1. Liver – Physiology, pathology,
Biochemistry & Dietary
management

2. Anatomy
• The liver is located in the upper right-hand portion of the abdominal
cavity, beneath the diaphragm, and on top of the stomach, right kidney,
and intestines.
• Shaped like a cone, the liver is a dark reddish-brown organ that weighs
about 3 pounds.
• There are 2 distinct sources that supply blood to the liver, including the
following:
• Oxygenated blood flows in from the hepatic artery

3. • Nutrient-rich blood flows in from the hepatic portal vein
• The liver holds about one pint (13%) of the body's blood supply at
any given moment. The liver consists of 2 main lobes. Both are
made up of 8 segments that consist of 1,000 lobules (small lobes).
• These lobules are connected to small ducts (tubes) that connect
with larger ducts to form the common hepatic duct. The common
hepatic duct transports the bile made by the liver cells to the
gallbladder and duodenum (the first part of the small intestine)
via the common bile duct.

5. Functions
• The liver regulates most chemical levels in the blood and excretes a
product called bile. This helps carry away waste products from the
liver.
• All the blood leaving the stomach and intestines passes through the
liver. The liver processes this blood and breaks down, balances, and
creates the nutrients and also metabolizes drugs into forms that are
easier to use for the rest of the body or that are nontoxic.

6. • More than 500 vital functions have been identified with the liver.
• Intermediary metabolism – Gluconeogenesis from amino acids
• Conversion of glucose into fatty acids, ketone body formation, inter
conversion of monosaccharides
• Storage – glycogen, vit A, D B12, Iron
• Synthetic – plasma albumin, alpha globulins, lipoproteins, transferrin, and
other carrier proteins, , coagulation factors.

7. • Excretory – cholesterol, other steroids, steroid hormones, bile slats,
pigments, drugs, toxins
• Haematopoiesis – main site of formation of erythrocytes in early
foetal life, after birth of potential but rarely used site.
• Production of bile, which helps carry away waste and break
down fats in the small intestine during digestion
• Production of certain proteins for blood plasma
• Production of cholesterol and special proteins to help carry fats
through the body

8. • Conversion of excess glucose into glycogen for storage
(glycogen can later be converted back to glucose for energy)
and to balance and make glucose as needed
• Regulation of blood levels of amino acids, which form the
building blocks of proteins
• Processing of hemoglobin for use of its iron content (the liver
stores iron)

9. • Conversion of poisonous ammonia to urea (urea is an end
product of protein metabolism and is excreted in the urine)
• Clearing the blood of drugs and other poisonous substances
• Regulating blood clotting
• Resisting infections by making immune factors and removing
bacteria from the bloodstream
• Clearance of bilirubin, also from red blood cells. If there is an
accumulation of bilirubin, the skin and eyes turn yellow.

10. • When the liver has broken down harmful substances, its by-products are
excreted into the bile or blood. Bile by-products enter the intestine and leave
the body in the form of feces. Blood by-products are filtered out by the
kidneys, and leave the body in the form of urine.
• Bile – 1-1.5 L per day,

11. • Bile Salts
• Bile Pigments
• Function of Bile –
1. Digestion and absorption of fat
2. Acid neutralisation
3. Excretion of toxins, drugs, steroid hormones, inorganic
substances like copper, zinc, mercury.
4. Solubility of cholesterol

12. • Humoral regulation – acids and products of CHO, Prot, fats digestion
increase the release of hormones, secretin, CCKPZ from duodenum.
• CCKPZ releases for fat and protein digestion products whereas acids for
secretin
• Secretin and CCK-PZ increase biliary secretion by Gall Bladder contraction.

13. Agents Causing Liver Disease
• Dietary Deficiency – kwashiorkor – 30-50% fat weight – intrahepatic fat
accumulation due to excess fatty acids to liver, aka Lipogenesis. This is
combined with impaired lipid transport from liver secondary to
apoprotein deficiency. After protein ingestion, fat clears from Liver for
short period of time
• Infective agents-virus
• Hepatitis A virus which is excreted in stool of patients or carriers of the
disease and spread by faecal oral route. Sewage may often contaminate
drinking water supply. Poor personal & environmental hygiene are
responsible for spread of this infection. Hepatitis E is deadly for
pregnancy. Hepatitis B spread via blood transfusion.

14. Aetiology of Liver Diseases
• Dietary deficiency – protein deficiency and increase in fat
• Infective agents – Hepatitis A virus – excreted in stool of patient carrier of
disease and spread by feacal oral route. Sewage contaminating water,
hepatitis B VIRUS SPREAD BY BLOOD TRANSFUSION , donor and carrier, less
sterilised needles, drug addicts, etc.
• Entamoeba migration to portal vein from LI and cause hepatitis and liver a

15. • Toxic agents –
Alcohol – 90-95% alcohol is oxidised in liver. Large and continuous
intake lead to hepatic damage, leading to fatty degeneration of liver
cells. Affecting lipid metabolism- fatty acid synthesis , decrease
oxidation and producing stimulation to triglyceride formation.
 Drugs – Every drug is metabolised in liver. Drugs like paracetamol
Chemicals – workers in industry may develop liver damage. Excess
stores of copper, iron, galactose and glycogen may accumulate in liver
leading to Cirrhosis.
• In born error of metabolism – Fructose intolerance, Tyrosinaemia,
galactosemia, etc.

16. Changes in Liver Disease
1. Atrophy – degeneration of hepatic cells
2. Fatty Globulation/Infiltration – deposition of droplets of fats fat in
hepatic cells. This is completely reversible. But if change is severe or
long lasting, it may lead to fibrosis or necrosis.
3. Fibrosis – End result of any liver damage wherein the functioning of
hepatic cells are replaced by connective tissue cells. It give rise to
cirrhosis.
4. Necrosis – death of hepatic cells. May be slight involving part of lobule
or extensive
5. Cirrhosis/ Fibrosis- End result of any liver damage wherein the
functioning hepatic cells are replaced by connective tissue cells,
giving rise to Cirrhosis.

17. Jaundice and its Types
Jaundice - Jaundice is a condition in which the skin, sclera (whites of the eyes)
and mucous membranes turn yellow. This yellow color is caused by a high level
of bilirubin, a yellow-orange bile pigment. Bile is fluid secreted by the liver.
Bilirubin is formed from the breakdown of red blood cells.
TYPES
• Hepatocellular – damage of hepatic cells by toxins or infective agents
interfering with the uptake and conjugation of bilirubin by cells or due to
blocking of bile canaliculi.
• Pre hepatic – increase bilirubin level in blood as a result of destruction of RBC.
• Post hepatic – Obstruction of bile flow between liver and duodenum

18. Disease and Dietary Management
A. Infective/Viral Hepatitis – A,B,C,D,E,G

19. Case Study
• Anil kumar is a 10 year old boy studying in a public school. There was
an epidemic of infective hepatitis and he was a victim. The doctor
advised him complete bed rest and now he is recovering.
• Age – 10 years
• Gender – male
• HIG group
• Non vegetarian
• Disease condition – infective hepatitis

20. Cholecystitis
• Inflammation of Gall bladder

21. Cholangitis
• Cholangitis is an inflammation of the bile duct system. The bile
duct system carries bile from your liver and gallbladder into the
first part of your small intestine (the duodenum). In most cases
cholangitis is caused by a bacterial infection, and often happens
suddenly. But in some cases it may be long-term (chronic)

22. Cholelithiasis

24. NAFLD- Non Alcoholic Fatty Liver Disease
• Foods That Help Fatty Liver Disease
• Give the Mediterranean diet a try. Although it wasn't created for
people with fatty liver disease, this style of eating combines the
kinds of foods that help reduce fat in your liver: healthy
fats, antioxidants, and complex carbohydrates.
• Things you’ll see on the table that you should reach for include:
• Fish and seafood
• Fruits
• Whole grains
• Nuts
• Olive oil
• Vegetables
• Avocados
• Legumes

25. Choose the Right Fats
Your cells use glucose, a kind of sugar, for energy. The hormone insulin helps get the
glucose from digested food into your cells.
People with fatty liver disease often have a condition called insulin resistance. That
means your body makes insulin but can’t use it well. Glucose builds up in your blood,
and your liver turns it into fat.
Certain fats in your diet can help your body use insulin better. That means your cells
can take in glucose and your liver doesn't need to make and store fat.
Get more of these:
•Omega-3 fatty acids, found in fish, fish oil, vegetable oils, nuts (especially
walnuts), flaxseeds and flaxseed oil, and leafy veggies
•Monounsaturated fats in plant sources like olives, nuts, and avocados
Fatty Liver Foods to Avoid
Steer clear of saturated fats, which lead to more fatty deposits in your liver. This includes:

26. • Poultry, except for lean white meat
• Full-fat cheese
• Yogurt, except low-fat
• Red meat
• Baked goods and fried foods made with palm or coconut oils.
• Sugary items like candy, regular soda, and other foods with added sugars
including high-fructose corn syrup.
• Antioxidants and Supplements for Liver Health
• Coffee
• Green tea
• Raw garlic
• Fruits, especially berries
• Vegetables
• Vitamin E - Sunflower seeds, Almonds, Liquid plant-based oils with
monounsaturated fats, like olive or canola oil.

27. Symptoms
NAFLD usually causes no signs and symptoms. When it does, they may
include:
• Fatigue
• Pain or discomfort in the upper right abdomen
• Possible signs and symptoms of NASH and advanced scarring (cirrhosis)
include:
• Abdominal swelling (ascites)
• Enlarged blood vessels just beneath the skin's surface
• Enlarged spleen
• Red palms
• Yellowing of the skin and eyes (jaundice)

28. Prevention
To reduce your risk of NAFLD:
•Choose a healthy diet. Choose a healthy plant-based diet that's rich in fruits, vegetables,
whole grains and healthy fats.
•Maintain a healthy weight. If you are overweight or obese, reduce the number of calories
you eat each day and get more exercise.
•If you have a healthy weight, work to maintain it by choosing a healthy diet and exercising.
•Exercise. Exercise most days of the week. Get an OK from your doctor first if you haven't
been exercising regularly.

29. Cirrhosis
• Mr chopra has cirrhosis of the liver and has been prescribed a 2200
kcal diet to help him again the weight he has lost . Plan a days diet
for him regain the weight he has lost. Plan a days diet for him and
suggest alternate foods which he can include in his diet.

30. DETOXIFICATION

31. Xenobiotics
• Foreign chemical substance
• Can be absorbed across lungs, skin, or ingested
• Drugs are considered xenobiotics
• Excreted in bile, urine, sweat, & breath
• As a part of normal metabolism , produces toxins which have to be
eliminated
• Humans are exposed to exogenous and endogenous toxins
constantly

32. Biotransformation & Detoxification
• It is a process in which a substance is changed from one chemical
to another by a chemical reaction in body.
• Detoxification is a process by which toxic substances are
converted into more soluble and less toxic substances which are
eliminated through urine and bile.
• Place – liver
• Compounds – Drugs, antibiotics, cardiac drug, and steroids, etc.
• Carcinogens – food dyes, preservatives, artificial sweeteners,
alcohols, cosmetics etc.

35. Detoxification
• WHY-When these toxins aren't processed efficiently, they are stored in the body. Toxins have
an affinity for fatty tissue. They get deposited in your fat tissues and fatty areas, like the brain.
Having a high toxic load and dieting can release those toxins into your system at a high rate
and create symptoms like headache, body aches and fatigue, as your body tries to eliminate
these as fast as they are being released. A proper detoxification system will help support
natural detoxification pathways and make this transition faster and easier. The body needs
certain nutrients to support the different phases of detoxification.

36. • Even if your diet is clean, the odds of
getting the nutrients necessary to
properly detox are slim, especially
while dieting, as calories are being
cut. Supplementation is an absolute
necessity and a detoxification
protocol may be your best chance of
seeing optimal results. The major
cause of 'diet plateau' in our office is
the lack of detoxification, making
detoxing a must before and during the
diet.

37. PHYSIOLOGICAL PHASES OF DETOX
The body processes toxins in 3 phases.
All 3 phases must be addressed and
supported or you will not properly
detoxify.
The liver is the primary detoxification
organ; it filters blood coming directly
from the intestines and prepares toxins
for elimination from the body.
Significant amounts of detoxification
also occur in the intestine, kidney, lungs,
and brain, with phase I, II, and III
reactions occurring throughout the rest
of the body to a lesser degree

38. PHASES
• Phase 1 is the Enzymatic Transformation phase
This provides the transformation of fat-soluble toxins into easier to handle
water soluble toxins. Most toxins are fat-soluble and tend to build up in the
fatty tissues of the body.
• Phase 2 is the Enzymatic Conjugation phase
This is where the products from phase 1 are attached to compounds that allow
further processing to make them easier to excrete out of the body.
• Phase 3 involves the elimination of the transformed, bound toxins from
phase 1 and 2.
These three steps or phases of removing undesirable or harmful lipid-soluble
compounds (toxins!) are performed by three sets of cellular proteins or
enzymes, called the phase I (transformation) and phase II (conjugation or
attachment) enzymes, and the phase III (transport) proteins.

40. THANK YOU