Cirrhosis of the liver - British Liver Trust Cirrhosis of the liver What is Cirrhosis Cirrhosis is the result of long-term, continuous damage to the liver and may be due to many different causes. The damage leads to scarring, known as fibrosis. Irregular bumps (nodules) replace the smooth liver tissue and the liver becomes harder. Together, the scarring and the nodules are called cirrhosis. Cirrhosis can take many years to develop and can do so without any noticeable symptoms until the damage to the liver is very serious. The build-up of scar tissue can interfere with the flow of blood to your liver and stop it from functioning properly. Cirrhosis can lead to liver failure. How common is cirrhosis? No one knows for sure how many people in the UK have cirrhosis as most people do not know they have it until the condition is serious. However, there is no doubt that the number of people with the condition continues to increase. Every year over 4,000 people in the UK die from cirrhosis. Around 700 people have to have a liver transplant each year to survive. Who is at risk of cirrhosis?

Cirrhosis can affect anyone – men and women, young and old. People most at risk of cirrhosis: drink too much alcohol have a long-term liver infection, such as Hepatitis B or Hepatitis C have an inherited liver disease, such as Haemochromatosis have an immune system problem that leads to liver disease are clinically overweight or obese and have a fatty liver Symptoms You are not likely to feel any symptoms of cirrhosis early on. In fact, many people with cirrhosis only find out during tests for an unrelated illness. Additionally, the symptoms can be very non-specific, meaning that they are also caused by other conditions not related to cirrhosis. If you have cirrhosis, you may develop one or more of the symptoms below. If you have or are worried about any of these symptoms discuss them with your doctor.

Early symptoms generally feeling unwell and tired all the time loss of appetite loss of weight and muscle wasting feeling sick (nausea) and vomiting tenderness/pain in the liver area spider-like small blood capillaries on the skin above waist level (spider angiomas) blotchy red palms Later symptoms, as the liver is struggling to function intensely itchy skin yellowing of the whites of the eyes and the skin (jaundice) white nails ends of fingers become wider/thicker (clubbed fingers) hair loss swelling of the legs, ankles, feet (oedema) swelling of the abdomen (ascites) dark urine pale-coloured stools or very dark/black tarry stools frequent nosebleeds and bleeding gums easy bruising and diffi culty in stopping small bleeds vomiting blood in men: enlarged breasts and shrunken testes in women: irregular or lack of menstrual periods impotence and loss of sexual desire dizziness and extreme fatigue (anaemia) shortness of breath fevers with high temperature and shivers forgetfulness, memory loss, confusion and drowsiness subtle change in personality writing becomes difficult, spidery and small staggering gait when walking; tendency to fall increased sensitivity to drugs, both medical and recreational increased sensitivity to alcohol

 Red flag symptoms If you have any of the following symptoms you must see a doctor straight away, especially if you have recently been diagnosed with cirrhosis: fever with high temperatures and shivers, often caused by an infection shortness of breath very dark or black tarry stools (faeces) periods of mental confusion or drowsiness.

Although these symptoms may seem very different, because your liver is responsible for so many different functions, if it stops working properly, a range of problems can result. Yellow eyes or skin If your skin and the whites of your eyes turn yellow you may have jaundice. Two things can cause jaundice: a blockage (obstruction) in the bile duct damage to your liver or some defect affecting the liver so that it cannot deal with bilirubin, a by-product of the breakdown of old red blood cells. If either of these occurs, bilirubin – which is yellow – flows back into the blood and shows up in the skin and the eyes. Swollen stomach and legs Swelling in your abdomen is known as ascites. The swelling is caused by fluid building up in the lining around your abdomen. This can happen slowly over weeks or months and can be painful, especially if the fluid becomes infected and requires urgent attention. You may also get swelling in your legs, ankles or feet, known as peripheral oedema. Fever with high temperatures and shivers People with cirrhosis are prone to infections, which can make their liver condition worse. As a result, they should seek medical attention if they develop a temperature.

Tarry black stools or vomiting blood Internal bleeding due to liver damage is often first noticed in very dark or black tarry faeces (maelena) and the vomiting of blood (haematemesis). Having either of these symptoms will need urgent medical attention. If your liver is badly scarred from extensive fibrosis or cirrhosis, blood will be unable to flow through it easily. As a result, pressure builds up in the vein that carries blood to the liver from the gut – the portal vein. Having high blood pressure in the portal vein is known as portal hypertension. As the pressure mounts, blood begins to back up. It finds another way of reaching the heart by using extra veins lining your oesophagus and stomach known as varices. Varices have fragile walls, which cannot easily handle the increased blood flow and often burst, leading to internal bleeding. This blood loss may just be a gentle ooze, resulting in symptoms of anaemia that include tiredness and shortness of breath, but sometimes there can be major bleeding, with a haemorrhage and vomiting of blood. Haemorrhaging varices are a serious and life-threatening complication of cirrhosis and need emergency medical treatment.

Memory loss and confusion (Encephalopathy) Confusion, short-term memory problems and even loss of consciousness can result if your liver is not working properly. You might feel sleepy, experience tremors and have difficulty performing simple tasks. This is because the liver, when working well, gets rid of waste products. When it is damaged, the waste products are carried to the brain by your blood. This condition is known as encephalopathy. Diagnosis It is not always easy to diagnose cirrhosis. A doctor will take a careful medical history, carry out a physical examination and make plans for further tests. The tests for cirrhosis include: blood tests, which among other things measure the liver function and damage. These are most commonly Liver Function Tests (LFTs). These are used to gain an idea of how the different parts of your liver are functioning. The liver function test is made up of a number of separate examinations, each looking at different properties of your blood. It is used to gain an indication of how much your liver is inflamed or unable to work properly. The test will measure, for example, levels of the liver enzymes ALT and AST as these are increased during inflammation (hepatitis).

It will also look at how well your blood clots (referred to as INR time) and how well your kidneys remove a product called creatinine. These are good indicators for how well your liver is working, and how this is affecting the rest of your body. imaging tests in which your liver may be scanned using ultrasound, computerised tomography (CT) or magnetic resonance imaging (MRI). Ultrasound, the same technology used to confirm all is well in pregnancy, sends sound waves into your body. The echoes are picked up and used to build a picture of the condition of the liver. MRI and CT provide a detailed view of your internal organs and are able to generate very detailed cross-sectioned images (or ‘slices’) of your body area. liver biopsy in which a tiny piece of the liver is taken to be looked at under a microscope. A fine hollow needle is passed through the skin into the liver and a small sample is withdrawn. The test is usually done under local anaesthetic and may mean an overnight stay in hospital, although most people are allowed home later the same day if they live close by.

endoscopy in which, following sedation, a thin flexible tube with a light and a tiny camera on the end (endoscope) is passed down your oesophagus and into your stomach. This is to check for varices in the oesophagus or stomach which may rupture and suddenly bleed. What are the different stages of cirrhosis? Cirrhosis is sometimes called end stage liver disease. This simply means it comes after the other stages of liver damage which can include inflammation (hepatitis), fatty deposits (steatosis) and increased stiffness and mild-scarring of your liver (fibrosis). Many people with cirrhosis can feel quite well and live for many years without needing a liver transplant. This is because the liver can function relatively well even when it is quite severely damaged. Cirrhosis is classified as compensated or decompensated. Compensated cirrhosis is where the liver is coping with the damage and maintaining its important functions. In decompensated cirrhosis, the liver is not able to perform all its functions adequately. People with decompensated liver disease or cirrhosis often have serious symptoms and complications such as portal hypertension, bleeding varices, ascites and encephalopathy.

There are also systems for grading cirrhosis according to its severity. One of these is the Childs Pugh Score, which uses symptoms including encephalopathy and ascites together with blood test results for bilirubin, albumin and clotting, to grade cirrhosis from A (relatively mild) to C (severe). There are other systems including MELD (model of end-stage liver disease) which are used to help decide which patients most urgently need liver transplants. It uses blood test results for bilirubin, creatinine and clotting (INR). Prevention viral infections such as Hepatitis B and Hepatitis C a build up of fat in the liver known as Non-Alcohol Related Fatty Liver disease (NAFLD) that may progress to a more severe condition known as non alcoholic steatohepatitis or NASH certain inherited diseases, such as Haemochromatosis and Wilson’s disease long-term contact with some drugs and poisons blood vessel (vascular) disease, such as Budd-Chiari Syndrome . Treatment Treatment depends on the cause and stage of the cirrhosis.

The aim of treatment is to stop the cirrhosis getting worse, to reverse any damage (if this is possible) and to treat any disabling or life-threatening complications. Stopping the progression Making lifestyle changes and cutting alcohol out of your diet may help delay progression. Many causes of liver disease can now be treated much more successfully than before to stop or at least slow down any decline in the condition of your liver. This includes treating infections such as hepatitis B or C with new anti-viral medications and autoimmune diseases such as Autoimmune Hepatitis (AIH) with steroid-based drugs. Genetic Haemochromatosis (GH), an inherited liver disease, can be managed successfully with phlebotomy or venesection, a procedure similar to blood donation in which a quantity of blood is regularly taken from a vein in your arm. Reversing the problem Until recently, it was thought that a liver with cirrhosis could not be healed. This is usually the case because most diseases that cause scarring of your liver (fibrosis) are long-term and difficult to ‘cure’.However, recent research has shown that it may be possible to heal scarring and even cirrhosis where the liver disease causing this damage is able to be successfully treated.

The treatment of Hepatitis B and C, as already mentioned, gives hope for the development of new drugs to combat scarring of the liver. More research, however, needs to be done before any new treatments become widely available. Treating and managing the effects of cirrhosis Another aspect of treatment is to deal with the complications of cirrhosis as early as possible. For this reason your doctor may suggest you have regular tests to identify problems even before you notice any symptoms. You may also be given other drugs to reduce blood pressure, to prevent and treat infections and to help support your body’s functions. Portal hypertension and variceal bleeding Medicines including beta blockers such as propranolol can reduce the risk of bleeding and reduce the severity of any bleed, should it occur. If there is a serious bleed, initial treatment is to replace the fluid and then to identify and correct the cause of bleeding. There are several techniques aimed at stemming the bleeding which involve endoscopy. One of these is called banding, where a single vein (called an oesophageal varix) is sucked into a ring at the end of the endoscope. A small band is then placed around the base of the varix which will control the bleeding.

Injection sclerotherapy is also used and involves injecting a substance into the veins of the gullet to induce clotting and scar tissue that will help stop the veins from bleeding. If bleeding can not be stopped by endoscopy, a Sengstaken tube is passed down the throat into the stomach. This device has two balloons which once inflated, put pressure on the varices and help control the bleeding. People are heavily sedated for this procedure. If bleeding still cannot be controlled a procedure to lower pressure in the portal vein called a transjugular intrahepatic portosystemic stent shunt (TIPSS) may be needed. In this procedure a metal tube (stent) is passed across your liver to join two large veins (the portal vein and hepatic vein). This creates a bypass (shunt) so the blood flows straight into the hepatic vein relieving the pressure which causes the varices. Ascites and peripheral oedema Ascites (fluid building in your abdominal cavity, appearing like a bulge across your tummy area) and peripheral oedema (swelling in your ankles and legs) are very common in people with advanced cirrhosis.

Ascites can be uncomfortable and make it hard for people to breathe and eat normally. In addition, there is a risk of infection in the fl uid, called spontaneous bacterial peritonitis (SBP), which can be life threatening and is treated with antibiotics. The main treatments for ascites and oedema are sodium restriction (low salt diet and diuretics, such as spironolactone and Furosemide). It can be helpful to see a dietitian about how to manage on such a strict diet. Some patients benefit from having the fluid drained off the abdomen with a needle and tube. This usually needs to be repeated every few weeks. Patients considered at higher risk of infection may be offered prophylactic (preventative) antibiotics to take every day. Hepatic encephalopathy Many people with cirrhosis experience episodes of hepatic encephalopathy, most at a level where it is not very noticeable. In overt stages (where it is noticeable), it can show up as sleep disturbance, mild confusion, subtle personality changes and slightly poorer performances in tests such as drawing a star and connecting dots.

It can also feature problems in movement (called ataxia) and speech, slurring of words, tremor and a particular symptom of fl apping hands when you extend your arms (called asterixis). In some people the sleepiness can progress to a loss of consciousness and even to a coma, where it can be life-threatening. The main treatment for encephalopathy is lactulose (a sweet syrupy medicine). This not only acts as a laxative but also helps the body remove the toxins that build up in the body when the liver is failing. People are given enough lactulose so that they have one or two loose bowel movements each day. They may also be given other laxatives and/ or an enema. Most periods of encephalopathy are triggered by problems such as an infection, constipation, dehydration, a medicine or a bleed. It is important that patients seek medical advice so the cause of an episode can be identified and treated. Bleeding The liver makes products to help blood clot (including clotting factors and platelets) and when the liver stops working effectively, patients can be at risk of severe bleeding. Treatments include administering vitamin K and plasma in medical emergencies.

People should seek specialist advice before having medical procedures, including any dental work, and ensure that they treat any cuts that bleed with pressure and bandages and seek medical help. Kidney problems People with decompensated cirrhosis who are already very ill with problems such as encephalopathy, jaundice and bleeding problems, are at risk of a serious complication called hepatorenal syndrome, which is kidney failure in liver disease. For most patients, a liver transplant is needed, for some urgently. Liver cancer Some people with cirrhosis develop liver cancer, most commonly hepatocellular carcinoma (HCC). The aim is to detect and treat liver cancer as early as possible. Treatment can involve cutting out the part of the liver affected by cancer. There are a variety of other treatments aimed at controlling the cancer, including injections of chemotherapy, radio frequency ablation and oral medicines. A liver transplant may be an option for some patients. Liver transplantation If your liver is very badly damaged, a liver transplant may be needed. This is a procedure where a diseased liver is removed during a lengthy operation and replaced with a healthy donor liver. A liver transplant is usually only recommended if other treatments are no longer helpful and your life is threatened by end stage liver disease.

It is a major operation and you will need to plan it carefully with your medical team, family and friends. Liver transplantation is usually very successful although in some cases it is possible for liver diseases to return and affect your new liver. Discuss any worries you have about your suitability for treatment with your specialist nurse or doctor and those nearest to you. Looking after yourself Day-to-day coping strategies In general, it is best to aim for as near to a normal life as possible. However, there are some points that you should keep in mind to help you feel as healthy as you can. Take care of yourself by ensuring enough rest and exercise. Follow sensible hygiene measures if your immunity is low. Always discuss the use of over-the-counter drugs with your doctor since it is important to avoid some, especially painkillers such as aspirin and ibuprofen, if you have cirrhosis. Try to limit your exposure to colds and other infectious diseases. Talk to your doctor about having a flu vaccination in the winter months. Before travelling abroad, talk to your doctor about whether you should have any vaccinations. Join a support group for more information and personal support. Take an active interest in your healthcare.

Gather as much information as you need from charity telephone helplines and their supporting websites. If you find yourself becoming depressed, talk this over with your doctor who can discuss ways of overcoming this. If appropriate, certain medications can be helpful in helping you cope. Remember that liver function can improve if you take care of yourself and receive early treatment. However, you must ensure that health professionals know you have cirrhosis before giving or prescribing any treatment or medication for you. Diet It is important to eat well and to include a good balance of foods in your diet including vitamins, minerals and calcium. It is likely you will need extra energy and protein. Cirrhosis affects your ability to store glycogen, a carbohydrate that gives you short-term energy. This means that your body has to use its own muscle tissue to provide energy between meals and this can lead to muscle wasting and weakness. If you are affected in this way, snacking between meals is a way you can top up on calories and protein. Another good method is to eat three or four small meals in a day rather than one large protein or carbohydrate-heavy meal. You may find having nourishing drinks a help.

These can include homemade milkshakes or commercially-made products such as Build Up, Complan, Recovery and Nourishment. These are available at most chemists. It is a good idea to check with your doctor or dietician first to make sure they are suitable for you. Try to avoid salty foods or adding salt to what you eat, to help control fluid retention. Alcohol and cirrhosis Almost everyone who drinks too much alcohol will suffer some liver damage, but this does not necessarily turn into cirrhosis. As many as nine out of ten people who drink to excess will develop a fatty liver, with one in ten progressing to cirrhosis. In general, the more you drink, the greater your chance of developing alcohol related hepatitis or cirrhosis. A poor diet may make the problem worse. All types of alcoholic drinks can lead to liver disease. If you have cirrhosis – whether it is caused by alcohol or not – you should not drink alcohol at all. Support Please visit the support section of our website for information on Support groups in your area or visit our Useful Links section for other organisations who may be able to offer information and support.

NICE Guidelines This guideline covers assessing and managing suspected or confirmed cirrhosis in people who are 16 years or older. It aims to improve how cirrhosis is identified and diagnosed. It recommends tools to assess the severity of cirrhosis and gives advice on monitoring people with cirrhosis to detect and manage complications early, and referral criteria for tertiary care. Click here to view the guidance. Click here to view the information for the public. Download publication Dark Urine Could Indicate a Liver Problem Dark Urine Could Indicate a Liver Problem Share Print Urine that is orange, amber or brown might signify liver disease. Know what you can rule out and which other symptoms might point to the same conclusion. Liver disease is becoming one of the most common problems of our modern society, yet has few recognizable symptoms. Unfortunately, liver disease symptoms typically appear only when the illness has advanced to one of the later, irreversible stages. Thus, recognizing a potential problem with the liver via simple observation is extremely valuable. Observing the color of your urine is a reasonable way to be alerted that your liver’s health might be in jeopardy.

It is normal for the color of pee to vary throughout the day, changing based on how much fluid you’ve had, and what foods and medications you’ve ingested. Even so, observing dark-colored urine should serve as an alert that something is off. In general, dark urine could be a signal that the liver is struggling to function properly. When referencing dark-colored urine, the following colors are implied: Orange Besides a liver problem, other possible reasons for dark colored urine include: Dehydration – The darker the urine, the more dehydrated you might be. Eating certain foods like rhubarb, aloe and fava beans. B Vitamins – Although this typically results in bright orange urine. Medications like rifampin, pyridium, laxatives with cascara or senna, sulfasalazine, some chemotherapy drugs, medications for malaria such as primaquine and chloroquine, the antibiotics nitrofurantoin and metronidazole, and methocarbamol. Urinary Tract Infection. Kidney Problem. If none of these six possible causes of dark urine are applicable, liver function might be compromised. Most liver diseases have a better prognosis the earlier they are detected and treated.

Thus, swift diagnostics (prompted by recognizing dark urine) could potentially be life-saving. Although symptoms are rare in the beginning stages, other symptoms of liver disease might include: An enlarged abdomen Loss of appetite Fatigue Dark urine can be the result of a problem with the liver or bile ducts, especially if accompanied by lighter-than-normal stools. Dark urine and light stools are one of the ways to detect jaundice, when there is too much bilirubin in the body. Outwardly, jaundice is recognized as a yellowing of the skin and whites of the eyes, but what we excrete is also revealing. Bilirubin is a yellow pigment that is formed by the breakdown of dead red blood cells in the liver. Jaundice occurs when the liver doesn’t break down bilirubin properly. Jaundice arises for one of these reasons: The liver is damaged and can’t break down bilirubin. The bilirubin can’t make it to the digestive tract to be removed in stool. There may be too much bilirubin trying to enter the liver at once. Too many red blood cells may be dying at the same time.

While orange or brownish urine can have a multitude of causes, liver disease must be ruled out. Cirrhosis, hepatitis, pancreatic cancer, pancreatitis, bile duct cancer or blockage and alcoholic liver disease all are known to cause dark urine. Thus, observing cola-colored pee without understanding its etiology should result in a quick referral to a doctor. Only then can liver disease either be ruled out or treated as soon as possible. View All Supplements » Ann Pochin I have been diagnosed with fatty liver and lately have noticed my urine is a browny/green colour is this something to worry about? accretiondisc I’m not a doctor but I have amber urine that i am trying to find the cause of. Brown green sounds pretty serious and i do know that brown can be from bilirubin not being broken down by the liver so it accumulates in the blood then urine. I also know green stools could signal blocked pancreatic ducts. Good luck and I hope by now you have your answer. Top Pages Bile | definition of bile by Medical dictionary Bile | definition of bile by Medical dictionary bile [bīl] a clear yellow or orange fluid produced by the liver.

It is concentrated and stored in the gallbladder, and is poured into the small intestine via the bile ducts when needed for digestion. Bile helps in alkalinizing the intestinal contents and plays a role in the emulsification, absorption, and digestion of fat; its chief constituents are conjugated bile salts, cholesterol, phospholipid, bilirubin, and electrolytes. The bile salts emulsify fats by breaking up large fat globules into smaller ones so that they can be acted on by the fat-splitting enzymes of the intestine and pancreas. A healthy liver produces bile according to the body's needs and does not require stimulation by drugs. Infection or disease of the liver, inflammation of the gallbladder, or the presence of gallstones can interfere with the flow of bile. bile acids steroid acids derived from cholesterol; classified as primary, those synthesized in the liver, e.g., cholic and chenodeoxycholic acids , or secondary, those produced from primary bile acids by intestinal bacteria and returned to the liver by enterohepatic circulation, e.g., deoxycholic and lithocholic acids . bile ducts the canals or passageways that conduct bile.

There are three bile ducts: the hepatic duct drains bile from the liver; the cystic duct is an extension of the gallbladder and conveys bile from the gallbladder. These two ducts may be thought of as branches that drain into the “trunk,” or common bile duct. The common bile duct passes through the wall of the small intestine at the duodenum and joins with the pancreatic duct to form the hepatopancreatic ampulla, or ampulla of Vater. At the opening into the small intestine there is a sphincter that automatically controls the flow of bile into the intestine. The bile ducts may become obstructed by gallstones, benign or malignant tumors, or a severe local infection. Various disorders of the gallbladder or bile ducts are often diagnosed by ultrasonography , radionuclide imaging, and x-ray examination of the gallbladder and bile ducts using a special contrast medium so that these hollow structures can be clearly outlined on the x-ray film. bile (bīl), Avoid the jargonistic substitution of this word for bile pigment(s) in expressions such as bile in the urine and bile staining of tissues.

Yellowish-brown or green fluid secreted by the liver and discharged into the duodenum, where it aids in the emulsification of fats, increases peristalsis, and retards putrefaction; contains sodium glycocholate and sodium taurocholate, cholesterol, biliverdin, bilirubin, mucus, fat, lecithin, and cells and cellular debris. [L. bilis] bile (bīl) a fluid secreted by the liver, concentrated in the gallbladder, and poured into the small intestine via the bile ducts, which helps in alkalinizing the intestinal contents and plays a role in emulsification, absorption, and digestion of fat; its chief constituents are conjugated bile salts, cholesterol, phospholipid, bilirubin, and electrolytes. bile (bīl) n. A bitter, alkaline, brownish-yellow or greenish-yellow fluid that is secreted by the liver, stored in the gallbladder, and discharged into the duodenum and aids in the emulsification, digestion, and absorption of fats. Also called gall1.

bile [bīl] Etymology: L, bilis a bitter, yellow-green, viscid alkaline fluid secreted by the liver. Stored in the gallbladder, bile receives its color from the presence of bile pigments such as bilirubin. Bile passes from the gallbladder through the common bile duct in response to the cholecystokinin (CCK) produced in the duodenum in the presence of a fatty meal. Bile emulsifies these fats (breaks them into smaller particles and lowers the surface tension), preparing them for further digestion and absorption in the small intestine. Any interference in the flow of bile will result in the presence of unabsorbed fat in the feces and in jaundice. Also called gall . See also biliary obstruction, jaundice . biliary, adj.

bile (bīl) The yellowish-brown or greenish fluid secreted by the liver and discharged into the duodenum, where it aids in the emulsification of fats, increases peristalsis, and retards putrefaction; contains sodium glycocholate and sodium taurocholate, cholesterol, biliverdin and bilirubin, mucus, fat, lecithin, cells, and cellular debris. [L. bilis] bile The dark greenish-brown fluid secreted by the LIVER , stored and concentrated in the GALL BLADDER , and ejected into the DUODENUM to assist in the absorption of fats. Bile contains bile salts which help to emulsify fats, bile pigments derived from the breakdown of red blood cells, cholesterol, lecithin and traces of various minerals and metals. Fig. 64 Bile . The human gallbladder and bile duct. bile a thick, brown-green fluid secreted by the liver which is alkaline in its reactions, containing bile salts, bile pigments, CHOLESTEROL and inorganic salts.

Bile is transferred from the liver to the DUODENUM via the bile duct which in many mammals contains a reservoir called the gall bladder. The bile pigments (bilirubin and biliverdin) result from the breakdown of HAEMOGLOBIN in red blood cells, giving the bile its coloration which in turn affects the colour of the FAECES . The amount of cholesterol excreted in bile depends upon the blood fat level, the cholesterol in the bile normally being kept in solution by the bile salts. Reduction in the bile salt concentration can cause cholesterol to be deposited in the gall bladder, contributing to the formation of gallstones. Although bile contains no digestive enzymes, bile salts are also responsible for the EMULSIFICATION of fats in the duodenum, lowering the surface tension of the fatty film surrounding fatty food particles, so producing a larger surface area on which digestive enzymes (LIPASES) can work. Secretion of bile from the liver is stimulated by the hormone SECRETIN which is produced in the wall of the duodenum.

Mentioned in: Cholecystitis , Cholestasis , Gallbladder x Rays , Liver Disease , Wilson Disease bile secretion of the liver, variably stored in the gall bladder and discharged into the gut (duodenum). Contains the bile acids, important in the digestion and absorption of fats, and is the route for excretion of bile pigments (mainly bilirubin, from breakdown of the iron-containing pigments haemoglobin and myoglobin) and cholesterol . bile (bāl), n emulsifying fluid secreted from the gallbladder into the intestines. Bile breaks down fat globules to provide fat-absorbing enzymes with a larger surface area. bile (bīl) Avoid the jargonistic substitution of this word for bile pigment(s) in expressions such as bile in the urine and bile staining of tissues. Yellowish-brown or green fluid secreted by the liver and discharged into the duodenum, where it aids in the emulsification of fats. The Ultimate Liver Cleanse MANUAL A HEALTHY LIVER AND GALLBLADDER Please note Dr.

Hulda Clark states that people intending to do a liver cleanse must zap for 3 weeks before doing their first liver cleanse to kill and release liver flukes that congest the liver's bile ducts in advance of the cleanse. See the enlarged photo of the liver fluke (below). The 16 liver cleanse testimonials (below) include 3 sets of photos of liver flukes emailed to me by a customer who zapped before doing The Ultimate Liver Cleanse. Ken, I completed my first liver cleanse! Wowiiee!! The amount of stones was totally unreal, at least 360 of all sizes. The largest was the size of a quarter. Thanks again for your time and knowledge. This is an amazing healing journey and you're a great guide! Sincerely, Trish T., Jan. 9, 2008. Value $6.95 The Ultimate Liver Cleanse is by far the most powerful liver cleanse in the world. This instructional e-booklet tells in clear, non-technical language everything you need to know about successful liver cleansing. The instructions provide all the details, step by step, of how to do the cleanse and what to expect. The Ultimate Liver Cleanse is guaranted to work.

It has worked for thousands of people over the past 15 years. The Ultimate Liver Cleanse clears gallstones from the liver and gallbladder. It has an important effect on 4 metabolic functions: 1. The Ultimate Liver Cleanse promotes healthy fat metabolism. It can help lower cholesterol levels because cholesterol is manufactured in the liver. Please read the discussion about cholesterol, below. 2. The Ultimate Liver Cleanse allows the liver to normalize its detoxifying functions. The liver is the largest internal organ in the body and it performs most of the vital detoxifying functions of the body, rendering environmental toxins inactive. 3. The Ultimate Liver Cleanse promotes normal glucose metabolism. Glucose is stored as glycogen in the liver. When the bile ducts are clogged glucose metabolism can be impaired and high blood sugar can be the unfortunate result. Liver cleansing can help diabetics and pre-diabetics. 4. The Ultimate Liver Cleanse also has another important effect. Many people report a positive change in mood and well-being after liver cleansing. The Ultimate Liver Cleanse acts on many levels. The ingredients for The Ultimate Liver Cleanse are inexpensive. You can buy them at your local drug store.

Scroll down this page to read 16 unsolicited testimonials taken from the hundreds of testimonials I have received over the years from people who obtained amazing results with The Ultimate Liver Cleanse. The testimonials will show you what to expect. The results reported, below, are not unusual, nor are the photos. The results they describe are very typical of the results people get when they do The Ultimate Liver Cleanse. PHOTOS OF GALLSTONES EXCRETED AFTER LIVER CLEANSING THE BEST LIVER CLEANSE AVAILABLE I developed The Ultimate Liver Cleanse in 1996. It took nearly a year of liver cleansing and discussions with many others who were experimenting with liver cleansing to develop The Ultimate Liver Cleanse and to offer it to others in this e-booklet. The Utimate Liver Cleanse works when other liver cleanses fail to give satisfactory results. When you go to all the trouble of doing a liver cleanse (liver cleansing ins not easy) there is nothing more discouraging than to see few if any stones coming out. I did a liver cleanse a while back and I got out over 400 stones, many as large as peas and cherry pits, and some much larger. It was amazing.

I have done 17 Ultimate Liver Cleanses. The Ultimate Liver Cleanse never fails. I have not received a single email in the past 15 years from a dissatisfied customer. In my opinion Dr. Clark's cleanse was the best liver cleanse available up to the mid-1990's. But it disappointed many people because it produced inconsistent results. This was also my personal experience with Dr. Clark's liver cleanse. After months of experimenting I developed the best liver cleanse in the world. Over the past 15 years thousands of people have done The Ultimate Liver Cleanse and have experienced consistently superior results with it. 15 unsolicited testimonials are offered below. Liver cleansing has been reported as far back as biblical times. Many liver cleanses have been developed through the centuries. They have been used by countless people in their quest for better health. In the modern era Dr. Alfred Vogel published a liver cleanse in his book The Swiss Herb Doctor. More recently, Dr. Hulda Clark developed a liver cleanse which people have used with varying degrees of success. She gives the details of her cleanse is her groundbreaking book The Cure for All Diseases. Dr.

Clark says "cleaning the liver bile ducts is the most powerful procedure that you can do to improve you body's health". She says it is very important to zap for 3 weeks before doing your first liver cleanse to clear the liver of liver flukes and other parasites. This maximizes results. THE LIVER AND GALLBLADDER WHAT ARE GALLSTONES? Gallstones are formed in the liver. They are made from a waxy substance called cholesterol which is manufactured in the liver. 80% of the cholesterol in the body is produced in the liver. 95% of gallstones are not "stones" at all, contrary to what the medical profession would like you to think. They are waxy agglomerations of coagulated chloesterol, as the photos on this page show. Gallstones often agglomerate into "stones" that are relatively large in size. I have seen a waxy "stone" of a friend that was the size of a golf ball! Not to worry, even the largest gallstones are excreted from the intestinal tract painlessly thanks The Ultimate Liver Cleanse's unique formula. In fact, only 5% of gallstones are hard, or calcified.

So, they seldom show up on x-rays or with ultrasound because they are waxy, not solid. They are coagulated cholesterol. They are usually green in color because they are infused with bile which is also produced in the liver. Cholesterol "stones" clog the bile ducts in the liver as well as the gallbladder itself. CHOLESTEROL AND GALLSTONES Here it the definition of gallstones taken from medical books. There are three types of gallstones: cholesterol stones, bilirubin stones and pigment stones. Cholesterol stones: scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason. 95 % of all gallstones are Cholesterol stones. Bilirubin stones are formed from cholesterol and bilirubin. Pigment stones: the cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia. Some medical practitioners claim that the gallstones excreted during liver cleansing are congealed olive oil. This is totally false.

Why are gallstones not made from congealed olive oil? Because olive oil only congeals, or coagulates, at temperatures below 55 degrees F (13 C). Normal body temperature is 98.6 degrees F (37 C). Olive oil always remains liquid in the body. Furthermore, olive oil does not contain cholesterol, bilirubin, pigment or bile salts. Gallstones are made of cholesterol (95%), bilirubin, pigment and bile salts. The liver makes cholesterol which in turn create hormones. It takes weeks, months and years for gallstones to form from cholesterol. Gallstones do not form in 3 hours because of the ingestion of olive oil during a liver cleanse. First of all they do not form from olive oil, as discussed above, and it takes a long time for them to form from cholesterol. Saturated fatty acids (and alcohol and concentrated sweeteners that are rapidly transformed into saturated fatty acids) are the chief culprits in raising blood cholesterol, creating gallstones, and in increasing the risk of heart disease. But dietary cholesterol also plays a part.

The average American man consumes about 360 milligrams of cholesterol a day; the average woman, between 220 and 260 milligrams. The main causes of a high cholesterol count are diet and gallstones. Cholesterol is in every cell in your body, and every cell needs it. You can't live without cholesterol, which is one type of the fat-like substances (lipids) in your blood. Among the essential roles of cholesterol are to help insulate nerves and to create hormones. The term "cholesterol" is used for both the cholesterol you eat (dietary cholesterol) and the cholesterol produced in your body. Your liver makes about 80 percent of the cholesterol in your blood (blood cholesterol). Only about 20 percent comes from your diet. Animal products that you eat, such as meat and dairy foods, contain dietary cholesterol. Vegetables do not. The good news about liver cleansing is that, in most cases, after 5 to 10 liver cleanses gallstones stop coming out, no matter how much olive oil you drink. So, when your liver is clean, even olive oil will not make gallstones. The fact is that it never did in the first place, of course.

AVOIDING GALLBLADDER SURGERY Gallbladder surgery is big business. Removing gallbladders is very profitable for doctors but, in many cases, it is a procedure that can be avoided. Having your gallbladder out can lead to a lifetime of problems. The gallbladder is the recepticle for bile which is manufactured in the liver. When you eat fatty foods the gallbladder squirts bile on the fat in your digestive tract to metabolize it. Without a gallbladder the liver still produces bile but it can only drip from the liver to metabolize fats. Problems with fat metabolism can be the lifelong result of gallbladder surgery. If the gallbladder is diseased an operation may be inevitable. But in the vast majority of cases the gallbladder is not diseased. The doctor wants to remove it for personal financial gain, not because removing it is absolutely necessary. In fact, if it is clogged with gallstones and it is not diseased then an operation may be avoided. Indeed, what doctors used to do in such cases in "the old days" was to cut the gallbladder open, remove the "stones" then sew it back up.

Many people have been able to avoid gallbladder surgery by doing The Ultimate Liver Cleanse. TESTIMONIAL #1 Dear Ken, ... As you know I started zapping (and performed several parasite cleanses with Dr. Clark's Black Walnut/Wormood/Clover treatment) a couple of months ago. I also did 24 liver cleanses following partly your great flushing procedure which still(!) gives me enormous results (meaning green/yellow 'stones' of of up to cherry pit size and larger). Attached ... you find three images I took after three different liver flushes. They show always the same feature which I think could be an animal, a fluke maybe? What do you think? Can this be a liver parasite? I checked the internet but did not find really similar looking pictures which would identify what I found as a small or big liver fluke. Anyway, I will continue doing liver flushes until my acne and these annoying syptoms (dizziness, tinitus, tiredness, breathlessness) are gone. However, from your experience could you give me a hint what I am facing here?? Thanks for your help in advance.

Best regards, THE FOLLOWING PHOTOS WERE ATTACHED TO THIS TESTIMONIAL TESTIMONIAL #2 Dear Ken, ... Another thing ... is when I was in [a country in South America] in 1978 as a 5 year old child. My father is from this country but my mother is from Germany. So I already considered that I may got these flukes from this 2 weeks journey ... If I look at the result my last (25th) liver cleanse revealed, all that debris of still up to berry sized 'stones', a lot of slime and these flukes (see attachment) I actually wonder why I do not feel even more sick! I decided of course to go on flushing (I skipped the epsom salt btw. completely because I vomitted horribly at the end of two flushes. I can not stand this stuff. I use a 30 min coffee enema before the flush and as last thing next morning instead to open my bile ducts. The key is to combine it with the hot water bottle and enough oil as you recommended ... I am zapping now more aggressively (30min, 30min, 1h) and I ...

connect the hand sticks directly under the right and left rib cage ... Just have a look [at the photos, below]. I am convinced that this is a fluke but still do not know which one (size of the glass object holder is 8cm x 2.5cm). It never is a whole fluke but only a fragment what I get out by the flushes, I think the head is missing. I had it under an optical microscope and although I think it is partly digested since it took about 8 hours from taking the oil to flush it out I think I could identify its intestines. I will get in contact with a tropical hospital in Germany for a more professional solution. Would you know a better herbal treatment than Dr. Clark's Walnut/Wormwood/Clover? I want to avoid antibotics of any kind if possible. Thanks for your kind responses! I really appreciate to know somebody who does look further than the common school medicine because all doctors I consulted say my symptoms are not specific to any known disease or that "everything is normal" because interestingly my blood values which were analyzed are normal.

Apparently, parasites really know how to hide undetected in the body and I do hope that these have not ruined my liver if they are really there for that long time. Kind regards, THE FOLLOWING PHOTOS WERE ATTACHED TO THIS TESTIMONIAL TESTIMONIAL #3 Dear Ken, To keep you updated here (attachment) the astonishing results from my 36th liver flush using your method (without epsom salt but coffee enema instead). Almost no 'stones' as expected after 36 flushes but a lot of 'chaff' and flukes. I don't know what they are but the evidence is convincing me that they are animals. Have a look yourself. Interestingly, I am about to distinguish either different types or different stages of development or even gender (if they have). I show you the example of a huge (in volume) 4 cm long 'fat' critter and a 'long' one of about double total length but very flat. Note the same/similar outer structure they have and always had since I study them. The surface is kind of rippled and the inside is multiply structured. The whole animal looks by far more complex then an earthworm ...

Being moved in water they look quite different and brighter but they are the same as on the fotos. The double tail was always there when they were more or less intact and not in pieces. If you compare them to the fotos I sent you earlier they are the same kind ... I started zapping today again and I will continue in combination with the herbs to potentize there action ... All the best, THE FOLLOWING PHOTOS WERE ATTACHED TO THIS TESTIMONIAL TESTIMONIAL #4 Dear Mr. Presner, After 14 successful liver cleanses of different types I did during the last six months I got out less and less stones as expected when the liver gets cleaner. I did your liver cleanse yesterday and today and I have to say: You are right. I got out more stones than ever, sizes from pinheads (~200) to hazelnuts with shell (7) and lots of sizes in between. INCREDIBLE! I never used pink grape fruit before (but lemons) and never used a hot-water bottle and Epsom salt before either. Also I never took that much oil before...this cleanse was the most effective I did so far! Thanks a lot.

Now I am looking forward to more health improvement with your zapper. Merry Christmas and a happy New Year! Robert TESTIMONIAL #5 Dear Mr. Presner, I did your ultimate liver cleanse last night (my first one) and I have a few questions. First let me tell you that the final outcome was beyond by greatest expectations. I got out at least 400 'stones' (they're more like nodules aren't they). It was hard to get an exact count because many were small and there was a lot of chaff, but some were really quite large (the largest about the size of 1/2 a golf ball!) I appreciate you making this plan available and I don't have the words to tell you just how pleased I am with the final outcome!" Anonymous (by request) TESTIMONIAL #6 Dear Mr. Presner, It has been a number of weeks since I attempted the liver and gallbladder cleanse that you recommended.

It was very successful and I removed about two cups of soft stones, some as large as red grapes, some more like green grapes, and hundreds of small ones the size of lentils and hundreds more the size of uncooked barley...I was glad to have such good results... Gratefully, TESTIMONIAL #7 Hello Ken, I did your "Ultimate Liver Cleanse" this past weekend and had great results. I have tried Dr. Clark's method twice with no luck, so I was very pleased to have passed so many stones. I'm having a little bladder trouble now (feels like an infection) and I'm wondering if it's because I didn't do the other things first (ie. -parasite cleanse, bowel cleanse, kidney cleanse). I also can't seem to find the website I visited that states all of the preliminary cleanses that I need to perform. Are these steps included in your detox protocol? Could I please get more information about your protocol? I have a variety of health problems (autoimmune) and am inspired by your story. You're doing a great service to humanity by making all of these resources available at a reasonable cost.

Thanks, TESTIMONIAL #10 Good day Ken, Just thought I'd let you know that I have successfully completed my first liver cleanse! Wowiieeee!!! There's some crazy build-up in my system! The amount of stones that came through was totally unreal! There must have been at least 360 or more stones of all sizes. The largest one was the size of a quarter! So amazing! I also weighed myself before and after and there was an 8 pound difference...though I doubt all those 8 pounds are attributed to the stones alone. Having come through it and feeling fairly good, except for feeling tired due to the lack of sleep during the cleanse ... Thanks again for your time and knowledge. This is an amazing healing journey and you're a great guide! Sincerely, TESTIMONIAL #11 Hi Mr. Ken, I zapped for 3 weeks for 6 minutes (3 times) each day. I did my first liver cleanse starting friday. It was very successful. Praise God and Thankyou very much for the detailed step by step instructions for the ultimate liver cleanse. It was very helpful.

I passed many little stones and some pea sized ones, some double that size, some as big as marbles, five or six bigger than that and two were almost the size of a walnut (with shell). I had a question though - I was feeling very thirsty after 6 PM on Friday evening. I kept drinking water little by little - should we drink water or not since all those enemas probably dehydrate us? I also have a few questions about subsequent cleanses. I will email later for info. Right now I want to just enjoy the success. Thank you again. Feb. 23, 2008. TESTIMONIAL #12 Another good update. My husband has been complaining of pain in his gut (below his ribcage) for about 8 months. Before it was a dull ache that was bearable. He went to the doctor and the doctor told him it was IBS and sent him home with a prescription for a strong antacid. This past week the pain got unbearable. We got our zapper a few weeks ago and he has been zapping faithfully.

We also got your recovery protocol and last night he did the liver cleanse thinking it might be gallstones since the pain was in his gallbladder and liver area, and he passed 30-40 stones with his first visit to the bathroom! He told me this morning that the pain is going away and he is very happy. He is going to continue the cleanse until he no longer passes any stones. We also found a holistic dentist that has a special process for mercury vapor capture and we are looking into getting his silver fillings out. The zapper and the liver cleanse are just the start of turning his life around. I can't say thank you enough! Amanda TESTIMONIAL #13 Hello Kenneth, My name is Scott S. I'm 38 years old and struggling to regain my health. I've ordered and studied your Recovery Protocol e-book and your Chelating e-book .... This past weekend I completed my 25th (yes, 25th) liver cleanse. My liver must have been completely full because I continue to get out stones. This last cleanse produced 1000+ small stones and a few pea size stones ... Your Ultimate Liver Cleanse is great!

I've tried many protocols and have produced great results with your cleanse. Relaxing for three hours with the hot water bottle on my liver has been very effective. Great job! I can't say thank you enough! Scott S. TESTIMONIAL #15 Hello Ken, Firstly I would like to thank you for your Ultimate Zapper which myself and my spouse have been using since purchasing it and have killed many different parasites using it. I have just purchased two of your ebooks and am looking forward to reading same. So after reading your site we both removed our mercury fillings in 2007 and since then have been using your zapper and doing liver flushes (thanks to your site) ... When my spouse started to do the liver flushes we hoped it would clear up his symptoms (poor circulations, ringing ears). However the number of stones at this stage since the beginning of 2008 has now reached an excessive amount i.e. 10,000. These vary in size from peas to lots over the years larger than an inch and a half, much much bigger than walnuts ... Thank you. TESTIMONIAL #16 Hi Ken ...

I completed my very first liver cleanse on the last week-end (I don't know how to thank you), I expelled hundreds of light tan coloured fatty floating things (just from the first rounds of enemas) BUT, the real shocker for me were several huge stones (some 30mmX23mm) not to mention the approx. 400 hundred green stones that followed of mostly a small size. I never thought I would have such large stones. The pic shows some of the larger ones. P.S. I found the entire liver cleanse process very do-able and each step was actually never as bad as what I was imagining it would be - even the cup of olive oil & grapefruit juice (I found it almost good to the taste), that's my opinion. Question: Is there any problem doing another liver cleanse this coming week-end again? Thanks Mar.

23, 2011 TESTIMONIAL #17 Date: Wed, 19 Jan 2011 01:54:44 -0800 From: wheniwanttoshop@yahoo.com Subject: Liver Cleanse To: kenpresner@hotmail.com Dear Ken, I can't thank you enough for the wonderful amazing marvelous zapper you have created. I have been sick for 25 excruciating years with a weak to zero immune system. Your zapper is amazing and powerful - I have just started using it a few months. I will relate to you in a separate email just how much it has been helping me. My concern right now it your ultimate liver cleanse. I just did it a week ago for the first time. I got out about 30 small to large pea sized "stones" ranging in color from light green to very dark green (and some sort of creature or nest of eggs the next day). Amazing! Thank you for telling us how to do this amazing cleanse!

(By the way, I have done several other liver cleanses and never ever ever had this result!) My concern is this: From the beginning I had a strong reaction to the Epsom salt - I developed extreme diarrhea. I couldn't spend all of the prescribed time laying down with the hot water bottle on my liver because I had to keep racing to the toilet. And what came out of me was just liquid - burning hot liquid that felt like acid and made my whole rectal area red and swollen and extremely sensitive. After I drank the grapefruit juice / olive oil concoction I had a hard time falling asleep because I kept having diarrhea and having to run to the bathroom. Needless to say, I didn't take the prescribed Epsom salt in the morning as I was still suffering from these symptoms. So I'm asking for your advice: I plan on reducing the amount of Epsom salt from 2 tablespoons twice at night and once in the morning down to 2 teaspoons twice at night and once in the morning. Does this throw up a red light for you or do you think it's okay that I give this a try for my next liver cleanse?

Also, I was not able to hold the enema water in for 5 minutes - at most I did 30 seconds. Do you think this is a big problem? Thank you Ken! I really appreciate you personally answering my questions! Monika K. Liver Abscess - Symptoms, Causes, Treatments Liver Abscess Treatments What is a liver abscess? Liver abscess is a pus-filled cyst in the liver. The liver is an organ in the digestive system that assists the digestive process and carries out many other essential functions. These functions include producing bile to help break down food into energy; creating essential substances, such as hormones; cleaning toxins from the blood, including those from medication, alcohol and drugs; and controlling fat storage and cholesterol production and release. Anyone can get a liver abscess. The condition can be caused by infections spread directly from nearby structures, such as the bile-draining tubes, from the appendix or intestines, or carried in the bloodstream from more distant parts of the body. A liver abscess can also develop as a result of surgery or other trauma to the liver. Looking for a Doctor? Search Now Find a Gastroenterologist Near You The most common type of liver abscess is caused by bacterial or parasitic infection.

Bacterial liver abscess is often called pyogenic liver abscess. Microscopic organisms called amebas, which cause the intestinal disorder amebic dysentery, can also cause amebic liver abscess. 8 Foods That Aid Digestion Here's what you can eat help keep your digestive tract healthy and happy. When detected in time, liver abscess is usually treatable and often can be cured with a course of antibiotics or a combination of antibiotics and a surgical procedure to drain the abscess. Left untreated, however, a liver abscess can burst and spread the infection, leading to sepsis, a life-threatening bacterial blood infection. An untreated liver abscess can cause sepsis, a life-threatening blood infection. Seek immediate medical care (call 911) for serious symptoms, such as choking or severe difficulty breathing, which may be combined with high fever (higher than 101 degrees Fahrenheit); change in level of consciousness or alertness, such as passing out or unresponsiveness; or a change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions.

Seek prompt medical care if you experience any of the following symptoms, including yellowing of the skin or whites of the eyes (jaundice); abdominal pain (especially in the right upper abdomen); nausea with or without vomiting; clay-colored stools; dark urine; fever or chills; loss of appetite; unexplained weight loss; or weakness. SPONSORED

Question: What is the name of the thick dark green fluid manufactured by the liver?
Answer: Bile