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The liver plays a vital role in many metabolic processes in the body including protein synthesis, detoxification, nutrient storage (such as glycogen), platelet production and clearance of bilirubin. With progressive liver damage; hepatocyte death and replacement of functional liver tissue with fibrosis in cirrhosis, these processes are disrupted.
The liver synthesizes angiotensinogen, a hormone that is responsible for raising the blood pressure when activated by renin, an enzyme that is released when the kidney senses low blood pressure. The liver produces the enzyme catalase to break down hydrogen peroxide, a toxic oxidising agent, into water and oxygen.
Liver failure is the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology. Two forms are recognised, acute and chronic (cirrhosis). [ 1 ] Recently, a third form of liver failure known as acute-on-chronic liver failure ( ACLF ) is increasingly being recognized.
Hyponatraemia is an almost universal finding due to water retention and a shift in intracellular sodium transport from inhibition of Na/K ATPase [citation needed]. Hypoglycaemia (due to depleted hepatic glycogen store and hyperinsulinaemia), hypokalaemia, hypophosphataemia and metabolic alkalosis are often present, independent of renal function.
Liver damage is also a clinical feature of alpha 1-antitrypsin deficiency [11] and glycogen storage disease type II. [12] In transthyretin-related hereditary amyloidosis, the liver produces a mutated transthyretin protein which has severe neurodegenerative or cardiopathic effects. Liver transplantation can be curative.
Fatty liver disease (FLD), also known as hepatic steatosis and steatotic liver disease (SLD), is a condition where excess fat builds up in the liver. [1] Often there are no or few symptoms. [ 1 ] [ 2 ] Occasionally there may be tiredness or pain in the upper right side of the abdomen . [ 1 ]
Chronic liver disease takes several years to develop and the condition may not be recognised unless there is clinical awareness of subtle signs and investigation of abnormal liver function tests. Testing for chronic liver disease involves blood tests, imaging including ultrasound, and a biopsy of the liver. The liver biopsy is a simple ...
Liver showing chronic passive congestion associated with tricuspid valve incompetence. So called 'nutmeg liver', Split nutmeg, for those who have never seen this appearance. Close up of congested liver showing the 'nutmeg' appearance. Congestive hepatopathy, is liver dysfunction due to venous congestion, usually due to congestive heart failure.