Liver Diseases

Liver disease Unless liver damage is fairly severe or advanced, diseases of the liver are often “silent” and patients may be unaware of any problem. The signs and symptoms of liver disease can be explained by considering the various liver functions. Different liver diseases may affect some functions more than others, resulting in variability between patients.  The impairment of processing of nutrients results in wasting of tissues, particularly muscle. Impairment of the liver’s ability to excrete bile causes accumulation of its constituents including bilirubin pigment, responsible for the yellow discoloration of skin and urine (jaundice), and bile acids, which may be responsible for the chronic itch, suffered by some patients.  The decreased absorption of vitamin K and inadequate production of blood clotting factors causes easy bruising and bleeding, initially from the gums.  Massive bleeding from the gut is due, in part, to blood from the gut being diverted away from its usual course through the liver, to other channels in the esophagus (gullet), which may rupture under pressure.  The decreased production of blood proteins involved in body fluid balance and the scarring of the liver contribute to the accumulation of fluid in the abdomen and legs.  The failure of the liver to deal adequately with poisons produced in the gut can cause drowsiness, forgetfulness, and lack of concentration, confusion and coma.  A damaged liver is also much slower at dealing with alcohol and drugs causing increasing sensitivity to their use.  Inadequate removal of microorganisms or “germs” from the blood coming from the gut partly explains the increased incidence of serious infections in patients with liver disease.

 

Hepatitis B and C:
Hepatitis B is a viral disease, which if left untreated can cause the liver to progress towards end stage liver disease over several years and also predispose the liver towards cancer formation. India comes in moderate zone if one looks at global prevalence of Hepatitis B viral infection. It can be acquired at birth through vertical transmission from the mother or later in life through infected blood transfusion, sharing of infected needles or blades, sexual transmission etc. Now a day’s immunization against hepatitis B is included in the universal immunization schedule for a newborn, which has drastically reduced the prevalence of the disease in the population. Effective antiviral drugs are now available which can help eliminate or keep the virus under control, and so this disease can be tackled effectively under medical supervision.Hepatitis C is a viral illness, which also causes progressive liver damage, but at a slower rate than hepatitis B. India comes under moderate zone of prevalence of hepatitis C. This viral infection is usually acquired through transfusion of infected blood, use of infected syringes or blades, sexual transmission etc. So far no effective vaccine is available against hepatitis c virus. Till recently the drugs used against this illness were not very effective with more than 50% of patients relapsing back with the viral disease post treatment. But now with the recently available new generation medications, more than 95% cure rates have been reported and one can halt the disease before it causes major liver damage.

Fatty Liver
Fatty liver disease is characterized by progressive accumulation of fat in the liver. It is partly due to unhealthy life styles. Fat accumulation may occur in patients with diabetes, regular alcohol consumption, certain drugs, obese individuals, enzymatic defects, etc. Different stages of fatty liver disease have been described depending upon the amount of fat accumulated and whether this is leading to damage to liver cells which is evident by rising liver enzymes on LFT. Proper evaluation to know the cause of the diseases, dietary counseling, regular exercise regimen, and avoidance of liver toxic medications can help control and sometimes revert this disease and halt the progression of liver damage. If however this goes untreated, then it can progress to cirrhosis and infact is now becoming a leading cause in the world for development of cirrhosis.

 Alcohol-Related Liver Disease:
Most people who develop cirrhosis of the liver due to excessive alcohol use do not need a liver transplant; they just need to stop drinking. For patients with advanced liver disease, where prolonged abstinence and medical treatment fail to restore health and liver disease is progressive, we discuss liver transplantation. All patients in this setting must be alcohol free for at least 6 months before they can be listed for a liver transplant as well as attend Alcoholics Anonymous and have random alcohol and tox screens.

 

Liver Cancer:
Liver cancer usually occurs in the background of chronic liver disease and hence in these patients besides the cancer the rest of the liver quality is also bad due to cirrhosis. Liver cancers tend to be multifocal, which means that more than one cancer can be present in different areas of the liver simultaneously. Therefore it is recommended that if certain criteria are met then liver transplant should be offered since in transplant the entire diseased liver is removed. The recurrence rate of cancer (chances of cancer coming back) is therefore much lower for liver transplant than for liver resection (in which only the part of liver having the cancer is removed). However in certain situations, such as when the patient has early stage of cirrhosis and has cancer limited to only one area, then surgical resection instead of transplant can be offered.

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Why liver transplant ?

Liver Transplant is needed when a person develops either acute (sudden) or chronic liver failure. Liver transplant is a life saving procedure in this setting.
Acute liver failure (ALF) happens suddenly. It may be caused by various reasons. In India, acute viral infection from Hepatitis A and E are the commonest cause, though it may also occur from drug induced liver damage (DILI), with acetaminophen being the leading cause
Chronic liver failure, also called end-stage liver disease, is a slower process, which progresses over months, years, or decades. Most often, chronic liver failure is the result of cirrhosis, a condition in which the liver cells progressively get destroyed and are replaced with scar tissue through out the liver.