepatic artery, hepatic portal vein. Hepatic artery carries oxygen rich blood from aorta and portal vein carries nutrient rich blood from GI, spleen and pancreas. The nerve supply is by the hepatic plexus.
Liver carries out many important functions in our body. Some of those are:
- Production of bile
- Excretion of bilirubin, cholesterol, drugs, hormones, toxins
- Activation of enzymes
- Storage of glycogen, vitamins and minerals
- Fat, protein and carbohydrate metabolism
- Plasma protein synthesis (albumin and clotting factors)
- Detoxification and purification of blood
- Stores iron and plays a role in converting iron into heme (component of hemoglobin)
- Detoxification of harmful substances like alcohol, solvents, pesticides and heavy metals.
The liver is responsible for 500 different functions in combination with other systems and organs.Hence, currently no artificial organ or device is capable of reproducing all the functions of liver.
Diseases of the liver can be inherited (genetic) or can be due to variety of causes such as alcohol, viruses and obesity. Damage to the liver causes scarring of the liver also called as cirrhosis leading to liver failure which can be a life threatening condition.
More than 100 diseases cause liver pain and it can be felt on the upper part of abdomen and right hand side. It can be non-specific and dull or might be severe. Liver pain can result in backache and sometimes liver pain can be confused with kidney pain, right shoulder pain and abdomen pain. It is necessary to diagnose the pain and get it treated, otherwise it may be life-threatening.
- Sever or dull pain on the abdomen
- Dark urine
- Fatigue/ Chronic fatigue
- Itchy skin
- Yellowing of skin or whites of eyes
- Loss of appetite
- Nausea and vomiting
- Tendency to bruise
- Pale, bloody or tar colored stool
- Abdominal pain and swelling
- Swelling in the ankle and legs
Common Causes Of Liver Diseases
- Excessive consumption of alcohol causing inflammation of liver called as hepatitis
- Drugs like acetaminophen, statins, Norco, Vicodin etc. may damage the liver
- Iron overload called hemochromatosis, excessive storage of iron may cause liver damage
- Hepatitis A, B, C, D, E viral infections damage the liver
- Obesity, excess fat causes nonalcoholic fatty liver
- Epstein-Barr virus infection causes liver damage
Liver Diseases That Causes Pain
- Fatty liver disease – Alcoholic/ Non-alcoholic
- Alcoholic hepatitis
- Liver abscess
- Budd-Chiari syndrome
Fatty Liver Disease
Fatty liver can be alcoholic and nonalcoholic. Alcohol causes inflammation of the liver and directly affects the liver. Non-alcoholic fatty liver is due to various illnesses.
Causes Of Fatty Liver Disease
- Excess consumption of calories. The liver is not able to metabolize all the fat leading to fat accumulation.
- Some diseases like type 2 diabetes, obesity, celiac disease, high triglycerides in blood lead to fatty liver.
- Certain medications like tamoxifen, amiodarone and methotrexate may cause nonalcoholic fatty liver disease.
How Does Overconsumption Of Alcohol Damage Your Liver? – Alcoholic Liver Disease
- Overconsumption of alcohol leads to damage to your liver due to buildup of fat, inflammation of liver and scarring of liver. It can be life threatening.
- Alcoholic liver disease is the main cause of chronic liver disease and third most common cause of liver transplants.
The Four Stages Of Alcoholic Liver Disease
- Alcoholic fatty liver
- Alcoholic hepatitis
1. Alcoholic Fatty Liver : Drinking large amount of alcohol leads to fatty acid accumulation in the liver. This stage shows no symptoms and it is reversible if the person stops drinking alcohol at this point.
2. Alcoholic Hepatitis : Continued drinking of alcohol causes inflammation of liver. This occurs after many years of heavy drinking and may also occur after binge drinking. (Hepatitis – hep means liver, itis means inflammation, inflammation of liver). Alcoholic hepatitis is reversible if person abstains completely from alcohol.
3. Fibrosis Of Liver : Fibrosis is protein and collagen buildup in the liver. It occurs in all types of chronic liver diseases. It is reversible if it is mild to moderate. If it is present for a long time, may lead to inflammation and cancer of the liver.
4. Cirrhosis Of Liver : When the liver is inflamed for a longer duration, cirrhosis of liver occurs. Cirrhosis is death of liver cells leading to scarring of the liver and loss of its functions. This condition can be life threatening. Cirrhosis is irreversible but further damage can be prevented by abstaining from alcohol. Since liver loses its function of detoxification of drugs, it becomes sensitive to medications and alcohol. Alcohol consumption at this time leads to further complete damage of liver.
Signs And Symptoms Of Alcoholic Hepatitis
- Tremors and jaundice
- Swelling of lower limbs
- Extremely itchy skin
- Loss of weight
- Clubbing of fingers
- Blood in vomit
- Pain in abdomen
- Decreased appetite
How Do You Treat Alcoholic Hepatitis?
- The first and foremost is abstinence from alcohol
- Gradually decrease alcohol intake, as sudden stopping can lead to withdrawal symptoms
- Seek immediate medical attention
- Your doctor may prescribe corticosteroids to help reduce inflammation
- Use of probiotics and antibiotics
- Liver transplant in patients with liver failure.
Prognosis (Outlook) Of Alcoholic Hepatitis
- The life expectancy of persons with alcoholic liver disease reduces as the disease progresses
- Once person stops drinking and starts treatment, life expectancy increases.
Viral Hepatitis (Viral Liver Disease)
There are 5 main types of viruses that cause hepatitis or inflammation of liver. The three main viruses are A, B and C. Each one is caused by a different virus, can be acute (shorter duration) or chronic (lasting longer). Each are transmitted in a different manner and have different characteristics, but they may have similar symptoms.
Hepatitis A is caused by hepatitis A virus (HAV).
Causes Of Hepatitis A Infection
- Poor sanitation, poor hygiene environment
- Consumption of food or water contaminated by infected feces
- Infection can spread from person to person through close personal contact (family members)
- It does not lead to chronic liver disease.
Person develops immunity to hepatitis A after one infection.
Symptoms Of Hepatitis A Viral Infection
Symptoms cannot be seen initially. Later symptoms show up as
- Nausea, vomiting
- Abdominal pain
- Yellowing of skin (jaundice)
It can be fatal in older people. The hepatitis A virus can survive for a month in soil, water, waste water.
- Routine vaccinations are available for hepatitis A, has led to 95% reduction of this infection
- People infected can recover fully
- Rest, adequate hydration
- Pain relievers
How Do You Prevent Hepatitis A Infection?
- Proper sanitation and hygiene
- Immunization with hepatitis A vaccine
Hepatitis B Infection
Infection of liver by hepatitis B virus (HBV) causes hepatitis B infection.
Causes For Hepatitis B Infection
It occurs when person comes in contact with blood, body fluids of a person who has hepatitis B virus.
It is highly contagious, spreads via
- Direct contact with infected blood
- From mother to baby during birth
- Pricked by contaminated needle
- Oral, vaginal and anal intercourse
- Using person’s personal item with infected fluids (razor blade etc.)
- Multiple sexual partners
Who Are At Risk For Hepatitis B?
- Healthcare workers as they may come in contact with infected blood during their work
- People using IV drugs, sharing of infected needles
- People having multiple sexual partners
- People with chronic liver disease
- People above age of 60
- People having kidney disease
What Are The Symptoms Seen In Hepatitis B?
Symptoms may not be seen for many months and when seen may include
- Joint and muscle pain
- Loss of appetite
- Abdominal discomfort
- Yellowing of skin and sclerae (white part of eye)
How Is Hepatitis B Diagnosed?
Diagnosis is done by blood tests. Tests include,
- Hepatitis B surface antigen test
- Hepatitis B surface antibody test
- Liver function tests
What Is The Treatment For Hepatitis B?
- Antiviral medications are given for chronic hepatitis B
- If the liver is severely damaged, then liver transplant may be needed
How Do You Prevent Hepatitis B?
- Hepatitis B vaccination is the best way to prevent infection from hepatitis B virus
- Infants receive the vaccine at the time of birth
- Children not vaccinated at birth should be given the vaccine
- Healthcare workers, anybody who have not been vaccinated, can receive the hepatitis B vaccine
- Practicing safe sex, avoid drug abuse (sharing infected needles can cause hepatitis B)
- Using sterile instruments by healthcare workers helps prevent hepatitis B
Hepatitis C Infection
- Hepatitis C is caused by hepatitis C virus (HCV)
- Individuals affected by hepatitis C virus may fail to eliminate the virus completely and become chronically infected (the virus mutates and remains in the body for a longer duration).
How Does Hepatitis C Spread?
- It spreads through infected blood
- Shared needles (IV drug abusers)
- Acquiring hepatitis C through sexual contact is low
- It is transmitted through instruments used without adequate sterilization from one patient to another
- It may also be transmitted during organ donation
Hepatitis C does not spread by casual contact, kissing, sharing of utensils and food. People show no symptoms at all until extensive scarring of liver is seen. Hepatitis C is the most common cause of chronic hepatitis and liver transplantation.
Symptoms of Hepatitis C Infection
Most individuals do not show any symptoms at all, but a few who have symptoms can experience:
- Abdominal pain
- Muscle and joint pains
- Loss of appetite
Structure Of Hepatitis C Virus
- The hepatitis C virus consists of at least 6 different strains or genotype, with genotype 1 being the most common strain.
- The hepatitis C virus multiplies very fast causing higher levels in the body and the genes also mutate (change) very quickly and hence the body is unable to keep making anti-HCV antibodies against all of these variations. This is the reason that an effective vaccine has not yet been developed as it has to protect against all the genotypes the virus makes.
- Hepatitis C causes the trigger of immune system causing inflammation of the liver. There is chronic inflammation with no symptoms at all and the chronic inflammation leads to scarring and cirrhosis and ultimately cancer of liver.
Signs And Symptoms Of Hepatitis C
- Dark urine
- Yellow eyes
- Clay colored stools
Later on as the inflammation of liver progresses, person may develop :
- Elevated liver enzymes in blood
- Tiredness and fatigue
- Abdominal pain
- Weight loss
- Decreased clotting of blood
- Yellow skin (jaundice)
How Is Hepatitis C Diagnosed And Treated?
- It is diagnosed by blood tests for anti-HCV antibodies in blood, for genotypes of HCV
- Biopsy of liver may also be done
- Medications like interferon, direct acting agents (DAA) antiviral are given to treat HCV
- Combination of drugs is more effective in treatment of HCV
Inflammation of bile duct by bacterial infection causes cholangitis. Bile duct carries bile juice from liver to gallbladder and intestines that help digests food. Due to bacterial infection, tumors and gallstones, bile duct may be blocked and results in cholangitis. Infection may spread to liver as well.
Liver abscess occurs due to the formation of Pus, infected fluids in the liver. Bacterial infection, viral, parasites or fungal infection may cause liver abscess. It spread to other healthy tissues and damage liver that result in death. Antibacterial, antifungal medications can be prescribed to treat and drain the pus and infection.
It is very rare and occurs due to the occlusion of hepatic veins that drain liver. Symptoms include abdominal pain, liver enlargement, ascites. Blood clot formation in the hepatic veins can also cause Budd-Chiari syndrome.
How Can You Stop Liver Pain?
You feel a dull throbbing pain in your upper right part of the abdomen. Sometimes you may feel it radiating to back and shoulder blade. If you feel this pain for a considerable period of time, then it might be an indication that something is not right and visiting your healthcare provider is the best approach to get this diagnosed.
- Drink plenty of water if you are experiencing pain after a heavy meal or after heavy drinking
- Avoid fatty, spicy, fried foods
- If you are having nonalcoholic fatty liver, it may be reversed by just dietary modifications
- Sit up from lying down position to prevent pressure on liver
- Avoid taking analgesics (painkillers) as this worsens the condition. Liver’s main function is to filter toxins, so when you take painkillers, you are giving your liver more work to do and you are causing your liver more harm by taking all those painkillers
- If you are a regular consumer of alcohol and have started having dull achy pain in the region of your liver, then it is obvious that it is due to the alcohol you are consuming
- Visit your healthcare provider who will diagnose the cause of your liver pain and treat it accordingly by taking your history and by doing a few blood tests.
What Does It Mean If Your Liver Hurts?
- You have this dull pain in your right upper part of abdomen on a daily basis
- It means you may be having liver pain.
- It may be due to an inflammation in your liver. You may not feel the enlarged liver, but your abdomen may become larger than usual due to the accumulation of fluids
Visit your healthcare provider immediately if this does not go away in a few days and is consistently occur on a daily basis.
What Are The Early Signs Of Liver Damage?
- Your skin and eyes may become yellow (jaundice)
- There may be abdominal pain and swelling (due to fluid buildup)
- There may be swelling in the legs and ankles
- Loss of appetite
- Tiredness and fatigue
If you have these symptoms, visit your healthcare provider to get diagnosed and treated.
How Do I Clean My Liver?
As we discussed above, liver is a major organ in our body that filters out harmful toxins from our body along with a host of other important functions, hence having a healthy liver is important for a healthy life.
Cleansing or detoxifying your liver helps you have a healthy body in total. So how do you do this?
- Start by eliminating the toxin, alcohol. Total abstinence is best for your liver
- Try to minimize caffeine, sodas
- Drink plenty of water to flush out the toxins from your liver
- Minimize fast foods (although complete elimination may not be possible in today’s world) as they contain lot of fat, oil, grease which damages your liver
- Avoid artificial sweeteners, artificial coloring agents as they may be harmful to your liver
- Increase the amount of garlic in your diet as garlic contains sulfur compounds which activates the enzymes of liver that help to flush out toxins. The allicin and selenium in garlic protects your liver from harmful toxins
- Eat lot of fruits and have lot of fruit juices.
De-stress your life to de-stress your liver, meditate, yoga, exercise regularly to have a healthy liver and a healthy body.