We hope you have enjoyed the first week of the course. You should now be able to understand basic principles of liver anatomy and have an idea about the cells that constitute the liver microenvironment. Did you take the quiz, to test your knowledge? We would love to hear from you, at every step of this course. So please keep using the online comment facilities. Even at the point of preparing these teaching materials, thousands of you have already enrolled for this course.
There is strength in numbers and tapping into this tremendous resource, we would encourage you to post and read posts from other participants, to promote discussions and enrich your learning experience.
Week one covered the critical importance of our liver for life. A healthy liver can perform 500 different functions. You should be able to name a few, by now.
The liver is the only internal organ that can regenerate. Even if three quarters of the liver are removed, doing surgery, the remaining part can grow back to take up its original volume. Our poor livers can take a lot of damage, before they start complaining. And, for this reason, we don’t notice until it is severely hurt. Maybe you have had the chance to look at this in more detail. Have you read about the myth of Prometheus?
In week two of this course, we will learn about factors that damage your liver and can cause liver disease. Many of us think of alcohol abuse, when we hear about liver cirrhosis.
Although alcoholic liver disease is a big problem in the UK, and worldwide, there are many other conditions that can effect our livers and even lead to cirrhosis, including genetic disorders, fatty diet, viruses that can choose the liver as their nest for replication.
Let’s start by taking a quick quiz, to test our current perceptions about the causes of liver damage. We will then introduce the signs and symptoms that may lead us to suspect liver disease.
Reading early signs of liver distress can often help take action against further damage and give this organ the chance to repair itself.
Once we can recognise the hallmarks of liver disease, we will hear from some of our consultant liver doctors who work at the Queen Elizabeth Hospital, behind me, and are experts in the field. Each of them have years of experience in treating patients with liver diseases, and they run research groups of international reputation, aiming to find new treatments.
We are hoping that you will enjoy learning about liver diseases, this week. Please keep in touch.
How do you know your liver is sick?
Although there are many different causes of disease, the liver often responds to the damage in characteristic ways which can be recognised by your physician to help him diagnose the problem.
In our next activities we will consider four of the main causes of liver disease, viral hepatitis, drug and alcohol damage, autoimmunity and finally obesity-related disease. We will highlight what causes the disease and particularly what the symptoms or tell-tale signs of the disease are. We will also discuss who is likely to suffer from such conditions, and touch on how they can be treated.
Listen carefully to the discussions of symptoms and see whether you notice any common phrases which reappear. We will then go on to consider two particular outcomes of liver damage (fibrosis and cirrhosis) in later activities.
what is alcohol liver disease and what are the symptoms? So alcoholic liver disease bridges quite a few different diseases. Just by its name you know that it’s something that’s caused by alcohol excess. But what we’re beginning to learn is that– number one– not everyone who drinks excessively develops liver disease, and also some people who– perhaps to you or I– perhaps don’t drink that much seem to develop cirrhosis. So I prefer to call it alcohol-related liver disease, although in many patients alcohol is the dominant injury to the liver. And it usually affects people in young adulthood or middle age.
But it can affect people of any age. And it’s probably the commonest cause of liver disease in the UK. And who can get alcohol liver disease? Pretty much anyone who’s vulnerable to liver disease. So for instance, you might be talking to people about fatty liver disease. Well we know that if you have a tendency to fatty liver disease then the risk threshold is lower. And so anybody who drinks in excess of what their liver can metabolise safely might be at risk of alcoholic liver disease. But clearly if someone in the general public were listening to this they would have in their mind a picture of someone who lives under a railway arch and drinks all day.
But not everyone with alcohol-related liver disease is like that. In fact that’s a minority of the patients we see here. And a lot of the patients that we see here with alcohol-related liver diseases would look very normal to someone outside the clinic. Do we know how alcohol damages the liver? Yeah we’re getting better at that. I mean we haven’t fully understood the mechanisms. But one of the strongest predictors for alcohol-related liver disease is actually genetics. And we’re beginning to unpick some of those genetic patterns that will predict these things.
And in fact we’re finding that a lot of the risk factors that lead to alcohol-related liver disease are similar to the genetic risk factors that might be to fatty liver disease. So some people have a kind of genetic vulnerability and the alcohol just adds on to that and, if you like, it amplifies or accentuates the injury. Also we know that certain other liver diseases will give you a vulnerability. So it’s quite common actually for someone to be referred with alcohol cirrhosis and for us to find that, yeah, there’s alcohol damage but they also might have too much iron in their liver. Or they might have a problem with some proteins that are stored in the liver.
So there might be more than one process that’s damaging the liver. And can the liver also be damaged by drugs? Yes it can. And it can be damaged by drugs that doctors prescribe. And it can be damaged by drugs that people take themselves and perhaps the doctor doesn’t know about it. So we know, for instance, that if you take cannabis then that might accelerate fibrosis for a variety of reasons. We know that some drugs that we might give for skin diseases can sometimes cause fibrosis in patients.
And actually sometimes drugs that are given for all sorts of different things in the wrong person can react in a bad way with the liver and can damage the liver so badly that it stops working. Do we know what are the current treatment options for alcoholic liver disease? Yeah it’s difficult to treat. And that’s because you have to deal with the addiction, if the person’s drinking too much, and you have to deal with the effects of the liver damage. So you can’t take the two apart. They’re all part of the same thing. Presumably it’s the same for drugs as well? Exactly, yeah.
So in many cases people have drunk harmfully for well over a decade and it’s part of their life. And in some cases, in truth, it’s a part of their life they’re not willing to give up. It’s who they are. It’s how they are. It’s where their friends are, in the pub. And so they find it very difficult to make those changes. So you have to work with the psychology. You have to work with the addiction psychiatry elements of these things. And at the same time we try to do our best to manage the problems of the cirrhosis as well. So it’s a multi-disciplinary issue.
It involves a lot of different experts bringing in a lot of different skills in order to manage the patient successfully.
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