Evaluating the Liver :

Liver disease may be detected during a physical examination. Tapping the abdomen on the top [percussion] will reveal any enlargement of the liver. By gently pressing along the border will reveal if it feels soft, firm or hard, smooth or nodular, painless or tender.

Architecture of the Normal Liver :

The Normal Liver will be smooth, not shrunken nor enlarged and is not tender. Looking through the microscope, it will show a large blood supply, 80% through the portal circulation from the intestines and the remaining through the hepatic artery, from the heart. The sinusoids then carry the blood to the liver cells.

Biopsies indicating liver damage :

If viral hepatitis infection occurs, it may resolve on its own. The type A hepatitis which is spread through food and water clears this way. The type B and type C hepatitis which are spread through blood and Serum contacts may some times becomes chronic, leading to long standing inflammation, scarring and damage to liver cells. However, patients with chronic hepatitis often do not experience any symptoms for a long time.

Some times, some may feel excessive fatigue, weakness, loss of appetite and reduced capacity to exercise. So, it may become necessary to perform biopsy [getting a piece of the tissue and seeing it under a microscope.] to determine whethet there is ongoing liver inflammation and damage. As the chronic hepatitis progresses, damage to the liver cells may impair liver function. Pictures below show the liver cell architecture in early and late stages of liver damage and scarring [Cirrhosis]

Complications of hepatitis: - A shrinking liver -

Chronic hepatitis can lead to cirrhosis or possibly even liver cancer. In patients with cirrhosis, the liver begins to shrink in size and also hardens -[picture right side above ]. This change in the liver's structure lead to permanent impairment of liver function.

As cirrhosis worsens, almost all liver functions are lost.The liver becomes even harder and smaller - [picture on the left side above]. Fluid accumulation in the abdomen and legs may occur. As the blood clotting factors decrease, bleeding from large veins inthe intestinal tract may occur. Mental slowing, confusion and disorientation also may occur.