Your Liver, Your Health
By Canadian Liver Foundation, Oct 2001
More information from the Canadian Liver Foundation

Where is the liver located in the body?
Your liver, the largest internal organ in the body, is located in the right upper quadrant of the abdomen, immediately under the diaphragm.

What does your liver do?
The liver is a complex chemical factor that works 24 hours a day. Virtually all the blood returning from the intestinal tract to the heart passes through the liver. This means everything you swallow that is absorbed into the bloodstream passes through the liver.

Your liver is a complex organ that is essential to life. You simply cannot live without it.

Specifically, your liver helps you by:

• Cleansing blood:
  - metabolizing alcohol and other drugs and chemicals
  - neutralizing and destroying poisonous substances

• Regulating the supply of body fuel:
  - producing, storing and supplying quick energy (glucose) to keep the mind alert and the body active
  - producing, storing and exporting fat

• Manufacturing many essential body proteins involved in:
  - transporting substances in the blood
  - clotting of blood
  - providing resistance to infection

• Producing bile which eliminates toxic substances from the body and aids digestion

• Regulating the balance of many hormones:
  - sex hormones
  - thyroid hormones
  - cortisone and other adrenal hormones

• Regulating body cholesterol by producing it, excreting it, and converting it to other essential substances

• Regulating the supply of essential vitamins and minerals such as iron and copper

• Performing literally hundreds of other specific functions!

Who is affected by liver disease?
Liver disease affects people of all ages. Today, one in every 12 Canadians suffers from some form of liver or biliary tract disease.

How common is liver disease?
There are over 100 known liver disease. The most common ones such as gallstones, viral hepatitis, cirrhosis, liver cancer and some children's liver disease are described below.

GALLSTONES
Gallstones form in the gallbladder when cholesterol or pigments crystallize out of bile. They can very in size from as small as grains of sand to as large as golf balls. Sometimes gallstones get stuck in the bile ducts causing severe abdominal pain. Gallstones occur in 20% of Canadian women and 10% of men by the age of 60. The tendency to form gallstones is partially inherited and is more common in people who are obese, overeat or lose weight rapidly through extreme diets.

VIRAL HEPATITIS
Viral hepatitis is an inflammation of the liver caused by one of several viruses. In Canada, the most common hepatitis viruses are A, B, and C.

HEPATITIS A is spread through contaminated food and water. In Canada, infection mainly occurs in adults who travel to area where hepatitis A is more common, such as Africa, Asia, Latin America and Eastern Europe. Most people suffer flu-like symptoms, including weakness, headache and fever. Hepatitis A will eventually run its course, and a lifelong immunity develop. Hepatitis A can be prevented by vaccination.

HEPATITIS B is spread through infected blood and body fluids. Since 50% of people who get hepatitis B don't experience symptoms, they often remain undiagnosed and are therefore in danger of infecting others unknowingly. About 10% of adults infected with hepatitis B will develop chronic hepatitis, which can eventually lead to cirrhosis and cancer of the liver. There are treatments available for chronic hepatitis B which may help some people. Hepatitis B can also be prevented by vaccination.

HEPATITIS C is spread through direct contact with the blood of an infected person. About 85% of people infected with hepatitis C will develop chronic hepatitis C, which in some any eventually lead to cirrhosis and liver cancer. There are treatments available which may help patients whose hepatitis C is more advanced. there is no vaccine for hepatitis C.

CIRRHOSIS
Each year, thousands of Canadians die from cirrhosis. If left untreated, any liver disease may result in cirrhosis (scarring of the liver). In Canada, the leading causes of cirrhosis are viral hepatitis (in particular, chronic hepatitis B and C), alcohol, chemicals and the excessive storage of metals such as iron and copper.

LIVER CANCER
there is still much to be learned about cancer which originates in the liver. A major cause of liver cancer worldwide is the hepatitis B virus. Liver cancer is often associated with cirrhosis and can be caused by certain parasites, drugs and environmental toxins.

LIVER DISEASE IN CHILDREN
Thousands of Canadian children - from infants to adolescents - have liver disease, and many die from it each year. Some are born with a liver disease, others contract it at birth or early in life. The more common types of liver diseases that affect children are biliary atresia, galactosemia and tyrosinemia. Advances in liver transplantation offer hope for children with severe, irreversible liver disease.

AUTOIMMUNE HEPATITIS
In this condition, the body's own immune system, for unknown reasons, attacks the liver cells often leading to chronic active hepatitis and cirrhosis. Some patients require treatment with corticosteroids, which suppress the overactive immune response. This disease is not infectious although it is called "hepatitis." It is most common in young women, but can be found in all age groups as well as in men.

ALCOHOL-RELATED LIVER DISEASE
Alcohol-related liver disease is a major problem in Canada. There are three types of alcohol-related liver disorders: fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. These may be present either alone or in combination.

HEMOCHROMATOSIS
Hemochromatosis is a hereditary disease in which the body absorbs too much iron from the diet resulting in the accumulation of iron in the liver and other organs. Individuals with hemochromatosis frequently have no symptoms until the disease has produced severe irreversible damage to the liver or pancreas. there is an increased risk of primary tumours of the liver developing in patients with advanced hemochromatosis. Tissue damage is entirely preventable if the disease is diagnosed in the early stages and treated with regular removal of blood to rid the body of the excess iron. A new development is a genetic test for hemochromatosis.

PRIMARY BILIARY CIRRHOSIS
Primary biliary cirrhosis (PBC) is a liver disease that affects mostly women, but an occur in men. It appears to arise as a result of the body's immune system attacking the small bile ducts in the liver. the symptoms of PBC are varied and include fatigue, itching of the skin, bleeding and fluid retention. A new treatment using a bile salt has been shown to improve liver function and delay the development of cirrhosis.

What are the symptoms and signs of liver disease?
Consult you physician if you observe any of the following symptoms:

• a yellow discolouration of the skin or eyes
• the appearance of very dark urine or passage of pale, bloody or tar-like stools
• abdominal swelling
• prolonged itching of the skin
• chronic fatigue
• nausea or loss of appetite
• vomiting of blood
• severe prolonged abdominal pain

How can you take care of your liver?

• Maintain a healthy, well-balanced diet.
• Avoid taking medication unnecessarily. Do not exceed the maximum daily dose and do not mix alcohol and medication.
• If you drink, alcohol, have two or fewer drinks a day.
• Protect yourself from viral hepatitis A and B by getting vaccinated.
• Avoid exposure to industrial chemical.

What is liver transplantation?
Liver transplantation is a life-saving operation for children and adults with certain liver diseases when no other treatment is available. the operation involves taking out the diseased liver and replacing it with a healthy liver of suitable size and blood type. Overall, about 80-90% of adult patients and 75-85% of children survive a liver transplantation and resume normal livers although they continue to need medication to prevent rejection.

Unfortunately, many patients succumb to liver disease before transplantation can be undertaken. Public awareness of the need for organ donation is an important element in the overall success of liver transplantation.

What about the future?
Although progress is being made, much more needs to be done. The Canadian Liver Foundation actively supports and encourages doctors and scientists to pursue research into the causes, diagnosis, treatment and prevention of liver disease. Research is the key to finding treatments and cures for all forms of liver disease.

At the same time, the Foundation has expanded its activities, not only to address the needs to patients and their families, but also to promote awareness and a better understanding of liver disease among health professionals and the general public.

How can you help?
Take care of your liver by following the guidelines given herein and by learning more about liver health and prevention of disease.

If you are interested in supporting the Canadian Liver Foundation through a contribution of time or money, please contact our National office or your local chapter.

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