The liver is the main warehouse for nutrients absorbed from the small intestine. Its job is to store, package and change these nutrients according to the needs of the body and then supply them to the blood stream for delivery to the various organs. The liver is a very large organ located in the upper right quadrant of the abdomen protected by the rib cage. It also produces bile which is stored in the gallbladder. Bile is necessary for the digestion and absorption of fat in the diet.

Liver Disorders

Acute and Chronic Hepatitis - The term "hepato" refers to the liver and "itis" refers to "inflammation of." The term hepatitis therefore means inflammation of the liver. This inflammation is most commonly caused by various hepatitis viruses or by medications. Viral hepatitis can be caused by type A (infectious hepatitis), B, C or D viruses. We have markers for type A, type B, type C and type D hepatitis viruses. Other hepatitis viruses exist which when we have markers for them will probably be called hepatitis E, F, etc. Type A hepatitis is present in the stool of infected persons and can be transmitted when infected stool contaminates water or food and is ingested. Hepatitis B is most often spread by intravenous drug abuse (sharing infected needles), sexual intercourse (either heterosexual or homosexual) with infected persons, and blood transfusions (blood contaminated with hepatitis virus). Hepatitis C is most commonly transmitted by exposure to blood products. Type D hepatitis known as delta hepatitis occurs only in people who have had prior type B hepatitis. When a person contracts viral hepatitis, the virus invades the liver and causes inflammation of the liver cells. On rare occasions, if it is a particularly severe form of hepatitis, a patient may die from acute hepatitis. In most situations, however, the body's defense mechanisms will control the inflammation and after a period of time eliminate the virus. Then the liver will heal itself completely. This is particularly true of type A hepatitis, however, type B and type C hepatitis can progress to chronic hepatitis where there is ongoing inflammation in the liver. There are two types of chronic hepatitis. One is called chronic persistent hepatitis in which the inflammation in the liver occurs in an ongoing fashion but does not result in the continued significant injury of liver cells. The other is chronic active or chronic aggressive hepatitis in which the continued inflammation results in the destruction of liver cells. A liver biopsy is frequently necessary for the physician to determine if chronic persistent or chronic active hepatitis is present. If active hepatitis continues, it may result in the development of cirrhosis. Cirrhosis comes form the Greek word meaning "orange-yellow." This word was used by the Greeks to describe patients who became jaundiced (in other words, developed a yellow discoloration to the whites of their eyes and their skin). Cirrhosis really means scarring within the liver. It does not mean cancer. With adequate treatment, the development of cirrhosis can be prevented if treated soon enough.

Drug Induced Liver Disease - Medications can also cause hepatitis in some patients. Certain people are susceptible to the effect of a drug or one of its breakdown products which may result in injury to the liver. When this is recognized, the drug should be discontinued immediately. In most cases, this is sufficient to allow the liver to heal on its own.

The Liver, Gallbladder, and Pancreas

Alcohol Induced Liver Disease - Alcohol is present in various concentrations in beer, wine and whiskey, as well as other similar beverages. Consumption of any of these in significant amounts on a regular basis can produce liver cell injury. If alcohol consumption continues, the liver injury worsens producing excessive fat in the liver and/or alcoholic hepatitis, a condition in which liver cells become swollen and may die. Chronic (long term) consumption of alcohol often results in cirrhosis (scarring within the liver resulting from the death of many liver cells). Once alcohol induced liver disease occurs the treatment is complete abstinence from all alcoholic beverages forever.

Esophageal Varices - The esophagus has small veins just beneath its surface lining.  The nutrients absorbed from the intestine reach the liver and are processed. Blood flows through the liver into the inferior vena cava, then up into the heart.

When cirrhosis (scarring) of the liver develops, the normal flow of blood from the portal vein through the liver is blocked (partially or even completely). Blood must then return to the heart by other routes. One such route is through the esophageal veins. Blood flow follows an alternative route:

The esophageal veins are normally quite small but with the increased flow of blood become quite dilated and are then known as varices.  Varices sometimes rupture if the blood flow becomes too great resulting in gastrointestinal hemorrhage. This is a serious situation and requires immediate medical attention. A physician can pass a scope called an endoscope through the mouth down into the esophagus and inject the varices with a chemical which will stop the bleeding. This technique is called endoscopic variceal sclerosis or sclerotherapy. Usually these injections need to be repeated to decrease the size of the varices and prevent further bleeding.

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