Liver Long and Prosper

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The liver is underappreciated. It is responsible for many chemical processes in the body.

Just think, all that food is broken down into tiny nutrients. Instead of letting it go straight to the main blood circuit, it goes through a special vein to the liver to be processed and released into the body in a controlled fashion over hours rather than minutes. The liver holds onto sugar and releases it slowly, as needed. It does the same to fat and protein. It manufactures many of our important chemicals from these basic food building blocks; there are too many chemicals to name and explain here.

The older red blood cells are removed from circulation and broken down. The byproducts of hemoglobin (red) become bile (green) and bile helps form a soap-like substance around the oils you eat to help break them up into tiny particles to be absorbed. Bile is stored in the gall bladder and hormones signal the gall bladder when to squeeze a little bile into the intestine to help digest the fat coming down the intestine. This is recycling at its best; very little waste!

The liver is damaged by viruses, chemicals or gallstones. Gallstones form in the gall bladder for complex reasons. They are more common in those who are overweight, females (especially those who have had several pregnancies, and in those over 40. The stone can just sit there and not cause a problem, so surgery is not always necessary. It can block the exit from the gallbladder or the end of the tube (bile duct) as it joins the small intestine. When there is blockage, nerves send out signals of pain. Blood tests show high chemicals, especially the bile backed up in the blood; this is why we turn yellow and our urine can turn brown during liver disease. The stool is not as dark since there is less pigment coming down. This can happen more when a fatty meal causes a strong signal for more bile to be sent down. The pain can be severe. The gall bladder can become inflamed; surgery is needed then. An ultrasound ( and less so, a CAT) scan is quite helpful at diagnosing gall stones.

Hepatitis can be from germs or chemicals. We are all familiar that more than 2 shots or drinks or beers a day for a female, and 3 for a male can damage the liver. The liver is funny in that it may not show the damage that has taken place until the reserves run out years later. Do not doubt that the liver takes a hit when these numbers are exceeded. The more and sooner you drink alcohol, the sooner the reserves will run out and the liver will fail. Overdoses of Tylenol can hurt the liver also, but suffering is much quicker.

Viral hepatitis is quite common. Hepatitis A is transmitted from people not washing their hands well after pooping and then preparing food for others. Hepatitis B and C are mainly transmitted from needle sharing, and some from sex. Hepatitis A rarely leads to long-term problems. If B doesn’t get cured naturally, as it does in the majority, then it needs treatment. Very few C patients are cured naturally.

Treating A is usually with rest. B uses drugs similar to anti-HIV medications which are quite tolerable. C needs an injection weekly and pills daily for usually a year. If the lab tests are not improving then treatment should be stopped since it is not working. Hepatitis C is curable for some. The Hepatitis C medications can sometimes make you quite ill. But it is usually better than having cirrhosis which is replacement of most of the liver by scar tissue, so very little of the liver is working. We have vaccines for A and B and all are encouraged to get them.

Cirrhosis has multiple complications. Since there is so much liver scar tissue, the blood from the intestines and spleen back up, causing a large, sometimes painful spleen. Platelets, the blood clotting cell pieces, get trapped in the large spleen so there may be dangerous bleeding. Fluid leaks from the intestinal lining since there is so much back pressure; and this causes swelling of the abdomen. The liver doesn’t make its regular products so there are problems with low levels of blood protein (causing swelling in the legs and scrotum–the sac holding the testicles) and blood clotting factors (causing bruising and bleeding). This back pressure causes hemorrhoids and esophageal varices (like hemorrhoids but in the bottom of the food pipe). The varices can break open any time and cause massive bleeding which goes down the intestines (painless and hidden) or out the mouth (vomiting). A person can bleed to death from hidden sites without waking up.

Being obese can cause fat to infiltrate the liver causing liver failure also.
So keep an eye on your weight, keep your daily alcohol intake down, get vaccinated, wash after pooping, don’t use needles, wear condoms, and see your doctor regularly. Thank God for your liver!

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