The liver is a large solid organ situated in the upper right side of the abdomen. The liver has multiple functions. It plays a central role in processing the foods that we eat to both store and produce fats, sugars, proteins, and vitamins that the other organs in our body can use. In this way it helps regulate blood sugar, cholesterol, and protein levels in our blood. It produces important proteins like albumin, blood clotting factors, and many other proteins necessary for normal metabolism.
The liver also breaks down and excretes many toxins and drugs that we ingest every day. In fact, about 80% of all drugs are metabolized (broken down or activated) in the liver. It also produces bile, which is a liquid stored in the gallbladder and then excreted into the intestine. Bile contains the breakdown products of proteins, drugs, cholesterol, and other fats. It is also a soap that helps the absorption of dietary fats.
The liver also functions as an immune organ that helps to protect us from the bacteria and viruses in our intestines.
The Liver Clinic manages a wide variety of liver diseases:
- Viral infections, including infection with the hepatitis A, B, and C viruses.
- Autoimmune liver diseases: e.g. autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis
- Fatty liver disease
- Alcohol-related liver disease, as well as other drug-related liver injuries
- Metabolic liver diseases including hemochromatosis, Wilson’s disease, and alpha 1 antitrypsin deficiency
- Cirrhosis: the end-stage of liver disease which can be complicated by abdominal fluid (ascites), enlarged esophageal veins which are prone to bleeding, liver failure, and liver cancer
- Liver tumors, including liver cancer and non-cancerous tumors
- Fibroscan (vibration-controlled transient elastography): a simple ultrasound-based test to assess the severity of liver scarring. This can be performed in the clinic at the time of the clinic visit
- Magnetic Resonance Elastography and Protein Density Fat Fraction: MRI-based tools to assess the amount of liver fat and scarring. These tests are performed in the Radiology Department
- Liver biopsy to assess the severity and type of liver injury
- Radiological studies including ultrasound, CT scan and MRI
- Effective treatments now exist for hepatitis B and C. Hepatitis C can now be cured in the majority of people and hepatitis B can be controlled with medications.
- Fatty liver disease: Care is coordinated with the weight loss and endocrine program. A number of clinical trials investigating potential drug treatments are also actively enrolling patients.
- Management of the complications of cirrhosis and alcohol-related liver disease, including treatment of esophageal varices, TIPS procedure, and paracentesis for fluid accumulation in the abdomen.
- Treatment of liver tumors is coordinated with the surgeons, radiologists and cancer specialists. A weekly multidisciplinary conference is held to coordinate the care of patients with liver tumors.
- BMC does not have a liver transplant program but will facilitate referral to one of the local transplant centers. Some of our liver providers are trained in liver transplantation and can help coordinate and manage patients following transplantation.
Faculty and Staff
David Nunes, MD, FRCPI: Director of liver disease. Interest in viral, autoimmune and metabolic liver disease
Uri Avissar, MD: General hepatology and gastroenterology. Trained in liver transplantation.
Michelle T. Long, MD, MSc: Director of clinical research. Special interest in fatty liver disease: NAFLD and NASH.
Robert Lowe, MD: Interest in viral, autoimmune and metabolic liver disease.
Arpan Mohanty MD: Special interest in end stage liver disease: Trained in liver transplantation and post transplant care.
Beth Cline, NP
Lorraine Sanphy: Specialist nurse in liver disease
Shubha Bhat: Pharmacist and pharmacy support