The liver is one of the most vital organs of the body, though most neglected. One’s survival and quality of life depends on the well being of the liver. The liver produces glucose which is vital to provide energy to the body cells for their functioning. It also manufactures proteins which help the body cells to cope up with wear and tear. Clotting factors, that is, substances which stop bleeding are also produced in the liver. The liver is also where cholesterol is manufactured. Cholesterol serves as a reserve fuel for the body and also as a medium for transport of lipids and lipoproteins across the body for various metabolic functions. Antibodies against various infectious agents are made in the liver. It serves to detoxify substances toxic to the body like alcohol. Various drugs and other chemicals are metabolised through the liver. Considering the so many vital functions of the liver, one should not ignore it. Alcohol is the substance most abused, and which is very harmful to the liver. To a large extent, the body tries to detoxify it but when consumption exceeds the capacity of the liver to eliminate it, it becomes sick. If the process continues unabated, the liver gets damaged beyond repair. More than 900 drugs have been identified which can damage the liver to more or less extent in various ways. Use of some of them is unavoidable. For example, use of rifampicin for tuberculosis and nevarapine for HIV/AIDS is mandatory. But use of some of the hepatotoxic drugs is avoidable. Pain killing medicines like diclofenac and paracetamol, are harmful to the liver as well as the kidneys. They are misused by people ignorantly. For any pain, it is common to see people consuming a pill on their own. Corticosteroids are also harmful to the liver. Because of their easy availability, affordable prices and potent anti-allergy and anti-inflammatory properties, they are also used by people much. Some of the chemicals used in industries like arsenic, carbon tetrachloride, vinyl chloride used in plastics, organochlorine insecticides, e.t.c. also damage the liver. Some herbs, certain kind of mushrooms also lead to damage of the liver. Many of these substances may cause manifest liver disease, where the patient may have loss of appetite, nausea, vomiting and weakness with or without frank yellow discoloration of the eyes. Unchecked the damage may progress to liver failure, coma and death. At times, if one is exposed to any of these substances, there may be only derangement of the liver function, but no clinical illness. Subsequently, if there is damage to the liver again by some hepatotoxic substance or illness like viral hepatitis, one may get florid liver damage. Once the liver is damaged, there is no drug to correct it. The only treatment offered is palliative to cure the symptoms and maintain vital signs. Liver transplant is a procedure possible only in select centers. One needs to find a very suitable donor and then after a major surgery, immune suppressive drugs have to be taken for a long time, even for life to prevent rejection of graft. Hence it is wise to save the liver from any damage as far as possible. Alcohol is best avoided. Unless absolutely needed, one should not take any medicines. While consuming herbs or mushrooms, one should verify before whether they are safe or not. Those working in industries should take due precautions to avoid exposure to hepatotoxic chemicals. If in spite of these precautions one does get any feature of liver damage, they should get their liver function tests done to assess if any damage has occurred to the liver. Dr. Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital
