FATTY Liver (I)

The liver is the largest glandular organ in the body weighing about 3 lb (1.36 kg), reddish brown in color and is divided into four lobes of unequal size and shape. It lies on the right side of the abdominal cavity beneath the diaphragm. Even with half or a third of the liver removed, it can still grow back to full size within months. Being the most durable organ in the human anatomy, it does not deteriorate till a ripe old age of 70 if well taken care of.


Structure



Blood is delivered to the liver via two large vessels. The hepatic artery carries oxygen-rich blood from the aorta of the heart whilst the portal vein carries blood containing digested food from the small intestine. They subdivide in the liver repeatedly, terminating in very small capillaries leading to thousands of lobules with each lobule made up of hepatic cells - the basic metabolic cells of the liver.


Functions


+  Liver is responsible for carrying out over 1500 biochemical functions in our body. The most important role is the secretion of bile which is stored in the gallbladder and released as needed for digestion. When raw nutrients entered the digestive system (in the form of carbohydrates, proteins, amino acids etc), bile breaks them down into small globules to be stored or sent to different parts of the body appropriately. It also produces proteins such as albumin (in blood plasma), hormones, clotting factors, enzymes, antibodies etc.


+ Liver helps to remove unwanted wastes from our bloodstream, excreted via the skin, kidneys and bowels. When proteins are broken down, a toxin known as ammonia is released and converted into urea. It also breaks down medicines, herbal supplements, alcohol, industrial and food processing chemicals and hormones, such as insulin, estrogen and adrenalin, after they have served their function as messengers to other cells.

+ The liver serves as a storeroom for certain vitamins such as vitamin A, B12, D and trace elements like copper and iron.


Causes

Poor liver function can be due to the presence of cumulative toxins, an improper diet, overeating (fatty liver), drug-induced and infections from viruses (hepatitis A, B, C).

What is fatty liver?

Having some fats in the liver is natural for most adults. However, when the liver’s weight is up by more than 5%-10%, you may be suspected of alcoholic or nonalcoholic liver disease which can lead to serious complications in some cases.


Alcoholic Liver Disease (ALD)


Statistics showed more than 15 million people in the U.S. abused or overused alcohol, and virtually all of them developed fatty livers or acute alcoholic liver disease or ALD. It does not matter whether one drinks moderately over an extended period or heavily in a short period.


Blame it on your genes if you are an alcoholic as it may influence how much alcohol you consume and your likelihood of developing alcoholism. Also it may affect levels of liver enzymes involved in the breakdown of alcohol.


Other factors that may influence your chances of developing alcoholic fatty liver disease include:


+ Hepatitis C (may lead to liver inflammation)

+ An overload of iron

+ Obesity

+ Rich diet

Nonalcoholic fatty liver disease (NAFLD)

Nonalcoholic fatty liver disease is currently the most common cause of chronic liver disease in the U.S. Having excess fat in the liver is not normal, but not life-threatening if it does not lead to inflammation or damage.

Similar in danger to alcoholic liver disease, nonalcoholic fatty liver can lead to permanent liver damage though the sufferer drinks little or no alcohol. The liver may develop into cirrhosis when its cells hardened over time, to be replaced by scar tissue. Breakdown in this detoxifying organ may develop into liver failure, liver cancer and liver-related death.

With both conditions becoming prevalent these days, it is shocking to find up to 20% of adults and more than 6 million children having one of these conditions, and even more common amongst Asian and Hispanic children, especially those who are obese.

Causes/Contributory factors

Certain factors tend to increase risk, but in some cases, no risk factors show up.

+ The chance of running in the family is high.
+ Those who are middle-aged, overweight or obese, and have problems like high cholesterol or triglycerides, diabetes or pre-diabetes (insulin resistance) are likely candidates.
+ Oxidative stress, which leads to damage of liver cells.
+ Release of toxic inflammatory proteins from liver or other cells like the intestines.
+ Slower rate in breaking down and removal of fat by the liver.
+ Self-destruction of liver cells – can be caused by autoimmune or inherited liver disease or external attacks like viral hepatitis.
+ Malnutrition/medications.
+ Under-populated flora population in the small intestine.


Symptoms


Fatty liver disease is difficult to detect as there are no or few noticeable symptoms in the initial period. As it progresses over a period of years or even decades it can cause:


+ Fatigue/weakness

+ Weight loss or loss of appetite

+ Nausea

+ Confusion, impaired judgment or trouble concentrating

+ Pain in the center or right upper part of the abdomen

+ An enlarged liver

+ Patchy, dark skin discoloration, usually on the neck or underarm area

Cirrhosis

With alcoholic liver disease, symptoms may worsen after periods of heavy drinking. With NAFLD, the disease process can stop or reverse, or it may worsen. If cirrhosis develops, the liver loses its ability to function. This can cause signs and symptoms such as:

+ Fluid retention

+ Muscle wasting

+ Internal bleeding

+ Jaundice (a block to the pancreatic duct resulting in the bile not transporting to the intestines, and accumulates in the blood, resulting in the skin and whites of the eyes becoming yellow)

+ Liver failure


Diagnosis/test


A routine checkup can detect a slightly enlarged or visible signs of a fatty liver on a blood test.


What are the substances measured in such a blood test?

1. Total protein. This is a measure of the concentration of proteins in the blood, consisting of albumin and total globulin.  
As albumin is made in the liver to transport drugs and a few other substances, decreased level is related to liver damage, kidney disease, digestive inflammation, starvation and protein loss. Less common causes are hypothyroidism, leukemia, adrenal hyper-function and congestive heart failure.
- Globulin forms the main transport system for various substances as well as constituting the antibody system that fights infections. High level could be due to liver problems (likely auto-immune) , chronic infections, rheumatoid arthritis, lupus, multiple myeloma. Low level is linked to malnutrition and impaired immunity.


Clinical note: High A/G ratio indicates too high protein consumption with corresponding rise in protein and cholesterol level and low A/G ratio suggests ulcerative collitis, burns, kidney disease, cirrhosis, multiple myeloma.

2. Total Bilirubin. This is a waste product from the breakdown of hemoglobin excreted in the bile. High levels of bilirubin in the blood causes jaundice resulting in a yellowness of the skin and the white part of the eyes. It is also associated with liver disease, gallstones and haemolytic anaemias. In cases of long-term liver illness (chronic hepatitis), the level usually stays within the normal range until significant liver damage has occurred and cirrhosis is present.

3. Gamma GGT. This is an enzyme produced in the bile ducts. Damage to liver cells can cause it to be released in large amounts into the bloodstream. A mild liver disease due to drugs and alcohol can elevate its level. Very high levels are seen in alcoholic, cirrhosis and other serious liver disorders. If the value exceeds 150 U/L with a serum bilirubin of over 2.8 mg/dL, is strongly suspect of biliary obstruction. If the value exceeds 5 times its clinical range, suspect pancreatitis.

4. ALP (Alkaline Phosphatase). ALP is an enzyme present in the bone, intestine, kidneys and liver. In children, high concentration is found in growing bones. In adults, high level can be caused by liver disease or bone disorder. Low level indicates low functioning adrenal glands, protein or zinc deficiency, malnutrition.

Look for elevations in certain liver enzymes such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). The serum ALT level usually is greater than the AST level in non-alcoholic variant and the opposite in alcoholic FLD ( AST:ALT more than 2:1).

5. SGPT (ALT or alanine transaminase) is an enzyme produced in hepatocytes (the major type of liver cells). Elevated level happens when hepatocytes are damaged or died caused by all types of hepatitis. Low level may indicate B6 deficiency.

6. SGOT (AST or aspartate transaminase) is an enzyme present in the cells of many organs such as the liver, heart, skeletal muscle and blood cells. High level of SGOT are often associated with cell destruction in organs like heart attack, hepatitis (especially alcohol-related), and pancreatitis. Damaged liver cells causes a higher than normal amounts of enzymes into the bloodstream. Low level can indicate B6 deficiency.

Clinical note: SGPT values are greater than SGOT in liver destruction. The reverse happens with cirrhosis of the liver, liver neoplasms and jaundice.

Source: The Simplified Patient Reference Guide By Ronald J. Grisanti D.C ; Mind Your Body, Mar 9, 2011

Treatment

+ Treating any underlying disease such as diabetes is essential to reduce the burden of the liver.

+ For alcoholic liver disease, a heavy drinker has to quit drinking immediately before advanced diseases like alcoholic hepatitis or cirrhosis sets in. Alcohol should be avoided by all with liver problems.

+ Obese or overweight individuals should lose weights gradually. A recent study showed that weight loss of at least 9% over few months can help reverse NASH as there is lessen buildup of fat in the liver.

+ Have a balanced and healthy diet and increase your physical activity. In addition to limiting calories, avoid diets loaded with refined, rapidly digested carbohydrates, such as white bread, white rice and concentrated sugar. Detoxification is necessary on an overloaded organ.


+ The herb milk thistle and its components silymarin and silibinin have two therapeutic mechanisms. First, they alter the structure of the outer membrane of the liver cells to prevent penetration of poison into the interior. Second, they stimulate the action of nucleolar polymerase A, resulting in an increase in ribosomal protein synthesis, thus stimulating the regenerative ability of the liver and the formation of new liver cells.

+ Avoiding unnecessary medications can also help slow or reverse the disease. Clinical trials are also looking at the effectiveness of certain antioxidants linked to oxidative stress and diabetes. Probiotics are live cultures that can be introduced to improve the function of the liver.

+ If cirrhosis becomes severe, surgery may be required to remove the damaged portion and to let it regrows.
Source: http://www.webmd.com/hepatitis/fatty-liver-disease

VIVA corner

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