The liver is the largest organ in the body, normally weighing about 1.5kg (although this can increase to over 10kg in chronic cirrhosis). The liver is the main organ of metabolism and energy production; its other main functions include:
- Bile production
- Storage of iron, vitamins and trace elements
- conversion of waste products for excretion by the kidneys
Anatomy of the Liver - rear view
The right lobe is separated from the other lobes by the gallbladder fossa and the fossa for the inferior vena cava on the visceral surface of the liver.
The Portal Circulation
The liver is unusual in that it has a double blood supply; the right and left hepatic arteries carry oxygenated blood to the liver, and the portal vein carries venous blood from the GI tract to the liver.
The venous blood from the GI tract drains into the superior and inferior mesenteric veins; these two vessels are then joined by the splenic vein just posterior to the neck of the pancreas to form the portal vein. This then splits to form the right and left branches, each supplying about half of the liver.
On entering the liver, the blood drains into the hepatic sinusoids, where it is screened by specialised macrophages (Kupffer cells) to remove any pathogens that manage to get past the GI defences. The plasma is filtered through the endothelial lining of the sinusoids and bathes the hepatocytes; these cells contain vast numbers of enzymes capable of braking down and metabolising most of what has been absorbed.
The portal venous blood contains all of the products of digestion absorbed from the GI tract, so all useful and non-useful products are processed in the liver before being either released back into the hepatic veins which join the inferior vena cava just inferior to the diaphragm, or stored in the liver for later use.
Surface Markings of the Liver
When examining a patient, it is important to recognise where the internal organs lie relative to the surface anatomy you can see. The liver can essentially be visualised as a triangle, with its upper margin below the nipples on either side of the chest, and the lower margin making a line from just above the tenth rib on the right side to below the nipple on the left side. The superior surface of the liver lies just below the diaphragm; this means that the lower margin of the liver will move downwards on inspiration, and this can be palpated. As the liver is also a very dense organ, it is very dull to percussion and you can easily percuss out the borders of the liver if palpation is unsuccessful.
The gallbladder area can be palpated around the tip of the right ninth rib. The normal gallbladder is impalpable; it only becomes palpable when distended with stones or bile, and the area will become very tender if there is inflammation present.
Water for the Liver
Water is largely responsible for the fluid content of blood. As the organ that filters the blood, its viscosity impacts the liver’s detoxification abilities. Accordingly, not drinking enough water will increase the blood’s thickness and make it harder to filter. Since the livers of those with chronic liver disease already face obstacles to efficient detoxification (like inflammation or scarring), not having enough water to keep the blood viscous magnifies this challenge.
A special concern about water intake may surface for someone whose liver disease has led to ascites. A sign of advanced liver disease, ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs. Those affected must know that water does not cause or perpetuate ascites. Rather, ascites is often a result of portal hypertension and is made worse with salt intake. Therefore, sodium restriction – not fluid restriction – is the mainstay of ascites treatment. However, those with extreme hyponatremia (sodium levels in the blood that are too low) may be required to limit their water intake.
Unless dealing with hyponatremia, those with liver concerns have an incentive to drink plenty of water throughout the day. Besides water’s long list of healthful properties, staying well-hydrated also helps the liver with detoxification. By using your urine’s color as your guide, you can make sure to consume enough water and avoid the additional burden of dehydration.
For Your Liver’s Sake: The Best Times to Drink Water
There are several reasons why drinking water benefits the liver – and these four times of the day are the best to reap those benefits.
There are certain times of the day that are ideal for hydrating. These include:
1. Upon waking up – Drinking a glass of water after waking up is a great way to activate the internal organs: liver included. Consuming water first thing in the morning helps flush circulating toxins out prior to the first meal of the day. Unfortunately, many people reach for a cup of coffee in the morning before a glass of water. Because coffee is a diuretic, it encourages fluid loss, which is dehydrating and increases blood viscosity. Thicker blood provides a greater toxin-filtering challenge to the liver than thinner blood.
2. Before a meal – Drinking water thirty minutes before each meal helps with satiety, reducing the chances of overeating. Because overeating can contribute to obesity and fatty liver disease, water consumption prior to eating can help keep the liver lean. In addition, water before a meal helps prepare the stomach for food by stimulating digestive enzymes and bile production.
3. Prior to and following physical activity – As we all know, staying physically fit is key for wellness, including optimal liver health. Drinking water before and after physical activity protects against dehydration. Especially for someone with a fibrotic liver, dehydration means thicker blood that makes filtration by the liver that much more challenging. Drinking water before and after a workout prevents dehydration, therefore protecting the liver from processing a backlog of toxins.
4. Before bed – Experts don’t necessarily agree on how soon before bed, but most concur that drinking a glass before bed provides the body with water needed to aid in detoxification during sleep. Although some advocates suggest a glass right before bed, others advise having your last drink of water two hours prior to bed if going to the restroom at night is an issue.
Between helping with detoxification, digestion, weight management and blood viscosity, water is clearly the beverage of choice for those with chronic liver disease. By drinking a glass when you wake up, before a meal, before and after physical activity and prior to going to sleep, your water consumption timing will provide your liver with optimal hydration.
Love Your Liver With Lemon Water
Discover why there are few beverages as beneficial as lemon water when it comes to actually helping guide your liver towards better health.
Because the liver is affected by everything we ingest, beating chronic liver disease requires every drink, snack or meal to be a health conscious decision. As one could imagine, such analysis can be draining to those who are not trained health or nutrition professionals. Nowhere is this decision making process more important for an ailing liver than in the beverage category. Tastier than plain water and containing several health benefits, those with chronic liver disease have every reason to make lemon water their go to hydrating medium.
Imagine a relatively inexpensive, palate-pleasing, refreshing beverage that is good for your liver. Amidst all of the warnings describing which drinks to avoid because they harm the liver, such an ideal beverage does exist. Squeezing some fresh lemon juice into a glass of purified water is all that is required to create a liver-loving liquid.