Liver disease

The liver is a large organ connected to the digestive system and composed of four lobes. It is located to the right on the highest wall of the abdominal cavity and is positioned beneath the transverse colon and the stomach. It carries out various organic functions, such as:

• Metabolising and detoxifying substances that would otherwise be harmful for the organism
• Converting nutrients from food into essential haematic components
• Regulating coagulation of blood
• Producing enzymes and proteins
• Maintaining hormonal balance
• Serving as a deposit for vitamins
• Producing components to support the immune system in defending the organism from infection
• Removing bacteria from the blood
• Producing bile, an essential component in the digestive process

Liver disease refers to any condition that causes inflammation or damage, and compromises liver function. Causes can include infections, wounds, exposure to pharmaceuticals or toxic substances, auto-immune diseases and genetic defects that can lead to the depositing and formation of harmful substances, such as iron or copper. Damage to the liver can lead to inflammation, scar tissue, clotting disorders and liver failure.

The main forms of liver disease are alcoholic and non-alcoholic steatosis, hepatitis. cirrhosis, liver tumours, haemochromatosis and alcoholic liver disease.

Hepatitis is an inflammation of the liver that in the majority of cases is caused by a virus, but can also be due to pharmaceuticals, alcohol, hereditary diseases or auto-immune diseases.

Inflammation can be acute, flaring up and then receding in just a few weeks or months, or chronic, lasting for a number of years. Chronic hepatitis can last for 20 years or more before causing significant symptoms related to progressive damage to the liver such as cirrhosis, liver tumours or death.

 

Cirrhosis is the acute formation of scar tissue in the liver due to the presence of chronic liver disease. Liver tissue is gradually replaced with scar tissue, thus affecting liver function.

The most common causes of cirrhosis are alcohol abuse, chronic viral hepatitis and non-alcoholic steatosis, a form of steatosis due to the abnormal accumulation of fat in the liver cells.

Cirrhosis can lead to a reduction in liver function, chronic liver failure, frequent haemorrhaging and ecchymosis, muscle atrophy, an accumulation of liquid in the abdomen (ascites), portal hypertension (an increase in pressure in the portal vein) and many other problems.

 

haemochromatosis is a disease affecting the metabolising of iron and can be either hereditary or acquired. People suffering from haemochromatosis accumulate more iron than is required by the organism. The difficulty faced by the organism to eliminate the excess iron leads to a progressive build-up of this substance in tissue and organs. Consequently, the excess iron can lead to the dysfunction and collapse of many organs, particularly the heart, the liver and the endocrine section of the pancreas. Complications include arthritis, diabetes, cirrhosis of the liver, cardiac arrhythmia and a characteristic pigmentation of the skin.

There are two types of haemochromatosis: the primary form (hereditary, therefore passed from parents to children, and the acquired form (caused by another concurrent disease).

 

The liver is responsible for the metabolism of ethanol, which is broken down to favour its elimination by the organism. Alcohol can damage or destroy the hepatocytes, consequently compromising the liver when consumption exceeds the liver’s capacity to process it. Alcohol abuse is the most common form of liver damage, and alcoholic liver disease can emerge after years of excessive consumption. These diseases can cause: steatosis (the excessive accumulation of fat in the hepatocytes), alcoholic steatosis (an inflammatory disease characterised by an enlargement of the liver) and cirrhosis.

Causes of liver disease can be either congenital or due to the toxicity of alcohol or pharmaceutics. The various factors that can increase the risk of liver disease can be the following:

• Alcohol, drug or pharmaceutical abuse
• Exposure to toxic substances
• Food deficit
• Trauma
• Metabolic diseases
• Infections (viral or bacterial)
• Obesity

Symptoms of liver disease are often silent and difficult to link to a liver problem.

In acute liver disease the most common signs and symptoms include:

• Jaundice (a yellow colouring of the skin)
• Dark-coloured urine
• Loss of weight and appetite
• Nausea, vomiting and dizziness

Typical symptoms of chronic hepatitis, in addition to jaundice and dark urine, include:

• Abdominal swelling
• Itching
• Unexplained changes in weight
• Severe abdominal pain

Initially, liver disease does not result in any symptoms, and the patient is unaware that they suffer from this problem, unless diagnosed through tests carried out for other reasons. Tests for determining liver disease are:

• Liver biopsy
• CAT scan
• Blood tests
• Endoscopic retrograde cholangiopancreatography
• Assessment of symptoms by a specialist

Treatments vary according to the type of liver disease diagnosed: the specialist will recommend the therapy most suited to the patient’s case.

Patients with chronic liver disease are at high risk of macro- and micro-nutrient deficiency for a number of general and specific reasons related to the illness. It has been demonstrated that malnutrition effects 75% of patients with chronic liver disease, with more than 40% of patients suffering from either moderate or serious malnutrition.[1]

Guaranteeing suitable nutrition for patients with chronic liver disease is very complicated.

 

In the event that natural nourishment is not sufficient, it is necessary to contact one’s nutritionist, who will be able to recommend the most suitable treatment, with oral nutritional supplements providing high branched-chain amino acid support.

[1] GHUFRAN, Aiman. Nutrition in Chronic Liver Disease: A Point‐of‐Care Review. Nutrition in Clinical Practice, 2020, 35.2: 211-217.