Liver: The Unsung Hero That Keeps Us Alive
by Joshua Wong, Senior Patient Care Pharmacist
Unlike the heart and brain which get more attention, the liver quietly works hard to keep us healthy
- akin to what Batman does for Gotham City.
Here are some of the many roles our body's largest internal organ plays:
- Neutralises harmful substances and converts them into waste products to be expelled from
- Stores substances, including vitamins and minerals
- Produces bile, a substance that breaks down fats for absorption
- Produces cholesterol in the body
- Produces proteins that are essential for blood clotting
- Produces hormones
- Converts excess glucose to glycogen for storage
As the liver takes on numerous roles, any disease that affects it or its functionality may be
detrimental or life-threatening.
Common forms of liver disease
Any condition that affects the functionality of the liver makes it a liver disease. Some of the more
common liver diseases include fatty liver, hepatitis (i.e. inflammation of the liver) and cirrhosis.
If these conditions are left unmanaged, they may lead to liver cancer, which is the fourth most
common cancer in Singaporean men.
Symptoms of liver disease
Though the symptoms of liver diseases vary with the disease's state, the most obvious symptom for
all liver diseases is jaundice.
Jaundice occurs when the liver is unable to break down bilirubin (i.e. a by-product of the breakdown
of red blood cells) to be removed from the body.
As a result, bilirubin accumulates in the body, producing a yellow colouration in the skin and eyes.
Other conditions affecting the pancreas, gall bladder or bile duct may lead to jaundice as well.
Symptoms that are not specific to liver disease may also indicate the possibility of a liver condition.
These include nausea and vomiting, upper right abdominal pain and swelling, fatigue, weakness,
unexplained weight loss, dark coloured urine and itchy skin.
In most cases, people with liver disease may not experience any of the above-mentioned signs
and symptoms until at least ¾ of the liver has been damaged.
Causes of liver disease
There are various factors that lead to liver problems. Read on to find out what they are.
Alcohol has always been known as 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 liver's capability to process the alcohol, which
can lead to liver problems.
Alcohol can also cause other health conditions such as high blood pressure, stomach disorders, heart
muscle disease, obesity and more.
Most medications are neutralised in the liver and removed safely from the body. A liver with normal
functions can process any consumed medication as long as it was taken as prescribed.
If the medication, over-the-counter or prescribed, is over-used, liver damage may follow. A common
medication, paracetamol can also lead to liver toxicity which may result in death if over-used.
Most medications for chronic diseases may affect the liver in some ways. This makes it common for
elderly and individuals with chronic diseases to be more susceptible to liver damage.
A combination of medications and alcohol will cause an even more severe case of liver toxicity.
Types of liver disease
Fatty liver occurs when fat accumulates in the liver. This is not normal, but 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
affects the middle-aged. However, the incidence of a fatty liver in younger Singaporeans with little
or no alcohol intake is currently on the rise.
Hence, it is highly possible that fatty liver is linked to obesity, diabetes and other metabolic diseases.
If you are a fan of high-calorie food, now's the time to start watching your diet.
Hepatitis is the swelling or inflammation of the liver, and can be caused by any of the following.
- Viral infection
- Infection caused by microorganisms such as parasites and bacteria
- Fungal conditions
- Chronic exposure to toxins
- Side effects of certain medication
- Overdose of medications
- Autoimmune disorder (i.e. the body's immune cells attack the liver)
- Other inherited disorders (e.g. hematocromatosis, where excess iron accumulates in the
Cirrhosis is a medical term used to describe the scarring of the liver in response to any chronic liver
The liver will constantly repair itself when subjected to injuries caused by infection, chronic alcohol
abuse, medications or other liver diseases. During the repair process, scar tissues are formed.
And with time, more of the functioning liver cells will be replaced by scar tissues. These scar tissues
serve no purpose, and increase the burden on proper liver function.
Testing for liver disease
Liver blood tests are commonly performed to detect any disorder that affects the organ. These tests
measure the level of liver enzymes, two common ones being aspartate amino transferase (AST) and
alanine aminotransferase (ALT).
In a healthy liver, the liver enzymes are stored in the liver cells. However, any damage to the liver
will cause enzymes to be released in the blood.
ALT is most concentrated in the liver, hence any rise in the blood's ALT level 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 the blood's AST level may not be a result of any liver damage, but can be a result of other
health conditions (e.g. heart attack).
For a better assessment of the liver's health, a combination of other blood tests is required.
Can liver damage be reversed?
Due to the liver's ability to regenerate itself, liver damage may be reversed, depending on the
severity. In cases where the liver is not severely damaged, normal liver function may be restored
once the cause is removed (e.g. alcohol).