SOMETHING TO KEEP IN MIND
In most cases, only one or a few symptoms are present for people with liver imbalance. It is rare, for cases with liver imbalance, to exhibit all the symptoms.
1. What are the structure and functions of the liver?
The liver is the second largest organ of the body, just after the skin. It is the largest and heaviest internal organ, weighing between 1200 - 1500 grams (about 3 pounds) in an average adult. This is about 1/40 - 1/50 of an average adult's total weight. An infant's liver is about 1/20 - 1/16 of his/her body weight.
The liver fills most of the space in the upper right part of the abdominal cavity just underneath the diaphragm muscle. It is partially protected by the lower rib cage, its upper surface being at the level of the 5th or 6th rib. In medical terms, the regions occupied by the liver are referred to as the right hypochondriac region and part of the epigastric region of the abdominopelvic cavity. The liver is divided into 2 main parts called the right lobe (comprising 4/5 of the liver) and the left lobe. The two lobes of the liver are separated by a fold of the parietal peritoneum called the falciform ligament. This ligament extends from the diaphragm muscle and helps to suspend the liver in the abdominal cavity. The much larger right lobe is partly concealed behind the rib cage and can not normally be palpated although much of the liver may be palpated in the abdominal area below the xiphoid process of the sternum.
The liver has an irregular wedge shape and is dark red in color. It is soft, brittle, and easily ruptured. The liver is composed of approximately 500,000 microscopic functional units called hepatic lobules. Each hepatic lobule can be thought of as a "small liver" because in these units that carry out all of the functions of the liver. The lobules are six-sided structures consisting of specialized cells called hepatocytes arranged around a central vein. The liver contains about 2.5 billion cells in total.
2. Why is the liver a special organ?
The liver is the only organ in the body that receives both oxygenated and deoxygenated blood. The oxygenated blood flows into the liver and is distributed to the hepatic lobules through the hepatic artery which is a branch of the celiac plexus - a group of blood vessels coming out of the abdominal aorta. Oxygen rich blood is supplied to all other organs in the body in a similar way. The deoxygenated blood supply, which is unique to the liver, comes from a special blood vessel called the hepatic portal vein. This vein collects all of the blood that has passed through the digestive system and directs it to the liver. Therefore, the liver lobules receive blood that has already given away its oxygen supply to the digestive organs but is rich in all of the nutrients absorbed from the intestines along with whatever drugs, microbes, or toxins that may be present.
3. Why do I feel tired, fatigued, or weak?
When the function of the liver is out of balance many people report a feeling of weakness and whole body fatigue that makes them lose the desire to do any kind of physical exertion. Such a person might even be seen as "lazy" by others who do not know of this condition. There are two factors related to liver function that may contribute to this condition.
The liver is a prime storage site for Vitamin E. One of the many functions of this vitamin is to promote the production of red blood cells which absorb, transport, and release oxygen to all the tissues of the body. In some cases, liver dysfunction may deplete the bodies reserves of Vitamin E impacting red blood cell production and thus the supply of oxygen needed by cells to carry out their functions. Under these conditions the muscles may become weak and easily fatigued.
One of the known causes of muscle fatigue is the build up of lactic acid in the body. During exercise, some of the glucose (the main carbohydrate used as fuel by muscles and other cells) being metabolized by active muscles is not completely consumed. The partially metabolized glucose residues are converted to lactic acid. Normally, the lactic acid is released into the blood stream and finds its way to the liver where about 80% of it is converted back into glucose. The ability of the liver to convert lactic acid into glucose serves two purposes. It provides new glucose fuel that is available for metabolism and it lowers lactic acid levels. If the liver is not able to efficiently remove lactic acid it may build up to levels that cause weakness and fatigue.
4. Why do I feel abdominal distension?
Abdominal distension (ascites) is one of the most common symptoms associated with liver dysfunction. It is particularly prevalent in people suffering from chronic hepatitis but can result from a number of other liver ailments. Because the liver is associated with so many vital functions in the body, imbalances and damage to the liver can result in many secondary symptoms including abnormal body fluid accumulation in the abdomen.
A large quantity of blood (about 20% of your blood volume) and lymphatic fluid move through the liver. When the structure of the liver is damaged, the flow of these fluids can be impeded resulting in a build up of pressure, which in turn increases the rate at which fluids seep out of the blood and lymphatic vessels into the surrounding tissues.
In addition, liver disease may result in a decrease in the synthesis of albumins and other liver derived proteins which are normally secreted into the blood and which help to maintain fluid balance between the blood and tissues. As a result of this condition, there may be an increase in the movement of fluids from blood vessels into the tissues and body cavities such as the abdominal cavity.
Normally the secretion of bile by the liver not only helps with the digestion of fats, but is also part of a complex hormonal signaling system that regulates intestinal motility and secretion of digestive chemicals by the pancreas. Imbalances in bile secretion, pancreatic secretion, and intestinal motility can slow digestion and lead to GI tract edema, damage to the intestinal structures (villi) necessary for nutrient absorption, and the production of excessive quantities of gas in the stagnated food. Gas accumulation can distend the intestines and further increase fluid pressure in the abdominal cavity.
5. Why do I have difficulty sleeping and excessive dreams?
The amount of blood flowing through different parts of the body can change dramatically in a very short period of time. During rest, a much larger volume of blood is found in organs such as the liver and the spleen. These organs are sometimes referred to as "blood reservoirs" for this reason. When the level of physical activity increases, more of this blood moves out of the liver and into the system to provide additional blood flow to the muscles.
For instance, when going from a state of rest to moderate levels of physical activity, blood flow to the liver may decrease by 56% or more. The large volume of blood in the liver during periods of low physical activity, such as sleep, provides it with the raw materials needed to do its many jobs such as detoxification, processing of nutrients, etc. Liver imbalances or impaired liver functioning may prevent the return of the proper volume of blood flow to the liver. This means that, relatively speaking, more of the blood is involved in unnecessary activities which can interfere with sleep. Besides depriving the body of the time it needs to rest and regenerate energy, the frequent periods of awakening may make us much more aware of our dreams.
6. What is spider angioma and liver palm?
A spider angioma is formed when a group of blood vessels dilates in a characteristic "spider leg" pattern. It appears on the skin surface as a red dot with tiny blood vessels radiating out from the center. A spider angioma can be seen in a healthy person without any apparent cause, but is more common in individuals with liver disease or altered hormone levels. The size of a spider angioma may vary from 0.2cm up to 5cm and the number these markings may vary greatly from individual to individual. They commonly appear on the face, neck, chest, and the back of the hands but are not limited to these areas. A spider angioma is not harmful in itself but is usually indicative of an underlying medical condition - especially liver dysfunction and certain hormone imbalances.
Liver palm is a similar surface manifestation of an internal imbalance. In this case, a number of indistinct red spots alternating with red and white colors may appear on the palm of the hand especially in areas close to the thumb and little finger. These spots are sometimes found on the finger pads or soles of the feet.
The presence of these surface markings may indicate a liver dysfunction relating to the role of the liver in helping to maintain a normal estrogen balance. Estrogen is a reproductive hormone and is normally inactivated in the liver. When the liver is not able to play its role in balancing estrogens, levels of this hormone may increase in the blood. It is this elevated estrogen level that is believed to cause the blood vessel dilation that manifests as the above mentioned spider angioma and liver palm.
7. Why do my gums bleed when I brush my teeth?
The liver had a great deal to do with the control of bleeding by producing and activating many of the elements involved in blood clotting (coagulation). Blood clotting is a complex process that involves a cascade of chemical reactions in the blood. This "chain reaction" involves a number of proteins produced by the liver along with several vitamins and other elements. If even one of the elements necessary for this cascade to occur is not present, the blood will simple not clot. The most notable example of such a condition would be hemophilia. However, milder symptoms such as bleeding gums, nose bleeding, petechia, and heavy menstruation in women, may come about if a liver imbalance or dysfunction interferes with the production of normal amounts of the blood clotting factors. Under these conditions bleeding occurs more readily and the clotting process becomes inefficient.
8. Why am I easily irritated or stressed out? Why do I sigh a lot?
According to traditional Chinese medical theory, the liver ensures the free flow of Qi upwards and outwards in all directions. That is to say, the liver likes a free and smooth environment and dislikes being frustrated and constrained. When the liver is disharmonized in any way, normal liver function is impaired, thus, the liver can not work freely and the free flow of its rhythm is obstructed. Sighing, feeling irritated, being easily angered and depressed are all the external signs and symptoms of liver frustration.
9. Why do I have dull facial complexion?
The liver is involved in the metabolic processing of all nutrients entering the body. This includes amino acids for protein synthesis, carbohydrates, fats, and vitamins. It also processes many hormones and enzymes circulating in the blood. These nutrients are made available to all of the tissues to support all of the cellular metabolic life processes including the production of new blood. In addition, the liver secrets bile, some of which circulates in the blood. In short, the liver is responsible for supplying the raw materials required by all tissues and organs for normal functioning. When the liver is not functioning properly, there may be a decrease in the balance of vital nutrients and an increase in circulating bile compounds such as bilirubin. These changes in blood composition may become visible superficially as a dulling of skin complexion - a surface manifestation of altered blood composition.
10. Why do I have a bitter taste in my mouth?
Bile produced by the liver is stored in the gall bladder and injected into the small intestine to help in the digestive process. Bile also contains certain waste products that are eliminated with the solid wastes. The liver produces 800 - 1000ml of bile each day. When the liver is damaged, bile production and elimination may be impaired resulting in indigestion. The food that can not be normally digested accumulates in the body resulting in a bitter taste in the mouth, especially in the morning.
11. Why do I feel uncomfortable or have pain around my rib area?
Not every form of liver damage is accompanied by a distinct sensation of pain. Pain is most commonly associated with clearly identified liver diseases such as acute hepatitis, chronic active hepatitis, late stage cirrhosis, and liver cancer. However, even when a distinct localizable sensation of pain is absent, other forms of discomfort in the abdominal and lower rib cage area are frequently reported. These sensations are generally reported as being recurring and disturbing sensations that are very difficult to describe. The symptoms include a variety of sensations such as a pulling sensation under the rib cage, something akin to a constant dull pain, or simply the feeling that something in the liver area is uncomfortable and don't feel right. As difficult as these symptoms are to describe, they often indicate an underlying, and possibly undiagnosed, liver condition. One of the body's most immediate reactions to tissue damage is the inflammatory response. This protective mechanism causes an accumulation of fluids within the tissues and consequent swelling of the organ involved. The swelling and enlargement of the liver causes its surface to irritate nerves in the area which accounts for the vague but disturbing physical sensations mentioned above.
12. Why am I experiencing unformed stool or diarrhea?
The principle digestive function of the liver is to produce a complex liquid called bile. This fluid is stored in the gall bladder and injected into the small intestine during the digestive process. Bile is essential for the efficient digestion of fats. When liver function is impaired, its bile secreting function may be reduced which in turn prevents the normal processing and absorption of fats. The undigested fats pass all the way through the intestinal tract and leave the body with the solid wastes. Normally fats are digested and absorbed along with sufficient quantities of water to make the stool more solid and compact for elimination. The presence of abnormal amounts of fat in the solid wastes accounts for the loose and unformed nature of the stool.
13. Why don't I have daily bowel movements?
The normal functioning of the liver and its production and secretion of bile into the intestine is part of a complex regulatory system involving signals to the nervous system and the secretion of a variety of hormones. When the liver is not functioning properly and bile secretion is impaired, this process is interrupted. The end result of this imbalance in the system may be decreased secretion of digestive enzymes by the pancreas resulting in slowed digestion and decreased motility of muscle wall of the large intestine. The large intestine is at the end of the digestive tract and it receives all of the undigested nutrients and byproducts of the digestive process that are to be eliminated as solid wastes from the body. Slowing of the contractions of the large intestinal wall causes the wastes to remain in the large intestine for a longer time. The wastes accumulate in the intestine and become dry and difficult to eliminate. Thus, a decrease in the frequency of bowel movements (constipation) can occur. In some people, bowel movements may occur every 2 or 3 days. In more severe cases bowel movements may be suppressed for a week or longer.
14. Why can long-term alcohol consumption damage the liver?
The body is constantly exposed to potentially toxic chemicals. Some of these come into the body with our food, others
are produced by bacteria, and a great many are produced as the normal byproducts of cellular metabolism. Every cell in the body has some ability to get rid of certain toxic chemicals but liver cells are particularly rich in the enzymes involved in breaking down toxins. For this reason, the liver is the principle organ or the body for the absorption and chemical detoxification of a great variety of potentially harmful substances.
Under normal circumstances, the liver can easily break down the alcohol we consume. While some of the byproducts of this process are also toxic, the liver is normally able to eliminate the residues without damage to its own cells. However, the consumption of a large amount of alcohol over a long period of time exceeds the ability of liver cells to detoxify the alcohol and dispose of the byproducts efficiently. Liver cells eventually begin to die as a result of this constant chemical assault. As liver cells die there are fewer and fewer left to detoxify the alcohol and so the remaining healthy cells are exposed to even greater toxic loads and begin to die in larger numbers. As the condition continues the liver becomes inflamed and normal liver tissue is replaced by fibrous connective tissue (scar tissue). This condition is referred to as cirrhosis of the liver and can also be brought on by chronic inflammation due to hepatitis.
15. What are the common symptoms for chronic hepatitis?
A study of 1,250 cases of chronic hepatitis (of all types) in China shows the following common symptoms and the percentage of cases in which each of these symptoms was observed.
85.1% enlarged liver that can be palpated below the lower edge of the rib cage on the right side
83.2% dull or sharp pain under right side of rib cage
77.6% reduced appetite
76.25 tiredness, fatigue, or weakness
55.1% normal GPT, TTT, TFT in multiple examinations
35% dry stool followed by diarrhea
30% unformed stool or diarrhea
30% abdominal distension
25.4% dull or sharp pain under the left side of rib cage
15% alternating diarrhea and dry stool
10% dry stool or no daily bowel movement
7.6% reduced vision, dry eyes, or tired eyes
5% altered levels of skin pigmentation
3% gum or nose bleeding
2.5% typical or non-typical spider angioma
2.2% skin petechia
6.8% females experiencing irregular menstruation or amenorrhoea
3.3% males experiencing reduced sexual function
