Main cells of the liver, hepatocytes perform a large number of vital functions: filtration of the blood, elimination of toxins, storage and synthesis of sugars, etc.

The majority of the liver consists of hepatocytes organized in spans, between which circulate blood capillaries and biliary heat waves. True biochemical factories, these cells can therefore both capture the toxins circulating in the blood and get rid of these wastes in the bile. But this is not their only function, since they also store and manufacture many substances essential to the body: glucose, triglycerin, albumin, bile salts, etc.

Without functional hepatocytes, the body’s lifespan does not exceed a few hours. These cells indeed provide many vital functions, including:

• la blood sugar management : in the event of hyperglycemia, the pancreas secretes insulin, which will activate the uptake and storage of blood glucose by the hepatocytes. Conversely, in the event of hypoglycemia, it excretes glucagon, to encourage the hepatocytes to release this energy in the blood;
• blood detoxification : hepatocytes rid the blood of toxins (alcohol, drugs, drugs, etc.), then evacuate them with the bile; 
• the secretion of bile which, stored in the gallbladder, will be released into the intestine at the time of digestion. This substance contains both the waste extracted from the blood and bile acids, capable of breaking down the lipids ingested by food into triglycerides, another “fuel” of the body;
• the synthesis of triglycerides from sugar and alcohol. These are the same fatty acids as mentioned above. Like them, they are therefore transported by the blood to the cells that need them (muscles, etc.) or stored in adipose tissue;
• production of clotting factors, that is to say proteins involved in blood clotting.

Hepatic steatosis

It is an accumulation of triglycerides in hepatocytes. This pathology can result from excessive alcohol consumption but also – and it is more and more often the case – develop in patients who do not drink but are overweight or have type 2 diabetes. non-alcoholic fatty liver disease (NAFLD).

Hepatic steatosis remains asymptomatic for a long time before causing hepatitis. It is this inflammatory response that most often leads to the discovery of the pathology.

Hepatitis

Inflammation of the liver, hepatitis can be caused by fatty liver disease, but also by a virus that multiplies in hepatocytes (hepatitis A, B or C virus), by drug intoxication, by exposure to a toxic product or, more rarely, by an autoimmune disease.

Symptoms vary a lot from case to case: 

• fever;
• loss of appetite .
• diarrhea;
• nausea;
• abdominal discomfort;
• jaundice;
• etc.

They can be mild or severe, go away on their own, or persist. Hepatitis C, for example, becomes chronic in 80% of cases, while hepatitis A can resolve spontaneously. The infection can also go unnoticed, and only be discovered after it has progressed to cirrhosis or cancer.

Cirrhosis

If their chronic inflammation is not taken care of, the hepatocytes end up dying one after the other. The liver then gradually loses its functions.

It is the appearance of one or more complications that most often leads to the discovery of cirrhosis: digestive hemorrhage, ascites (abdominal distension linked to an accumulation of fluid in the peritoneal cavity), jaundice (jaundice of the skin and white of the eye, dark urine), cancer, etc.

Liver cancer

Hepatocarcinoma, or hepatocellular carcinoma, begins in a hepatocyte which, having become abnormal, begins to proliferate in an anarchic manner and form a malignant tumor. It is very rare for this type of injury to occur on a liver that did not have steatosis, hepatitis or cirrhosis.

Unexplained weight loss, loss of appetite, abdominal pain, nausea and vomiting, general fatigue, the appearance of a lump in the liver area, especially if associated with jaundice , should alert you. But beware: these symptoms are common to other liver pathologies. Only a doctor can make the diagnosis.

Focal nodular hyperplasia

Focal nodular hyperplasia is the increase in the number of hepatocytes in the liver, causing it to increase in size. Fibrous nodules of 1 to 10 cm may appear. These tumors, rare and benign, are favored by taking oral contraceptives or estrogen-based treatments. Their complications are rare. This is why it is rare to remove them surgically.

By effectively and durably treating the causes of hepatitis (antiviral treatment, alcohol withdrawal, weight loss diet, diabetes control, etc.), cirrhosis can be prevented or stopped. If tissue has already been destroyed, it will not heal, but the rest of the liver will no longer be on hold. If the cirrhosis is very advanced, only a transplant can restore the poor liver function, provided a graft is available.

In the event of cancer, the panel of treatments is wide:

• partial removal of the liver;
• total ablation followed by a transplant;
• destruction of the tumor by radiofrequencies or microwaves;
• electroporation;
• chemotherapy;
• etc. 

The treatment strategy depends on several factors, including the number of lesions, their size, their stage and the condition of the liver.

Faced with symptoms suggestive of a hepatic pathology, a blood test confirms the involvement of the liver (hypoalbuminemia, etc.). If no virus is detected in the blood sample, an ultrasound will be prescribed, supplemented if necessary with an MRI, a CT scan or a Doppler ultrasound. A biopsy may also be requested in addition.