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The liver is the largest abdominal organ. The liver weighs about 1200 1500 grams in an average roughly 2% of body weight. Liver, though a single organ, generally it may be divided into 2 parts right and left liver and eight independent segments (each having its blood provide and biliary drainage) functioning as a single organ. Liver as an entire has a hepatic artery supply oxygenated blood, a portal vein carrying blood from intestines to liver and bile ducts draining bile formed in the liver to intestines. Blood from the liver is delivered-to-heart-via-three-hepatic-veins.
Patients who need a liver transplant could have a variety of symptoms including jaundice (yellowing of the eyes), ascites (fluid in the abdomen), hepatic encephalopathy (confusion or even coma), and bleeding in the upper and lower gastrointestinal tract from Varices (large veins that form in the esophagus or food pipe in patients with cirrhosis). Some cirrhotic patients could have years of ill health whereas in other patients symptoms could develop abruptly and suddenly for instance with bleeding varices. In a few types of cirrhosis, for instance, Primary Sclerosing Cholangitis ( PSC ), other symptoms could be prominent like itching. Additional symptoms experienced by patients who need a liver transplant could include severe fatigue, frequent bruising or loss of muscle mass.
Once cirrhosis is suspected, the patient needs many tests to determine its cause and severity. The cause of liver disease could be obvious from the record. For instance, a record of heavy drinking in a patient suggests that liver disease is due to alcohol excess. In most patients, the accurate diagnosis of the cause of liver disease needs additional workup including blood tests, X-Rays and on occasion liver biopsy. Blood work that is ordinarily ordered includes tests for hepatitis B or C, antibody tests for autoimmune hepatitis and Primary Biliary Cirrhosis, and other tests to exclude excessive iron (hemochromatosis) or excessive copper (Wilson Disease). For some normal disorders, such as Fatty Liver Disease, there is no single diagnostic test. As a result, the diagnosis is made in patients whose blood tests are negative for other causes of liver disease and whose medical record and physical test are consistent.
Once a patient s specialist, typically a gastroenterologist, decides that a patient could require a liver transplant, a referral is made to a transplant center where a number of physician visits and additional testing happen. The reason for these is to make sure that the patient does not have any treatment options for their liver disease apart from a liver transplant and that she or he doesn t have any conditions like severe heart disease or ongoing medicine or alcohol use which would make a transplant less likely to be successful. The patient is assigned a nurse coordinator to oversee their care. The patient typically sees the transplant hepatologist and transplant surgeon in addition to other specialists like cardiologists if required. An important part of the workup is a meeting with the social worker to make sure the patient and family have the resources, both emotional and financial, to support the patient before and after the transplant. If the patient has a history of medicine or alcohol use they also could be seen by a psychiatrist to come up with a plan to make sure they will not have a relapse after transplant.
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