The liver is the largest internal organ in our body which performs multiple functions and it is the only gland that can regenerate quickly when it is healthy. The main role of the liver is to clean and filter blood coming via digestive tract previous to it flows to remaining body parts. Liver failure results in reduced ability of blood clotting, thereby causing severe problems in case of injuries. Apart from that, alcohol and viruses are also significant factors that stop the liver from functioning properly.

Liver Transplantation
Liver Transplantation enables even the people at the final stage of liver failure to lead longer and happier life. The success rate of Liver transplantation has increased drastically due to advanced surgical techniques. Liver transplant is the best option when the liver is damaged partially or entirely. It is a surgery that involves replacing a failed liver in a recipient with a healthy liver of a donor.

Who should go for it?
The main cause of liver failure in infants is Biliary Atresia. This occurs when bile ducts are absent or partially/fully blocked. Whereas in adults, liver disease is caused due to Cirrhosis - a condition in which liver is scarred and becomes dysfunctional in the worst case. Most common reasons for Cirrhosis are Hepatitis B and C, genetic disorders, alcohol consumption, toxic metals and obesity. One should immediately seek advice from a doctor when he/she suffers from following symptoms:

Fatigue
Nausea
Weakness
Weight loss
Jaundice
Fever
Abdominal Pain
Itchy Skin
Liver Transplantation Surgery
Two kinds of the liver transplant are available: 

Deceased donor transplant 
Living donor transplant
There are not enough deceased donor livers available to match all the liver transplant needs. Any living donor with a matching liver can donate a part of their organ to the person undergoing the liver transplant. As the liver can regenerate itself to its normal size in healthy people within a few months, there are no side effects of donating a part of the liver. A thorough physical and mental health examination will be performed for both the donor and the recipient to ensure that they can cope with the process and are aware of the risks involved. This includes psychological tests and blood tests. Patients are added to a waiting list as per their priority score. The score is assigned to a patient based on three blood samples creatinine, bilirubin and INR.

The priority score is termed as MELD (model of end-stage liver disease) in adults and PELD (pediatric end-stage liver disease) in children. The patient cannot undergo liver transplant if he/she has contracted cancer in any other part of the body or is suffering from heart disease or severe infections.

During the liver transplantation procedure, the surgeon removes some part of the liver from a donor and replaces damaged liver in the recipient with it. Both recipient's and donor's liver re-grow rapidly and reach normal size within months. As per statistics, recipients who receive the liver from living donor have a higher survival rate than those who receive it from deceased donors.

After surgery, both donor and recipient should maintain healthy and clutter-free life and follow strict diet rules and get vaccinated as per the chart provided by the doctor. They also need to avoid consumption of alcohol entirely and talk to a medical practitioner before taking any medications.

Liver Transplant Surgery - Who Should Go For It?

The human body s ability to manage the fats consumed and the way the liver functions to handle this in the overall metabolism setting are dependent on choline. Choline, which is present mostly in the form of Vitamin B12, is available in plenty in most of the foods consumed by people regularly. The issue arises when the body system fails to absorb choline nutrient from the food consumed. There are also cases where the dietary intake does not possess adequate choline in it.

Natural Difficulty in Absorbing Choline
There are certain conditions in which the system finds it difficult to absorb choline though the diet may contain the nutrient. People who have just undergone a by-pass surgery or those who have had a kidney transplant done or if there is already a liver problem like cirrhosis face this issue. There are other reasons also which can lead to choline deficiency, such as the prolonged intake of anti-convulsant drugs and so on.

How to Detect or What are the Symptoms?
Some apparent symptoms can lead the GP to ask for more tests to establish that the person does have choline deficiency. In normal person, even high blood pressure could be caused due to choline deficiency. Then in many cases, a blood test for any other condition might reveal very low levels of VLDL (Very Low-Density Lipoprotein). This substance in the blood is used by the liver to transport fats and naturally, if VLDL is below a certain threshold the person is bound to be suffering from choline deficiency. High level of cholesterol is another symptom. It has to be understood that choline is also essential for the human brain to be functioning at its active best. Deficiency of choline can lead to an early setting in of dementia. Of course, any patient with liver and kidney related condition reaching the doctor will be checked for choline deficiency since these are closely related.

Where to Get Choline from?
The next obvious question is which foods can get you choline easily and you won t suffer from a deficiency. As mentioned there are plenty of food items of daily consumption which have choline in them. The most frequently recommended are the yolk of the egg. Pastured eggs are recommended and though even one egg can give some 115mgms of choline, you can make a couple of eggs a part of your daily breakfast menu. The other suggestion is raw liver as in beef liver which is quite rich in choline. Those who consume only vegetarian foods can always eat a lot of green vegetables like cauliflower, cabbage and also nuts and legumes (soaked) and milk and yoghurt are all good for choline intake.

Choline is an essential nutrient in the human body and is critical to the growth and development of cognitive functions and its deficiency can lead to many serious conditions, including liver impairment and brain disorders. There are plenty of foods rich in choline and should be consumed regularly.


Choline Deficiency - Signs You Are Suffering From It + Sources Of Choline!! 

Pregnancy is a time when your body undergoes a plethora of changes, both emotionally and physically. In such a situation, an acute liver failure only triggers further complications, threatening to affect both the mother and the fetus. The ambit of liver diseases range from mild complications to those that can be life threatening. Acute liver failure or ALF, as it is commonly known as in medical parlance is a condition which is caused when then there is a sudden impairment of the ability of the blood to clot. In spite of the erratic nature of the ailment and its ability to affect anybody with a complete disregard of the individual, s pre-existing history of liver problems, there are certain causes that are said to propel it. Some of them are-

Eclampsia with liver infraction: This is an extremely rare condition. Generally, eclampsia refers to the occurrence of convulsions in pregnant women, mostly in those who suffer from high blood pressure. Those women who suffer from eclampsia along with liver infraction are more susceptible to have a liver failure.
Hepatic rupture: Much like eclampsia, hepatic rupture is also caused in women who have high blood pressure. This heightens the risk of an impending liver failure in pregnant women.
Fatty liver: Sometimes excess of fat develops in the liver deterring its functioning. This is not only detrimental to your health but also poses a great danger in triggering a liver failure.
In spite of these, there have been multiple treatments which have developed to manage and curb it. Some of them are-

Remedial measure for coagulation: The inability of blood to clot blood is known as coagulation which is extremely fatal and one of the primary causes that leads to liver failure. Therefore timely and potent intervention of medicine is important to prevent that and in turn diminish the possibility of liver failure.
Volume replacement: Volume replacement refers to the condition where fluids are resuscitated or replenished into the body, those that were lost but at the same time are mandatory for the proper functioning of the body.

Acute Liver Failure in Pregnancy

Liver is one of the most important organs of the living beings, which performs various functions to keep the body healthy and fit. In some people, the liver will be malfunctioning due to several reasons. So, in these technology days, it is possible for the transplanting it from a healthy person to the patient. Though it is possible but, this transplantation will not be successful for all which can be due to individual health conditions and the stage of liver failure. In order to determine whether a patient can go for the liver transplant or not there are several tests to consider.

Steps to undergo liver transplantation
Liver transplantation is not as simple as it is said, but there are several steps to consider before one thinks of this surgery. Some of the primary steps involved in the process of liver transplantation are:

The first step is to visit the doctor and discuss about liver transplantation.
Then as per the suggestion of the doctor visit the referred liver transplant centre.
The patient is provided with the required information regarding liver transplant.
In this course of time patient will meet several members of the transplant team.
Next medical history of the patient is viewed and recommends some tests to determine the requirement of transplantation.
Then the results of the tests say about the patient condition.
After that, a donor is found out who can be either a living donor or deceased one.
Once the donor is found, transplant centre asks the patient to be prepared for the transplantation.
Process of determining liver transplantation
Determining the requirement of liver transplantation is the most important step which is evaluated by the specialists only. These specialists will be from various fields to know whether it is highly essential or not. This evaluation will be based upon the medical history of the patient, in some of the cases interviewing or discussions with the patient and huge number of tests. All these will be conducted by a professional liver transplant team at the liver transplantation centre only. This team includes:

Liver specialists are also known as Heptalogist
Transplant coordinator
Transplant surgeons
Psychiatrist
Financial coordinator
Social worker
Insurance manager
Anesthesiologist
Dietitian
Chemical dependency specialist
Tests to evaluate the need of Liver Transplantation
Patients are required to present all their previous health records which include X-rays, liver biopsy slides along with the medications during the pre-evaluation of liver transplantation. The common tests that are performed to evaluate the necessity of liver transplantation include following:

Computed tomography for generation of liver pictures
Doppler ultrasound for checking blood vessels from and to the liver is in open condition.
Echocardiogram for the evaluation of heart condition.
Pulmonary function to determine the condition of lungs in respiration process.
Blood test to check the type of blood, clotting ability along with the biochemical status of the blood.
In some patients, AIDS along with Hepatitis are also included.
All the above tests along with the exams help in diagnosing if a patient needs liver transplantation depending upon the condition.

How To Evaluate If Liver Transplant Is Required By A Patient?

Fatty liver is a condition where excess fat is deposited on this organ. Also called as steatosis, this condition happens when more than 5- 10 percent of the weight of the liver is made up of fat.

Fatty liver is a common condition among people. A study from coastal regions of India found ~ 25% of healthy persons had patients had fatty liver on ultrasound.

It can occur at all ages including childhood, highest prevalence is in 40 50 year age group. Prevalence more in patient who are obese and in diabetic patients.

Types of Fatty Liver

1 Alcoholic fatty liver: This condition occurs when there is a heavy consumption of alcohol. Gastroenterologists recommend abstention from alcohol for this condition to subside. If the patient continues to consume alcohol, then liver cirrhosis may develop.

2 Non alcoholic fatty liver (NAFL): One may develop a fatty liver even if one is not an alcoholic. The liver in some cases is unable to process the fat in cells causing them to build-up on the organ.

When more than 10% of the liver is made of fat then this condition is called Non Alcoholic Fatty Liver (NAFL).

Non alcoholic steatohepatitis (NASH): When fatty liver is associated with inflammation in liver patient is said to be having Non alcoholic steatohepatitis. NASH is a more advanced stage of NAFLD, and has a higher risk of progressing to liver cirrhosis or hepatocellular carcinoma (HCC). These condition display symptoms like jaundice, vomiting, nausea, loss of appetite and abdominal pain. Blood test (LFT) shows raised enzymes level. Approx 5-8% of the Indian population has NASH. Consult a doctor if you are experiencing any of these symptoms.

3 Fatty liver during pregnancy: Occurring mainly in the third trimester, the symptoms of this condition are vomiting, nausea, pain the right part of the abdomen and jaundice.

Symptoms

During the early stages (fatty liver) of the disease, patients usually have no symptoms directly related to liver disease. However, people may experience a vague abdominal discomfort. If their liver is inflamed (NASH) then they may display symptoms of poor appetite, weight loss, pain in the abdomen and disorientation.

What causes fatty liver?

The most common cause of fatty liver is alcoholism. When the human liver is unable to metabolize fat fast enough or when there is an excess accumulation of fat on the liver cells then the liver becomes fatty. However, intake of high-fat foods may not result in a fatty liver.

Predisposing factor:

1 Diabetes mellitus

2 Obesity or being overweight

3 Hyperlipidemia or the condition where there are high levels of fat in the blood

4 Genetic reasons

5 Rapid loss of weight

6 Drugs: Aspirin, steroids, tamoxifen, tetracycline etc. cause side effects which also leads to fatty liver

7 Nutritional status (eg, overnutrition, severe malnutrition, total parenteral nutrition [TPN], or starvation diet)

8 Other health problems (eg, Hepatitis C infection, celiac sprue and Wilson disease)

Know More About Fatty Liver!

Liver disorders are very common. Gastroenterologists trained in liver diseases are known as Hepatologists.Symptoms of liver disease include jaundice, vomitting of blood(Hemetemesis), bleeding in the motions(also known as Melena or hematochezia),altered sensorium known as Hepatic encephalopathy(HE), Renal failure also known as Hepatorenal syndrome(HRS), Breathlessness (due to Hepatopulmonary syndrome and portopulmonary hypertension).

Let s understand the liver disease point by point: 

1. Hepatitis B: Hepatitis B is a virus which is usually acquired in four ways. Unprotected sexual intercourse with the infected partner, from infected to the child, infected needles, infected blood. It takes many years for the hepatitis B virus to cause liver damage. Once the liver is damaged it is called Cirrhosis or chronic liver disease. When liver is more then 80 percent damage, it causes blood vomiting also known as hematemesis, Ascites(water in the stomach), Jaundice, HE, HRS etc. Treatment depends on virus count which is calculated by HBV DNA PCR and other lab parameters. Once the treatment starts monitoring of viral count is done to document the effectiveness of the treatment. All the family members and sexual partners must get HbsAg screening done to detect early silent infection. All those who test negative, Hepatitis vaccination should be done, by three injections which provide them with 100% protection against the HBV infection.

2. Hepatitis C: Hepatitis C is a virus which is acquired by injection drug abuse and infected needles and blood. Transmission by unprotected sexual intercourse is possible but chances are very low. Hepatitis C virus damages the liver slowly and takes years before clinical symptoms of liver failure appear. Once the liver is damaged it is called Cirrhosis or chronic liver disease. When the liver is more than 80 percent damage, it causes blood vomiting also known as hematemesis, Ascites(water in the stomach), Jaundice, HE, HRS etc. All hepatitis C virus infected patients must be treated irrespective of virus count. Baseline virus count by HCV RNA  is done to measure the effectiveness of the treatment. HCV Genotype is done for patients with cirrhosis. Vaccination is not available for hepatitis C but newer medicines(Direct acting antivirals DAA) for Hepatitis C can cure it with more than 95% certainty.

3. Acute viral Hepatitis: Sudden infection in the liver can be due to multiple causes but commonly is due to Hepatitis A and Hepatitis E, which are caused due to eating or drinking contaminated food and water. Rarely Hepatitis B and Hepatitis C can cause Acute hepatitis including Acute liver failure. Acute hepatitis presents with Jaundice, loss of appetite, generalised fatigue, vomiting and abdominal pain.  Patients are usually treated on an outpatient basis but if they have severe vomiting, abdominal pain or altered sensorium, they are admitted for inpatient care and monitoring. Drugs or complementary and alternative medicines (CAM) such as herbal or bodybuilding protein supplements which contain steroids and heavy metals can cause acute hepatitis.

4. Liver transplant: Removing the damaged liver and to put a new liver in the patients is called Liver transplant. Liver transplant is major surgery and costs around 20 to 30 Lacs. Indications of liver transplant are an acute liver failure due to hepatitis viruses such as hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E, decompensated cirrhosis due to any cause including chronic hepatitis B and C, Drug-induced liver failure such antitubercular drugs(ATT). The donor for liver transplant is either a close relative (Living donor liver transplant LDLT) or a brain dead donor (deceased donor liver transplant DDLT).

5. Chronic liver disease or Cirrhosis: It is the end result of slow damage to the liver, where many liver cells are damaged and replaced by fibrosis. Apart from viruses such as Hepatitis B and Hepatitis C, Alcohol is one of the most common causes of cirrhosis.

Drinking alcohol for years together causes irreversible liver damage causing cirrhosis. Alcohol can cause acute severe hepatitis, acute liver failure and chronic liver disease.  Patients with suspected heavy alcohol drink must-visit Hepatologist (Liver doctor ) for proper diagnosis of stage of liver damage and deaddiction programme. USG Abdomen, blood tests, endoscopy and Fibroscan is usually done to know the liver health.

Fatty liver is also known as non-alcohol fatty liver disease(NAFLD) is a lifestyle disorder due to lack of exercise, high fat diet, obesity and due to drugs. Fatty liver causes silent liver damage and if not recognised in time can cause irreversible liver damage and cirrhosis. The evaluation includes Liver function tests, Ultrasound abdomen, Fibroscan. Treatment includes daily moderate-intensity aerobic exercise, drinking coffee and a low-fat diet. Few medicines are available which help in the reversal of fatty liver.

What Should You Know About Liver Disorders?

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