I wonder why I am often not given the same importance as my colleagues and co-organs, the heart or the brain. Well, I am as important for your health.
I reside below your diaphragm, behind the right ribs, in close proximity to the gall bladder and stomach. You will feel my presence only when I’m overgrown and supersizing myself (not good for you), your doctor is well aware of my resting place.
I am enveloped by the softest sheath called the Glisson’s capsule which protects me. When you are taking a deep breath to give your lungs a good workout session, I move off a bit downwards to let my co-organ have his share of significance and expand with glory- being the decent one that I am!
I am firm, toned and a mass of fragile dark red tissue. I assure you, despite my fragility, I endow you with strength and stamina. To your utter surprise, shock or both, I happen to be the heaviest of your glands next to your skin, weighing a whopping 1.5 kilograms.
My tissues are extensively irrigated by a complex network of blood vessels reaching deep inside my core. In fact, there are two distinct systems of circulation, one set (the portal system) bringing me blood from the intestines and another set (systemic circulation), bringing me blood from the heart.
Here’s what makes me smart and spectacular - I am unique from other tissues in one surprising way - I can regenerate my own tissues. If I am cut, for example, and a part of me is removed - as it is when transplanted into another person whose liver is damaged beyond repair - the cells of the remaining part of me can multiply and I become near normal again. How super smart is that?
I am well behaved and a disciplined organ and rarely will trouble or put you in a mess. But if you do something really bad to me to get me all worked up, you may be inviting problems to yourself.
Frankly, you don’t have any idea of the sheer complexity of the work I carry out which makes you doubtful about my presence. Whether you are watching a movie and mindlessly gobbling the contents of a bucket of popcorn down your gullet, driving to work or sipping an energy drink, partying to the fullest and overdoing it, eating a double cheese burger at mid night, or drinking by the beach side, I am watching you. After having done with your indulgences, I clean up after you and take out the trash. All of the blood leaving your stomach and intestines passes through me, I process this blood and break it down, balance and create nutrients for the body to use.
I work dedicatedly and hard for you, your life depends on it. You got to be lucky, trust me!
Allow me to enumerate the things I do to keep you healthy:
I may be afflicted with a wide variety of conditions: infections-acute or chronic hepatitis of which there are several varieties, deposition of fat in my substance(fatty liver), scarring of my substance (cirrhosis), and cancer (both local and that carried to me from another part of the body by blood).
If I am not well, I usually do not say so at first. I fight it out, I am a valiant being. But if you persist on dumping me with trouble, I guess I do give up out of despair eventually. When a large part of me is affected, I start making my presence felt by signs, so to speak.
So when I am giving up on my faith in you, you may get jaundice, a swollen body and bleeding tendencies. You may also tire easily, lose your appetite and have pain in the abdomen.
So when I am giving up on my faith in you, you may get yellowish discoloration of eyes(jaundice), collection of water in the tummy(ascitis), swelling of feet, and blood vomtius and other bleeding tendencies, and you may get incoherent or comatose. You may also tire easily, lose your appetite, muscle mass and havewith infection may get pain in the abdomen.
If you do suspect that I am not at my best behavior, please visit a doctor who will examine you and do some tests to find out the problem help me and you get back to our respective feet. The doctor will take your detailed medical history and try to delve deeper into your usual lifestyle. He will do a complete physical examination, check your eyes to rule out jaundice and try to feel me with his hand below your right ribs.
The doctor may then recommend a battery of blood and urine tests that will either free me or implicate me, pretty easily. Since I am a living chemical laboratory for all practical purposes, is it surprising that my illness is reflected readily in the tests? The jaundice may reflect as raised Bilirubin levels of which there are 2 main types. Either type may be raised depending on the nature of my illness. Also, the blood level of a few enzymes may go haywire and may be indicative of serious illness. The more advanced sonography and CT scan tests are, of course, available for finding out my structural abnormalities more precisely.
The many medicines available for my ailing condition serves well to buy time till I am able to mend myself, which I do quite well and quite often.
The doctor does a complete physical examination and checks for the liver, spleen, free fluid in the abdomen, obesity, lymph nodes, anemia and jaundice. The history may include questions regarding drugs intake, tattoos, unprotected sex, alcohol intake, occupation, history of diabetes, high lipids in blood and family history.
Sometimes, yes. It may be required but if I am damaged beyond repair in which case , you have to get rid of me and have a new liver instead(liver transplant). It is a complex procedure performed by experts in the field.
The new liver comes from either your own family who is blood group compatible (a chunk of the liver tissue is taken out of the donor and fitted into you (LDLT-Living Donor Liver Transplant),or could be from some brain dead person whose family might kindly agree for donation(Deceased Donor Liver Transplant) thus giving a new lease of life to you and me. The transplanted liver functions in your body – its new host - under cover of good medication(immunosuppression).
But does that mean you will now have only a piece of liver (in LDLT) as a make-good? And what happens to the living donor? Does he/she have to live with a chunk of liver missing? If you remember what I told you about myself earlier on, you will know that I have an astonishing ability to regenerate. So I grow and multiply my cells to make myself whole again in both your body and in the donor. So, in first 2-3 weeks about 80% of size recovery occurs and in the remaining 3 months liver approaches 100% of the original size. However, both the chunks of liver(in yourself and in your living donor) the liver continues to function adequately all along. At the end of the day, both parties end up with two full size livers respectively. Wonderful, isn’t it?
Liver transplant from a brain dead donor generally involves fitting in of full size liver.
While you are waiting for a donor liver, you will be constantly followed up with your physician and surgeon to guard you from and serious illness and if there is any such serious problem because of my ill health, you might require treatment in the hospital however, unlike my co-organ kidney which has a lifeline in the form of dialysis, I do not have a lifeline like liver dialysis.