“Keeping Legionella bacteria out of water is the key to preventing infection.”

CDC Centers for disease control and prevention

“The term “legionellosis” may be referred to either Legionnaires’ disease or Pontiac fever.”

CDC Center for Disease Control

“Legionnaires’ disease (LEE-juh-nares) is caused by a type of bacterium called Legionella (LEE-juh-nell-a). The bacterium is named after a 1976 outbreak, when many people who went to a Philadelphia convention of the American Legion suffered from this disease, a type of pneumonia (lung infection).”

CENTER FOR DISEASE CONTROL

A Baker’s cyst, also called a popliteal (pop-luh-TEE-ul) cyst, is usually the result of a problem with your knee joint, such as arthritis or a cartilage tear.

MAYO CLINIC

“NAFLD affects about 25 percent of the people in the United States, including children. People who are overweight or obese, have high cholesterol and/or triglycerides, or have diabetes, are most likely to contract this liver ailment. Overweight children are being diagnosed more and more frequently with this disease.”

WEB MD

      A NASH LIVER (FAT)

• CONTINUATION OF YESTERDAY’S LIVER AND DISEASE

NASH  What is NASH?

Nonalcoholic steatohepatitis (NASH) is liver inflammation and damage caused by a buildup of fat in the liver. It is part of a group of conditions called nonalcoholic fatty liver disease. You may be told you have a “fatty liver.” Many people have a buildup of fat in the liver, and for most people it causes no symptoms and no problems. But in some people, the fat causes inflammation and damages cells in the liver. Because of the damage, the liver doesn’t work as well as it should.

•  Causes: NASH:NASH affects 2 to 5 percent of Americans. An additional 10 to 20 percent of Americans have fat in their liver, but no inflammation or liver damage, a condition called “fatty liver.” Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver.
• Nonalcoholic steatohepatitis or NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.
• Most people with NASH are between the ages of 40 and 60 years. It is more common in women than in men. NASH often has no symptoms and people can have NASH for years before symptoms occur. NASH is one of the leading causes of cirrhosis in the United States.  Up to 25% of adults with NASH may have cirrhosis.  Know people have NASH even if they do not have one risk factor can get the disease.
• Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. Diabetes and high blood cholesterol are also becoming more common among Americans.
• • Nonalcoholic steatohepatitis (NASH) is fat in the liver, with inflammation and damage.
  • NASH occurs in people who drink little or no alcohol and affects 2 to 5 percent of Americans, especially people who are middle-aged and overweight or obese.
  • NASH can occur in children.
  • People who have NASH may feel well and may not know that they have a liver disease.
  • NASH can lead to cirrhosis, a condition in which the liver is permanently damaged and cannot work properly.
  • Fatigue can occur at any stage of NASH.
  • Weight loss and weakness may begin once the disease is advanced or cirrhosis is present.
  • NASH may be suspected if blood tests show high levels of liver enzymes or if scans show fatty liver.
  • NASH is diagnosed by examining a small piece of the liver taken through a needle, a procedure called biopsy.
  • People who have NASH should reduce their weight, eat a balanced diet, engage in physical activity, and avoid alcohol and unnecessary medications.
  • No specific therapies for NASH exist. Experimental therapies being studied include antioxidants and antidiabetes medications.
  •            Other Pointers in knowing about the types of liver diseases:

• Most liver diseases are managed and not cured. The exception is for gallstone disease and some viral infections like Hepatitis A and infectious mononucleosis. All forms of liver disease has the ability to progress to cirrhosis and cause liver failure. Complications associated with cirrhosis and liver failure include an increased risk of bleeding and infection, malnutrition and weight loss, and decreased cognitive function.
• Depending on the type of cause for liver disease, determines how it is treated. Hep A requires supportive care from others to maintain hydration while the body’s immune system continues to fight off infections. Other diseases may require long-term care to control and minimize consequences of a particular disease. With cirrhosis and end-stage liver disease patients, they are often given medications to control the amount of protein absorbed in the diet. For other cirrhosis patients, they may not be able to metabolize waste products which raises their blood ammonia levels. To help them function, they need to take water pills (diuretics) and start a low sodium diet to minimize water retention. Only when all other options have failed is liver transplantation an option.
• Symptoms of liver disease range depending on the exact cause for the limited liver function. The general symptoms include a weakness or fatigue, weight loss, nausea, vomiting, fever and a yellow discoloration. If these symptoms are experienced without an explanation, it may be time to consult a medical professional. The time for education is before something like this happens. The survival rate is much higher for the individuals that seek medical attention early on through the act of having the knowledge to make the right decision. By the way the yellow discoloration is what we call Jaundice.
• Some of the other viruses that cause liver disease are viral infections like Mononucleosis, Adenovirus and Cytomegalovirus. There are also non-viral infections like toxoplasmosis and Rocky Mountain Spotted fever that could lead to liver disease but they are less common.

There are other conditions like Hemachromatosis (iron overload), which is a metabolic disorder that leads to abnormally elevated amounts of iron that is stored in the body. It is an inherited disease. Wilson’s disease is another inherited disease but it affects the body’s ability to metabolize copper. Gilbert’s Disease is an abnormality in bilirubin metabolism in the liver and affects up to 7% of the North American population.

• Most people with NASH are between the ages of 40 and 60 years. It is more common in women than in men. NASH often has no symptoms and people can have NASH for years before symptoms occur. NASH is one of the leading causes of cirrhosis in adults in the United States. Up to 25% of adults with NASH may have cirrhosis. Know people have NASH even if they do not have one risk factor. *
•  Due to alcohol abuse acting as the most common cause of liver disease, it is recommended that alcohol consumption is in moderation. It may help minimize the risk of alcohol-related liver disease. Hepatitis B and C contraction can be decreased by minimizing the risk of exposure to another person’s bodily fluids. There is a vaccination available for Hepatitis A and B. There is screening available for Hepatitis C at most clinics or doctors offices. Fatty liver disease is preventable by the promotion of a healthy lifestyle. Those lifestyle choices include a well-balanced diet, weight control, avoiding excess alcohol consumption and routine exercise.

“The sooner you treat your Hep C, the better your chances may be of being cured, meaning the virus can no longer be detected in your blood.”

Hepatitis C. com

Liver disease is also referred to Hepatic Disease. Liver Disease is a term that is used when there is any disturbance of the liver function that causes illness. It is a broad term to describe when more than 75% or three quarters of liver tissue needed is affected and decreased function in the liver occurs. The number one cause of liver disease is alcohol abuse in North America. They can cause liver inflammation, referred to as alcoholic hepatitis. Other causes include Cirrhosis, Cholestasis, Steatosis, Hepatitis, Viruses, Non-Alcoholic Fatty Liver, Hemachromatosis, Wilson’s Disease and Gilbert’s Disease.

Causes: Cirrhosis

Cirrhosis is when the liver cells are replaced by permanent scar tissue as a result of chronic liver disease. It is considered the late-stage of liver disease. Cirrhosis is common among chronic alcohol abuse users where the fat accumulation occurs in the liver cells and causes scar tissue. Cholestasis is when the bile flow is obstructed from the gallbladder or duodenum. Steatosis is the term used when cholesterol and triglycerides accumulate in the liver.

Causes: Hepatitis

Hepatitis is a term used to describe the inflammation on liver cells. They can become inflamed due to infection.

There are many forms of Hepatitis:

Hepatitis A (Hep A) is a viral infection primarily spread through the fecal-oral route when small amounts of infected fecal matter are ingested. An acute inflammation of the liver occurs but there is a way to prevent this type of infection. There is a vaccine available and the best way to help prevent it is by a good hand washing.

Hepatitis B (Hep B) is spread by exposure to body fluids and can cause an acute infection. If left untreated, it can progress into a chronic inflammation and on into cirrhosis. There is also a vaccine for this form of hepatitis. Typically, the vaccine contains both Hep A and B in a combination series of doses.

Hepatitis C (Hep C) is caused by a virus different from Hep A or Hep B. It can either be “acute” or “chronic” and is primarily spread through contact with the blood of an infected person. The most common way is by sharing needles or other equipment to inject drugs. Before 1992, Hepatitis C was also commonly spread through blood transfusions and organ transplants which led to the start of a widespread screening of blood supplies. Another way it can be transmitted is through being born to a mother who has it. There are less common ways to contract Hepatitis C, and that’s through sharing personal care items that may have come into contact with another person’s blood (razors, toothbrushes), or having unprotected sex with a infected person. Some people are at an increased risk for Hepatitis C. Those individuals include: Children born to mothers infected with this Hep C; current injection drug users (most common way Hepatitis C is spread in the US), past injection drug users, recipients of donated blood (blood products and organs), hemodialysis patients who spent many years on dialysis for kidney failure, people who received body piercings or tattoos done with non-sterile instruments, & people with known exposure to Hepatitis C like Health care workers or recipients of blood or organs from a donor who tested positive.

Hepatitis D (Hep D) is known as “delta hepatitis” can also be “acute” or “chronic” but is uncommon in the United States. It requires the Hepatitis B virus to survive. It is transmitted through sexual contact with infected blood or blood products. There is also no vaccine available for this virus. Hepatitis E (Hep E) is caused by Ribonucleic Acid (RNA) virus. It is transmitted mainly through the fecal-oral route due to fecal contaminated drinking water.

Causes: NAFLD

Non-alcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. liver’s weight is fat, then it NAFLD tends to develop in people who are overweight or obese or have diabetes, high cholesterol or high triglycerides. Rapid weight loss and poor eating habits also may lead to NAFLD. However, some people develop NAFLD even if they do not have any risk factors. NAFLD affects up to 25% of people in the United States. However, if more than 5% up to 10% of the liver’s weight is fat then the liver is called a fatty liver called steatosis.  Non-Alcoholic Fatty Liver (NAFL) describes the accumulation of fat within the liver that can cause an inflammation and a gradual decrease in function.

 Those at risk for NAFLD? NAFLD tends to develop in people who are overweight or obese or have diabetes, high cholesterol or high triglycerides. Rapid weight loss and poor eating habits also may lead to NAFLD. However, some people develop NAFLD even if they do not have any risk factors. NAFLD affects up to 25% of people in the United States.

RISKS NAFLD may cause the liver to swell (steatohepatitis). A swollen liver may cause scarring (cirrhosis) over time and may even lead to liver cancer or liver failure.

SYMPTOMS NAFLD often has no symptoms. When symptoms occur, they may include fatigue, weakness, weight loss, loss of appetite, nausea, abdominal pain, spider-like blood vessels, yellowing of the skin and eyes (jaundice), itching, fluid build up and swelling of the legs (edema) and abdomen (ascites), and mental confusion.

DIAGNOSIS NAFLD is initially suspected if blood tests show high levels of liver enzymes. However, other liver diseases are first ruled out through additional tests. Often, an ultrasound is used to confirm the NAFLD diagnosis.

TREATMENT There are no medical treatments yet for NAFLD. Eating a healthy diet and exercising regularly may help prevent liver damage from starting or reverse it in the early stages.

• See a doctor who specializes in the liver regularly
• Talk to your doctor about ways to improve your liver health
• Lose weight, if you are overweight or obese
• Lower your cholesterol and triglycerides
• Control your diabetes
• Avoid alcohol

The Liver and its anatomy and physiology:

Weighing in at around 3 pounds, the liver is the body’s second largest organ; only the skin is larger and heavier. The liver performs many essential functions related to digestion, metabolism, immunity, and the storage of nutrients within the body. These functions make the liver a vital organ without which the tissues of the body would quickly die from lack of energy and nutrients. Fortunately, the liver has an incredible capacity for regeneration of dead or damaged tissues.

The liver is a roughly triangular organ that extends across the entire abdominal cavity just inferior to the diaphragm. Most of the liver’s mass is located on the right side of the body where it descends inferiorly toward the right kidney. The liver is made of very soft, pinkish-brown tissues encapsulated by a connective tissue capsule. This capsule is further covered and reinforced by the peritoneum of the abdominal cavity, which protects the liver and holds it in place within the abdomen.

The peritoneum connects the liver in 4 locations: the coronary ligament, the left and right triangular ligaments, and the falciform ligament. These connections are not true ligaments in the anatomical sense; rather, they are condensed regions of peritoneal membrane that support the liver.

• The wide coronary ligament connects the central superior portion of the liver to the diaphragm.
• Located on the lateral borders of the left and right lobes, respectively, the left and right triangular ligaments connect the superior ends of the liver to the diaphragm.
• The falciform ligament runs inferiorly from the diaphragm across the anterior edge of the liver to its inferior border. At the inferior end of the liver, the falciform ligament forms the round ligament (ligamentum teres) of the liver and connects the liver to the umbilicus. The round ligament is a remnant of the umbilical vein that carries blood into the body during fetal development.
• The liver consists of 4 distinct lobes – the left, right, caudate, and quadrate lobes.

• The left and right lobes are the largest lobes and are separated by the falciform ligament. The right lobe is about 5 to 6 times larger than the tapered left lobe.
• The small caudate lobe extends from the posterior side of the right lobe and wraps around the inferior vena cava.
• The small quadrate lobe is inferior to the caudate lobe and extends from the posterior side of the right lobe and wraps around the gallbladder.These bile ducts next join to form the larger left and right hepatic ducts, which carry bile from the left and right lobes of the liver. Those two hepatic ducts join to form the common hepatic duct that drains all bile away from the liver. The common hepatic duct finally joins with the cystic duct from the gallbladder to form the common bile duct, carrying bile to the duodenum of the small intestine. Most of the bile produced by the liver is pushed back up the cystic duct by peristalsis to arrive in the gallbladder for storage, until it is needed for digestion.Regulations,Synthesis,andSecretion. Hepatocytes are metabolically active cells They are involved in regulation of various biochemical and metabolic functions and are involved in synthesis of various substances in the body. They take up glucose, minerals, and vitamins from portal and systemic blood and store them. Many important substances such as blood clotting factors, transporter proteins, cholesterol, and bile components are synthesized by the hepatocytes. The hepatocytes also regulate blood levels of substances such as cholesterol and glucose, the liver helps maintain body homeostasis. The liver store glucose when it is in excess after the person has food and release glucose in the blood when he is starving. This is an important function which when impaired during liver disease, result in hypoglycemia (low blood glucose). Bile Hepatocyte synthesize bile. Bile is a greenish fluid containing cholesterol, phospholipids, bilirubin (a metabolite of red blood cell hemoglobin), and bile salts. It is secreted into biliary ducts. It then leaves the liver to be temporarily stored in the gallbladder before emptying into the small intestine. Bile salts act as “detergents” that aid in the digestion and absorption of dietary fats. Liver damage or obstruction of a bile duct (e.g., gallstone) can lead to cholestasis, (the blockage of bile flow, which causes the malabsorption of dietary fats), steatorrhea (foul-smelling diarrhea caused by non-absorbed fats), and jaundice. Storage As mentioned above, the liver store important substances eg glucose (in the form of glycogen). The fat-soluble vitamins (vitamins A, D, E and K), folate, vitamin B 12 , and minerals such as copper and iron. Ammonia The liver converts ammonia to urea. Urea is then excreted into the urine by the kidneys. In the presence of severe liver disease, ammonia accumulates in the blood because of both decreased blood clearance and decreased ability to form urea. Elevated ammonia levels can be toxic, especially to the brain, and may lead to the the development of hepatic encephalopathy.HormonesDrugs Most drugs are metabolized by the liver. Especially, oral drugs are absorbed in the intestine and then In the liver, drugs may undergo first-pass metabolism, a process in which they are modified, activated, or inactivated before they enter the systemic circulation, or they may be left unchanged.In patients with liver disease, drug detoxification and excretion may be dangerously altered, resulting in drug concentrations that are too low or too high or the production of toxic drug metabolites. Regeneration of the Liver
• Toxins The liver is responsible for detoxifying many chemical agents and poisons including alcohol. Liver disease may inhibit or alter detoxification processes and thus increase the toxic effects of these agents. Additionally, exposure to chemicals or toxins such as alcohol may directly affect the liver, ranging from mild dysfunction to severe and life-threatening damage.
• Liver plays important roles in hormonal modification and inactivation. chronic liver disease may cause hormonal imbalances. For example, the masculinizing hormone testosterone and the feminizing hormone estrogen are metabolized and inactivated by the liver. Men with cirrhosis, have increased circulating estrogens relative to testosterone derivatives. This may result in testicular atrophy and gynaecomastia.
• Bilirubin Bilirubin is a yellow pigment. It is formed as a breakdown product of red blood cell hemoglobin. The spleen, which destroys old red cells, releases ünconjugated” bilirubin into the blood, where it circulates in the blood bound to albumin. The liver takes up bilirubin and “conjugates” it with glucuronic acid to form “water-soluble” bilirubin that can be excreted into bile. Increased production or decreased clearance of bilirubin results in jaundice.
• Purification, Transformation, and Clearance The liver removes harmful substances (such as ammonia, toxins, various drugs) from the blood and then breaks them down or transforms them into less harmful compounds.
• Lipids Liver synthesizes cholesterol. It is then packaged and distributed to the body or excreted into bile for removal from the body. Increased cholesterol concentrations in bile may predispose to gallstone formation. The liver also synthesizes lipoproteins. These are made up of cholesterol, triglycerides phospholipids, and proteins. Lipoproteins transfers cholesterol between the liver and body tissues. Most liver diseases do not significantly affect serum lipid levels. However, cholestatic diseases, may be associated with increased levels.
• Proteins Most blood proteins (except for antibodies) are synthesized and secreted by the liver. One of the most abundant serum proteins is albumin. Impaired liver function results in decreased serum albumin level. The liver also produces most of the proteins responsible for blood clotting, called coagulation or clotting factors. Hence in severe liver disease, excessive bleeding may result due to lack of these factors.
• Glucose
• Liver perform multiple functions important for survival of human being. These include:
• Bile Ducts The tubes that carry bile through the liver and gallbladder are known as bile ducts and form a branched structure known as the biliary tree. Bile produced by liver cells drains into microscopic canals known as bile canaliculi. The countless bile canaliculi join together into many larger bile ducts found throughout the liver.

The liver has a remarkable capacity to regenerate after injury and to adjust its size to match its host. The liver is an amazing and such a vital organ we need to keep healthy for if we don’t disease comes on. Check out part 2 on liver disease tomorrow.