The Martin Pollins Blog

History, economics, business, politics…and Sussex

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Introduction[1]

The liver is the largest organ inside the human body. Among its many functions, it helps your body digest food, store energy, and remove poisons. Liver disease[2] is a type of damage to or disease of the liver. When the course of the problem lasts long, chronic liver disease[3] ensues. There are many kinds of liver diseases, including:

Key Facts[4]
The liver is the largest solid organ inside the body. It removes toxins from the body’s blood supply, maintains healthy blood sugar levels, regulates blood clotting, and performs several hundred other vital functions. It is located beneath the rib cage in the right upper abdomen.

  • The liver filters all of the blood in the body and breaks down poisonous substances, such as alcohol and drugs.
  • The liver also produces bile, a fluid that helps digest fats and carries away waste.
  • The liver consists of four lobes, each comprising eight sections and thousands of lobules (or small lobes).

Functions
The following are some of the liver’s most important functions:

  • Albumin Production: Albumin is a protein that keeps fluids in the bloodstream from leaking into the surrounding tissue. It also carries hormones, vitamins, and enzymes through the body.
  • Bile Production: Bile is a fluid that is critical to the digestion and absorption of fats in the small intestine.
  • Filters Blood: All the blood leaving the stomach and intestines passes through the liver, removing toxins, by-products, and other harmful substances.
  • Regulates Amino Acids: The production of proteins depends on amino acids. The liver makes sure amino acid levels in the bloodstream remain healthy.
  • Regulates Blood Clotting: Blood clotting coagulants are created using vitamin K, which can only be absorbed with the help of bile, a fluid the liver produces.
  • Resists Infections: As part of the filtering process, the liver also removes bacteria from the bloodstream.
  • Stores Vitamins and Minerals: The liver stores significant amounts of vitamins A, D, E, K, and B12, as well as iron and copper.
  • Processes Glucose: The liver removes excess glucose (sugar) from the bloodstream and stores it as glycogen. As needed, it can convert glycogen back into glucose.

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Picture Credit: File: Anatomy of liver and gall bladder.png” by Jiju Kurian Punnoose is marked with CC BY-SA 4.0.

Liver Specialists[5]
Gastroenterology is the branch of medicine focused on the digestive system and its disorders.

Hepatology, or hepatobiliary medicine, encompasses the study of the liver, pancreas, and biliary tree, and is traditionally considered a sub-speciality of gastroenterology, while proctology encompasses disorders of the anus, rectum, and colon and is considered a sub-speciality of general surgery.

Your Digestive System[6]
The digestive system comprises the gastrointestinal tract – also called the GI tract or digestive tract – and the liver, pancreas, and gallbladder:

  • The GI tract consists of hollow organs joined in a long, twisting tube from the mouth to the anus.
  • The hollow organs that make up the GI tract are the mouth, oesophagus, stomach, small intestine, large intestine, and anus.
  • The liver, pancreas, and gallbladder are the solid organs of the digestive system.
  • The small intestine has three parts. The first part is called the duodenum. The jejunum is in the middle, and the ileum is at the end.
  • The large intestine includes the appendix, cecum, colon, and rectum. The appendix is a finger-shaped pouch attached to the cecum.
  • The cecum is the first part of the large intestine. The colon is next. The rectum is the end of the large intestine.
  • An army of bacteria (also called gut flora or microbiome) sit in the gut and helps with our digestion.
  • Parts of the nervous and circulatory NIH external link systems also help. Nerves, hormones, bacteria, blood, and the digestive system organs work together, digesting the foods and liquids we eat or drink each day.

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The gastrointestinal tract (also called the digestive tract, alimentary canal, or gut) is the system of organs within multicellular animals that takes in food, digests it to extract energy and nutrients, and expels the remaining waste.
Attribution: LadyofHats, Public domain, via Wikimedia Commons File URL: https://upload.wikimedia.org/wikipedia/commons/c/c5/Digestive_system_diagram_en.svg

The Liver and its Functions[7]
The liver is a large, meaty organ that sits on the right side of the abdomen. It weighs about three pounds and is a reddish-brown colour. Normally you can’t feel the liver because it is protected by the rib cage.

The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver’s main job is to filter the blood coming from the digestive tract before passing it to the rest of the body. The liver also detoxifies chemicals and metabolises drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

There are several kinds of liver diseases and conditions, and many are explored in detail later in this publication. Some, like hepatitis, are caused by viruses. Others can be the result of drugs or drinking excessive alcohol. Long-lasting injury or scar tissue in the liver can cause Cirrhosis. Jaundice, or yellowing of the skin, can be one sign of liver disease.

Symptoms of liver disease can vary, but they often include swelling of the abdomen and legs, bruising easily, changes in the colour of stools and urine, jaundice, or yellowing of the skin and eyes. Sometimes there are no symptoms at all. Tests such as imaging tests (scans) and liver function tests can check for liver damage and help diagnose liver diseases.

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Anatomy of the human abdomen, by Ties van Brussel / tiesworks.nl. Public domain.
Attribution: Tvanbr, via Wikimedia Commons.

File URL: https://upload.wikimedia.org/wikipedia/commons/1/15/Anatomy_Abdomen_Tiesworks.jpg

Signs and Symptoms of Liver Disease
Some of the signs and symptoms of liver disease are the following:

  • Jaundice – a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment.[8]
  • Confusion and altered consciousness caused by hepatic encephalopathy – a nervous system disorder brought on by severe liver disease. When the liver doesn’t work properly, toxins build up in the blood. These toxins can travel to the brain and affect brain function. People with hepatic encephalopathy may seem confused. Treatments can rid the body of toxins and reverse this temporary condition.[9]
  • Thrombocytopenia – people with thrombocytopenia have low platelet levels. Platelets aid blood clotting and help stop bleeding. When platelet levels are low, bruising and bleeding may be excessive. Certain cancers, cancer treatments, medications and autoimmune diseases can cause the condition. Platelet levels often improve when the underlying cause is treated.[10]
  • Coagulopathy – which may be caused by reduced levels or absence of blood-clotting proteins, known as clotting factors or coagulation factors.[11] and [12]
  • Bleeding – a risk of bleeding symptoms, particularly when taking place in the gastrointestinal tract.[13]

Types and Causes of Liver Disease
Whilst there are over 100 types of liver disease, the following are some of the most common and their cause[14].

Liver

Comprehensive list of Liver Disease Conditions and Treatment[31] (Click on Links below)

Healthy Liver Tips – a selection from The American Liver Foundation[32]

  • Avoid taking unnecessary medications. Too many chemicals can harm the liver.
  • Don’t mix medications without the advice of a doctor. Mixing medications could be poisonous to your liver.
  • Drink alcohol responsibly and never mix alcohol with other drugs and medications.
  • Be careful when using aerosol cleaners. The liver has to detoxify what you breathe in. Make sure the room is well ventilated, or wear a mask. Be careful what you breathe.
  • Get vaccinated for Hepatitis A & B, and make sure your children are vaccinated as well.
  • Exercise regularly – walk a little further, climb the stairs. If you haven’t exercised for a long while, consult your GP first.
  • Don’t share personal use items such as combs, razors, and manicure tools.
  • If you received a blood transfusion before 1992, you might have hepatitis C. You should talk to your healthcare provider about getting tested.
  • Eat a well-balanced, nutritionally adequate diet. If you enjoy foods from each of the food groups, you will probably obtain the nutrients you need.
  • Keep your weight close to ideal. Medical research has established a direct correlation between obesity and the development of fatty liver disease.
  • Do not smoke.

Gaucher Disease and its Symptoms[33]
Gaucher disease is a rare genetic disorder passed down from parents to children (inherited). When you have Gaucher disease, you are missing an enzyme that breaks down fatty substances called lipids. Lipids start to build up in certain organs such as your spleen and liver.[34] Gaucher disease type 1 (there are three types) is most commonly found among Ashkenazi Jews who have a high number of carriers of the defective GBA gene.

The most common symptoms of Gaucher Disease include:

  • Swollen belly (enlarged spleen and liver)[35]
  • Easy bruising (low platelet count)
  • Bleeding that is difficult to stop
  • Anaemia (low red blood counts)
  • Fatigue (excessive tiredness)
  • Bone pain/easily fractured bones
  • In some cases, respiratory problems

Doctors don’t yet know if Gaucher disease treatment[36] reduces the risk of hepatocellular carcinoma – a cancer that starts in the liver. It’s different from “secondary” liver cancers, which have spread to the liver from other organs. If caught early, it can sometimes be cured with surgery or a transplant. It can’t be cured in more advanced cases, but treatment and support can help the patient to live longer and better.

Doctors do not yet know whether or if Gaucher disease treatment can help reduce the risk of some of the listed disorders. Learn more about Gaucher disease and associated conditions.

Wilson’s Disease and its Symptoms[37]
With Wilson’s disease (named after Dr Samuel Wilson, who first described the disorder in 1912) the liver can’t process and remove copper from your body in the usual way. Copper is an important mineral we all get from our food, but only small amounts are needed as excessive copper is poisonous (toxic). In Wilson’s disease, copper builds up and can damage your liver, brain and other organs.

Wilson’s disease is a rare inherited disorder that affects about one in 30,000 people. But this figure is fiercely debated, and the true numbers are unknown. As with most rare diseases, health data are disjointed because patients are treated at hospitals throughout the NHS, with many, except the larger centres, looking after only a few patients[38].

Onset of the disease can occur at any age, though mainly between 3 and 55 years old. Copper builds up in your liver cells (hepatocytes) first, and in about half the cases of those with Wilson’s disease, the liver is the only organ that shows signs of the disease – copper causes inflammation, damage and, in some cases, scarring (fibrosis), in your liver, which is known as hepatitis.

Symptoms[39]
Copper building up in your brain, central nervous system and liver can lead to confusion, physical tremors, and problems with coordination or clumsiness. A fuller list of symptoms is:

  • Fatigue, lack of appetite or abdominal pain.
  • A yellowing of the skin and the whites of the eye (jaundice)
  • Golden-brown eye discolouration (Kayser-Fleischer rings)
  • Fluid buildup in the legs or abdomen.
  • Problems with speech, swallowing or physical coordination.
  • Uncontrolled movements or muscle stiffness.
  • Some people with Wilson’s disease develop liver cirrhosis.

Treatment
At present, Wilson’s disease cannot be cured, but at most stages, treatment is helpful and can stop further damage to your body. People with Wilson’s disease can enjoy a full and healthy life – however, if it is not treated, people can die from Wilson’s disease. The main treatments are medicines that stop copper from building up, and you will need to take these for the rest of your life. Dietary changes may also be necessary to absorb less copper from food.

Wilson’s disease only affects people who have two faulty genes, one inherited from each of their parents. A particular gene on chromosome 13 does not work. The gene is called ATP7B. This gene normally controls how the liver cells get rid of excess copper. You can have one faulty gene without having the disease. So the parents of people with Wilson’s disease are often not affected themselves and probably did not know they carried a defective gene. The close relatives of people with Wilson’s disease can be checked for the faulty gene.

Is there a Link between Gall Bladder Removal and Non-Alcoholic Fatty Liver?
In medical jargon, the surgical removal of the gallbladder is called Cholecystectomy – a common treatment for symptomatic gallstones and other gallbladder conditions. The removal procedure was the eighth most common operating room procedure performed in hospitals.[40]

After a gallbladder is removed, your liver will still produce enough bile to help digest your food, but it won’t be stored in the same way. Without a gallbladder to store bile between meals, your small intestine will need to rely on your liver to produce more of the bile it needs in real-time[41]. Healthy eating habits[42] after gallbladder removal include:

  • avoiding fried, fatty, and greasy foods
  • avoiding spicy foods
  • excluding foods that cause gas from the diet
  • reducing caffeine intake
  • eating smaller meals
  • increasing fibre intake slowly

Science Direct reports[43] that Cholecystectomy is a risk factor for non-alcoholic fatty liver disease development. Hepatic steatosis and gallstone disease are highly prevalent in the general population – the shared risk factors are age, ethnicity, obesity, insulin resistance, metabolic syndrome, atherosclerosis, risk of cardiovascular disease, and mortality. The presence of insulin resistance is the critical element in this association because it represents a crucial link between metabolic syndrome and non-alcoholic fatty liver disease, as well as a higher susceptibility to gallstone formation.

To date, a cholecystectomy is considered a relatively innocuous procedure. However, in a large population-based study[44] in the US, researchers Ruhl and Everhart showed:

‘… an independent association of non-alcoholic fatty liver disease (NAFLD) with Cholecystectomy. It has been hypothesised that gallstones may be an early biomarker signalling the development of metabolic syndrome (MS) and liver steatosis even before (morbid) obesity is present. On the other hand, it is conceivable that Cholecystectomy actually drives the development of NAFLD (2), which would increase the unknown medical and financial burden of this presumably low-risk operation significantly.’

The abstract[45] of the paper by Ruhl and Everhart on the American College of Gastroenterology website concludes that the association of NAFLD with Cholecystectomy, but not with gallstones, indicates that a Cholecystectomy may itself be a risk factor for NAFLD.

Liver Transplants[46]
A damaged human liver has been treated and preserved in a machine for three days before being successfully transplanted into a patient, researchers say. The man quickly recovered his quality of life without any signs of liver damage, as well as rejection, and remains healthy a year after surgery.

Researchers say the development may save lives because the technology could increase the number of livers available for transplant and allow surgery to be scheduled days in advance.

A cancer patient on the Swiss transplant waiting list was given the choice of using a treated human liver. Following his consent, the organ was transplanted in May 2021, and the patient was able to leave hospital a few days later.

Liver transplant surgery
Picture Credit: Liver transplant surgery, by Tareq Salahuddin. Fair Use.
Image Link: https://live.staticflickr.com/7078/7273434238_a40e5fc127_b.jpg

Choline and Fatty Liver Disease[47]
Choline is essential for healthy liver function, and research has linked choline deficiency to fatty liver disease. There is no evidence to suggest that choline can reverse fatty liver disease, but it may help prevent the condition. Choline is an essential nutrient that people need to maintain overall health.

Although the body produces some choline, people also need to consume it in food to obtain the required amounts. Choline has several functions in human health, such as:

  • forming and maintaining cell membranes by synthesising phospholipids (a type of fat)
  • producing the neurotransmitter acetylcholine
  • playing a role in fat metabolism and transport
  • modulating gene expression
  • contributing to early brain development

How does choline affect the liver?
Research on humans and other mammals suggested that choline is necessary to maintain the liver’s normal function[48]. As long ago as the 1930s, scientists demonstrated that choline deficiency caused fatty liver disease in dogs and rats. The scientists introduced choline to the animals’ diet and found that this resolved the disease, although whether this happened by prior research or as a result of serendipity is unclear. The fact is that choline plays a role in the metabolism of amino acids[49] and methylation reactions[50] in the body. Methylation reactions are essential for gene expression.

Food sources of choline include:

Choline supplements
Choline is available in dietary supplements alone or combined with vitamins and minerals. The supplements may be in the form of choline bitartrate, phosphatidylcholine, or lecithin.

Caution
High intakes of choline may cause adverse effects, including:
Adverse effects from too much choline can include:

Summary 
Scientists have not identified how much choline can reverse fatty liver disease. However, it is clear that choline is an essential nutrient for liver health, and choline deficiency may contribute to fatty liver disease. Choline also plays a vital role in brain health and fat metabolism, and we need choline for overall health. People can consume choline in animal protein and plant sources. They may decide to take a choline supplement following a doctor’s advice.

High Fructose Corn Syrup link to Liver Disease[51]
Researchers investigating a possible link between non-alcoholic fatty liver disease (NAFLD) and high fructose corn syrup consumption found that consuming high amounts of fructose was linked to a higher risk of NAFLD. NAFLD happens when an excess of fat builds up in the liver, which can lead to permanent scarring of the liver, called cirrhosis. Around 24% of adults in the US have the condition[52].

Risk factors[53] for NAFLD include:

  • Low HDL cholesterol
  • Type 2 diabetes
  • High BMI
  • Age
  • Hypertension
  • Waist circumference

Previous research[54] indicates that diets high in sugar from sucrose or high fructose corn syrup increase NAFLD risk. Other research also suggests that NAFLD prevalence is highest in Hispanics[55] compared to Whites and Blacks.

Fructose is a natural sugar found in fruits, fruit juices, certain vegetables, and honey. Fructose is also present in high fructose corn syrup, which is often added to foods such as sodas and sweets. Typically, fructose consumption comes from various sources, the main ones being:

  • 29% from baked goods, pasta, and other grains
  • 28% from fruits and items containing fruit
  • 16% from sweeteners, condiments, and sauces
  • 16% from sodas

Research shows that, among all ethnic groups, those with a higher fructose intake were more likely to have NAFLD.

Reversing Non-Alcoholic Fatty Liver Disease[56]
As people age, old or damaged cells stop dividing to produce new cells. Over time, these senescent[57] cells accumulate in the liver and other tissues. Previous studies have linked such cells to certain age-related diseases.

Non-alcoholic fatty liver disease (NAFLD) means there’s a build-up of fat in your liver. But unlike other types of liver disease, there’s no damage to the organ in NAFLD. You can take steps to reverse the condition before it becomes a more serious problem. A fatty liver is linked to several other health conditions. If you treat those issues, you can help reverse NAFLD, too.

Losing Weight
Research suggests that losing weight is the single best thing you can do to control or reverse NAFLD. A good goal is to lose 10% of your total body weight, but even a loss of 3% to 5% can improve your liver health.

Talk with your doctor about the best way for you to lose weight safely and effectively. Options can include:

  • Diet
  • Exercise
  • Weight loss surgery
  • Weight loss medication

Changing what you eat
Improvements in your diet may help you lose weight. Some adjustments you can make are:

Alcohol can cause fat to build up in your liver. It also can damage the organ. You should avoid alcohol if you have NAFLD.

Talk to your doctor about all the drugs and supplements you take. Some people with liver problems should not take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.

Medications to Consider
No medications are approved specifically to treat NAFLD. But there are some medications and supplements you and your doctor may want to discuss. You may need vaccines to protect you against hepatitis A and B – viruses that can damage your liver. It’s also important to get a flu jab every year.

Some studies have found that vitamin E seemed to improve how well some people’s livers worked, but the science is not settled. If you’re interested in trying this supplement, talk to your doctor first. It may not be safe for everyone, and it has been linked to prostate cancer.

A report[58] from the US in 2014 about a new drug for the common liver disease by the National Institutes of Health (NIH) offers hope for sufferers, although there were some issues with changing cholesterol levels. Keep in touch with your doctor about your condition. Researchers are working on new drugs to treat NAFLD, and one of them may be right for you.

Cholesterol-Lowering Medications – Considerations[59]
Another common group of medications that can affect liver tests are the cholesterol-lowering medications commonly known as “statins”. Millions of people have used these medications with an excellent safety record and very little evidence of liver damage, even when used in people with mild liver disease. However, it is not rare for people to develop minor elevations of the liver tests soon after they start taking these medications.

In most cases, these elevations are less than three times the baseline level, and the levels return to normal despite continued use of the medication. If the liver tests are monitored, the medication should not be stopped if only minor elevations of liver tests are noted.

Supplements and Herbs 
Supplements and herbs, despite being natural, can be toxic to the liver. The production and distribution of these supplements are not regulated as carefully as the production of prescription medications. Natural products can be sold with little testing and with no proof of efficacy. Sometimes the herb or supplement itself can cause liver damage. In other cases, impurities or toxins introduced during the product preparation may be toxic to the liver. Too much iron or vitamin A can result in significant liver damage – generally speaking, iron supplements are unnecessary unless you have been diagnosed with iron deficiency. Vitamin A dose should never exceed 5,000 units a day unless provided as beta-carotene[60].

Medication Use in People with Liver Disease
With very rare exceptions, people with mild liver disease can safely take most common prescription and non-prescription medications at the recommended dose. Having mild liver diseases such as hepatitis C or fatty liver does not increase the risk that a given medication will be toxic to the liver. However, if a person with pre-existing liver disease develops liver injury from a medication, the resulting liver damage may be more severe than would occur in an otherwise healthy person with the same reaction. For that reason, whenever possible, physicians prefer to use liver-safe medications when a patient has liver disease.

Often, doctors may be reluctant to start patients on a cholesterol-lowering medication if the liver tests are already mildly elevated: usually due to fatty liver disease. Research has shown that cholesterol-lowering medications are safe in people with fatty liver disease or mild hepatitis C infection, which may benefit the liver by decreasing inflammation. However, people with more severe types of liver disease such as Cirrhosis have to take greater care regarding the types and dose of medications they take.

Fatty Liver Disease Specialists[61]
Fatty liver disease, also known as hepatic steatosis, is a condition where a person has a build-up of fat in their liver. A person with fatty liver disease may require treatment from a liver specialist.

The US National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) notes that around 25% of adults in the US have nonalcoholic fatty liver disease (NAFLD):

  • Fatty liver disease can permanently scar or damage the liver – the scarring is known as cirrhosis. Cirrhosis of the liver can lead to a person developing liver cancer.
  • It is important to treat fatty liver disease to prevent it from worsening.

Specialists
There are several different fatty liver disease specialists to choose from: the process may start with an initial diagnosis from a GP or NHS hospital. Referral might then be made to a gastroenterologist or hepatologist, both being medical professionals:

Specialist Speciality
Gastroenterologist                                                                                                                               Gastroenterologists specialise in conditions that affect the digestive organs: including the liver, gall bladder, oesophagus, intestines and pancreas.
Hepatologist Hepatologists specialise in conditions of the liver, gallbladder, and pancreas.

Certain factors can influence what fatty liver disease specialist a person chooses. This includes:

  • which specialists are available in their area
  • cost
  • appointment availability
  • recommendations from friends, family, or a doctor
Sources and Further Reading

Caution: No advice is implied or given in articles published by us. This guide is for general interest only and is compiled from the sources stated but has not been medically reviewed. It should never be used as a substitute for obtaining advice from your Doctor, a consultant Gastroenterologist, Hepatogist or other qualified 
clinician/medical practitioner. If you have already been given dietary advice you should not make changes without first talking to your GP, consultant or dietitian. If medications are mentioned, they include names for US drugs. The facts are believed to be correct as at the date of publication, but there may be certain errors and omissions for which we cannot be responsible. The information contained in this paper is provided for informational purposes only. There is no implied endorsement or promotion of any organisation by the writer. The hyperlinks were valid at the date of publication.

  1. Source: Mainly from https://en.wikipedia.org/wiki/Liver_disease
  2. Also called hepatic disease.
  3. Chronic liver disease is a progressive deterioration of liver functions. Liver functions include the production of clotting factors and other proteins, detoxification of harmful products of metabolism, and excretion of bile. This is a continuous process of inflammation, destruction, and regeneration of liver parenchyma leading to fibrosis and cirrhosis. Source: https://www.ncbi.nlm.nih.gov/books/NBK554597/
  4. Source: Center for Liver Disease and Transplantation at https://columbiasurgery.org/liver/liver-and-its-functions
  5. Source: https://en.wikipedia.org/wiki/Gastroenterology
  6. Source: https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works
  7. As described by WebMD at: https://www.webmd.com/digestive-disorders/picture-of-the-liver#1
  8. Source: https://my.clevelandclinic.org/health/diseases/15367-adult-jaundice
  9. Source: https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/hepatic-encephalopathy
  10. Source: https://my.clevelandclinic.org/health/diseases/14430-thrombocytopenia and https://en.wikipedia.org/wiki/Thrombocytopenia
  11. See: Spahn, DR.; Bouillon, B.; Cerny, V.; Coats, TJ.; Duranteau, J.; Fernández-Mondéjar, E.; Filipescu, D.; Hunt, BJ.; et al. (Apr 2013). “Management of bleeding and coagulopathy following major trauma: an updated European guideline”. Crit Care. 17 (2): R76. doi:10.1186/cc12685. PMC 4056078. PMID 23601765.
  12. See: Blonski, W; Siropaides, T; Reddy, KR (2007). “Coagulopathy in liver disease”. Current Treatment Options in Gastroenterology. 10 (6): 464–73
  13. Sources: https://en.wikipedia.org/wiki/Bleeding and https://en.wikipedia.org/wiki/Gastrointestinal_tract. See also: Tripodi, Armando; Mannucci, Pier Mannuccio (2011-07-14). “The Coagulopathy of Chronic Liver Disease”, New England Journal of Medicine. Massachusetts Medical Society. 365 (2): 147–156, at: https://www.nejm.org/doi/full/10.1056/nejmra1011170
  14. Over 100 – see https://www.nhs.uk/conditions/liver-disease/
  15. Source: https://en.wikipedia.org/wiki/Liver_disease#cite_note-9
  16. Source: https://www.cdc.gov/parasites/fasciola/index.html
  17. Source: https://www.nhs.uk/conditions/hepatitis/
  18. Sources: https://medlineplus.gov/hepatitis.html
  19. Source: https://medlineplus.gov/ency/article/000281.htm
  20. Source: https://medical-dictionary.thefreedictionary.com/Hepatic+steatosis
  21. Source: https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/
  22. See: Leslie, Nancy; Tinkle, Brad T. (1993). “Pompe Disease”. In Pagon, Roberta A.; Adam, Margaret P.; Ardinger, Holly H.; Wallace, Stephanie E.; Amemiya, Anne; Bean, Lora J.H.; Bird, Thomas D.; Dolan, Cynthia R.; Fong, Chin-To (eds.). Glycogen Storage Disease Type II (Pompe Disease). Seattle (WA): University of Washington, Seattle. PMID 20301438
  23. Sources: https://medlineplus.gov/hemochromatosis.html and https://medlineplus.gov/alpha1antitrypsindeficiency.html
  24. Source: https://medlineplus.gov/genetics/condition/transthyretin-amyloidosis/
  25. Source: https://medlineplus.gov/genetics/condition/gilbert-syndrome/
  26. Source: https://medlineplus.gov/ency/article/000255.htm
  27. Source: “Liver cancer – Hepatocellular carcinoma: MedlinePlus Medical Encyclopedia”.
  28. Sources: “Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia” and https://www.nhs.uk/conditions/primary-biliary-cirrhosis-pbc/.
  29. Source: https://medlineplus.gov/ency/article/000285.htm and https://www.nhs.uk/conditions/primary-biliary-cirrhosis-pbc/
  30. Source: “Hepatic vein obstruction (Budd-Chiari): MedlinePlus Medical Encyclopedia”and https://britishlivertrust.org.uk/information-and-support/living-with-a-liver-condition/liver-conditions/budd-chiari/
  31. Sources: https://www.niddk.nih.gov/health-information/liver-disease, https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/
  32. See: https://liverfoundation.org/25-ways-to-love-your-liver/
  33. Sources: National (US) Gaucher Foundation at https://www.gaucherdisease.org/about-gaucher-disease/symptoms/ and https://www.hopkinsmedicine.org/health/conditions-and-diseases/gaucher-disease
  34. Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/gaucher-disease
  35. When Gaucher cells build up in the spleen and/or liver, these organs become enlarged and can cause your abdomen to become swollen and painful.
  36. See: https://www.gaucherdisease.org/gaucher-diagnosis-treatment/treatment/
  37. Sources: https://britishlivertrust.org.uk/information-and-support/living-with-a-liver-condition/liver-conditions/wilsons-disease/, https://patient.info/digestive-health/abnormal-liver-function-tests-leaflet/wilsons-disease,
  38. See: https://www.ndrs.nhs.uk/data-is-being-used-to-find-out-how-many-people-in-england-have-wilsons-disease-to-help-improve-care/
  39. Source: https://www.mayoclinic.org/diseases-conditions/wilsons-disease/symptoms-causes/syc-20353251
  40. Source: Association of Cholecystectomy With Liver Fibrosis and Cirrhosis Among Adults in the USA: A Population-Based Propensity Score-Matched Study, in the US, reported at: https://www.frontiersin.org/articles/10.3389/fmed.2021.787777/full

  41. Source: https://www.everydayhealth.com/gallbladder/surgery-complications/
  42. Source: https://www.medicalnewstoday.com/articles/317659#diet-after-surgery
  43. At: https://www.sciencedirect.com/science/article/pii/S1365182X20311059
  44. See: The American College of Gastroenterology –  Ruhl CE, Everhart JE. Relationship of non-alcoholic fatty liver disease with cholecystectomy in the US populatio n. Am J Gastroenterol 2013;108(6):952–8 and https://journals.lww.com/ctg/fulltext/2020/04000/the_association_between_cholecystectomy,_metabolic.10.aspx
  45. See: https://journals.lww.com/ajg/Abstract/2013/06000/Relationship_of_Non_alcoholic_Fatty_Liver_Disease.19.aspx
  46. Source: https://www.medicalnewstoday.com/articles/worlds-first-doctors-successfully-transplant-human-liver-treated-in-a-machine
  47. Excerpted from: https://www.medicalnewstoday.com/articles/how-much-choline-is-needed-to-reverse-fatty-liver
  48. See research findings at: https://journals.lww.com/nutritiontodayonline/fulltext/2018/11000/choline__the_underconsumed_and_underappreciated.4.aspx
  49. Amino acids are compounds that combine to make proteins. When a person eats a food that contains protein, their digestive system breaks the protein down into amino acids. The body then combines the amino acids in various ways to carry out bodily functions.
  50. Methylation is a key reaction cycle through which a methyl group is transferred on to, enzymes, amino acids, proteins, and DNA in cells or tissue to control healing processes, cell energy, DNA expression, neurological function, liver detoxification, and immunity (Source: Kim et al. 2009; Yang et al. 2010). 
  51. Excerpted from: https://www.medicalnewstoday.com/articles/high-fructose-corn-syrup-intake-linked-to-liver-disease
  52. Source: National Institute of Diabetes and Digestive and Kidney Diseases (US), at: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts
  53. Source: https://www.ncbi.nlm.nih.gov/books/NBK384735/
  54. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893377/
  55. See: https://www.sciencedirect.com/science/article/abs/pii/S1542356517311837
  56. Source: https://www.webmd.com/digestive-disorders/reverse-nonalcoholic-fatty-liver-disease and https://www.nih.gov/news-events/nih-research-matters/reversing-common-liver-disease
  57. In biology, senescence is a process by which a cell ages and permanently stops dividing but does not die. Over time, large numbers of old (or senescent) cells can build up in tissues throughout the body.
  58. See: https://www.nih.gov/news-events/nih-research-matters/new-drug-common-liver-disease-assessed
  59. Excerpted from: https://gi.org/topics/medications-and-the-liver/#basics_1 (Author(s) and Publication Date: Jorge L. Herrera, MD, FACG, University of South Alabama College of Medicine, Mobile, AL – Published November 2007. Updated December 2012.)

  60. Beta- carotene belongs to a group of coloured pigments called carotenoids. It’s converted to vitamin A in the body and found in many fruits and vegetables. vitamin A for healthy skin and mucus membranes, our immune system, and good eye health and vision. Beta carotene in itself is not an essential nutrient, but vitamin A is. Vitamin A can be sourced from the food we eat, through beta carotene, for example, or in supplement form. The advantage of dietary beta carotene is that the body only converts as much as it needs. Source: https://www.medicalnewstoday.com/articles/252758#what_is_carotene
  61. Source/Excerpted from: https://www.medicalnewstoday.com/articles/fatty-liver-disease-specialists#choosing-a-specialist

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