- for the neutralization of substances dangerous to us: toxins, poisons, certain drugs, etc.; — oxidation and synthesis of proteins and carbohydrates; - glycogen stores are stored in the liver (a substance that, in an “emergency” situation, quickly turns into glucose to feed the body); - it participates in the process of digestion, synthesizing the bile necessary for it; - Vitamin A is synthesized here. Alcohol Alcohol is the most important liver poison. The reason is simple: alcohol, in essence, is the same “chemistry” as some kind of dichlorvos (by the way, alcohol in any amount destroys liver cells). It would seem that you can destroy alcohol and live in peace. But no - when alcohol decomposes in the body, the substance acetaldehyde is formed, which is 30 times more toxic than alcohol itself (it is thanks to him that we suffer from a hangover the next morning). Acetaldehyde is destroyed by the liver for a few more days, and all this time it suffers from poisoning. So our metabolism goes through a stump-deck, resistance to infections decreases.

What progress has come to - wherever you look, everywhere is “chemistry”. We receive our doses of poison daily from polluted air, unfiltered water, vegetables and fruits treated with chemicals, even meat and milk contain residues of hormones and antibiotics. And the unfortunate liver works around the clock, disinfecting all this disgrace. It's no wonder that sometimes she can't handle it. The most annoying thing is that even conscious citizens who lead a healthy lifestyle are not immune from this ... Vitamins and trace elements The most "liver" vitamins are C, E and lipoic acid. Vitamin C improves metabolism and protects the liver from toxins. E (it is abundant in vegetable oil and nuts) keeps liver cells from destruction. Lipoic acid (available in pharmacies) improves liver function and reduces exposure to harmful substances. The most important trace elements for the liver are selenium (pistachios, garlic, fish and seafood) and zinc (red meat, fish and eggs). Selenium and zinc reduce the toxicity of drugs and alcohol and prolong cell life. "Enemy" food The liver perceives as poison everything fried, smoked, pork, bacon, hard-boiled eggs, mushrooms and overeating in general. Fasting in order to lose weight is no less harmful, because it leads to the oppression of liver cells and even their death. By the way, the Atkins diet (the so-called “fatty”) is still the same blow to the liver. Losing weight refuse carbohydrates, but eat a lot of protein and fat. And it turns out that they make the liver work like a slave in a galley: they give the hardest work and refuse food.
ide Mother's hated phrase "Wash your hands before eating" has served many of us in good stead. Because simple rules of hygiene protect us from a dangerous viral liver disease - hepatitis. So clean hands, short nails (also clean), boiled water and washed fruits and vegetables keep us from the virus. But all sorts of pies bought on the street, shawarma and other handicrafts - this is best avoided. Save yourself not only from hepatitis, but also a bunch of other contagious ailments. Medications It's no secret that most drugs do not have the best effect on the liver. She regards any "chemistry" as poison and begins to work hard to neutralize it. And some drugs generally inhibit the work of liver cells or even cause their death. The second "necessary evil" coming from doctors is dental treatment and gastric probing. These two interventions sometimes “reward” an innocent patient with the hepatitis virus. Therefore, always ask: are the instruments sterilized? Read the continuation of the series about the internal organs in the next issues.

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One of the most important organs in the human body is the liver.

the importance for our body cannot be overestimated, and in those cases when pronounced pathological changes occur in it, no other organ can replace it. From how clearly and correctly the liver of a person works, his physical condition and even his psycho-emotional state depend. In addition, this organ also plays an important role in the appearance of a person. The human liver per day passes through itself 2 thousand liters of blood, purifying it, it takes part in the breakdown of fats, promotes the production of bile acids, etc. she was healthy, to maintain her efficiency, to take into account all her needs and to avoid conditions harmful to her work. Otherwise, this body may simply fail.

The great importance of the liver is also due to the fact that in the human body it acts as a barrier to all toxic substances that can come from outside. It disinfects toxins, removes harmful substances, the liver is necessary for the proper digestion of food, blood disinfection, etc. An important role is also given to the liver in such processes in the human body as the metabolism of carbohydrates, proteins, and fats. Albumin proteins are synthesized in this organ (about 15 g daily), due to which the necessary pressure is maintained inside the body, and the blood transports vital substances. However, albumin is not the only protein necessary for the human body that the liver produces (for example, globulins).

Thus, the liver is also an organ that takes an important part in the processes of metabolism, blood circulation, and digestion. Inextricably linked with the work of the liver and processes such as hormonal, vitamin, protein, fat, carbohydrate, pigment, mineral, water metabolism. This organ is necessary to maintain the internal environment of the human body at a constant, necessary level for it. Protective, neutralizing excretory and enzymatic functions are carried out in the liver.

1. Skin diseases.

2. Allergic diseases.

3. Diseases of blood vessels and joints.

4. Changes in the composition of the blood.

5. Violation of mineral, cholesterol metabolism and much more.

Serious diseases and severe damage to the liver may well lead to tragic consequences. The operation on this organ is very complicated, its transplantation is carried out very rarely (even less often than a heart transplant). In cases of malfunctions in the liver, this will certainly affect the functions of other organs, since everything is interconnected in the human body. The general state of health will certainly worsen, which is why it is necessary to treat the liver with care, treat diseases in time if they occur, engage in prevention, and use means to maintain it in good condition.

Tags: liver, human body

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Hepatitis >> The role of the liver in the human body

Before we continue talking about prevention, diagnosis and medical treatment viral hepatitis, we will discuss most carefully the role of the liver in the human body. This is necessary because the role of the liver is very important, and because the liver is the organ that most often contains viruses, especially the hepatitis virus. In addition, the hepatitis virus is the most dangerous virus for the liver.

The liver is the largest gland in the human body, the mass of the liver is 1.5-2 kg. The liver is located directly below the diaphragm in the upper part of the abdominal cavity, on the right side. In adults, a small portion of the liver is located to the left of the midline of the body. The liver is conditionally divided into two asymmetrical lobes - right and left.

The liver has a lobular structure: the lobules are surrounded by interlobular veins, which are branches of the portal vein, and interlobular arteries-branches. The bile ducts are located between the liver cells. Leaving the lobule, the bile ducts flow into the interlobular ducts, then join into the common hepatic duct, which exits into the duodenum 12.

Utri lobules The endothelium of the hepatic capillaries consists of stellate cells that have the ability to capture foreign and harmful cells and break them down (phagocytosis). hepatitis virus difficult to split like this. The liver differs from other organs in that it simultaneously includes the hepatic artery and portal vein, that is, in addition to arterial blood, the liver also receives venous blood. This explains the fact that the liver is most often exposed to the "invasion" of hepatitis viruses. The arteries enter other organs, bringing in fresh, “clean” blood, and the veins leave them, carrying away the spent, “dirty” blood. Entering the gates of the liver (the common entrance of the arteries, ducts and branches), the portal vein, which carries blood from the unpaired organs of the abdominal cavity, branches into the thinnest branches located between the lobules. In the substance of the liver, capillary networks are obtained from arteries and veins, from which blood is collected in the central vein, which flows into the vena cava, which goes to the right atrium. Therefore, sometimes a patient with hepatitis has heart pain. Also hepatitis often affects to the lungs and brain.

Lymphatic vessels go between the lobules, then flow into the plexus of the lymphatic vessels that accompany the branches of the portal vein. About half of the entire body lymph is excreted from the liver. Hence, with hepatitis, lymph suffers.

After analyzing the structure of the liver, it is clear why it often becomes the first target of hepatitis. Although in some cases hepatitis strikes other organs.

The liver is both an organ of digestion, circulation and metabolism of all kinds, including hormonal. It performs over 70 functions. Here are the main features:

Digestive function

The liver produces bile, which enters the duodenum. Bile is involved in intestinal digestion, helps to neutralize the acidic slurry coming from the stomach, breaks down fats and promotes their absorption, and has a stimulating effect on the peristalsis of the large intestine. During the day, the liver secretes up to 1-1.5 liters of bile. With hepatitis, no more bile is secreted than in the absence of hepatitis.

barrier function

The mucous membrane of the hepatic vessels and special cells absorb and break down toxic substances that come with the blood and lymph. Many scientists call the liver a "graveyard for corpses." Dead microbes, bacteria, viruses, protozoa (giardia, chlamydia, gonococci, gardnerella, oiistorchi, Trichomonas), worms - ascaris, echinococcus enter the liver with blood and lymph; tissue cells and blood cells, including dead hepatitis viruses. Up to 200 billion dead red blood cells pass through the liver every day. The liver must also neutralize living microorganisms: viruses, worms, protozoa that come with blood, prevent their reproduction and settling in other vital organs: lungs, brain, heart, eyes, etc. Therefore, if hepatitis immediately affects the liver , it does not immediately cause complications on other organs. But over time, hepatitis affects all organs of the body.

Chronic, long-term illnesses, especially chronic hepatitis, “deliver” to the liver not only a huge amount of “corpses”, but also harmful chemical compounds of medicines: salicplats, antibiotics, nicotinic acid, sulfonamides, contraceptives (contraceptives), progestins, estrogens that destroy the liver. In this case, she is not able to overcome such a number of harmful compounds, microorganisms, "corpses", and they again enter the bloodstream, spreading throughout the body and poisoning it. This process is called "self-poisoning". Self-poisoning in hepatitis is especially detrimental to the body.

Protective function in the pathology of digestion and absorption of proteins

Insufficient digestion and assimilation of protein products in the small intestine leads to increased bacterial breakdown (rotting) of protein, peptides and amino acids in the large intestine. As a result, poisonous decay products are formed. With a normally functioning liver and a small amount of these poisons, the liver completely neutralizes them, and with an excess, it does not have time to neutralize them, they enter the bloodstream, causing a general poisoning of the body, including the liver.

For example, the following decay products enter the blood:
phenol, mercaptan, thioether, which lead to the development of intestinal autointoxication, manifested in the following symptoms: dizziness, weakness, minor abdominal pain, insomnia, recurrent headaches, "fatigue syndrome", apathy, depression;
indole, which increases the above symptoms with manifestations of sepsis, subfebrile temperature, diarrhea;
indican negatively affects the state of the stomach (gastritis with low acidity develops), the pancreas (its enzymatic ability decreases), leads to an even greater formation of such poisons as ammonia, hydrogen sulfide, phenol, cresol, skatole, which, in turn, poison the liver and other organs. As a result, more formidable diseases develop: glomerulonephritis, nephropathy - up to wrinkling of the kidneys, uremia (impaired urine formation), diseases of the gastrointestinal tract and biliary tract, inflammation of the peritoneum, purulent processes in the tissues. In addition, immunity is sharply reduced, and the risk of oncological and immunodeficiency diseases increases.

Participation in blood circulation

In the reticuloendothelial cells of the liver, oxidative cleavage of hemoglobin and other blood cells occurs, resulting in the formation of biliverdin, and then, by combining it with acid, bilirubin. Bilirubin is excreted in the bile and excreted by the intestines. With the weakening of the functions of the biliary tract (dyskinesia), the passage of bile slows down, bilirubin precipitates in the ducts of the liver, gall bladder, cystic duct, intestines, where bilirubin, rather large (up to the size of a walnut), green stones are gradually formed. Sometimes they stick together with cholesterol - yellow-green conglomerates are obtained. The bilirubin excretory function of the liver is gradually disrupted, which is also facilitated by infections, toxic substances (alcohol, drugs, antibiotics), increased destruction of red blood cells, suppression of the vital activity of the intestinal microflora, loss of the enzyme link that provides the biosynthesis of glucuronide (a substance that oxidizes bilirubin). The content of bilirubin in the blood increases, decomposed erythrocytes settle in the cells of the liver and other organs, and the mitotic activity of hepatocytes (protective cells) decreases by 25-75 times. The pancreas and thyroid glands suffer secondarily (their function decreases).

Most dangerous for the liver virus - hepatitis. People living in countries with an increased risk of hepatitis should be tested more often for the presence of the hepatitis virus. Today among the CIS countries hepatitis is the most common in the countries of Central Asia. Among European countries, hepatitis is common in Moldova, Ukraine, Russia, Romania. In Russia, insufficient funds are allocated for the fight against hepatitis, at the same time hepatitis continues to spread. Hepatitis is least common in northern Europe and Canada. The global focus of hepatitis is central and southern Africa. Therefore, in order to slow down hepatitis epidemics other countries should tackle hepatitis not only in their own countries, but also in hepatitis hotspots such as Africa and South Asia. In countries such as Congo, Zambia, etc. hepatitis is spreading mostly in rural areas. In Russia, hepatitis spreads in cities, so if you live in a city, you should wash your hands more often as a preventive measure against hepatitis.

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The value of the liver for the body

The liver is rightly called the "factory of life". This multifunctional organ is considered both the “main filter of the body” and its “main chemical laboratory”, in which the most important chemical processes take place. The liver is like a multifunctional computer that is simultaneously responsible for metabolism, digestion and blood circulation. Just think, this organ performs more than 500 functions, and every second, 400 trillion processes take place in it. chemical reactions!

The liver is the body's main "filter"

Most of us know that the most important function of the liver is to cleanse the body of harmful substances that come with the air, with food, or are formed in the body itself. In addition, the liver neutralizes viruses and bacteria that enter the body, preventing them from settling on vital organs. At the same time, the liver works not only during the day, but also at night, removing fatigue toxins from the body, and returning the much-needed morning vigor to a person. If this body ceases to cope with its duties, a person will wake up lethargic and tired.

The liver is the "accumulator" of digestion

During the day, the liver produces approximately 1 liter of bile, which enters the gallbladder - a special reservoir for storing this essential substance. 90% of bile enters the intestines, where it takes an active part in the breakdown and absorption of fats (without bile, fats are simply not absorbed), as well as in the absorption of calcium salts. In addition, the liver stimulates intestinal motility, and also eliminates the processes of fermentation and putrefaction in this organ. Doctors around the world agree that cleansing the liver is the most important condition for the prevention and treatment of dysbacteriosis.

The liver is the "protector" of the cardiovascular system

We have already mentioned that not all bile is spent on the breakdown of food that enters the body. Approximately 10% of this substance enters the blood, where it mixes with it. By diluting the blood to the desired consistency, bile promotes its passage through small blood tracts and capillaries, which means that it can be argued that the liver helps the circulatory system work.

Interaction between the liver and cholesterol

In terms of the interaction of the liver with the cardiovascular system, the influence of this organ on the synthesis of cholesterol, and hence on the development of atherosclerosis, is extremely interesting. According to the inhabitants, it is cholesterol that is considered the culprit in the development of atherosclerosis, which threatens a person with death from a stroke or heart attack. In fact, everything is not so simple. Cholesterol is a valuable organic compound that performs 2 important functions in the body: it is an integral part of cell membranes, and it also becomes a material for the synthesis of hormones, bile acids and vitamin D3 necessary for the body.

It is important to understand here that the level of cholesterol in the blood is regulated in the process of the renal-intestinal cycle. It happens this way: after the breakdown of fats and participation in other necessary processes in the duodenum, part of the bile enters the rectum, and part returns to the liver. If this cycle occurs with the participation of a healthy liver, excess cholesterol leaves the body without settling on the vascular walls. When the liver is sick and does not work at full capacity, the outflow of bile decreases, and excess cholesterol does not find a better place for itself than the blood vessels. This becomes a key factor in the development of atherosclerosis.

By the way, a healthy liver also performs a self-cleansing function, thanks to the same bile, which, leaving the body, takes with it harmful decay products, which means toxic and other dangerous substances.

The liver is the "keeper" of a slender figure

They say that a thin person does not have a liver, but a "furnace" in which all excess is burned. This is partly true. Enzymes that are produced by liver cells support metabolic processes in the body, thanks to which the human figure remains slim. However, against the background of pregnancy and childbirth, stress and other factors, hormonal failure occurs in the body, which can negatively affect the production of enzymes and provoke obesity. That is why, in most cases, it is useless to fight excess weight without adjusting the hormonal background, and without putting the liver in order.

The liver is a "cleaner" of the skin

It is no secret that human skin performs not only a protective function, but is also a thermoregulator, helps breathing and promotes metabolic processes in the body. Based on this, any problems inside the body are immediately reflected on the skin. At the same time, every doctor knows that the treatment of psoriasis, acne, eczema or neurodermatitis is impossible without restoring liver function. By the way, early wrinkles are also a “hello” from a diseased liver!

The liver is a hormonal "regulator"

Many will be surprised, but it is the liver that regulates the level of hormones in the body. This body produces part of the hormones and at the same time eliminates the excess of these biologically active substances, preventing hormonal imbalance. If the liver gets sick, it becomes the cause of hormonal failure, which can lead to a host of hormonal diseases, and even to the development of tumors. It has been proven that the development of mastopathy is based on malfunctions in the liver.

The liver is a "target" for harmful medicinal components

According to doctors, in 30% of cases, liver problems occur due to side effects of drugs. Moreover, these figures are increasing year by year. It is especially difficult for the liver of a person who simultaneously takes several drugs at once. The most dangerous for this body are antibiotics and steroids, cytostatics and hormonal drugs. That is why, when purchasing a medication, it is worth choosing the one that says “not metabolized by the liver” or there is a mark “completely excreted from the body”. By the way, a woman has a much higher risk of liver problems due to drugs, because. in the female body, much less enzymes are produced that break down toxins.

Alcohol is the worst enemy of the liver

The most common cause of liver damage is the abuse of alcoholic beverages. And do not think that only strong alcohol affects the liver. This organ is equally affected by both a glass of vodka and a mug of beer, and therefore it should not be surprising that after 10-15 years of regular consumption of alcoholic beverages, a person develops cirrhosis of the liver or hepatitis. At the same time, there are very few people whose body perceives alcohol as a poison. For the most part, a person is perfectly tolerant of alcohol, thereby dealing a devastating blow to liver health.

Symptoms of liver disease

In order to consult a doctor in a timely manner and eliminate existing problems with the liver, each person should know the main signs of diseases of this organ.

So, attention should be paid to the pain on the right side, which can be aching, with a feeling of heaviness, indicating a slowdown in the outflow of bile and swelling of this organ, or acute and paroxysmal, aggravated after eating fatty foods and hinting at the development of dyskinesia. These sensations are complemented by a "metallic" taste or bitterness in the mouth in the morning. In addition, there may be slight nausea, disturbing in the morning. If nausea worsens after eating fatty foods, there is every reason to assume bile stasis.

The digestive system signals a liver disease with increased gas and belching, pain in the abdomen after eating and problems with stools, bad breath, and a yellowish coating on the tongue.

If a person with a diseased liver looks at himself in the mirror, he will be able to note a dull, yellowish, and even earthy skin color (in advanced cases it becomes greenish). In addition, white wen may appear on his face, indicating an increased level of cholesterol, which means indirectly confirming problems with the liver. Yellow bags under the eyes, dry lips and poorly healing wounds in the corners of the lips should also alert. Brown spots in the temporal region are another indication of a clogged liver.

If the skin does not give cause for concern, liver problems can be determined by the eyes, namely by the yellowness of the sclera, which should be white in the normal state. Take a look at the hair too. In persons with liver disease, they are dry and brittle, and the scalp is constantly itchy and flaky. By the way, a diseased liver gives out itching, namely itching on the back of the palms, as well as on the wrists.

Don't ignore your waist as well. Puffiness in this area, for example, an uncharacteristically protruding belly, may indicate that the liver is not working properly and it urgently needs cleansing.

Treatment and cleansing of the liver

Having identified problems with the liver, you should immediately tell your doctor about them. Only a specialist has the right to prescribe the treatment of this organ, but self-treatment can lead to unpredictable consequences. The same applies to cleaning procedures.

Warning. There are many ways to cleanse the liver described on the Internet, however, most of them are not only ineffective, but also very dangerous for the body. Therefore, in order not to harm yourself, all liver cleansing procedures must be coordinated with your doctor!

In this article, we will describe how to cleanse the liver with milk thistle (thistle), as the most valuable, and at the same time the safest plant in terms of cleansing this most important organ.

Method number 1

Components:

• thistle seeds (100 g);
• milk thistle oil (70 g).

After grinding the seeds, and then filling the powder with oil, the product must be mixed. Taking such a cleansing suspension, 1 tsp. one r / day for a period determined by the doctor (usually 10 to 30 days), you will cleanse your liver and help this organ work at full capacity.

Method number 2

Components:

• milk thistle oil (70 g);
• milk thistle seeds (100 g);
• burdock root (5–10 g);
• dill (5–10 g).

This recipe repeats the previous one, with the only difference being that for ground thistle seeds, i.e. milk thistle, you need to add not only oil, but burdock root with dill. It is also necessary to take the composition in 1 tsp. 3 r / day, and the duration of the cleansing process should be determined by the doctor.

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What is the liver responsible for?

Liver- This is the most important organ of the human body, which weighs about 2 kg in an adult and is located in the abdominal cavity under the diaphragm. It works around the clock and performs many different physiological functions. Let's list the main ones.

1. The liver removes everything superfluous from the body: an excess of hormones, vitamins, harmful nitrogenous compounds formed as a result of metabolism, toxins coming from outside. The liver is the main filter, which, like a sponge, passes through itself and breaks down heavy metals, preservatives, pesticides into safe substances. After that, they are already easily excreted from the body.

The liver produces the substances needed by the body, one of which is bile. During the day, liver cells produce up to one and a half liters of bile, it is necessary for the absorption of fats. If this production were to stop, the digestion of food would become impossible. The liver also synthesizes blood plasma proteins, which are responsible for its normal coagulation. With normal blood clotting, healing of wounds and scratches occurs much faster. The role of the liver is also great in that it is directly involved in the processing of vitamins, helping them to perform their functions. The liver also plays an important role in the processing and storage of minerals such as copper, cobalt, and iron.

2. The liver is one of the reservoir organs in which a blood depot is created. This supply of blood is isolated from the main circulation. But in the event of a large loss of blood, it is quickly thrown into the vessels.

The liver is our "accumulator". It can control the level of glucose in the blood, which is the source of energy for our body. The liver converts excess glucose into glycogen and stores it. If we skip meals or work out in the gym, our blood glucose levels drop below normal. In this case, the liver converts glycogen into glucose and feeds the body with it. In the same way, she stores for us excess vitamins A, D, E, K, B6, B12.

Due to the absence of sensory nerves in the liver, even with large overloads, including overeating, alcohol drinking, smoking and other negative factors, the liver copes with its work without tangible signs of illness. However, her filters are not able to cope with the large flow of toxins and the liver needs our help. To help keep our liver healthy and recover from such overloads, proper nutrition, a reasonable attitude to taking medications, and timely taking of drugs to protect the liver will help.

The liver, being the largest human gland (can reach up to 2 kg), performs a number of vital functions. In the digestive system, everyone knows that its main role is the production of bile, without which most of the food simply will not be broken down (absorbed), but this is far from its only purpose. What other functions of the liver exist and how do they affect the human body? To understand this issue, first, you need to decide on its structure, location in the body.

The liver in the human body: structure and location

It is located in the hypochondrium of the right cavity, slightly capturing the left side. This organ is a set of lobules, similar to microscopic prisms (up to 2 mm), with a very complex structure. A vein passes through the central part of each lobule with a certain number of crossbars, which consist of 2 rows of cells. These cells produce bile, which through the bile capillary forms large channels that combine into a bile stream. The distribution of the bile stream: the gallbladder (the lateral branch enters there), the duodenum (for example, bile is transported to the intestine, participating in the digestive act). So, having an idea about the structure, location of this organ, we can safely take up the study of its main functions, which can be divided into two main blocks: digestive and non-digestive.

Digestive functions

The secretion of bile is perhaps one of the most basic and well-known functions of the liver. Bile is a yellowish-green liquid that is produced by the liver, providing a change from gastric to intestinal digestion. Bile pigments are constantly generated by the liver due to the cellular breakdown of hemoglobin.
This liquid performs a number of mandatory processes of digestion:

• emulsification of fats (in simple terms, the process of mixing fat with water) with a subsequent increase in their area for joint hydrolysis by lipase (the assimilation of fatty acids, the fats themselves and fat-soluble vitamins);
• dissolution of lipid hydrolysis products, facilitating their absorption and re-synthesis;
• a significant increase in the activity of intestinal enzymes (including lipase);
• increased hydrolysis and absorption of products of protein, carbohydrate nature;
• participation in the absorption of cholesterol, amino acids, salts;
• change in the acidity of gastric juice;
• maintaining normal intestinal motility.

In the absence of the need to break down food that enters the stomach, bile accumulates in the gallbladder with an increased concentration. Therefore, doctors often operate with the concepts of bile
hepatic and bladder. The secretion of bile (its amount) in all people occurs in different ways. However, the general principle is this: the sight, smell of food, its direct intake causes relaxation of the gallbladder, followed by contraction - a small dose of bile enters the duodenum. Then, after the gallbladder is empty, bile begins to flow from the bile ducts, only then from the liver. A healthy human body is able to produce 0.015 liters of bile per kilogram of weight per day.

Non-Digestive Functions

1. Detoxification function
   The liver is a kind of barrier when harmful substances enter the body. The protective functions of the liver are especially useful to us when:
   - inactivation of toxins (may enter with food, occur in the intestine when its microflora changes);
   - neutralization of nitrogenous products (deamination), which are formed during the breakdown of proteins (indoles, phenols, ammonia);
   - the fight against microbes (about 80% of the microbes that can enter the human blood will be concentrated in the liver).
   It is necessary to monitor the level of glycogen in the blood, with a decrease in the content of which, barrier functions in the liver deteriorate significantly.
2. Regulatory function
   The liver is able to regulate blood glucose levels. With an increased sugar content, the liver produces glycogen with subsequent deposition. Then, if there is not enough sugar, the stored glycogen is broken down into glucose, which again enters the bloodstream, normalizing the amount of sugar.
3. exchange function
   The liver is actively involved in protein, carbohydrate, lipid, vitamin and water-salt metabolism.
   The liver is capable of:
   • synthesize blood proteins, cholesterol and lecithins;
   • forms urea, glutamines and keratins;
   • create the necessary conditions for normal blood clotting, dissolution of blood clots;
   • synthesize vitamin A, acetone, ketone bodies;
   • stock up on vitamins, throwing them into the blood as needed (A, D, K, C, nicotinic acid);
   • retain Fe, Cl ions, bicarbonate salts (water-salt exchange).

   Sometimes the liver is called a reserve warehouse, as well as a depot for the above reasons.

4. Immunological function (participation in human immune reactions, for example, in the inactivation of mediators that accumulate during allergic reactions).
5. Endocrine function, in which it is able to remove or ensure the exchange of a number of thyroid hormones, steroid types, insulin.
6. Excretory (ensuring homeostasis, that is, the ability to self-regulate the human body, with any changes in the state, even with the restoration of blood).
7. The hematopoietic function is manifested most of all in the process of a woman's pregnancy during the formation of the fetus (a large amount of blood plasma proteins is synthesized to produce hormones and vitamins). Also, this gland is able to accumulate large volumes of blood, which can be thrown into the general vascular system during blood loss or shock situations, due to a sharp narrowing of the vessels supplying the liver.

Therefore, without the liver, as well as without the heart, the human body cannot exist. The liver takes part in many life-supporting processes, helps in moments of stress and a sharp shortage of any useful substances. The processes of food digestion and metabolism are possible only with normal liver function (retention, processing, distribution, assimilation, destruction, formation of a number of substances).

Liver dysfunction

Naturally, such an important human organ must be healthy and function normally. At the same time, medical practice knows a huge number of cases of liver disease. They can be classified into the following groups:

1. Damage to liver cells due to inflammatory (purulent) processes.
2. Mechanical damage (changes in its shape, structure, ruptures, open or gunshot wounds).
3. Diseases of the blood-supplying hepatic vessels.
4. Damage to the internal bile ducts.
5. The occurrence of neoplastic (cancerous) diseases.
6. Infectious diseases.
7. Abnormal and pathological changes in the liver (this also includes hereditary diseases).
8. Changes in the functioning of the liver in the pathology of other organs.
9. Functional (structural) tissue disorders, often provoking this insufficiency, cirrhosis.
10. Diseases caused by autoimmune viruses.

It is worth noting that any disease listed above will be accompanied by insufficiency and lead to cirrhosis.

Therefore, do not “postpone” if you notice any signs of liver dysfunction!

The main signs of impaired liver function

• 1st sign. Unwanted irritability and behavioral changes. Studies by scientists and experts in this field have shown that 95% of angry and irritable people suffer from certain liver diseases. Moreover, most people find their justification in everyday stress at the household level, although these are two interrelated processes. On the one hand, impaired liver function causes irritability in general, and, on the other hand, excessive anger and aggression contribute to the development of liver diseases.
• 2nd sign. Overweight and cellulite. This will clearly indicate violations of metabolic functions (prolonged intoxication of the body).
• 3rd sign. Reduced blood pressure even in young people. That is, hypotensive patients are at risk, they are advised to pay special attention to their liver.
• 4th sign. The formation of vascular networks and varicose veins. Here, too, everything is not so simple, the previous sign is interconnected in this. If you start to actively raise the pressure and thereby get rid of varicose veins, you can provoke the rapid development of hypertension. However, if such vascular diseases as varicose veins, hemorrhoids are observed in patients with high blood pressure, then this is already a very advanced process with abnormal liver function, including.
• 5th sign: irregular skin pigmentation and the appearance of "age" spots. The deposition of subcutaneous toxins will indicate a lack of antioxidants and the inability of the liver to perform protective and metabolic functions.
• 6th sign: excessive frequency of colds. This, most often, indicates poor microflora and intestinal motility against the background of intoxication of the body (the liver can no longer eliminate all toxins). So, toxins, reaching the liver and not being neutralized there, enter the organs of the respiratory system, negatively affect the immune system.
• 7th sign: stool disorders (most patients experience constipation). Normal bile secretion contributes to the absence of difficulties with the stool.
• 8th symptom: pain concentrated on the right under the ribs. This symptom is not as popular as the others (observed on average in 5% of patients), however, pain in this area will indicate violations of bile secretion (problems of its outflow).
• 9th symptom: long-term exposure to xenobiotics (drugs of a synthetic nature) provokes liver dysfunctions not immediately, but over time, especially when taken regularly.
• 10th sign: improper and irregular nutrition (3 meals a day is not an indicator of a proper diet, for those who want to have a healthy liver, it is advisable to eat about 5 times a day in small portions). It is also necessary to monitor the regularity of the consumption of vegetable fiber. It will not only improve the intestinal microflora, but also contribute to the normal synthesis of vitamins.
• 11th sign: dry skin, especially if this process is accompanied by hair loss. This indicates improper digestibility of food and a violation of the barrier function of the liver.
• 12th sign: lack of exogenous cholesterol with its subsequent accumulation in the vascular walls (signs of atherosclerosis). At the same time, you need to understand that an excess of carbohydrates in the diet, which is often observed with vegetarianism, will provoke stagnation of bile and the accumulation of cholesterol. The result can be not only atherosclerosis, but also non-alcoholic steatohepatitis of the liver. Although the main cause of it, fatty foods and alcohol, as such, were not overused.
• 13th sign: deterioration of vision, especially at dusk. Normal vision can only be with a sufficient amount of vitamin A, for which the liver is responsible. Vegetable fiber can again come to the rescue, in addition to binding toxins, it will significantly reduce the consumption of this vitamin A and its provitamins.
• 14th sign: reddened palms. The size of the areas of redness and their saturation can tell about the intensity of irritation in the liver tissues.
• 15th sign: changes in the results of tests that monitor the condition of the liver. Often this will indicate profound changes in the normal functioning of the liver.

Few people know, however, the causes of increased bone fragility and the development of osteoporosis may not be due to reduced calcium intake, but due to its improper absorption. When digested, food must be processed with bile so that the small intestine can absorb fat and calcium. If fat is not digested, it will settle on the walls of the intestine. Then, along with other waste, it will enter the large intestine, split a little, but most of it will still be excreted along with feces (if feces remain on the water at the time of emptying, this may indicate insufficient secretion of bile, because fat is lighter water, which means that the waste is supersaturated with undigested fat). The connection is quite interesting because calcium is not absorbed without fat. The body will take the lack of this substance from the bones in order to make up for its deficiency.

If we talk about the appearance of stony formations in the liver or gallbladder, then a person’s stool will definitely be disturbed (feces can turn orange, yellow), premature aging and self-destruction of the body will begin, because the body will be unable to ensure its normal functioning. The main reason for the appearance of stones in the biliary system is a violation of the metabolic processes of bilirubin and cholesterol, which can occur during: inflammatory processes, dietary disorders (the predominance of fats in the diet, especially pork), hormonal imbalance, viral or other diseases.
Tip: if any sign is already bothering a person, it is recommended to immediately visit a gastroenterologist. In this case, you can prevent many liver diseases in time.

Keeping the Liver Healthy

In addition to common viruses, infections and pathologies, very often the person himself is to blame for the development of liver diseases. The environment (ecology, food quality) also has a lasting effect on the liver, but anyone who does not want to have liver problems should take care of himself. It is necessary to monitor compliance with the rules on labor protection in hazardous industries. Foods that have undergone any additional chemical processing make it incredibly difficult for the liver to work. You can not abuse alcohol. In addition, always supervise the processing of medical equipment. Pay close attention to donated blood (it can be a source of viral hepatitis). Try to take care of your diet as much as possible and do not treat all diseases with pills - this may provide a short-term improvement, but in the future it will contribute to the development of liver diseases. It would not be superfluous to recall once again that self-medication and improper treatment of pathologies of other organs can lead to secondary liver damage.

Remember that the liver is a connecting element between the two most important systems of the human body (blood supply and digestion). Any disruption of the work of this gland will contribute to the development of diseases of the heart, stomach and intestines.
And the simplest advice from doctors: if in the interval between 5-7 in the morning a healthy person drinks at least half a glass of water or herbal decoction, night bile (especially toxic) will leave the body and will not interfere with the normal functioning of the liver until the end of the day.

We suggest that you read the article on the topic: "What is the liver responsible for" on our website dedicated to the treatment of the liver.

Liver(lat. jecur, jecor, hepar, other Greek ἧπαρ) is a vital gland of external secretion of vertebrate animals, including humans, located in the abdominal cavity (abdominal cavity) under the diaphragm and performing a large number of different physiological functions. The liver is the largest gland in vertebrates.

(1) right lobe, (2) left lobe, (3) caudate lobe, (4) quadrate lobe, (5) hepatic artery and portal vein, (6) lymph nodes, (7) gallbladder

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Liver anatomy

The liver consists of two lobes: right and left. In the right lobe, two more secondary lobes are distinguished: square and caudate. According to the modern segmental scheme proposed by Claude Quino (1957), the liver is divided into eight segments, forming the right and left lobes. The segment of the liver is a pyramidal section of the hepatic parenchyma, which has a fairly separate blood supply, innervation and outflow of bile. The caudate and square lobes, located behind and in front of the gates of the liver, according to this scheme correspond to SI and SIV of the left lobe. In addition, SII and SIII of the liver are isolated in the left lobe, the right lobe is divided into SV - SVIII, numbered around the gate of the liver in a clockwise direction.

Histological structure of the liver

The parenchyma is lobular. The hepatic lobule is the structural and functional unit of the liver. The main structural components of the hepatic lobule are:

• liver plates (radial rows of hepatocytes);
• intralobular sinusoidal hemocapillaries (between the hepatic beams);
• bile capillaries (lat. ductuli beliferi) inside the hepatic beams, between two layers of hepatocytes;
• (expansion of the bile capillaries when they exit the lobule);
• perisinusoidal space of Disse (slit-like space between the hepatic beams and sinusoidal hemocapillaries);
• central vein (formed by the fusion of intralobular sinusoidal hemocapillaries).

The stroma consists of an outer connective tissue capsule, interlobular layers of RVST (loose fibrous connective tissue), blood vessels, and the nervous apparatus.

Liver functions

The main internal organs of a human, front view. No. 4 - liver

• neutralization of various foreign substances (xenobiotics), in particular, allergens, poisons and toxins, by converting them into harmless, less toxic or more easily removed compounds from the body; the detoxification function of the fetal liver is insignificant, since it is performed by the placenta;
• neutralization and removal from the body of excess hormones, mediators, vitamins, as well as toxic intermediate and final products of metabolism, such as ammonia, phenol, ethanol, acetone and ketone acids;
• providing the energy needs of the body with glucose and converting various energy sources (free fatty acids, amino acids, glycerol, lactic acid, etc.) into glucose (the so-called gluconeogenesis);
• replenishment and storage of rapidly mobilized energy reserves in the form of glycogen and regulation of carbohydrate metabolism;
• replenishment and storage of the depot of some vitamins (especially large in the liver are the reserves of fat-soluble vitamins A, D, water-soluble vitamin B12), as well as the depot of cations of a number of trace elements - metals, in particular, iron, copper and cobalt cations. Also, the liver is directly involved in the metabolism of vitamins A, B, C, D, E, K, PP and folic acid;
• participation in the processes of hematopoiesis (only in the fetus), in particular, the synthesis of many blood plasma proteins - albumins, alpha and beta globulins, transport proteins for various hormones and vitamins, proteins of the blood coagulation and anticoagulation systems, and many others; the liver is one of the important organs of hematopoiesis in prenatal development;
• synthesis of cholesterol and its esters, lipids and phospholipids, lipoproteins and regulation of lipid metabolism;
• synthesis of bile acids and bilirubin, production and secretion of bile;
• also serves as a depot for a fairly significant volume of blood, which can be thrown into the general vascular bed in case of blood loss or shock due to narrowing of the vessels supplying the liver;
• synthesis of hormones (for example, insulin-like growth factors).

Features of the blood supply to the liver

Features of the blood supply to the liver reflect its important biological function of detoxification: blood from the intestines, containing toxic substances consumed from the outside, as well as waste products of microorganisms (skatol, indole, etc.) is delivered to the liver through the portal vein (v. portae) for detoxification. Further portal vein divides into smaller interlobular veins. Arterial blood enters the liver through its own hepatic artery (a. hepatica propria), branching to the interlobular arteries. The interlobular arteries and veins eject blood into the sinusoids, where, thus, mixed blood flows, the drainage of which occurs into the central vein. The central veins drain into the hepatic veins and then into the inferior vena cava. In embryogenesis, the so-called. duct of arantia, which carries blood to the liver for efficient prenatal hematopoiesis.

Toxin Detox Mechanism

Neutralization of substances in the liver consists in their chemical modification, which usually includes two phases. In the first phase, the substance undergoes oxidation (detachment of electrons), reduction (addition of electrons), or hydrolysis. In the second phase, a substance is added to the newly formed active chemical groups. Such reactions are called conjugation reactions, and the addition process is called conjugation. Also, when toxic substances enter the liver, the area of ​​agranular EPS increases in the cells of the latter, which allows them to be neutralized.

Liver disease

Diagram of the structure of the hepatic lobule

Cirrhosis of the liver- chronic progressive liver disease, characterized by a violation of its lobular structure due to the growth of connective tissue and pathological regeneration of the parenchyma; manifested by functional liver failure and portal hypertension.

The most common causes of the disease are chronic alcoholism (the proportion of alcoholic liver cirrhosis in different countries is from 20 to 95%), viral hepatitis (10-40% of all liver cirrhosis), the presence of helminths in the liver (most often opisthorchis, fasciola, clonorchis , Toxocara, Notocotylus), as well as protozoa, including Trichomonas.

The occurrence of benign adenomas, angiosarcomas of the liver, hepatocellular carcinoma are associated with human exposure to androgenic steroidal contraceptive and anabolic drugs.

The main symptoms of liver cancer:

• weakness and decreased performance;
• weight loss, weight loss, and then severe cachexia, anorexia.
• nausea, vomiting, sallow skin color and spider veins;
• complaints of a feeling of heaviness and pressure, dull pain;
• fever and tachycardia;
• jaundice, ascites and dilatation of the superficial veins of the abdomen;
• gastroesophageal bleeding from varicose veins;
• skin itching;
• gynecomastia;
• flatulence, intestinal dysfunction.

Aflatoxicosis

Aflatoxin B1

Extremely toxic and the strongest hepatocarcinogen.

Aflatoxicosis - acute or chronic intoxication with aflatoxins, the strongest hepatotoxins and hepatocarcinogens, occurs exclusively alimentary way i.e. through food. Aflatoxins are secondary metabolites produced by microscopic molds of the genus Aspergillus, in particular Aspergillus flavus and Aspergillus parasiticus.

Aspergillus affects almost all food products, but the main plant products are made from cereals, legumes and oilseeds such as peanuts, rice, corn, peas, sunflower seeds, etc. Acute aflatoxicosis occurs with a single use of contaminated (contaminated) food products with aspergillus - severe intoxication, accompanied by acute toxic hepatitis. With a sufficiently long use of contaminated food products, chronic aflatoxicosis occurs, in which hepatocellular carcinoma develops in almost 100% of cases.

Liver hemangiomas- anomalies in the development of liver vessels.
The main symptoms of hemangioma:

• heaviness and feeling of fullness in the right hypochondrium;
• dysfunction of the gastrointestinal tract (loss of appetite, nausea, heartburn, belching, flatulence).

• constant pain in the right hypochondrium;
• fast onset feeling of fullness and discomfort in the abdomen after eating;
• weakness;
• increased sweating;
• loss of appetite, sometimes nausea;
• shortness of breath, dyspeptic phenomena;
• jaundice.

• soreness;
• feeling of heaviness, pressure in the right hypochondrium, sometimes in the chest;
• weakness, malaise, shortness of breath;
• recurring urticaria, diarrhea, nausea, vomiting.

Other liver infections: clonorchiasis, opisthorchiasis, fascioliasis.

Liver regeneration

The liver is one of the few organs capable of restoring its original size even with only 25% of normal tissue remaining. In fact, regeneration occurs, but very slowly, and the rapid return of the liver to its original size is more likely due to an increase in the volume of the remaining cells.

Four types of liver stem/progenitor cells have been found in the mature liver of humans and other mammals, the so-called oval cells, small hepatocytes, liver epithelial cells, and mesenchymal-like cells.

Oval cells in rat liver were discovered in the mid-1980s. The origin of the oval cells is unclear. It is possible that they originate from bone marrow cell populations, but this fact is questioned. Mass production of oval cells occurs with various liver lesions. For example, a significant increase in the number of oval cells was noted in patients with chronic hepatitis C, hemochromatosis, alcohol poisoning of the liver and directly correlates with the severity of liver damage. In adult rodents, oval cells are activated for subsequent reproduction when the replication of the hepatocytes themselves is blocked. The ability of oval cells to differentiate into hepatocytes and cholangiocytes (bipotential differentiation) has been shown in several studies. The ability to support the reproduction of these cells under in vitro conditions has also been shown. Recently, oval cells capable of bipotential differentiation and clonal expansion under in vitro and in vivo conditions have been isolated from the liver of adult mice. These cells expressed cytokeratin-19 and other surface markers of liver progenitor cells and, when transplanted into an immunodeficient strain of mice, induced regeneration of this organ.

Small hepatocytes were first described and isolated by Mitaka et al. from the non-parenchymal fraction of rat liver in 1995. Small hepatocytes from the liver of rats with artificial (chemically induced) liver damage or with partial removal of the liver (hepatectomy) can be isolated by differential centrifugation. These cells are smaller than normal hepatocytes and can proliferate and develop into mature hepatocytes under in vitro conditions. It was shown that small hepatocytes express typical markers of hepatic progenitor cells - alpha-fetoprotein and cytokeratins (CK7, CK8 and CK18), which indicates their theoretical ability for bipotential differentiation. The regenerative potential of small rat hepatocytes was tested in animal models with artificially induced liver damage: the introduction of these cells into the portal vein of animals caused the induction of repair in various parts of the liver with the appearance of mature hepatocytes.

A population of liver epithelial cells was first identified in adult rats in 1984. These cells have a repertoire of surface markers that overlaps but is still somewhat different from the phenotype of hepatocytes and ductal cells. Transplantation of epithelial cells into the liver of rats led to the formation of hepatocytes expressing typical hepatocyte markers - albumin, alpha-1-antitrypsin, tyrosine transaminase and transferrin. Recently, this population of progenitor cells has also been found in the adult human. Epithelial cells are phenotypically distinct from oval cells and can differentiate into hepatocyte-like cells under in vitro conditions. Experiments on transplantation of epithelial cells into the liver of SCID mice (with congenital immunodeficiency) showed the ability of these cells to differentiate into albumin-expressing hepatocytes a month after transplantation.

Mesenchymal-like cells have also been obtained from mature human liver. Like mesenchymal stem cells (MSCs), these cells have a high proliferative potential. Along with mesenchymal markers (vimentin, alpha-smooth muscle actin) and stem cell markers (Thy-1, CD34), these cells express hepatocyte markers (albumin, CYP3A4, glutathione transferase, CK18) and ductal cell markers (CK19). Being transplanted into the liver of immunodeficient mice, they form mesenchymal-like functional islands of human liver tissue that produce human albumin, prealbumin, and alpha-fetoprotein.

Further studies are required on the properties, culture conditions, and specific markers of mature liver progenitor cells to assess their regenerative potential and clinical use.

Stimulants of liver regeneration

Recently, biologically active substances have been discovered that promote liver regeneration in case of trauma and toxic damage. There are various approaches to stimulating liver regeneration in case of liver damage or massive resections. Attempts have been made to stimulate regeneration by administering amino acids, tissue hydrolysates, vitamins, hormones, growth factors such as hepatocyte growth factor (HGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and a stimulant from the liver. (hepatic stimulator substance, HSS).

Stimulant from the liver

Stimulant from the liver ( hepatic stimulator substance, HSS) is an extract obtained from the liver after 30% resection. The substance known as the hepatic stimulator substance (HSS) was first described in the mid-1970s. The main active ingredient in HSS is the ALR protein discovered in 1980–1990 ( augmenter of liver regeneration, a product of the GFER gene). In addition to ALR, tumor necrosis factor, insulin-like growth factor 1, hepatocyte growth factor, epidermal growth factor and other already known and possibly not yet identified humoral factors contained in such preparations can also affect liver regeneration. There are various methods for obtaining HSS, differing in the options for purification of extracts of the regenerating liver of animals.

Liver transplant

The world's first liver transplant was performed by American transplantologist Thomas Starles in 1963 in Dallas. Later, Starles organized in Pittsburgh (USA) the world's first transplant center, which now bears his name. By the end of the 1980s, more than 500 liver transplants per year were performed annually in Pittsburgh under the direction of T. Starzl. The first in Europe (and the second in the world) medical center for liver transplantation was established in 1967 in Cambridge (Great Britain). It was led by Roy Kaln.

With the improvement of surgical methods of transplantation, the opening of new transplantation centers and the conditions for storage and transportation of the transplanted liver, the number of liver transplants has steadily increased. If in 1997 up to 8,000 liver transplants were performed annually in the world, now this number has increased to 11,000, with over 6,000 transplants in the United States and up to 4,000 in Western European countries. Among European countries, Germany, Great Britain, France, Spain and Italy play a leading role in liver transplantation.

There are currently 106 liver transplant centers in the United States. There are 141 centers in Europe, including 27 in France, 25 in Spain, 22 each in Germany and Italy, and 7 in the UK.

Despite the fact that the world's first experimental liver transplantation was performed in the Soviet Union by the founder of world transplantology V.P. Demikhov in 1948, this operation was introduced into clinical practice in the country only in 1990. No more than 70 liver transplants have been performed. Now in Russia, regular liver transplant operations are performed in four medical centers, including three in Moscow (the Moscow Center for Liver Transplantation of the N.V. Sklifosovsky Research Institute for Emergency Medicine, the Academician V.I. Shumakov Research Institute of Transplantology and Artificial Organs, the Russian Scientific Center for Surgery named after Academician B. V. Petrovsky) and the Central Research Institute of Roszdrav in St. Petersburg. Recently, liver transplants have been performed in Yekaterinburg (Regional Clinical Hospital No. 1), Nizhny Novgorod, Belgorod and Samara.

Despite the constant increase in the number of liver transplants, the annual need for transplantation of this vital organ is met by an average of 50%. The frequency of liver transplants in the leading countries ranges from 7.1 to 18.2 operations per 1 million population. The true need for such operations is now estimated at 50 per 1 million population.

The first human liver transplant operations were not very successful, as the recipients usually died within the first year after the operation due to transplant rejection and the development of severe complications. The use of new surgical techniques (cavocaval shunting and others) and the emergence of a new immunosuppressant - cyclosporine A - contributed to an exponential increase in the number of liver transplants. Cyclosporine A was first successfully used in liver transplantation by T. Starzl in 1980, and its widespread clinical use was allowed in 1983. Due to various innovations, postoperative life expectancy was significantly increased. According to the UNOS - United Network for Organ Sharing, the modern survival of patients with a transplanted liver is 85-90% one year after surgery and 75-85% five years later. According to forecasts, 58% of recipients have a chance to live up to 15 years.

Liver transplantation is the only definitive treatment for patients with irreversible, progressive liver damage when other alternative treatments are not available. The main indication for liver transplantation is the presence of chronic diffuse liver disease with a life expectancy of less than 12 months, provided that conservative therapy and palliative surgical methods of treatment are ineffective. The most common reason for a liver transplant is cirrhosis of the liver caused by chronic alcoholism, viral hepatitis C and autoimmune hepatitis (primary biliary cirrhosis). Less common indications for transplantation include irreversible liver damage due to viral hepatitis B and D, drug and toxic poisoning, secondary biliary cirrhosis, congenital liver fibrosis, cystic liver fibrosis, hereditary metabolic diseases (Wilson-Konovalov disease, Reye's syndrome, alpha-1 deficiency). -antitrypsin, tyrosinemia, type 1 and type 4 glycogenoses, Neumann-Pick disease, Crigler-Najjar syndrome, familial hypercholesterolemia, etc.).

A liver transplant is a very expensive medical procedure. According to UNOS, the necessary costs for hospital care and preparation of the patient for surgery, medical staff, removal and transportation of a donor liver, surgery and postoperative procedures during the first year are $314,600, and for follow-up and therapy - up to $21,900 per year . For comparison, in the United States, the cost of similar costs for a single heart transplant in 2007 was $658,800, lung - $399,000, kidney - $246,000.

Thus, the chronic shortage of donor organs available for transplantation, the length of the waiting period for surgery (in the US, the waiting time in 2006 averaged 321 days), the urgency of the operation (the donor liver must be transplanted within 12 hours), and the exceptionally high cost of traditional liver transplantation create the necessary prerequisites for the search for alternative, more cost-effective and effective strategies for liver transplantation.

Currently, the most promising method of liver transplantation is Living Donor Liver Transplantation (LDL). It is more effective, simpler, safer and much cheaper than classical cadaveric liver transplantation, both whole and split. The essence of the method is that the left lobe (2, 3, sometimes 4 segments) of the liver is removed from the donor, today often and endoscopically, that is, with little trauma. TPJD provided a very important opportunity related donation- when the donor is a relative of the recipient, which greatly simplifies both administrative problems and the selection of tissue compatibility. At the same time, thanks to a powerful regeneration system, after 4-6 months, the donor's liver completely restores its mass. The donor's liver is transplanted into the recipient either orthotopically, with the removal of one's own liver, or, more rarely, heterotopically, leaving the recipient's liver. At the same time, of course, the donor organ is practically not exposed to hypoxia, since the operations of the donor and the recipient are carried out in the same operating room and simultaneously.

Bioengineered liver

A bioengineered liver, similar in structure and properties to a natural organ, has yet to be created, but active work in this direction is already underway.

Thus, in October 2010, American researchers from the Institute of Regenerative Medicine at the Wake Forest University Medical Center (Winston-Salem, North Carolina) developed a bioengineered liver organoid grown on the basis of a bioscaffold from natural ECM from cultures of liver progenitor cells and endothelial cells. human cells. The bioframework of the liver with the system of blood vessels preserved after decellularization was populated with populations of progenitor cells and endothelial cells through the portal vein. After incubation of the bioscaffold for a week in a special bioreactor with continuous circulation of the nutrient medium, the formation of liver tissue with the phenotype and metabolic characteristics of the human liver was noted. In 2013, the Russian Ministry of Defense developed terms of reference for a bioengineered liver prototype.

In March 2016, Yokohama University scientists succeeded in creating a liver that can replace a human organ. Clinical trials are expected to take place in 2019.

Liver in culture

In Homeric ideas, the liver personified the center of life in the human body. In ancient Greek mythology, the immortal Prometheus was chained to the Caucasus Range for giving people fire, where a vulture (or eagle) flew in and pecked at his liver, which was restored over the next night. Many ancient peoples of the Mediterranean and the Middle East practiced divination on the liver of sheep and other animals.

Plato considers the liver to be the source of negative emotions (first of all, anger, envy and greed). In the Talmud, the liver is considered the source of malice, and the gallbladder is the source of opposition to this malice.

In Farsi, Urdu and Hindi liver (جگر or जिगर or jigar) is an image of courage or strong feelings. Expression jan e jigar(verbatim: the strength of my liver) in Urdu is one of the expressions of endearment. in Persian slang jigar can denote a beautiful person or an object of desire. In the Zulu language, the concepts of "liver" and "courage" are expressed in one word ( isibindi).

In the Gbaya language (Ubangian languages), the liver (sèè) is the source of human feelings. The expression "happiness" (dí sèè) is literally translated as "good liver", and "dissatisfaction" (dáng sèè) as "bad liver"; the verb "to envy" (ʔáá sèè) literally translates as "to place in the liver." Also, the liver in this language expresses the concept of the center.

In the Kazakh language, the liver is denoted by the word “ bauyr“. The same word (homonymous words) is often called a loved one and a close person. The appeal “bauyrym” is very common ( my native), as a rule, in relation to a person who is younger in age. Moreover, in this way they can turn not only to a relative, but also to a male stranger. Such an address is often used when Kazakhs communicate with each other, and also to emphasize the degree of closeness (in relation to a countryman, a representative of a kind, etc.). The Kazakhs have a male name "Bauyrzhan" ( kindred spirit, in the Russian version they sometimes write “Baurzhan”). In particular, that was the name of the Hero of the Soviet Union, the People's Hero of Kazakhstan ( Halyk Kaharmany) Bauyrzhan Momyshuly, Panfilov, heroic battalion commander during the Defense of Moscow in 1941.

In Russian there is an expression “to sit in the liver”, which means to disturb or annoy someone very much.

In the Lezgin language, one word is used to designate an eagle and a liver - "lek". This is due to the long-standing custom of the highlanders to expose the bodies of the dead to be eaten by predatory eagles, who first of all tried to get to the liver of the deceased. Therefore, the Lezgins believed that it was in the liver that the soul of a person was located, which now passed into the body of a bird. There is a version that the ancient Greek myth of Prometheus, whom the gods chained to a rock, and the eagle daily pecked at his liver, is an allegorical description of such a rite of burial of the highlanders.

see also

• Metabolism
• Regenerative surgery
• Regeneration

Notes

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25. Society for helping children with biliary cirrhosis
26. List of Liver Transplant Hosptials
27. European Liver Transplant Registry - ELTR
28. Demikhov V.P. Transplantation of vital organs in the experiment. M.: Medgiz, 1960. - 259 p.
29. Medical Olympus - Official portal of Yekaterinburg
30. Starzl T.E., Klintmalm G.B., Porter K.A., Iwatsuki S., Schröter G.P. Liver transplantation with use of cyclosporin A and prednisone. N Engl J Med. 1981; 305:266-269.
31. Request Rejected
32. Adult Transplant Services - TRANSPLANT - University of Texas Health Science Center - School of Medicine
33. Indications and Contraindications for Liver Transplants | University of Maryland Medical Center
34. Liver Transplant Costs | California Pacific Medical Center, San Francisco
35. How Much Do Organ Transplants Cost? | eHow
36. Liver Transplant Waiting List
37. Creating Functional Hepatic Tissue in a Bioengineered Human Liver.
38. Code "Prometheus": The Department of Defense needed a bioengineered liver.
39. Japanese scientists have grown a mini-liver. RIA News. Retrieved March 17, 2016.
40. Dissertation on the topic "The evolution of ideas about the soul in the culture of Ancient Greece" abstract on the specialty HAC 24.00.01 - Theory and history of culture | disserCat - electronic b…
41. Article from the Kazakh-Russian dictionary.
42. Article from the Russian dictionary.

Inflammation is often the cause of damage to liver cells (hepatocytes). Preparations containing glycyrrhizic acid (HA) and essential phospholipids (EP) can help in the fight against it.

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“The receptacle of the soul”, “the mother of the heart”, “the source of the life principle” - as soon as the liver was not called in antiquity. Ideas about the role of this gland were rather vague, but even at the dawn of medicine, the first researchers intuitively noted the great importance that the liver has for the body. Today, scientists have a rich arsenal of knowledge about the structure, functions and role of this gland, which means they have the opportunity to develop methods for maintaining its health for many years.

Where is the human liver located and what are its functions?

The liver is the largest gland in the body. As a rule, they talk about the liver in connection with the work of the digestive system, but it plays a huge role in maintaining metabolism, it neutralizes toxins. This involvement of the liver in various processes in the body explains the great attention that is usually paid to maintaining its health.

The liver is located in the abdominal cavity under the diaphragm. It is located in the region of the right hypochondrium, however, since its dimensions are quite large (the mass of a healthy liver can be up to 1800 grams), it also reaches the left hypochondrium, where it comes into contact with the stomach.

This gland consists of large lobes, and its tissue forms lobules. A lobule is a collection of hepatic cells that has the shape of a multifaceted prism. The lobules are literally entangled in a network of vessels and bile ducts. The lobules are separated from each other by connective tissue, which is rather poorly developed in a healthy liver. The cells of this gland are involved in the neutralization of toxins that enter the bloodstream, as well as in the production of bile and the formation of other compounds necessary for the body.

The main functions of the liver are:

• Metabolism. In the liver, proteins are broken down to amino acids, the most important compound, glycogen, is synthesized, into which excess glucose is processed, and fat metabolism also occurs (the liver is sometimes called the “fat depot”). In addition, the metabolism of vitamins and hormones is carried out in the liver.
• Detoxification. As we mentioned, various toxins and bacteria are neutralized in the liver, after which their decay products are excreted by the kidneys.
• Synthesis. This gland synthesizes bile, consisting of bile acids, pigments and cholesterol. Bile is involved in the digestion of fats, the absorption of vitamins, stimulates intestinal motility.

Reasons for the development of pathologies

Thus, normal metabolism (metabolism) in the body is impossible without the proper functioning of the liver. And that is why it is necessary to know what factors cause liver disease in order to avoid their development. The most dangerous are the following:

• Alcohol abuse
  The main metabolism of ethanol, the alcohol found in alcoholic beverages, takes place in the liver. With small volumes of alcohol consumption, liver cells have time to cope with its processing. When a reasonable dose is exceeded, ethanol contributes to damage to liver cells - the accumulation of fat in them (fatty hepatosis, or fatty degeneration), inflammation (alcoholic hepatitis) and destruction. At the same time, there is an excessive formation of connective tissue in the liver (fibrosis, and later cirrhosis and even cancer).
  A patient with alcoholic liver disease may complain of weakness, a general decrease in tone and appetite, and indigestion. Gradually, these symptoms worsen, they are joined by tachycardia, jaundice and others. In this case, very often in the early stages of alcoholic liver disease, there may be no pain.
• Improper nutrition
  The abundance of fatty foods and reduced physical activity lead to the fact that fat metabolism is disturbed in the body. As a result, fat begins to accumulate in the liver cells, causing their degeneration (steatosis). This leads to the fact that the active formation of free radicals begins - particles that carry an electric charge and are dangerous to cells. Foci of inflammation and necrosis appear in the liver, connective tissue grows, and cirrhosis may eventually develop.
  Improper nutrition causes diseases such as non-alcoholic fatty disease, cirrhosis, liver cancer.
• Violation of the rules for taking medicines and the effect of toxic substances
  Uncontrolled medication leads to an increased load on the liver, because the main part of the drugs is processed in it. It is believed that drug-induced liver damage accounts for up to 10% of all side effects that drugs have on the body, and its symptoms can appear up to 90 days after the end of use. There are other substances that are dangerous toxins for the liver, for example, industrial and vegetable poisons.
  Substances that have a toxic effect on the liver cause destruction of cell membranes, lead to malfunctions of hepatocytes (liver cells), and can cause hepatitis and liver failure. Patients complain of pain in the liver, weakness, general malaise; jaundice may develop.
• virus attack
  The impact of viruses on the liver is dangerous primarily by the development of viral hepatitis. This is an inflammatory disease of the liver, which, depending on the type of virus that caused it, can even be fatal. Often the disease is asymptomatic. Sometimes patients complain of malaise, fever, pain in the right hypochondrium, jaundice. In the case of severe hepatitis, necrosis of the liver tissue may begin.

Major liver diseases

Due to the heavy load that falls on the liver, this gland is quite vulnerable: we have listed only the main negative factors that affect it, but in fact there are many more. In total, there are about 50 pathologies of this gland, and, as noted by the European Association for the Study of the Liver, about 30 million Europeans currently suffer from its chronic diseases.

We list again the main types of pathological changes in the liver:

• hepatosis (fatty liver, steatosis)
• hepatitis;
• fibrosis
• cirrhosis;
• liver failure;
• cancer and others.

Note!
According to researchers' data, about 40% of patients with liver diseases in Russia have risk factors for alcoholic damage to this organ.

Signs of malfunction of the gland and diagnosis of diseases

Violations of the liver can characterize non-specific symptoms (characteristic of other diseases), so it is not always possible to make an unambiguous conclusion that the patient is faced with a liver disease. Patients report poor health, decreased appetite, lethargy, stool disorders, frequent colds, an increased tendency to allergic reactions, skin itching, irritability (toxins that are not neutralized in the liver have a negative effect on the brain).

Among the specific signs of violation can be identified:

• pain in the right hypochondrium;
• feeling of heaviness, discomfort in the abdomen, nausea;
• feeling of bitterness in the mouth.

The clearest sign indicating the presence of liver disease, of course, is jaundice - a change in the color of the skin and mucous membranes. This is due to the accumulation of bilirubin in the blood.

Since the symptoms of liver disease are not always specific, if these signs appear, it is necessary to undergo an examination. Early diagnosis will help the doctor prescribe effective treatment and restore liver function as much as possible.

Pathologies are treated by a gastroenterologist. For an accurate diagnosis, he directs the patient to a biochemical blood test to detect the level of ALT (alanine aminotransferase), LDH (lactate dehydrogenase) and AST (aspartate aminotransferase) in it. These indicators allow us to judge the presence of inflammation in the liver. By the content of other substances in the blood: GGT (gamma-glutamyl transpeptidase), bilirubin, alkaline phosphatase (alkaline phosphatase), one can judge the presence of bile stasis.

Also, the patient must pass a urine test, during which the content of bilirubin is measured.

On ultrasound of the liver, the doctor evaluates its size: in the presence of steatosis and inflammation, the gland increases, and the tissues acquire a heterogeneous structure. Modern ultrasound diagnostic technology - elastography - makes it possible to measure the so-called elasticity of liver tissues and allows you to determine the degree of fibrosis. In addition to ultrasound, magnetic resonance or computed tomography can be prescribed for diagnosis.

If the doctor needs to accurately determine the stage of the disease (for example, cirrhosis or fibrosis), a liver biopsy is performed - tissue sampling for study.

Prevention of liver diseases

One of the first steps to maintaining a healthy liver is diet control: the presence of a large amount of fatty foods, alcohol, fried and refined foods negatively affect the health of the gland. Meals should not be plentiful, it is better to eat 4-5 times a day in moderate portions.

All these measures are effective, but not always sufficient. That is why, in some cases, doctors may advise taking drugs that support liver function and help restore damaged cells.

So liver...

Ensures normal digestion

In the cells of the liver - hepatocytes - bile is formed, which is then sent to the gallbladder, and when food enters the body, it is released into the duodenum. Bile is needed for the digestion of fats - it helps them break down and be absorbed. It also facilitates the absorption of carbohydrates and proteins. Also, bile creates comfortable conditions for the work of digestive enzymes and stimulates the peristalsis of the small intestine, that is, it helps to ensure that the processed food moves in the right direction without any problems.

Liver cells secrete bile almost non-stop - an average of 800 to 1800 ml per day (depending on the person's weight). If this production suddenly stopped, the digestion of food would become impossible.

Helps control blood glucose levels

Glucose is the main source of energy for our body. It comes from foods containing carbohydrates - sugar, pastries, cereals, berries and fruits, juices. In order for the body to work well, blood glucose levels must be at a certain level and be more or less stable. Both excess and lack of glucose are extremely harmful: against such a background, various organs can be affected - from the retina of the eye to the heart muscle.

But we don’t always control our diet exactly, so sometimes too much glucose enters the bloodstream (it’s enough to eat several sweets at once). In this case, the liver "takes" the excess, turns it into a special substance - glycogen - and stores it. If we skip meals or work hard at the gym, our blood glucose levels drop below normal. Then the liver quickly converts glycogen into glucose and feeds the body with it.

If this function did not exist, we would have diabetes, and not having time to eat on time, we would risk falling into a hypoglycemic coma.

Regulates the volume of blood in the body

Blood moves through the vessels, bringing nutrients to the organs and taking away the waste. Everyone knows this from school. But not everyone knows that the body has a so-called blood depot, which is created by reservoir organs. The liver is one of these organs, it stores a large supply of blood. For the time being, this reserve remains isolated from the main blood flow, but in case of blood loss it is quickly released into the vessels. If the liver did not perform this work, in case of accidents, injuries, after medical operations, the threat to life would be much greater than now.

By the way, if there were no liver, we could even die from a small wound. It is in the liver that many blood plasma proteins are synthesized, including those that are responsible for its normal clotting, and therefore for the rapid healing of cuts and scratches.

Helps in the absorption of vitamins

Daily intake of all vitamins is the key to good health. If you adhere to a balanced diet, you can ensure the supply of nutrients to the body. But this is not enough - it is necessary that the vitamins are fully absorbed. In this sense, the role of the liver can hardly be overestimated: it is directly involved in the processing of vitamins A, C, D, E, K, PP and folic acid, helping them to perform their functions. The impact of these vitamins on the body is diverse: they are needed for the full functioning of the immune system and the nervous system, good vision, bone strength, normal metabolic processes, skin elasticity ...

Also, reserves of vitamins A, D and B12 are stored inside the liver, which the body uses if a new portion of useful substances has not been received for some reason. An important role is played by the body in the processing and storage of minerals - copper, cobalt and iron, which is necessary for the production of hemoglobin.

Removes all excess from the body

Our body is a huge factory. Like any production, it has its own waste - unnecessary, used, and sometimes just unnecessary components. Their removal from the body is also handled by the liver. It removes excess hormones and vitamins, as well as harmful nitrogenous compounds that are formed during metabolism.

Do not forget about the toxins that enter the body from the outside. The liver is not without reason called the main filter. Like a sponge, it passes through itself pesticides, heavy metals, preservatives, splits them into harmless substances. If this function did not exist, the body would look like a dump, and we would not live even a week, dying from poisoning.

Liver cells, hepatocytes, have a tremendous ability to regenerate. There are cases when the organ "grew" again after operations in which a person had only a quarter of it. But in order for the liver to replenish its resources, favorable conditions are needed. Alas, in modern life there are a lot of factors that can damage it, so its diseases are very common.

The peculiarity of the liver is that even if there are changes in it, it does not bother a person for a long time, pain appears only in the later stages of the disease. If you are exposed to risk factors, consult a gastroenterologist or hepatologist, undergo examinations and follow the recommendations given by your doctor.

As a rule, drugs from the group of hepatoprotectors are included in the complex therapy of liver diseases. They help the cells of the body recover faster and prevent their destruction. Some drugs from this group are also able to improve blood flow in the liver and remove excess fat from it. Such drugs can also be used for prophylactic purposes, but before taking it, you should consult your doctor.

The liver is called the body's chemical factory. It performs over 500 functions. It is the largest internal human organ. The liver is capable of regeneration, but this does not mean that it does not need to be protected.

body factory

The liver is the true chemical laboratory of the body. It performs more than 500 functions, the main ones being blood filtration, removing toxins from the body, regulating the level of fats and carbohydrates, and producing bile. And this despite the fact that most organs are responsible for only 1-2 processes. The liver is involved in the formation of half of the urea and lymph, it is a reservoir of blood and a “depot” of vitamins, it contains iron and glycogen, which, with an energy deficit, becomes glucose and works like a battery in the body.

largest internal organ

The liver is the largest internal human organ, which is consistent with the scope of its work. It was not in vain that the eagle pecked at the liver to Prometheus in ancient Greek myth. By the way, in ancient Greece, the liver was recognized by its importance as a more valuable organ than the heart, so the Greeks made an offer not “hands and hearts”, but “hands and liver”.

In Central Africa, it is generally believed that the liver is the seat of the soul, not only in humans, but also in animals. Therefore, by eating the liver of a beast, a male warrior can develop a soul, but women in African tribes are forbidden to eat liver. They are believed to have no soul.

It is significant that in the eighth week of embryonic development, the liver reaches half the weight of the fetus. This suggests that the liver "turns on" much earlier than many other organs, and already in the womb a person retains functionality thanks to this organ. The role of the liver in human life can be assessed by one more parameter: the liver consumes ten times more oxygen than a muscle of equal mass.

Liver and alcohol

In Russia, the liver is on a special account. It is talked about more than any other organ, jokes are told about it and jokes are made up. Basically, these conversations revolve around the most burning topic: the liver and alcohol.
According to the statistics of the World Health Organization, it is alcohol abuse that is the main pathogenic factor for the development of liver diseases.

The liver is extremely sensitive to alcohol. The maximum allowable dose that the liver can process for a healthy man weighing 80 kilograms is 80 grams of pure alcohol. In terms of bottles of beer, it will be about 5 liters.

Why is alcohol dangerous for the liver? Basically, the fact that its metabolic products, such as acetaldehyde, contribute to the destruction of liver cells. They die and are replaced by connective tissue and fat. As a result, this can lead to cancer and cirrhosis. A liver weakened by alcohol can no longer perform all the functions that are assigned to it, so even if a person avoids serious complications, any liver damage can affect the functionality of the body's systems, from the psyche to the blood circulation. Do not forget: the liver passes more than 700 liters of blood through itself per day.
By the way, if it’s impossible not to drink, then it’s better to do it in the time interval between 18 and 20 hours. At this time, the liver most effectively decomposes alcohol.

Liver and diet

Alcohol is not the only enemy of the liver. Even such seemingly “intangible” factors as stress and negative emotions can negatively affect her work. A powerful release of adrenaline takes the necessary supply of blood from the liver, which is why the balance is disturbed in it.

Any toxic food, smoked, fried, spicy can negatively affect the liver. Also, sharp jumps in weight are extremely harmful to the liver. Even slow obesity affects it not as fatally as its sharp decline. This is dangerous dubious diets, which have recently become widespread. With a sharp weight loss, the accumulated fat enters the blood and liver. Liver cells cannot always cope with such a fat stream, which is why they are damaged and may die.
If you want to lose weight - do it gradually, "throw off" no more than 1 kilogram per week.

If you study in detail the structure of the liver, then the process of understanding the functions of the liver becomes simpler and more understandable. From the article on the structure of the liver, we already know that this organ produces bile and cleanses the blood of harmful substances. What else functions inherent liver. From a wide variety of liver functions, which have more than 500 designations, generalized ones can be distinguished. So, the list of such functions includes:
- detoxification;
- excretory;
- synthetic;
- energy;
- hormonal metabolism.

Detoxification function of the liver

The detoxification function is due to the neutralization and disinfection of harmful substances that enter there along with the blood through the portal vein from the digestive organs. The composition of the blood entering the liver through the portal vein contains, on the one hand, nutrients and toxins that have entered there after digestion by the gastrointestinal tract of food. In the small intestine, many different processes take place simultaneously, including putrefactive ones. As a result of the flow of the latter, harmful substances are eventually formed - cresol, indole, skatole, phenol, etc. By the way, pharmaceuticals, alcohol, harmful substances contained in the air near busy roads or in tobacco smoke are also referred to harmful substances or, say, compounds not characteristic of our body. All these substances are harmful, they are absorbed into the blood and together with it enter the liver. The main role of the detoxification function is to process and destroy harmful substances and remove them along with bile into the intestines. This process (filtration) occurs due to the passage of various biological processes. Such processes include reduction, oxidation, methylation, acetylation, and the synthesis of various protective substances. Another feature of the detoxification function is that it lowers the activity of various hormones. Once in the liver, their activity is reduced.

excretory function of the liver

The figure shows the organs of the excretory system of the human body. Among these organs is the liver. Another function of the liver is called excretory. This function is carried out due to the secretion of bile. What is bile made of? It is 82% water, 12% bile acids, 4% lecithin, 0.7% cholesterol. The composition of the rest of the bile, and this is approximately somewhere a little more than 1%, includes bilirubin (pigment) and other substances. Bile acids, as well as their salts, in the process of contact break down fats into small droplets, thus facilitating the process of their digestion. In addition, bile acids take an active part in the process of absorption of cholesterol, insoluble fatty acids, calcium salts, vitamins K, E and B vitamins. Speaking about the role of bile, it should be noted that it prevents the development of decay processes in the intestine, stimulating the motility of the small intestine , participates in the process of digestion of carbohydrates and proteins, and also stimulates the secretion of juice by the pancreas, and also stimulates the bile-forming function of the liver itself. Ultimately, all toxic and harmful substances are excreted from the body along with bile. It should be noted that a complete (normal) purification of blood from harmful substances is possible only if the bile ducts are passable - small stones in the gallbladder can impair the outflow of bile.

Synthetic functions of the liver

If we talk about the synthetic functions of the liver, then its role is in the synthesis of proteins, bile acids, the activation of vitamins, the metabolism of carbohydrates and proteins. During protein metabolism, the breakdown of amino acids occurs, as a result of which ammonia is converted into neutral urea. About half of all protein compounds that are formed in the human body undergo further qualitative and quantitative transformations in the liver. Therefore, the normal functioning of the liver determines the normal functioning of other organs and systems of the human body. Everything in the body is interconnected. For example, liver disease leads to a malfunction of the synthetic function, which may result in a decrease in the production of certain proteins (albumin and haptoglobin). These proteins are part of the blood plasma and the violation of their concentration in an extremely negative way affects the state of health. Due to a diseased liver, the synthesis of proteins and other substances that are responsible for the protective function of the body, for example, normal blood clotting, may decrease.

As for carbohydrate metabolism, it consists in the production of glucose, which the liver reproduces from fructose and galactose and accumulates in the form of glycogen.

She strictly monitors the concentration of glucose and tries to maintain its level constant, and she does this constantly throughout the day. This process is carried out by the liver due to the reverse process of the transformation of the substances mentioned above - (fructose, galactose - glycogen, and vice versa glycogen - glucose). Here I would like to note a very important detail, which is that the source of energy that ensures the vital activity of all cells of the human body is glucose. Therefore, when its level decreases, the whole body begins to suffer, but first of all, this decrease affects the functioning of the brain. Brain cells differ from other cells in our body (in view of their specificity) and cannot accumulate a significant amount of glucose. In addition, they do not use fats and amino acids as an energy source. Therefore, if the blood glucose level is extremely low, this can lead to muscle cramps or even loss of consciousness.

Energy function of the liver

The human body, like any other creature, consists of cells - the structural units of the body. All cells have a fundamentally the same structure, which is due to the fact that they contain information encrypted in nucleic acid, which is located in the cell nucleus. This information determines the normal functioning and development of cells, and, consequently, the whole organism.

It is also important to note here that, although cells have a fundamentally the same structure, the functions performed by them are different. These functions are due to the program embedded in their core. You have the right to ask, what does the liver have to do with it and what effect does it have on other cells? The answer is the following - for normal life, cells need an external source of energy, which, as needed, could feed them with the necessary energy. Such a main and reserve source of energy reserves is the liver. These energy reserves are synthesized and stored in the liver in the form of glycogen, proteins and triglycerides.

Hormonal exchange

The liver itself does not produce hormones, but is actively involved in hormonal metabolism. This participation of the liver is due to the fact that it destroys an excess amount of hormones that are produced by the endocrine glands. With any liver disease, the content of hormones in the blood rises, which negatively affects the health of the body. Diseases such as tachycardia (increased heart rate) are due to an increased content of thyroxine, increased sweating - exophthalmos, sodium and water retention in the body - aldosterone.

As you can see in the human body are unique and varied. The health of the human body is very dependent on the health of the liver.

Be always healthy and happy!

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muvrasil.ru

The functions that this organ performs in the body

At the moment, more than seventy functions of this body are known, and the number of processes in which it participates exceeds five hundred. Here are the main functions of this body:

• Help the digestive system;
• fight against bacteria, viruses and infections;
• functions of the liver and gallbladder for the joint production of bile;
• storage of nutrients;
• hormone production;
• energy production for the body;

Below we will analyze each point in more detail.

Digestion

It is the liver that is the first stop of food for its subsequent splitting into components (energy, and the simplest hydrocarbon compounds). It transports already prepared pieces of food to other organs of the digestive system, helping to assimilate them. In addition, the liver neutralizes and removes poisons from the body, such as alcohol. Thus performing a protective function.

This organ also removes those substances that are left over from drugs and have not been digested and assimilated.

Malicious organisms

It's no secret that in our body there is a huge number of harmful microorganisms: viruses and bacteria.

There are many ways to enter the body:

• Respiratory system;
• digestive tract;
• through mucous membranes;
• various cuts and other violations of the skin.

All of them, one way or another, get into the blood. But before reaching all parts of the body, the blood first passes through the liver, where it is carefully filtered. Special cells of the body, macrophages attack pests and deal with them mercilessly, it is noteworthy that there are about the same number of these soldier cells in the liver as in the rest of the body. This feature ensures operation without danger to all organs.

Gallbladder and bile

Even if you just look at the location of the liver and gallbladder in the body, you can conclude that they work together. So it is, together they produce bile. It is an essential element of the digestion process.

Its function is that it helps to process fats. In just a day, the liver produces about one to two liters of this fluid.

The composition of bile includes various acids and salts. Bile begins to be produced half an hour after the start of a meal.

Nutrient storage

In addition to the function of processing and filtering nutrients, storing them is also a function of the liver. Liver cells - hepatocytes can accumulate nutrients and, if necessary, give them to the body. In addition, it also accumulates vitamins, micro-macroelements and other substances for subsequent return.

Hormones

The liver is involved in the production, breakdown and maintenance of hormone levels, which are vital for the proper development and functioning of the body. In addition to the usual hormones, its functionality also includes the reproduction of sex.

Energy accumulator of the body

By breaking down nutrients into simpler constituents, the liver stores glycogen. When necessary, it produces complex chemical reactions and converts glycogen into glucose. It is necessary to maintain the required level of energy in the body.

If glycogen stores are depleted, then after the next meal, all reserves will be restored.

Violation of the function and ways to restore it

Habitual reactions and processes occurring in the liver can be disturbed under the influence of external and internal factors. In most diseases, the symptoms can be very unpleasant. List of some reasons:

In order to understand exactly how each of the factors affects this organ, we will analyze them separately.

Alcohol

The harmful effect of alcohol on the liver has been known for a long time and effective methods of treatment are still critically few. Alcohol is a poison that is filtered by the liver. And the physiology of the liver obliges it to accumulate substances in certain volumes, all poisons are not completely eliminated and have a slow negative effect on this organ. This is almost the main reason. The situation can even reach cirrhosis.

Methods of treatment - complete cessation of alcohol intake and observation by specialists. With cirrhosis, part of the liver can be cut out, but it has the ability to regenerate, albeit very slowly.

Medications

Many people do not read the instructions and instructions for taking medications, for which they then suffer from internal organs and themselves. This situation is especially acute with antibiotics. Their negative effect is to deactivate the immune system, about half of which is located in the liver, through which drugs are filtered, which opens the way for diseases.

In such a situation, even an ordinary flu can be deadly, to be sure about hepatitis. Symptoms of this can be very different - from weakness and drowsiness to loss of appetite. First of all, with this development of events, it is necessary to stop taking the drugs and allow the immune system to recover on its own, if possible under the supervision of doctors.

Some drugs have a direct negative effect on the liver. With their long-term use, problems can become much more serious.

These items in the list of negative reasons can be directly related to each other. Stress can be caused by bad ecology, under the influence of which harmful creatures can enter the body. Symptoms of this situation affect the body as a whole, and also disrupt digestion and general condition.

To correct this situation, it is best to arrange a short vacation, preferably in a sanatorium in the fresh air.

There will be specialists working with you to help solve the problems that have arisen.

Treatment with monastery syrup

Many problems with the liver and its functionality can be solved with the help of a monastic liver cleansing syrup. This is a product of great ecological cleanliness made only from natural ingredients. Its composition includes

• Chamomile
• Fennel;
• elecampane root;
• highlander bird;
• corn silk;
• immortelle sandy;
• pharmacy apricot.

The interaction of these components has a cleansing and regenerating effect on its damaged cells. Helps prevent many diseases long before they appear. The syrup does the following:

Monastery syrup for liver cleansing is a very popular product among the population. Its action has been proven by many tests and consumer reviews. Monastic syrup should be used systematically for a full course, which on average lasts about two weeks.

Syrup should be taken two to three times a day, one tablespoon. Positive results begin to appear already a few days after the start of the intake, and intensify over time. Experts advise taking syrup about once a year to maintain normal liver function.

The liver is one of the most important organs in the human body and maintaining its performance at a normal level is vital.

You should avoid negative factors that affect it and give yourself a rest, relieving stress. And most importantly - try to reduce or completely abandon the intake of alcohol, because he is her worst enemy.

If there is no time to rest, there are frequent feasts that load this organ, then use the Monastic syrup to cleanse the liver. Even in a busy schedule of the day, you can find a minute to take it. And your body will thank you.

vsepropechen.ru

Liver functions

1.Barrier (protective) and neutralizing functions consist in the destruction of toxic products of protein metabolism and harmful substances absorbed in the intestines.

2. - a digestive gland that produces bile, which enters the duodenum through the excretory duct.

3.Participation in all types of metabolism in the body.

Consider the role of the liver in the metabolic processes of the body.

1. Amino acid (protein) metabolism. Synthesis of albumins and partially globulins (blood proteins). Among the substances coming from the liver into the blood, proteins can be put in the first place in terms of their importance for the body. The liver is the main place of formation of a number of blood proteins that provide a complex reaction of blood coagulation.

The liver synthesizes a number of proteins that are involved in the processes of inflammation and transport of substances in the blood. That is why the state of the liver largely affects the state of the blood coagulation system, the body's response to any impact, accompanied by an inflammatory reaction.

Through the synthesis of proteins, the liver takes an active part in the immunological reactions of the body, which are the basis for protecting the human body from the action of infectious or other immunologically active factors. Moreover, the process of immunological protection of the mucous membrane of the gastrointestinal tract includes the direct participation of the liver.

In the liver, protein complexes are formed with fats (lipoproteins), carbohydrates (glycoproteins) and carrier complexes (transporters) of certain substances (for example, transferrin is an iron carrier).

In the liver, the breakdown products of proteins that enter the intestine with food are used to synthesize new proteins that the body needs. This process is called amino acid transamination, and the enzymes involved in the exchange are called transaminases;

2. Participation in the breakdown of proteins to their final products, i.e., ammonia and urea. Ammonia is a constant product of protein breakdown, while at the same time it is toxic to the nervous system. matter systems. The liver provides a constant process of converting ammonia into a low-toxic substance urea, the latter is excreted by the kidneys.

With a decrease in the ability of the liver to neutralize ammonia, it accumulates in the blood and nervous system, which is accompanied by a mental disorder and ends with a complete shutdown of the nervous system - coma. Thus, we can safely say that there is a pronounced dependence of the state of the human brain on the correct and full functioning of his liver;

3. Lipid (fat) metabolism. The most important processes are the breakdown of fats to triglycerides, the formation of fatty acids, glycerol, cholesterol, bile acids, etc. In this case, short-chain fatty acids are formed exclusively in the liver. Such fatty acids are necessary for the full functioning of the skeletal muscles and the heart muscle as a source of obtaining a significant proportion of energy.

These same acids are used to generate heat in the body. From fats, cholesterol is synthesized by 80–90% in the liver. On the one hand, cholesterol is a substance necessary for the body, on the other hand, when cholesterol is disturbed in its transport, it is deposited in the vessels and causes the development of atherosclerosis. All of the above makes it possible to trace the relationship of the liver with the development of diseases of the vascular system;

4. carbohydrate metabolism. Synthesis and breakdown of glycogen, conversion of galactose and fructose into glucose, oxidation of glucose, etc.;

5. Participation in the assimilation, storage and formation of vitamins, especially A, D, E and group B;

6. Participation in the metabolism of iron, copper, cobalt and other trace elements necessary for hematopoiesis;

7. Involvement of the liver in the removal of toxic substances. Toxic substances (especially those that have entered from the outside) are distributed, and they are unevenly distributed throughout the body. An important stage in their neutralization is the stage of changing their properties (transformation). Transformation leads to the formation of compounds with less or more toxic ability compared to the toxic substance that has entered the body.

Elimination

1. Bilirubin exchange. Bilirubin is often formed from the breakdown products of hemoglobin released from aging red blood cells. Every day, 1-1.5% of red blood cells are destroyed in the human body, in addition, about 20% of bilirubin is formed in the liver cells;

Violation of bilirubin metabolism leads to an increase in its content in the blood - hyperbilirubinemia, which is manifested by jaundice;

2. Participation in blood coagulation processes. Substances necessary for blood clotting (prothrombin, fibrinogen), as well as a number of substances that slow down this process (heparin, antiplasmin), are formed in the liver cells.

The liver is located under the diaphragm in the upper part of the abdominal cavity on the right and is normally not palpable in adults, as it is covered by the ribs. But in young children, it can protrude from under the ribs. The liver has two lobes: the right (larger) and left (smaller) and is covered with a capsule.

The upper surface of the liver is convex, while the lower surface is slightly concave. On the lower surface, in the center, there are a kind of gate of the liver, through which the vessels, nerves and bile ducts pass. In the recess below the right lobe is the gallbladder, which stores bile produced by liver cells called hepatocytes. The liver produces 500 to 1200 milliliters of bile per day. Bile is produced continuously, and its entry into the intestine is associated with food intake.

Bile

Bile is a yellow liquid, which consists of water, bile pigments and acids, cholesterol, mineral salts. It is excreted through the common bile duct into the duodenum.

The excretion of bilirubin by the liver through bile ensures the removal of bilirubin, toxic to the body, from the blood, which is formed as a result of the constant natural breakdown of hemoglobin, a protein of red blood cells). In case of violations of at any stage of bilirubin release (in the liver itself or bile secretion through the hepatic ducts), bilirubin accumulates in the blood and tissues, which manifests itself in the form of a yellow color of the skin and sclera, i.e., in the development of jaundice.

Bile acids (cholates)

Bile acids (cholates), in combination with other substances, provide a stationary level of cholesterol metabolism and its excretion with bile, while cholesterol in bile is in dissolved form, or rather, is enclosed in the smallest particles that ensure the excretion of cholesterol. Violation in the metabolism of bile acids and other components that ensure the excretion of cholesterol is accompanied by the precipitation of cholesterol crystals in the bile and the formation of gallstones.

In maintaining a stable metabolism of bile acids, not only the liver, but also the intestine is involved. In the right sections of the large intestine, cholates are reabsorbed into the blood, which ensures the circulation of bile acids in the human body. The main reservoir of bile is the gallbladder.

gallbladder

With violations of its function, there are also violations in the secretion of bile and bile acids, which is another factor contributing to the formation of gallstones. At the same time, bile substances are necessary for the full digestion of fats and fat-soluble vitamins.

With a prolonged lack of bile acids and some other bile substances, a lack of vitamins (hypovitaminosis) is formed. Excessive accumulation of bile acids in the blood in violation of their excretion with bile is accompanied by excruciating itching of the skin and changes in the pulse rate.

A feature of the liver is that it receives venous blood from the abdominal organs (stomach, pancreas, intestines, etc.), which, entering through the portal vein, is cleared of harmful substances by liver cells and enters the inferior vena cava, which goes to heart. All other organs of the human body receive only arterial blood, and give venous blood.

The article uses materials from open sources:

Based on materials: health-medicine.info

health-medicine.info

Basic information about this body

The liver is located in the right hypochondrium and takes up a lot of space in the abdominal cavity because it is the largest internal organ. Its weight ranges from 1200 to 1800 grams. In shape, it resembles a convex mushroom cap. She got her name from the word "furnace", since this organ has a very high temperature. The most complex chemical processes are constantly taking place there, and work is going on without interruption.

It is impossible to unequivocally answer the question of what is the role of the liver in the human body, because all the functions that it performs are vital for it. Therefore, this organ has regenerative abilities, that is, it can regenerate itself. But the cessation of its activities leads to the death of a person in a couple of days.

Protective function of the liver

More than 400 times a day, all blood passes through this organ, being cleansed of toxins, bacteria, poisons and viruses. The barrier role of the liver is that its cells break down all toxic substances, process them into a harmless water-soluble form and remove them from the body. They work like a complex chemical laboratory, neutralizing toxins that enter the body with food and air and are formed as a result of metabolic processes. From what toxic substances does the liver cleanse the blood?

- From preservatives, dyes and other additives found in food products.

- From bacteria and microbes that enter the intestines, and from the products of their vital activity.

- From alcohol, drugs and other toxic substances that enter the blood with food.

— From exhaust gases and heavy metals from ambient air.

- From an excess of hormones and vitamins.

- From toxic products formed as a result of metabolism, such as phenol, acetone or ammonia.

It is in this organ that proteins, fats and carbohydrates coming from the intestines are converted into an easily digestible form. The role of the liver in the process of digestion is enormous, because it is there that cholesterol, bile and many enzymes are formed, without which this process is impossible. They are released into the intestines through the duodenum and help in the digestion of food. The role of bile is especially important, which not only breaks down fats and promotes the absorption of proteins and carbohydrates, but also has a bactericidal effect, destroying the pathogenic microflora in the intestine.

The role of the liver in metabolism

Carbohydrates that come with food, only in this organ are converted into glycogen, which enters the blood in the form of glucose as needed. The process of gluconeogenesis provides the body with the right amount of glucose. The liver controls the level of insulin in the blood depending on the needs of the person.

This organ is also involved in protein metabolism. It is in the liver that albumin, prothrombin and other proteins that are important for the life of the body are synthesized. Almost all of the cholesterol involved in the breakdown of fats and the formation of certain hormones is also formed there. In addition, the liver takes an active part in water and mineral metabolism. It can store up to 20% of blood and serves as a storehouse of many minerals and vitamins.

Participation of the liver in the process of hematopoiesis

This organ is called the "blood depot". In addition to the fact that up to two liters can be stored there, hematopoiesis processes take place in the liver. It synthesizes globulins and albumins, proteins that ensure blood clotting and its fluidity. The liver is involved in the formation of iron, which is necessary for the synthesis of hemoglobin. In addition to cleaning the blood of toxic substances, this organ breaks down red blood cells, resulting in the production of bilirubin. It is in the liver that proteins are formed that perform transport functions for hormones and vitamins.

Storage of useful substances

Speaking about the role of the liver in the human body, it is impossible not to mention its function of accumulating substances necessary for vital activity. What is this organ the repository of?

1. This is the only place where glycogen is stored. The liver stores it and, as needed, releases it into the blood in the form of glucose.

2. About two liters of blood is there and is only used in case of severe blood loss or shock.

3. The liver is a repository of vitamins necessary for the normal functioning of the body. Especially a lot of vitamins A and B12 are stored in it.

4. This organ forms and accumulates cations of metals necessary for the body, such as iron or copper.

What can liver dysfunction lead to?

If this organ for some reason cannot work properly, then various diseases arise. You can immediately understand what is the role of the liver in the human body, if you see what violations in its work lead to:

- Decreased immunity and constant colds;

- violation of blood clotting and frequent bleeding;

- severe itching, dry skin;

- hair loss, acne;

- the appearance of diabetes and obesity;

- various gynecological diseases, for example, early menopause;

- digestive disorders, manifested by frequent constipation, nausea and loss of appetite;

- nervous disorders - irritability, depression, insomnia and frequent headaches;

- violations of water metabolism, manifested by edema.

Very often the doctor treats these symptoms without noticing that the cause is liver damage. There are no nerve endings inside this organ, so a person may not experience pain. But everyone should know what role the liver plays in his life, and try to support it. It is necessary to give up alcohol, smoking, spicy and fatty foods. Limit the use of drugs, products containing preservatives and dyes.

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Half of the protein that is synthesized in the body per day is formed in this organ. From amino acids, blood proteins are produced here - albumin, α and β-globulins, blood coagulation factors.

The liver also synthesizes and accumulates reserve amino acids, which are used when there is insufficient protein intake from food. If there is exhaustion, severe poisoning, bleeding and the body needs protein, the liver gives up its reserve. The loss of protein during starvation can be up to 1/5 of the total mass, while in other organs it is only up to 1/25. Fully updated amino acids in the liver every three weeks.

One of the complex and multitasking proteins is AFP (α-fetoprotein). It is produced in the liver and has immune-suppressing properties. In the blood, this protein appears during pregnancy, tumors of the liver, ovaries, and testicles.

Non-essential amino acids are also actively synthesized in the liver.

lipid metabolism

The liver also plays a significant role in fat metabolism.

It is responsible for such mutually reversible processes, such as:

1. synthesis of cholesterol from fatty acids;
2. synthesis of bile acids from cholesterol.

This gland is directly involved in the deposition of fat. The formation of fatty acids is more active during the digestion of food, between meals and during fasting. The intensity of the use of fats depends on the intensity of muscle work. The higher the activity, the more they are consumed.

The processes of regulating the metabolism of fats and carbohydrates depend on each other. With an excess of sugar, lipid production increases. If glucose enters the body in insufficient quantities, it is synthesized from proteins and fats. The conversion of carbohydrates into fats occurs when the cells of the body are filled with glycogen to failure.

carbohydrate metabolism

In the liver cell (hepatocyte), glycogen is created from carbohydrates (glucose, galactose, fructose) - a reserve for a rainy day. When the body needs energy, glycogen is converted back into glucose. It immediately enters the bloodstream and is carried to the cells, in which it passes into energy. A constant amount of carbohydrates in the blood is mainly regulated by pancreatic hormones.

pigment exchange

The role of the liver in pigment metabolism is to convert free bilirubin into bound bilirubin, followed by its excretion with bile. Indirect bilirubin is formed from the breakdown of red blood cells and hemoglobin, which is part of the process of constant blood renewal. Free or indirect bilirubin is highly toxic. It undergoes a conjugation reaction and is processed into harmless - direct. This form of bilirubin is no longer toxic to the body.

Direct bilirubin is also called bound or conjugated. The liver takes an active part in removing this pigment from the body through the intestines. If the excretion of bilirubin is impaired, jaundice develops in the body.

If indirect bilirubin is increased in the analysis for liver biochemistry, this indicates an increased breakdown of red blood cells. This can be with hemolytic anemia, malaria.

Direct bilirubin is elevated in jaundice caused by gallstones.

The blood supply to the liver is unique because of its particular anatomy. Only this gland receives blood directly from the artery and vein. It is thanks to this function of the liver that detoxification processes constantly occur in our body. This organ is deservedly called a “filter”, which daily cleanses the body of toxins and harmful substances by purifying the blood.

The barrier (detoxifying, neutralizing, antitoxic) function of the liver is perhaps the most important of the tasks it performs.

The neutralizing function of the liver in the body is that deactivation (biotransformation) of toxic substances occurs in its cells. They are synthesized by the body or come from outside, for example, medicinal substances, chemical compounds alien to the human body - xenobiotics.

The liver takes part in the inactivation reaction of a number of biologically active compounds: estrogens, androgens, steroids, pancreatic hormones.

It binds ammonia through the formation of urea and creatinine. In addition, this organ has the task of processing toxic substances (indole, skatole, cresol, phenol) that are formed during the work of the intestinal microflora. They are converted into harmless compounds by a conjugation reaction. This is necessary in order to remove metabolic products from the body.

The protective function of the liver is also expressed in the phagocytosis of pathogens.

Digestive (metabolic) function

The indispensable role of this gland in digestion is the constant production of bile and its storage in the gallbladder. It contains bile acids, direct bilirubin, cholesterol, water and other substances. The formation of bile occurs in the liver cells - hepatocytes. In them, the function of its accumulation is performed by the Golgi apparatus.

After leaving the liver cells, bile is secreted first into the capillaries, then into the bile ducts. In the process of passing through the tubules, all the compounds necessary for other organs are extracted from it and only the substances necessary for digestion and waste products of the body remain.

Due to the unique anatomy of the gallbladder, it can store large amounts of bile between meals. During meals, it enters the intestines in a large portion, thereby improving the digestive process.

An important function of bile is to stimulate the intestines. Part of the bile acids undergoes a conjugation reaction and, together with bile, is excreted into the duodenum. There, the acid emulsifies fats, making them easier to absorb and digest.

As part of bile, direct bilirubin, decay products of toxic substances and xenobiotics are excreted from the liver.

An interesting feature of bile is the absence of enzymes in its composition.

Enzymatic function

Many biochemical reactions take place in the liver during the day. Some products for such processes are often needed very quickly. For example, in extreme situations, energy is required, which can only be obtained by breaking down a glucose molecule. In such cases, liver enzymes come to our aid, significantly accelerating the biochemical reactions occurring in its cells.

Role of liver enzymes

Almost every biochemical reaction is catalyzed (accelerated) by a specific enzyme suitable only for it.

Enzymes such as ALT and AST are synthesized in this organ. Partially synthesized GGT, alkaline phosphatase. If liver enzymes "grow" in the analysis of liver biochemistry, this most often indicates that the body is lacking something and an urgent need to look for the cause.

The content of ALT in the blood with hepatitis, cirrhosis, jaundice, myocardial infarction, burns increases, and decreases with a deficiency of B vitamins. The concentration of AST can increase with a heart attack, hepatitis, angina pectoris, severe physical exertion and decrease with liver rupture and a lack of B vitamins. Analyzes of these liver enzymes should be considered in relation to each other. If the ALT level exceeds the AST, it is most likely a liver disease. If the opposite is true, then hearts.

Other functions of the liver

Excretory (excretory) function

The excretory function of the liver is to excrete bile along with other metabolic products into the bile ducts, with their subsequent entry into the intestinal lumen and excretion from the body.

Vitamin exchange

The liver is directly involved in the synthesis and absorption of fat-soluble vitamins (A, D, E, K), and also stores and removes their excess from the body (A, D, K, C, PP). If during nutrition vitamins are not supplied in sufficient quantities to the body, it begins to consume them from its reserves.

Immune and allergic reactions

The liver takes part in the maturation of immune cells (immunopoiesis), and in immunological reactions. Also, the reaction of the body to allergens largely depends on it.

In conclusion, we can say that the liver is the most important organ of digestion. It plays a huge role in the metabolic processes of the body and the synthesis of important compounds, if its work is disrupted, this affects all aspects of health.