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?

Miscarriage is a spontaneous abortion that occurs around the first to second trimester of pregnancy; wherein the foetus is automatically expelled from the uterus due to its inability to survive because of environmental influences or chromosomal abnormalities.

Unless the miscarriage occurs due to a severe health issue, the fertility of the woman may not necessarily be compromised. Studies show that one miscarriage doesn t predict the possibility of a future one. Once the bleeding and pain subside, it is the emotional trauma that must be addressed to begin with which poses a greater threat than the physical one.

The fertility of the woman remains unaltered and the body can be ready after the menstrual cycle returns to normal. However, it still requires some time for the woman to be physically and emotionally prepared to go through another pregnancy. The medical history and reasons behind miscarriage must be evaluated before the couple decides to try again.

Complications after miscarriage only occur if the woman is above 35 years of age or has a rather unhealthy lifestyle. The concept of fertility varies from person to person and it isn t possible to pass a common judgement about fertility in this scenario.

The gynaecologist mostly suggests couple therapy after the trauma of the miscarriage. The psychological loss is given more importance before considering another attempt by most doctors. The fertility loss only occurs with age and unhealthy lifestyle and it is widely accepted and proven that a miscarriage has little or nothing to do with it.

Ways to Increase Fertility

If a couple is certain they are ready to conceive again, there are a few things a woman can do to help her chances of becoming pregnant-

The first thing to do is to stop any unhealthy habits. These include smoking, drug use, or alcohol abuse. It s reported that high consumption levels of caffeine are detrimental to conception so that should also be limited.
Eliminating stress can also help. Eliminating stress is one of the most important factors in having a successful pregnancy. So, it makes sense that getting over-stressed can reduce fertility levels.
Eat healthy. If depression was experienced due to the miscarriage, it s possible that the woman s diet has not been the healthiest. It s common for women who have experienced a miscarriage to have a loss of appetite and not eat enough or to eat out of sorrow, eating too much. More attention should be paid to the diet and more healthy foods added to meals.
Talk to a Doctor

If a couple is having issues with fertility after early miscarriage, they should talk to a doctor. There are many options available. More than likely, the first thing the doctor will do is to test fertility levels of both the man and the woman. If you don't want to visit a doctor for this, there is a new at-home kit available called Fertell. This test, retailing for approximately $100, measures fertility levels for both a man and a woman.

If it is found that there is a loss of fertility after early miscarriage, fertility drugs or therapies may be prescribed for a period of time.

The doctor may report that there are no issues with fertility. At this point, it would be a good idea to use an ovulation predictor in order to time effective intercourse. This isn't the most romantic idea, but it may well be one of the most logical ways for a couple to conceive.

Bottom Line

Fertility is not normally decreased after miscarriage. A woman's fertility levels return to normal as soon as her menstrual cycle returns. Fertility may be decreased due to emotional issues as a result of the miscarriage. However, if a couple is ready, both physically and emotionally, there should be no physiological hindrances to conception.

The decision to try again is not an easy one. However, fertility won't typically be an issue.

Pregnancy - Understanding Fertility After Early Miscarriage!

In healthy individuals, the liver contains little or no fat. In overweight or obese people, gradual fat accumulation leads to significant liver disease. Interestingly, these individuals may be consuming minimal to no alcohol. So, alcohol, which is the main cause for liver damage, does not have a significant role to play.

The non-alcoholic fatty liver disease (NAFLD) has 4 significant stages as outlined below. It is a chronically progressive disease and may take years to reach the final stages of cirrhosis and fibrosis.

1. Simple fatty liver (steatosis): This is usually identified when diagnostic tests are done for some other suspected conditions. There are usually no symptoms obvious in this stage, other than the buildup of fat in the liver.

2. Non-alcoholic steatohepatitis (NASH): The second stage where the liver is inflamed to a greater extent due to fat accumulation.

3. Fibrosis: The next degree of inflammation where blood vessels may be narrowed leading to scarring in the liver with impaired liver functions.

4. Cirrhosis: This is the most severe stage that occurs due to years of cumulative inflammation. The liver shrinks in size, is scarred, and liver functions are markedly impaired and can also result in liver cancer.

Risk factors for NAFLD: The exact reason why a person develops NAFLD is not established, but some of the risk factors include

1. Obesity, with more weight concentrated around the abdomen

2. Type 2 diabetes

3. High blood pressure

4. High cholesterol levels

5. Age greater than 50

6. Smoking

Symptoms: This will depend on the stage in which it is identified. While there are no symptoms in the early stages, in some people there could be a dull, aching below the ribs, unexplained weight loss, weakness, and extreme tiredness. As it progresses to cirrhosis, there could be jaundice, fluid accumulation in the abdomen and feet, and itching of the skin.

Management: While there is no treatment aimed at curing the disease per se, there are ways to manage the symptoms, as noted below.

1. Weight loss: Reducing excess accumulated fat will help reverse symptoms and prevent further progression of the disease. A BMI of 18 to 26 is considered optimal.

2. Dietary changes: Modify your diet to a carbohydrates and protein rich and reduced fats and sugars. Increasing fiber through fruits and vegetables is highly recommended.

3. Exercise: Whatever your choice of workout, it will do wonders for NAFLD. Keep a target of an hour or two of moderate to intense exercise per day to reduce weight.

4. Smoking: This is another risk factor and can also help prevent other effects of NAFLD such as diabetes and heart disease.

NAFLD is highly controllable with these changes and other damages can be reversed too.

What is Nonalcoholic Fatty Liver Disease (NAFLD)?

Interstitial cystitis (IC), also known as painful bladder syndrome, is a difficult condition. It is difficult to diagnose and though there are treatments that can make life easier, there is no long-term cure. Interstitial cystitis is a lifelong bladder problem, that causes pressure and pain below the belly button. Symptoms can be constant, or they may fluctuate. It causes painful and urgent trips to the bathroom. In severe cases, you may need to urinate about 40 to 60 times in a day.

What causes interstitial cystitis (IC)?

The bladder is a hollow, muscular organ that holds the urine your body needs to dispose. The reason why IC occurs isn t that clear, but there a few ideas:
1. An issue with bladder tissue allows chemicals in your urine to irritate the bladder.
2. Chemicals that are released when there is an inflammation in your body can cause the symptoms.
3. The bladder can be attacked by your immune system
4. Substances in your urine can damage your bladder
5. Nerve problems can wreak havoc on your bladder

Signs and Symptoms
People suffering from IC don t display the same symptoms. The symptoms keep changing, be it every day, every week or every month. Sometimes, the symptoms may entirely disappear without treatment. Some common IC symptoms include:
1. Bladder pressure and pain that worsens after the bladder gets filled with urine
2. Pain in your urethra (the tube that drains the urine from your bladder), pelvis, lower back and lower tummy
3. Women experience vaginal pain (or the area behind it) or in the vulva
4. In men, a sensation of pain in the penis, testicles, scrotum or the region behind the scrotum
5. The urge to urinate, even if you had urinated a few moments ago
6. Women experience pain during intercourse
7. Men experience pain after sex or during orgasm

One common symptom shared by all people suffering from IC is a swollen bladder. There are certain things that can worsen your condition. These include:
1. Certain drinks or foods
2. Physical or mental stress
3. Menstrual cycles

Interstitial Cystitis (IC) - 5 Things That Can Cause it

The build-up of fat in the liver may lead to the development of a condition known as nonalcoholic steatohepatitis or NASH. This condition is not related to the consumption of alcohol and the inflammation is due to the buildup of fats in the liver. In most cases, there are no symptoms till the stage when the fat deposition causes inflammation and damages the liver cells. This also hinders the normal functioning of the liver and if not treated, it may lead to an extreme condition known as cirrhosis. However, NASH does not always get worse and with some precaution, it can be treated.

The cause behind the development of this disease is not alcohol consumption and it could be some environmental factor that triggers liver inflammation or heredity might be another reason. However, the risk of developing this disease is high for people who are obese, have metabolic syndrome, have high cholesterol or are resistant to insulin.

There are hardly any symptoms of NASH that are seen in the early stage of this condition. However, at a much-progressed stage, the following symptoms may be seen:

Weight loss
Fatigue and weakness
Upper abdomen pain
Diagnosing NASH requires undergoing several tests that include a blood test, a CT scan, an MRI scan and also an abdominal ultrasound.

Benefits of Ayurvedic remedies in managing NASH



There are remedies which help in detoxification of the liver. They also enhance the body s capacity to digest fats and prevent it from accumulating in the liver.
A few remedies are rich in vitamin C content as they are very effective in treating liver problems.
Some remedies are packed with the antioxidant and vitamin C. And, it is this vitamin C that helps the liver in producing the enzyme, glutathione, which neutralizes the toxins and detoxifies the liver of all of the toxins.
Some remedies contain catechins, which are known to enhance the functioning of the liver. They are great for blocking the fat stored in the liver and works wonder in fighting against diseases associated with the fatty liver disease.
There are some fruits that are effective in treating fatty liver diseases. These fruits burn the dietary fat rapidly and also improves the functioning of the liver if consumed regularly.
Some Ayurvedic remedies are a storehouse of the fat-soluble Vitamin E, and are known to protect your liver against the accumulation of fats and will keep your liver healthy.
Apart from including these natural ingredients in your diet, you will also have to reduce your body weight, reduce cholesterol level, control your diabetes, exercise regularly and stop consuming alcohol. However, home remedies are just supportive, but not a complete line of treatment for NASH so you cannot depend completely only on them. As mentioned NASH can disturb your normal liver functioning and if not treated it can lead to liver cirrhosis so take proper Ayurvedic treatment under the guidance of an Ayurvedic doctor.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Nonalcoholic Steatohepatitis (NASH) - Home Remedies That Can Help Treat It!

Dealing with liver Cirrhosis largely depends on its stage. While it is good to know and read about Cirrhosis, referring to some qualified medical personnel is the best course of action. If a person is already undergoing medical treatment, there are simple ways to deal with this condition.

Get treated in the early stages: Liver being one of the most self-healing organs, a person has good chances of healing, if a donor donates partial-liver. A doctor eradicates the distorted portion of the liver and replaces the same with a partial transplant from the donor. For the donor, it takes about 3-4 months to grow back the donated portion of the liver, while the patient might take 10-12 months to fully recover. This is possible in the early stages of Cirrhosis.
Stop the catalyst of liver Cirrhosis: It is essential to stop the underlying cause of Liver Cirrhosis. Stuff like saturated fat, alcohol, salt, OTC pain relievers, excess sugar etc should strictly need to be avoided to ensure the progression of liver Cirrhosis is slow. Studies have shown that moderate consumption of coffee can help to deal with Liver Cirrhosis.
Sodium free food: It is advised by most doctors that Cirrhosis patients refrain from consuming sodium-rich food. It helps a cirrhosis patient to bypass edema and ascites. This is extremely challenging, since food without sodium tastes bland and unappetizing. It is therefore suggested that healthy herbs, paprika, pepper etc are consumed to make up for sodium.
A balanced diet: A liver Cirrhosis patient should be extremely careful when it comes to choosing the right diet. They should consume lots of fresh fruits and green vegetables. While consumption of animal protein is not advised, the quota of protein should be fulfilled from peas, tofu, quinoa, etc.
A good exercise regime: Patients with liver Cirrhosis should ensure that an adequate exercise regime is followed so that the muscles do not get wasted. Exercise for half an hour also helps to lose weight and negate the chances of water retention in the body. Exercise should also be followed by lots of sleep, so that the body gets enough time to recover from the stress of exercise.
Avoid NSAIDs: If a person is suffering from liver Cirrhosis, using drugs such as naproxen, aspirin, ibuprofen, acetaminophen etc should be strictly avoided for mild pain and inflammation. These drugs can be highly toxic for a person suffering from Cirrhosis. It is wise to consult a doctor before consuming any medication.
Stay away from infection: A patient with liver Cirrhosis suffers from a compromised immune system. It is therefore advised that a patient stays away from possible bacteria, viral and such other chronic infection. Any infection can result in inflammation of the bile duct that causes scarring of the liver tissue.

Liver Cirrhosis - 7 Ways To Deal With The Problem!

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