What is the liver and where is it located?
The liver is located high in the abdomen, mainly under the right rib cage, but extending towards the middle. It has a rich blood supply from the hepatic artery and portal vein. Bile ducts carry bile from the liver to the gallbladder and intestine.
The liver is divided into segments, which is important for surgery and imaging. The tissue consists of liver cells that process substances from the blood and produce bile and proteins, among other things.
Changes in the liver can be diffuse, such as fatty deposits and inflammation, or localized, such as cysts and tumors. Many incidental findings are benign but may need to be characterized.
What is the function of the liver?
The liver stores and releases glucose, processes fats and proteins, and breaks down drugs, alcohol, and other substances. It produces albumin and several clotting factors, and helps the body handle bilirubin from broken down blood cells.
Bile is produced in the liver and is needed for fat to be broken down and absorbed into the intestine. The liver also stores vitamins and minerals and participates in the immune system.
Because its functions are numerous, severe liver disease can affect fluid balance, bleeding tendency, consciousness, and nutritional status.
The liver can recover from some stress, but prolonged inflammation can lead to scarring and cirrhosis. Risk is influenced by factors such as alcohol, obesity, diabetes, viral hepatitis, certain medications and hereditary conditions. Prevention efforts need to be tailored to the cause.
Common liver changes and symptoms
Fatty liver, liver inflammation, cysts and vascular changes are examples of conditions that can be detected with tests or imaging. Read more about fettle lever, liver cyst and liver changes.
Early liver disease may cause few or nonspecific symptoms such as fatigue, nausea, and discomfort under the right rib cage. More pronounced effects can cause yellow skin and the whites of the eyes, dark urine, light stools, itching, swelling, and light bleeding.
Symptoms alone do not indicate which liver disease is present. Blood tests and risk factors need to be considered.
Liver disease can also affect hormones and nutrient absorption, causing muscle loss or decreased energy. A common mistake is to wait for obvious symptoms; people with risk factors may need testing even when they feel well.
When should you seek care for liver-related symptoms?
Contact your healthcare provider if you have yellow skin or the whites of your eyes, dark urine, prolonged itching, abdominal swelling, persistent pain under the right rib cage, or abnormal liver tests. Unexplained weight loss, fever, or significant fatigue may also need to be investigated.
Seek emergency care if you experience rapidly worsening confusion, heavy bleeding, bloody vomiting, black stools, severe abdominal pain, or rapid deterioration in your general condition. Acute liver failure and complications of advanced liver disease require hospitalization.
Do not change prescribed medications on your own if liver tests are abnormal. Discuss medications and dietary supplements with your healthcare provider.
How is the liver examined?
Blood tests can show liver cell damage, cholestasis, and the liver's production of proteins. The results need to be interpreted together because a single value rarely gives the whole answer.
Ultrasound is commonly used as the first imaging test and can show fatty deposits, bile ducts, cysts and larger changes. CT is used for broad mapping and vascular assessment. MRI can characterize tissue and circumscribed changes in more detail. Elastography can estimate liver stiffness in cases of fibrosis.
In some cases, tissue samples, special virus samples, or specialist assessment by a liver specialist are needed.
Liver tests can be altered by occasional infections, strenuous exercise, alcohol and medication. An abnormal test is therefore often retaken and assessed as a pattern over time. Normal values do not rule out all liver disease, especially early fatty liver or fibrosis.
When might MRI of the liver be relevant?
MRI can be used when a liver lesion needs to be characterized more closely, when the biliary tract needs to be assessed, or when ultrasound and CT do not provide sufficient information. Various MRI sequences and contrast agents can provide information about the properties of the tissue.
A targeted liver examination is different from a general abdominal examination. If the question concerns the liver, the protocol should be adapted accordingly. Read more about MRI abdomen.
MRI does not replace liver tests or clinical assessment. Diffuse liver disease may require follow-up even if no clearly demarcated change is visible.
Limitations and next steps
Imaging can show what the liver looks like but does not always provide a complete measure of function. Small or nonspecific changes may need to be followed over time, and some diagnoses require tissue samples.
The next step may be lifestyle treatment, medication review, treatment for a virus or other underlying condition, follow-up tests, or referral to a specialist. The treatment plan depends on the cause and degree of impact.
In the case of fatty liver and metabolic effects, treatment of weight, blood sugar, blood lipids and blood pressure is often central. In the case of alcohol-related or drug-induced effects, reducing exposure may be crucial. Such decisions should be made together with healthcare when there is a risk of withdrawal or other complications.