Thursday, August 11th, 2022 05:32:28

comprehending LIVER DISEASES

By Dr Anup Gupta
Updated: May 8, 2021 8:33 am

Liver is the largest internal organ in the body, performing many bodily functions from cleansing the blood of toxins to converting food into nutrients to controlling hormone levels. Most people never give their liver a thought until something goes wrong. In fact, there are many types of liver disease that can be caused by a virus, damage from drugs or chemicals, alcohol, obesity, diabetes or an attack from own immune system.

Main Functions of the liver are:

As the main metabolic organ in the body, the liver has many different functions, including:

  • Production of protein building blocks (amino acids), proteins (e. g. clotting factors, albumin), cholesterol and
    bile acids.
  • Regulation of the blood sugar level by production or use of glucose
  • Production and supply of bile for digestion of fats.
  • The neutralization and elimination of waste products of the body’s own metabolism and foreign substances such as drugs and environmental toxins.
  • Storage of nutrients (glycogen and sugar reserves), minerals (e. g. iron), or vitamins (e. g. vitamin B12).

Many common liver diseases can cause the organ to become inflamed. This inflammation can progress to scarring, or cirrhosis. It is critical that patients with cirrhosis, due to any type of liver disease, seek help because people with cirrhosis are at an increased risk for liver cancer or liver failure. Liver cancer and liver failure can be treated by a multidisciplinary approach including radiation, medication, or surgery, including transplant.

 

1.VIRAL HEPATITIS

Viral hepatitis is an inflammation of the liver caused by one of three virus forms, A, B or C (major) and others (D, E)

  • Hepatitis A (Hep A) – This infection is usually caused by consuming contaminated food or water. This form of hepatitis usually clears without lasting problems within six months and does not lead to a chronic infection. Typically, you cannot get it more than once since it causes lifetime immunity after first infection. A vaccine to prevent infection is available.
  • Hepatitis B (Hep B) – This virus is transmitted through bodily fluids that triggers an immune reaction, causing low-level inflammation and liver damage. It is normally successfully treated with oral medications that have few side effects or pegylated interferon injections. In a small number of cases, Hep B can develop into a chronic infection, which can lead to more serious liver diseases. A vaccine to prevent infection is available.
  • Hepatitis C (Hep C) – Spread through contact with infected blood, Hep C infection can be very serious. Most people infected experience no symptoms and the virus may remain in the liver for years and it is not discovered until much damage is done. It is increasingly successfully treated with pegylated interferon injections along with oral drugs. Up to 50 percent of those infected with Hepatitis C are able to fight off the virus within six months. However, many patients develop a chronic infection. A liver biopsy can determine the extent of injury and damage to the liver. Treatment includes antiviral medicines, such as pegylated interferon and ribavirin, to limit liver damage.

 

  1. ALCOHOLIC LIVER DISEASE

The most common cause for the development of cirrhosis of the liver is misuse of alcohol. When alcohol is misused over many years, liver damage and cirrhosis develops. This includes an increased risk for developing hepatic cell carcinoma. The risk of alcohol damage is significantly higher for women than for men. A daily intake of 60 g alcohol (for men) and 20–40 g alcohol (for women) over a prolonged period damages the liver. Alcohol provides 7 kcal per gram.

 

The alcohol content of various alcoholic drinks per 100 ml

Beer-                    1.0 –5.5 g

Wine-                   5.5 – 13.0g

Liqueur-               20.0–35.0 g

Vodka-                 14-20 g

whisky-                30-40 g

Spirits-                 32.0–50.0 g

Rum-                    40.0–70.0 g

 

Alcohol should be consumed in moderation. Alcohol steatohepatitis is a consequence of alcohol abuse but still represents a reversible transitional stage on the path from simple fatty liver to alcoholic liver cirrhosis. Severe acute alcoholic hepatitis is a life-threatening disease with high mortality. Absolute abstinence from alcohol once there are signs of liver disease.

 

  1. FATTY LIVER DISEASE

Fatty liver disease is an excess buildup of fat in the liver – or more than 5 to 10 percent of the liver’s total weight. There are various forms of fatty liver

  • Hepatic lipomatosis (due to overnutrition [calories, fat, carbohydrates])
  • Alcoholic fatty liver (caused by alcohol)
  • Deficiency fatty liver (due to protein and calorie deficiency)
  • Metabolic fatty liver (e. g. in diabetics)
  • Uncertain causes (fatty liver in endemic sprue)

This condition is most common in those who are overweight, diabetic or have metabolic syndrome. If unrelated to alcohol consumption, it is known as nonalcoholic steatohepatitis, or NASH. Otherwise, it is known as alcoholic liver disease. Excess liver fat can lead to inflammation, progressing to scarring (or cirrhosis) in 20 percent of patients. Treatment includes weight loss, exercise, diabetes control, regulating blood pressure and cholesterol, limiting or eliminating alcohol consumption and not smoking.

4.GENETIC LIVER DISEASES

  • Hereditary Hemochromatosis – The most common adult genetic liver disease in which a specific genetic defect leads to iron accumulation in the liver, leading to liver cirrhosis and liver cancer in some patients. Iron accumulation may go beyond the liver affecting the heart, joints and pancreas. Specific and effective treatments are available. Liver transplantation may be required in some of these patients.
  • Alpha-1 antitrypsin deficiency (Alpha-1) – This inherited disease may affect the liver and/or the lungs in children and adults. It is caused by an inability to produce enough of a particular protein, called Alpha-1 antitrypsin, which is used to prevent the breakdown of enzymes in various organs. Management of Alpha-1 antitrypsin deficiency includes patient education, maintaining normal nutrition, and closely monitoring patients so that any complications can be treated early. There are potential clinical trials for medical therapies. Liver transplantation successfully cures the condition.
  • Wilson’s disease – A rare genetic disorder that causes excessive buildup of copper in the liver and brain. Treatment is managed by both a hepatologist and neurologist and includes oral medication, which binds to the copper and removes it from the body. Therapy is continued to prevent its reaccumulation.
  • Hereditary amyloidosis – A condition in which the liver produces an abnormal protein that builds up in other organs, causing problems in the nerves and kidneys. Treatment includes medications or other therapies to avoid protein buildup, or a liver transplant to stop disease progression and prevent further damage to other organs. Counselling families with genetic liver diseases about the risk of their children and first degree relatives to have the same genetic disease of the liver and appropriate screening tests are required.

 

5.AUTOIMMUNE LIVER DISEASE

  • Primary sclerosing cholangitis (PSC) – This disease causes the liver’s bile ducts to become inflamed, scarred and eventually blocked. This can lead to cholangitis, a condition of bacterial infection of the bile, and cirrhosis. Treatment includes medication to relieve itching, antibiotics, anti-inflammatories, bile thinners and vitamin supplements. PSC is often associated with inflammatory bowel disease (IBD), which may require treatment on its own. PSC can cause liver failure and also is a risk factor for developing bile duct cancer, thus close follow up is required.
  • Primary biliary cirrhosis (PBC) – PBC is another disease that destroys the liver’s bile ducts, causing bile to accumulate in the liver and damage liver tissue. Initial treatment is usually aimed at providing symptom relief and includes vitamin therapy, calcium supplements and drugs to treat itching. Bile thinners and anti-inflammatory medications are also commonly used. While the disease cannot be cured, its progression may be delayed. However, if the liver becomes severely damaged, a transplant may be necessary.
  • Autoimmune hepatitis – This is a condition in which the body attacks the liver, causing the liver to become inflamed and scarred (hepatitis). If diagnosed and treated early, autoimmune hepatitis can usually be effectively controlled. Treatment typically includes a combination of medications and corticosteroids to slow down the overactive Immune system and prevent the disease from getting worse, and perhaps reverse some of the damage.

 

6.LIVER CIRRHOSIS :

FINAL STAGE IN CHRONIC LIVER DISEASES

Cirrhosis of the liver is defined as advanced, irreparable destruction of metabolically-active liver cells, transformation of the architecture of the blood vessels and increase in connective tissue. The connective tissue is unable to carry out the functions of the liver cells. The liver tissue becomes firm and shrinks, which is why cirrhosis of the liver is also known as “shrunken liver”. This shrinking also affects the blood vessels, blocking the inflow of blood flowing in from the bowel through the portal vein (portal hypertension). This can lead to the formation of varicose veins (dilated veins) in the esophagus (esophageal varices), ascites (accumulation of fluid in the abdomen) and disturbances of bowel function (e. g., reduced digestion of fats, bloating). Other complications of liver cirrhosis are malnutrition, frequent bacterial infections, brain dysfunction up to and including coma (hepatic encephalopathy) and hepatic cell carcinoma. The end point of advanced liver cirrhosis is either death or liver transplantation. There are a large number of so-called “liver protection agents”. Up to now there is no proof that cirrhosis of the liver can be improved or cured. The positive effect of dietetic treatment, on the other hand, is well-established.

 

7.LIVER CANCER (HEPATOCELLULAR CARCINOMA)

It can be caused by idiopathic, genetic, toxins, drugs, chemicals, alcohol and sequelae to various chronic liver diseases. The liver cancer is diagnosed and treated by a multidisciplinary team that includes hepatologists and experts from a number of other departments, including hepato-pancreato-biliary surgery, interventional radiology and medical oncology. As with any cancer, early diagnosis is critical. Patients with certain liver diseases are susceptible to liver cancer and should be screened regularly. Treatment includes medication, radiation, surgical resection and liver transplantation.

 

OVERALL Risk factors:

  • Heavy alcohol intake
  • Obesity
  • Type 2 Diabetes
  • Unhygenic food intake
  • Tattoos/body piercings
  • Injecting drugs/using shared      needles
  • Blood transfusion
  • Unprotected sex
  • Exposure to chemicals/toxins
  • Self medications
  • Family history

 

Signs &Symptoms:

  • Yellow skin and eyes (jaundice)
  • Abdominal pain & swelling
  • Swelling in legs and ankles
  • Itchy skin
  • Dark colour urine
  • Pale colour stool
  • Chronic fatigue
  • Nausea/vomiting
  • Loss of apetite
  • Tendency to bruise/bleed easily

 

DO’S AND DON’T’S

  • Avoid/Drink alcohol in moderation
  • Eat balanced diet
  • Maintain healthy weight & exercise regularly
  • Take hygenic food and water intake

 

(washing hands)

  • Avoid tattoos/piercings
  • Avoid unprotected sex
  • Avoid IV illicit drugs
  • Avoid contaminated needles
  • Use medications on prescription only
  • Protect your skin from chemical exposure
  • Get vaccinated
  • Regular health checkup

 

(The writer is Prof. & Head, Dept of Urology & Renal, VMMC & Safdarjung Hospital, Delhi)

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