THE LIVER

Anatomy:
The liver is the largest digestive and exocrine gland of the body. It is triangular in shape and located in the right upper quadrant of the abdominal cavity below the diaphragm. It can weigh up to 2kg due to the huge amount of blood it holds, which may also cause it to have a higher temperature compared to the surrounding organs. Due to the pressure difference between the thoracic and abdominal cavities, the pressure in the abdomen being considerably higher, there is a constant “suction” effect, drawing the abdominal contents up towards the diaphragm. Therefore, the effective weight of the liver is approximately 400g; hence, the diaphragm proves to be an important factor of the health of the liver.

The liver lies to the right of the stomach and overlaps the gallbladder, which stores the bile produced by the liver. Two major blood vessels transport blood to the liver: the hepatic artery, which carries blood from the aorta to the liver; and the hepatic portal vein, which carries blood from the entire gastro-intestinal tract, spleen and pancreas to the liver.

The liver is surrounded by the peritoneum, a layer of connective tissue, which supports and protects it. Thickening and folding of the peritoneum around the liver create strong fibrous ligaments, which connect the liver to surrounding structures like the diaphragm and the abdominal walls, for added support of the liver (see picture: Ligaments of the liver).

Function:

The liver has a variety of functions including

the breakdown or modification of toxic substances (i.e. drug metabolism)
the production of bile required for emulsifying fats
the involvement in amino acid synthesis, carbohydrate, lipid, and protein metabolism
the storage of a multitude of substances including glucose, vitamin A/D/B12, iron, and copper
an immunological effect as antigens are carried to it via the big blood vessels

Mobility and Motility:
Each organ has a passive and active movement. The passive movement or mobility of an organ is the movement the organ expresses as a result of voluntary movement i.e. from the musculoskeletal system. For example, every time a person takes a deep breath in and out, the diaphragm rises and falls within the thorax; pushing and pulling the abdominal organs up and down. The active movement of an organ or motility is the intrinsic motion of an organ, the “kinetic expression of tissues in motion”, which is very slow and of low amplitude. It is thought that all body cells have a memory, thus each organ remembers its migration through the body during embryological development. The theory is that the motility expressed by the organ follows the directions and axes of motion occurring during embryological development. All organs must be able to move freely in order to function optimally. No matter how small, any restrictions, fixations or adhesions to other structures will lead to functional impairment of the organ. It will cause the organ to move along different axes of motion bringing about significant changes in the organ itself and the surrounding structures. These changes will make the individual more prone to develop back pain and other pain patterns.

Osteopathic Disorders and Symptoms:
If the motion of the liver is compromised due to restrictions, fixations or adhesions, it will cause wide-ranging effects due the multitude of functions it possesses. Here are some symptoms, which may give an osteopathic manual therapist clues as to how the liver is functioning:

Headaches/Migraines
Eyesight problem
Oily hair / Dandruff
White coated tongue
Bad breath
Perspiration
Hypersensitive sense of smell
Sensitive gums
Irritation/inflammation of the mucous membrane
Dark colored urine
Dull/muddy complexion
Physical fatigue
Insomnia
Restless sleep
Vertigo
Difficult Digestion
Intellectual fatigue
Decrease of the fighting spirit
Hemorrhoids
Muscular problems (strains, tendonitis)
Joint pain (right shoulder)

Emotional Connection:
Osteopathic manual therapy embraces the concept of the body is a unit of mind, body and soul, and so it is important to also consider the emotional health of the individual. As the liver is the biggest organ to metabolize hormones, behavioral and emotional changes may occur if the liver function is compromised. Pre-Menstrual Syndrome (PMS) in women is a good example of how hormonal changes and emotions are connected. It is a well-known fact, that as hormones spike during the monthly cycle, some women can feel anxious, depressed or angry. Men are also subject to hormonal changes and may also experience these behavioral and emotional changes, however it may be a more subtle change in comparison to women. By releasing any restrictions or adhesions around the liver, the functional ability to metabolize hormones will improve and therefore may elevate and balance the emotional state of the individual.