Liver diseases are damaged the function of hapetocytes, it may causes hepatocellular necrosis, fibrosis, and regeneration with nodule formation.

Chronic liver disease in which liver damage slowly by process and persisting over long time.It means it act as slow poison for healthy human body. It is characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occurs as a result of a process inwhich damage tissue is regenerated.

It is already to progressive loss of liver function-cirrhosis is due to alcoholism, but in our population it is prohibited by people due religion, poverty and customs society, Hepatitis C, Hepatitis B virus are main role this dangerous disease in our population.

BASIC STRUCTURE OF LIVER

Liver is the largest gland in the body weighing about 1.4 k.g in an adult. It is situated under diaphragm in the upper abdomen cavity and is held in place by several ligaments.It is reddish-brown colour and comprise of four anatomical lobes.When viewed from the front the dominant left and right lobes can be seen which are separated by falciform ligament.

Situated in a depression on the posterior surface of the liver in the gall bladder, a pear shaped sac which stores bile synthesis by the liver.The liver performs many metabolic functions. It has ability to store and metabolites useful substances such as nutrients,but it breakdown or detoxifying harmful substances to render then inert and less harmful. (Dr.viva Rolfe 2004)

Liver weighing roughly 1.2-1.6 k.g performs many of the functions necessary for staying healthy. It is located in the right side of the body under the lower ribs and is divided into four lobes of unequal size. Two large vessels carry blood to the liver, the hepatic artery comes from heart and carries blood rich in nutrients absorbed from the small intestine.

These vessels divided into smaller and smaller vessels, ending in capillaries. Each lobule is composed of hepatocytes, add, and remove substance from it. The blood then leaves the liver via the hepatic vein, returned to the heart, and is ready to be pumped to the rest of the blood.

Among the most important liver functions are:

• Removing and excreting body waste and hormones as well as drugs and foreign substances.
• Synthesizing plasma proteins, including those necessary for blood clotting,12 clotting factors are produced by the liver.
• Producing immune factors and removing bacteria helping body fight against infection.
• Producing bile to acid digestion.
• Excretion of bilurobin.
• Storing certain vitamins, minerals, and sugars.

Liver is an organ in vertebrates, including humans. It plays a major in metabolism and has a number of functions in the body including detoxification, glucagon storage and plasma proteins sythesis.I t also produces bile, which is important for digestion. It also starts in hepato or hepatic from Greek word for liver, hepar. Hepatocytes play main role in:

• Liver produces and excretes bile required for food, some of the drain directly into duodenum and some stored in gallbladder.
• Glyconeogensis (formation of glucose from certain aminoacid lactate or glycerol).
• Glyucogenolysis (the formation of glycogen from glucose).
• Breakdown of insulin and other hormones.
• Lipid metabolism, cholesterol synthesis, production of triglycerides.
• Liver produces coagulation factor, 1(fibrinogen) 11 (prothrombin) v, vii.ix, xi, as well as protein c and proteins and antithrombin.
• Liver converts ammonia into urea.

The liver is vulnerable to a wide of variety of metabolic, toxin, microbial, circulatory and neoplastic insults. The dominant primary diseases of the liver are viral hepatitis, alcoholic liver disease and hepatocellular carcinoma. More often, hepatic damage is secondary, to some of the most common diseases in humans, such as cardiac decompensation, disseminated cancer and extrahepatic function. There are following morphological changes in liver:

• Degeneration and intracellular accumulation damage from toxin or immunologic insult may cause swelling of hepatocytes.
• Necrosis and aptosis, any significant insult to the liver can cause hepatocytes necrosis, in aptosis cell death isolated hepatocytes round up to form shrunken, pykinolic, and intensity esinophilic cells containing fragmented nuclie.
• Inflammation -injury to the liver associated with an influx of acute and chronic inflammatory cells is termed hepatitis.
• Regeneration hepatocytes have long life spans and they proliferate in response to tissue resection or cell death.
• Fibrosis -fibrous tissue is formed in response to inflammation or direct to toxic insult to the liver, fibrosis points toward generally irreversible hepatic damage.

ETIOLOGY OF LIVER DISEASE.

There are following main causes of liver diseases, Hepatitis virus A, B, C, D, E. Epstein-Barvirus, cytomegalovirus, yellowfever virus. Non-viral infection: leptospira, toxoplasma gendi, q fever, Poison-aflatoxin, carbantetrachloride, mushrooms, Drugs- paracetamol, halothane, alcohol, pergnancy, shock, wilson disease.

CLINICAL MANIFESTATIONS:

SYMPTOMS: anorexia, malaise, fever, jaundice, right abdomenal pain, hepatomegaly, ginecomastia, pruritus, hematamesis, confusions.

SIGNS: jaundice, hepatomegaly, pale stool, dark colored urine, palmer erythema, clubbing, spleenomegaly, testicular atrophy, ginecomastia, with other complications – colateralveins peripheral edema, ascites.

TESTS FOR LIVER DISEASES:

The diagnosis of liver diseases depends upon a combination of history, physical examination, labortary testing and sometime radiological studies and biopsy.

• Alanine aminotranferase: ALT is enzyme produced In hepatocytes, the major cell type in the liver. All types of hepatitis (viral, alcoholic, drug induced etc) cause hepatocyte damage that can lead to elevation in the serum ALT activity.
• Aspartate aminotransferase: AST similar to ALT but less specific for liver disease as it is also produced in muscle and can be elevated in other condition (heart attack). Alcoholic hepatitis and viral hepatitis may it.
• Alkaline phosphatase: It is an enzyme, produced in bileducts, intestine, kidneys, placenta and bone.It is elevated in case chronic liver diseases.
• Gamma glutamyl tranferase: It is an enzyme produced in bile duct, in alcohalism and biliary disease it is elevated.
• Bilirubin: Bilurubin is the major breakdown that results from the destruction of old blood cells. It is removed from the body by the liver, chemically modified by process call conjugation, secreted into bile passed into intestine and some extent reabsorbed by intestine. In chronic liver disease, acquired liver diseases, the serum biliurubin is elevated.
• Albumin: Many factors necessary for blood clotting are made in liver. When liver function is impaired, their synthesis and secretion into blood is decreased. In chronic liver disease, it highly elevated.
• Platelets count: These are smallest blood cells in liver disease, spleen becomes large, blood flow through liver is impaired platelets are fallen from normal.
• Serum protein electrophoresis: In cirrohosis, the albumin may decreased and the gamma- globulin can be significantly elevated.

Chronic liver disease is marked by gradual destruction of liver tissue overtime. It is seventh leading cause of death in United States, according to National Institute of Diabetes and Digestive and Kidneys disease becaudse of chronic damage to the liver, scar tissue slowly replaces normal functioning liver tissue, as the normal liver is lost, nutrients, hormones, drugs, and poisons,are not processed effectively by the liver. In addition, protein production and other substances produced by the liver are inhibited.