All You Need To Know About Various Liver Diseases
The liver is the second largest organ in the human body that plays a key role in digestion and detoxification from the human body. It releases chemicals crucial for the digestion and also breaks down unwanted compounds and detoxes the body. We must commit ourselves to protecting the liver from myriad problems. Many things can lead to serious Liver conditions.
Read further to know about the top causes of Liver Diseases.
What is Alcohol Use Disorder?
The term Alcohol Dependence or Alcohol Abuse is no longer in use for all the disorders that are related to alcohol consumption. Alcohol related liver disease is still one of the most common reasons why patients with liver disease go to a hospital. It is one condition which is associated with very high morbidity and is measured in the epidemiological term as a disability associated for life, as well as mortality while affecting younger people mostly. So, that means it is one of the most common causes of premature death amongst people.
There have been a number of attempts to treat severe alcohol hepatitis cases medically but in most instances these patients are extremely sick and they require liver transplantation. It is very difficult to manage these patients medically. A number of treatment options like Fecal microbiota transplantation, and Plasma exchange exist but none of these therapies has become a gold standard of care.
In a sick patient, especially someone who is suffering with liver failure syndrome, the only way that can resolve the problem is Liver Transplantation. Though it is difficult and challenging, one must keep in mind that the patient receives good psycho social support.
The most important thing to suggest is to drink in moderation and we should be very aware of the fact that binge drinking or drinking outside of mealtimes harms the liver more than anything else.
What is Non Alcoholic Fatty Liver Disease?
Non Alcoholic Fatty Liver Disease is a syndrome in which the liver is laden with fat, the fat contained in the liver can be variable but it is at least more than 5% of the liver cells, if they are liver fat or triglyceride, we term this as fatty liver. Patients with fatty liver are associated with inflammation and others with scarry, and this progress is called nash cirrhosis. It is one of the commonest causes of chronic liver disease, world wide and also in our country. Even young children and adolescents are falling prey to this disorder. This is partly genetic, epigenetic, environmental and lifestyle related. So, it’s not uncommon for young children to be glued to the screens and then eat whatever comes their way. Carbonated beverages are a big culprit to cause this disease. Unfortunately there is no proven therapy for this disorder except weight loss, and weight loss is extremely difficult as these patients are generally overweight with various joint issues and sleep disturbances. There are associations with other disorders too including Cardiovascular disorders, menstrual irregularity, hypothyroidism, uric acid going up, lipids being abnormal and then these people are also highly predisposed to cardiovascular syndrome as well as affection of Cancers in various parts of the body. In fact this syndrome is one of the most common causes of Liver transplantation, now in our country and also in the western world.
As mentioned earlier, there is no approved medical therapy. The only thing that works is weight loss and that it has to be achieved by curving the calorie intake as well as by exercising regularly. It has been seen that if you lose 10% of your baseline weight then you can even reverse this scar tissue which has been led down in the liver. However this happens frequently and even in a smaller proportion of patients this is obtained.
This is a lifestyle disorder, and hence parents have to play a very responsible role. While examining patients in the clinic every effort should be made to see if there is a metabolic perturbation which has led to this condition and try to treat that. Be it diabetes, hypertension, displedemenia, all of these disorders can be treated medically, and that can affect the natural history of this disorder.
What is Hepatitis B?
Hepatitis B and Hepatitis C are the ruling viruses for liver diseases. We all know that for Hepatitis B there is an extremely effective vaccine, and should always encourage people to get vaccinated. In fact the guideline suggests that at the time of child birth itself this vaccine should be pushed to the newborn. It should also be administered to the pregnant ladies, but still we can find that the coverage for this vaccine is not still wide as this ought to be. Once you fall prey to the chronic Hepatitis B you know the treatment is almost life long. This is the area where there is still lots of activity and research that is continuing to go on but still we are not able to come to a finite treatment for this syndrome.
Patients who are diagnosed with Cirrhosis due to Hepatitis B virus face another challenge, this is the commonest cause of liver cancer in our country. To be very mindful that once somebody has developed cirrhosis these patients should be kept under lifelong surveillance. So, in every 6 months we should scan them through ultrasound and mark them as tumors and their family history of live cancer.
What is Hepatitis C?
This has been a huge success for the medical community. At one point of time the treatment is extremely challenging and often we used to meet with failure. But come to 2014 we got some revolutionary drugs which started directly acting like antivirus. These drugs, when used for a short duration of time like 20 to 24 weeks, are able to eradicate this virus. And because this is a virus which does not get connected with the nucleus of the virus cell it can be eradicated and never comes back once one has attempted this sustained response.
What is Liver Cancer?
Liver Cancers are the fourth or fifth common type of cancer in mankind and it is an extremely aggressive kind of tumor seen in the human body. Increasingly we can see these cases due to NAFLD syndrome. The challenge of NAFLD syndrome is that you need not even have cirrhosis to form a liver tumor. That means these patients can form liver cancer even in the absence of cirrhosis being there. Therefore the surveillance strategy is not well charted out for these patients. Again the important thing to say is that these tumors should be picked up early, if it is detected early at a presymptomatic stage there are higher chances to cure it. Cure can be in the form of removing the tumor surgically or if the tumor affects various parts of the liver you can pt for transplant. Or if you find that the tumor is such which can not be removed for the patient then you have to do what is called as down staging procedures. These are procedures which reduce the tumor volume and then we can cut the patient into a shape, the tumor could be removed or we should opt for transplant. But this is an extremely challenging tumor, very aggressive, associated with very high mortality. Strident progress has been made in systemic therapy against these tumors and this is with the help of new drugs which are certain drugs that increase the immunity of the body, these are called immune check nabutas. It is a very active research area and which is going to revolutionize even the patients with advanced unreciptaple liver cancer.
What is Acute Liver Failure?
Liver failure or Acute Liver failure means liver failure is happening in a person who did not have any liver related disease . It is a huge challenge and the number of cases is very few and far but high volume centers can see 12 to 20 cases every year with this particular syndrome. Has there been any medical progress made in this syndrome? Yes. Those who present very acutely what we call as Hyperacute liver failure, a proportion of them can survive by intensive care including plasma exchange. However the prognosis or however the patient is going to fear is still dependent on the etiology that means what causes the liver failure can determine the outcome of the patient. Again, patients who present with an advanced grade of coma, they often need transplants because without transplants their mortality is to the tune of 60% to 80%. Far more commonly we are seeing the syndrome of acute on chronic liver failure, that means this is an acute disturbance with the patients who already have an underline chronic liver disease to the brink. The patients then start to develop not just liver failure but other organ failure of the body also including kidney failure, brain failure and so on and so forth. This condition is at least four to five times more common than acute liver failure and again we should try to manage these patients medically with good liver intensive care and organ support systems and if we find that these patients are not getting better then these patients are offered liver transplantation.
What about Liver Transplantation in this challenging time?
Especially in the last one and a half year with the pandemic. In the initial stages of the pandemic it was very difficult for us to justify the transplant because everyone was scared, we were scared that these patients after transplants will go on immuno separation. Is it going to adversely affect their outcomes? We found very quickly that was not the case however as confidence built the transplant numbers have again come back to the pre covid era. Liver transplantation has made huge progress and this has been because of a number of reasons including good and carefully patient selection, improved surgical and anesthetic techniques and most importantly the medical treatment of these patients after care after transplantation has also undergone. The average time that a patient stays for a transplant has now reduced significantly to just about 7 to 10 days. Also there is an increased lining towards using low immune separation in these patients after transplant. There have been improvements on how to make or salving organs which are not of good quality and that is called machine perfusion. Again this has become available to our country but it is still expensive and the cost remains a little prohibitive.
Lastly, what has been the impact of covid on liver diseases and liver patients we have seen over the last few months that covid can affect the liver in a number of ways. The virus can damage the liver itself or stimulate it. Number of medicines that are used to treat covid also are hepatotoxic, potentially damaging to the liver. And then patients who already have chronic liver disease if they were to contract covid patients then rapidly the liver function can deteriorate. Earlier we used to feel that it is only people who are overweight are at risk for covid and adverse outcomes but now it has been see and increasingly recognised by a number of workers all across the world that even patients with fatty liver disease and that is now also considered to be a predisposition to more severe covid infection.
Patients with immune separation and those with autoimmune chronic disease have to be managed well. If they get infected by COVID19 virus, they have to modulate their immune separation, so that the body can get rid of this virus and then once they have tested negative by PCR and their symptoms have resolved then these patients slowly move back to their initial immune suppression.
Pro health tips for the liver is a moderate diet, physical activity, and the things that downplay are alcohol indulgence, choosing junk food, carbonated beverages, not exercising, and then being indiscrete.
- Liver Diseases. Healthline, https://www.healthline.com/health/liver-diseases. Accessed on 16th April 2021.
- Liver disease. Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502. Accessed on 16th April 2021.
- Liver Diseases: What You Should Know. WebMD, https://www.webmd.com/hepatitis/liver-and-hepatic-diseases. Accessed on 17th April 2021.
- Liver Disease. MedicineNet, https://www.medicinenet.com/liver_disease/article.htm. Accessed on 17th April 2021.
About Author –
Dr. Dharmesh Kapoor, Sr. Consultant Hepatologist, Yashoda Hospital, Secunderabad
Liver Diseases & Transplant Surgery