Issue link: https://www.massageandbodyworkdigital.com/i/68173
pathology perspectives BY RUTH WERNER FATTY LIVER DISEASE The Nonalcoholic Spectrum Most readers probably know that the liver is the biggest gland in the body and the focal point of many of our metabolic processes and our ability to cope with environmental toxins. It mitigates damage related to noxious exposure (for instance, combining too much alcohol with pain relievers for the ensuing hangover). We may also know that chronic drug and alcohol abuse can take a serious toll on the liver and, consequently, on its ability to function and maintain health. What may be news to some, however, is that the fastest growing form of liver disease is related neither to toxic exposure (as with drugs and alcohol), nor to viral infection (as with hepatitis A, B, and C), but to the over-accumulation of triglycerides in hepatocytes—the working cells of the liver. In other words, increasing rates of liver inflammation and even cirrhosis may be related to a spectrum of often-silent conditions, beginning with nonalcoholic fatty liver disease (NAFLD). And because the liver is a keystone for fluid management in the body, it is important for massage therapists to be familiar with these conditions and the risks they involve. ANATOMY REVIEW: A HEALTHY LIVER The liver is an astonishing organ with a long list of important functions. A healthy adult liver weighs about 3 pounds. It occupies a large portion of the upper right quadrant of the abdomen, and it crosses over the midline to the left side. It lies just inferior to the diaphragm, deep to the xyphoid process, and superficial to the stomach. The blood supply to the liver is unique, as it is supplied both by the hepatic arteries, which deliver oxygen-rich blood from the aorta, and by the portal vein, which delivers nutrient-rich, but oxygen-poor, blood from the organs of digestion and the spleen. Through the portal vein, the liver has first dibs on the sugars and proteins absorbed in the intestines, but it also has to process a huge amount of blood from both arterial and venous supply. The liver is composed of four main lobes, and each of those has many lobules made of precisely organized hepatocytes—working liver cells. One function (among many) for hepatocytes is to manufacture bile. This chemical helps hold fats in suspension so that digestive enzymes can break them into smaller molecules for absorption. Bile is collected in a complicated set of channels that drain into the hepatic duct, then the cystic duct, and finally the common bile duct (which is shared by the liver, gallbladder, and pancreas) to be released into the small intestine. During active digestion, bile goes directly from the liver into the duodenum. But bile production is constant (at a rate of 500–1000 milliliters per day), so when the digestive system doesn't need it, bile backs up into the gallbladder for storage. In addition to manufacturing bile, the liver has many other essential functions: • It packages fatty acids in a form that can be transported for cells to use as fuel. • It builds amino acids into vital plasma proteins used for blood clotting, immune system function, and other things. connect with your colleagues on massageprofessionals.com 97