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Liver Facts

Liver Facts

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Why is the liver important?
As embedded in its name, the LIVEr is an important organ that keeps us aLIVE.. Below is a list of some of the liver’s many roles:

  • As a detoxifier to neutralise harmful substances (e.g. alcohol, medicines, toxins etc.) and convert them into waste products to be expelled from the body
  • As a storage area for many substances including vitamins (e.g. Vitamin B12) and minerals (e.g. iron)
  • Produces a substance known as bile to break down fats for absorption
  • Produces cholesterol in the body
  • Produces proteins that are important for blood clotting
  • Produces hormones
  • Converts excess glucose to glycogen (a storage form of glucose)

The roles of liver mentioned above are not exhaustive. Due to the many roles that the liver performs to maintain body functions, any diseases that affect the liver or its functionality may be detrimental and life-threatening.

What are the most common forms of liver disease?
Any conditions that affect the functionality of the liver constitute liver diseases. Some of the more common liver diseases include fatty liver, hepatitis (inflammation of the liver) or cirrhosis. If these conditions are left unmanaged, they may lead to liver cancer. Although we hardly hear of liver cancer, it is the fourth most common cancer that affects Singaporean men.

Does liver disease always come with symptoms?
The symptoms of liver diseases vary with the disease state; however the most obvious symptom of any liver condition would be jaundice. Jaundice occurs when the liver is unable to break down bilirubin (by-product of the breakdown of red blood cells) to be removed from the body. As a result, the substance accumulates in the body, producing a yellow colouration of skin and the eyes. Conditions affecting the pancreas, gall bladder or bile duct may also lead to jaundice.

Some other non-specific liver disease symptoms include nausea and vomiting, upper right abdominal pain and swelling, fatigue, weakness, unexplained weight loss, dark coloured urine, itchy skin and many others. However, in most cases, people with liver disease may not exhibit any signs and symptoms of failure until at least three quarters of the liver is damaged, due to the resilience of the liver and its ability to regenerate itself.

Is alcohol the main cause of liver problems?
Despite the recent controversy on the benefits of alcohol, in particular red wine for its heart protective properties, alcohol is known to be one of the main causes of liver problems, especially when taken in excess. When consumed in moderation, alcohol is converted into harmful substances to be eliminated from the body. However, excessive alcohol intake overwhelms the capacity of the liver to process the alcohol, thus leading to the development of liver problems. Such problems include fatty liver, hepatitis and liver cirrhosis.

Alcohol is also capable of causing other health conditions such as high blood pressure, stomach disorders, heart muscle disease (cardiomyopathy), obesity and many others. Lastly, “If you drink, don’t drive”, as alcohol causes many road accidents as well.

Can medication inflict liver damage?
Most medications are neutralised in the liver and then removed safely from the body. A liver with normal functions can process any consumed medication as long as it is taken as prescribed under recommended doses. However, if the medication is over-used intentionally or accidentally, liver damage may follow. Anything that is consumed in excess may have some negative effects on the body.

Even the most common and widely available OTC (over-the-counter) medication may affect the body when used beyond its safe recommended dose. Most people would have taken paracetamol at least once in their lifetime. Paracetamol is a very common OTC medication but, when over-dosed; paracetamol can lead to fatal liver toxicity.

Liver toxicity can be worsened if paracetamol or other medications are taken with alcohol. Most medication for chronic diseases may affect the liver in some ways. It is not uncommon for people, especially the elderly, to consume multiple medications for chronic diseases. Coupled with an aging liver or possibly with some existing liver problems, the elderly are more prone to liver damage caused by medication.

What is fatty liver?
Have you heard of the term “foie gras”? Foie gras is a French word which translates to fatty liver in English. In the culinary field, foie gras is regarded as a delicacy consisting of fatty liver of either duck or goose. Similarly, fatty liver can occur in humans when fat accumulates in the liver. Fat accumulation in the liver is abnormal and due to the complexity of liver functions, the exact cause of fatty liver is largely unknown.

In the past, fatty liver was mainly associated with excessive alcohol consumption and commonly affected the middle aged. However, there has been a recent report on the rise of fatty liver incidence in younger Singaporeans with little or no alcohol intake. With no link to alcohol consumption, this condition is largely related to the increased incidence of obesity, diabetes and other metabolic diseases. If you are a fan of high calorie food, including fatty goose or duck liver, do watch your diet or you may turn your liver into a "foie gras" as well.

What causes hepatitis?
Hepatitis refers to swelling or inflammation of the liver often caused by viral infection, mainly the Hepatitis viruses type A, B or C. Hepatitis can also be caused by other microorganism infections such as parasites, bacteria or, less commonly, fungal conditions.

Other causes include chronic exposure to toxins (e.g. alcohol, poisonous mushrooms etc.), side effects of certain medication, medication overdose, autoimmune disorder (body's immune cells attack the liver) and other inherited disorders (e.g. haemochromatosis where excess iron accumulates in the liver).

What exactly is cirrhosis? Cirrhosis is a medical term used to describe the scarring of the liver in response to any chronic damages. The liver constantly repairs itself when subjected to any injuries caused by infection, chronic alcohol abuse, medication or other liver diseases. During the repair process, scar tissues are formed. With time, the functioning liver cells are replaced by scar tissues that serve no purpose but increase the burden on proper liver function.

Can liver damage be reversed? Depending on the severity, some damage can be reversed as the liver is the only internal organ that can regenerate itself. As long as the cause of the liver damage (e.g. alcohol, medication etc.) is removed and the liver is not severely damaged to the point of failure, normal liver function may be restored.

What is liver enzyme count?
Liver blood tests, measuring the levels of liver enzymes, are commonly performed to detect any disorders affecting the organ. The two commonly used enzymes include aspartate aminotransferase (AST) and alanine aminotransferase (ALT). In a healthy liver, the liver enzymes are stored in the liver cells. However, any damage to the liver causes the enzymes to be released in the blood.

Between these two enzymes, ALT is most concentrated in the liver, hence any raise in the ALT level in the blood points more specifically to liver conditions. On the other hand, AST is found in other organs such as the heart, muscles, kidney and the brain. A rise in blood AST levels need not be a result of any liver damage but also could be a result of other health conditions, such as a heart attack.

A true representation of liver health is often assessed by a combination of other blood tests, including the coagulation test, albumin level test, bilirubin detection and platelet count.

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