Liver Disease

When the liver is not functioning as it should, it is caused by a variety of conditions and diseases and can lead to liver scarring (fibrosis) and cirrhosis where one has further scarring to the liver causing poor blood supply to the liver and loss of function.

The liver has the following functions:

• Break down:
  • Carbohydrates, fats, proteins from foods one eats
  • Bilirubin (a product made during red blood cells being formed,If bilurubin is not removed effectively from the body it causes jaundice)
  • Insulin
  • Hormones
• Produce:
  • Plasma proteins i.e. Albumin (to provide the right pressure environment for our cells and blood and help in Cell reactions)
  • Cholesterol (helps to protect nerve fibres and let signal to travel properly)
  • Glucose (helps to give us energy)
  • Bile (helps us to break down fats to give us energy)
  • Amino acids (source of food for our muscles)
  • Urea (to remove waste)
• Helps to store fat soluble vitamins (A,D,E and K) and glycogen (helps to store energy)
• Control blood sugar
• Help with immunity (the body defence)

Liver disease is classified according to both the pattern of damage seen and time over which the damage occurs.

• The main patterns of damage are classified as cholestatic or hepatocellular. However, these are not distinct entities and overlap occurs.
• Acute liver disease is when the history of onset of symptoms does not exceed six months; patients with symptoms of liver disease that last for more than six months have chronic liver disease.

Cholestasis 

• Occurs when there is disruption of bile flow between the bile duct and duodenum. Intrahepatic cholestasis affects biliary ductules and is seen in people with primary biliary cirrhosis, in drug-induced liver disease and inflammation.
• Extrahepatic cholestasis occurs when there is a mechanical obstruction (e.g. inflammation of bile duct, strictures, gallstones). Cholestasis leads to impaired biliary excretion and reduced absorption of fatty substances. Accumulation of bile salts can lead to damage of hepatocytes.

Hepatocellular disease

• Occurs when there is direct injury to hepatocytes (e.g. due to toxins or viruses). Accumulation of fat within hepatocytes is known as steatosis, which can further be categorised as either microvascular or macrovascular.
• Most people who regularly drink heavily will get a build up of fat in their liver cells.
• In most cases, this is usually asymptomatic and reversible with abstinence.
• Hepatitis is inflammation of hepatocytes, which can be acute or chronic and affect only a small area or be widespread.

Both cholestasis and hepatocellular disease can lead to fibrosis and cirrhosis.

• Fibrosis occurs when there is persistent, extensive hepatocyte damage, leading to active deposition of collagen and formation of scar tissue.
• Cirrhosis is a progressive disease defined as fibrosis and nodular regeneration, resulting in disruption of the normal architecture of the liver.
• Cirrhosis is also associated with a reduction in hepatic cell mass, and a corresponding decrease in the functional capacity of the liver.
• It can be classified as compensated cirrhosis (the liver is able to carry out most of its functions), or decompensated (the liver is extensively scarred and unable to carry out required functions).

The Pharmaceutical Journal, PJ, 21/28 March 2015, Vol 294, No 7854/5;294(7854/5):
DOI:10.1211/PJ.2015.20067991

• Liver function tests are preformed  and looks at a range of enzmes and chemicals and produced by your liver.
• These are not specific tests to the liver function as changes to liver enzyme and chemicals can occur by other medical conditions.
• Other investigations that may be carried out to assess liver function include ultrasounds, computed tomography (CT) scans, fibroscans and liver biopsies.

Medicines that can be affected by liver disease:

(Please talk to your medical doctor or pharmacist before considering the following medications)