WHO AM I?

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.

LET ME TELL YOU WHERE I RESIDE

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!

WHAT DO I LOOK LIKE?

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?

WHAT I DO FOR YOU: My roles and responsibilities

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 work on the glucose you have produced after a heavy meal. After that double decker sandwich or that three layered cheesy (extra cheese) burger, you end up with so much glucose, most of which you don’t need at that time. What happens to it? I convert it into insoluble glycogen and save it for a rainy day
  • On days when you don’t have the time to eat a proper meal or skip it entirely (you did that twice last week thanks to your disorganized boss and his last-minute agenda revisions) my colleague, the blood sugar, tends to act up, or rather down. Since, I’m unable to see you in a slump, I open the storehouse of glycogen and convert some it back into glucose so the blood sugar behaves itself
  • I convert non-sugary substances like amino acids into sugars, if necessary, and make several proteins for you, notably albumin and the factors needed for your blood to clot.
  • I also make cholesterol. Aha, now that has got you worried, right? Relax. Don’t get carried away by all this super-scary stuff about cholesterol and its really nasty intentions. You need a certain amount of cholesterol to stay healthy. It is crucial to the production of certain hormones and cellular repair
  • I make about 700-900 mg of cholesterol per day. About 300-500 mg comes from your diet (if you eat sensibly.)
  • I convert the highly toxic ammonia (which is a by-product in your body when protein is broken down) into urea which your bloodstream carries to the kidneys and they do a terrific job of getting rid of it. So, I hope you get the drift here. The more red meats and super-heavy proteins you eat, the more I have to hammer away at the ammonia
  • I also make bile which is stored in a small pouch below me - inside my other friend, the gall bladder. This green liquid is essential for fat digestion
  • I detoxify many poisons and medicines to render them harmless. Yeah, all those OTC drugs and antibiotics and whatever else you pop to banish the sniffles, fever and flu, someone needs to tackle them, right? I do it
  • I also make cells required for your immunity (from infections). Super important job because without immunity, you are aware of how vulnerable you can be to infections

MY WISH LIST (Humble yet un-granted)

  • Please eat a balanced diet - an overworked phrase, yet true.
    In any case, how difficult is it to eat a balanced meal? Fats, salt, sugar in limited quantities, good, lean protein and complex carbs in healthy quantities, vegetables and fruits in generous quantities?
    Imagine you are a house proud person and your spouse is a mess-maker. Every time you put your house in order, he dirties it. Eventually, you get tired of cleaning things. How do you think you would feel? I am like that home trying to keep myself clean, efficient and free of junk
  • Alcohol. Yes, the stuff that makes me want to quit once and for all, it is poison for me. Cleaning it or rather processing it and keeping you safe is a laborious task and the more you imbibe it, the more I get shattered trying to clean up for you. I am the happiest when you go off alcohol because every time I have to deal with it, I get damaged a little
  • Get shot! When you get a full course of Hepatitis vaccines, it’s like throwing me a lifeline. I am saved from self-destructing myself in bad circumstances
  • Go out and exercise. Yes, that’s right. Like my co-inhabitants, heart, lungs, brain, I too benefit from your exercise. The blood seems to flow much faster through me, a bit like how you drive faster through a street that is clear of traffic
  • My worst nightmare is to be invaded by germs. Maintain hygiene in your day-to-day life, especially in your food habits, thus avoiding the many infections that transmit through dirty water and food. It’s a battle I sometimes may even lose because they are nasty creatures, who don’t follow the rules of warfare. Fighting dirty is not my forte, it’s theirs
  • Cigarettes. What can I say about them which has not already been said? Every puff you take chokes me. Enough said already

MY OPPONENT/CHALLENGERS

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.

MEDICINES AND ME

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.

INVESTIGATIONS I REQUIRE

  • Bilirubin test (direct and indirect) to ascertain jaundice and its type
  • Total Proteins and Albumin test
  • Enzymes Alanine Aminotransferase – ALT
  • Aspartate Aminotransferase – AST
  • Alkaline Phosphatase (Elevated levels of the first 2 enzymes indicate liver cellular damage. Elevated levels of the last 2 enzymes indicate obstruction in the bile flow.)
  • Prothrombin time and INR (shows synthetic function of the liver)
  • Viral serology for Hepatitis B and C, Cytomegalo Virus, Epstein Barr Virus and HIV
  • Immunoglobulin Study
  • Ferritin
  • Alpha Fetoprotein
  • Biopsy of Liver tissue

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.

CAN THERE BE ANOTHER ME?

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.