The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

Sugar is the trigger to most of the diseases an adult faces in present times. Sugar is not only harmful for adults, but can pose severe threats to the health of a child as well, if not administered in monitored proportions. But again, sugar is indispensable when it comes to sweetening your drinks and desserts. In order to prevent yourself from the health hazards of sugar, you should know more about its scope and effects.
1. Sugar can lead to a fatty liver: Fatty liver is a troubling issue faced by many across the globe. It is wrong to think only alcoholics are subjected to this health condition. People who exercise little and consume huge amounts of fructose are also exposed to the threat of this disease. When a person doesn't do enough to burn up the existing amount of glycogen in his or her liver and take in fructose repeatedly, the liver turns that fructose into fat, impairing one's liver capabilities to a great extent.

2. Sugar may make you resistant to Leptin: Leptin is a hormone released by your fat cells. The hormone is particularly necessary as it sends signals to your brain telling it you are full and won't be requiring any more food. Fat people have more number of fat cells and thus additional Leptin too. The Leptin becomes inactive due to the effects of heightened blood triglycerides and insulin, both of which counter its functioning.

3. It is addictive and there lies the key to temptation: Sugar is enormously addictive. If you like sweetened products, you will find it hard to resist your cravings for cakes, cookies or chocolates. Sugar accelerates dopamine secretion; this hormone makes a person feel good. Dopamine is the hormone released on the consumption of drugs such as cocaine.

4. Calories in sugar are not balanced out with any mineral or vitamin: Because of its lack of nutrient value, sugar is said to have empty calories. Food items rich in sugar tend to make a person lethargic and slackened while depriving them of essential minerals and vitamins. It is therefore, best to not allow children to have pastries, chocolates or puddings in excess.

5. Sugar leads to extensive tooth decay: Sugar can accumulate on your teeth if you are having too many sweetened food items. This causes your teeth enamel to wear away, making it more prone to cavities and dental caries.

Why You Should Stay Away From Sugar?

The liver is a vital organ within the body, which functions as a filter for the blood that comes from the digestive system. One of the conditions that afflict this organ is fatty liver, which occurs due to the accumulation of triglycerides within it. There could be multiple reasons behind this, such as alcoholism, obesity, pregnancy, hepatitis among many others. Homeopathy has some great treatments for fatty liver disease, depending on the cause.

1. Nux vomica: one of the major reason of developing a fatty liver is alcoholism. While drinking moderate amounts of alcohol isn't harmful, the tendency to drink very regularly will lead to fatty liver disease. In such cases you may feel pain in the abdomen, especially a few hours after eating. You may also suffer from constipation with cravings for fatty and spicy food. Nux vomica is thus prescribed in these conditions.

2. Phosphorus: fatty liver has many symptoms, which may manifest differently in different people. Many people complain about indigestion and sour belching. Your liver area may be painful and you may also vomit. You may constantly crave for foods such as ice-creams, juices and cold drinks. In such case, s you may feel weak after passing stool. Phosphorus is a great remedy in such cases.

3. Chelidonium: this is one of the best overall remedies for fatty liver. Some of the symptoms where chelidonium may work are as follows:
A) pain in upper right abdomen
B) enlargement of liver
C) constipation
D) jaundice along with fatty liver
E) feeling excessively weak
F) craving for hot drinks and hot foods

4. Calcarea carb: if you are obese or fairly overweight and suffer from fatty liver, calcarea carbonica can be very effective in treating the symptoms. Some of the symptoms exhibited by the patients where this medication is effective would be a yearning for eggs, profuse sweating and sensitivity to air if it's cold.

5. Lycopodium: this medication is very effective in treating fatty liver disease, especially if you suffer from gastric issues and acidity. You may have symptoms like, bloating of the stomach, burning of the esophagus when belching or burping and pain in the upper right abdomen. You may also exhibit cravings for hot drinks and sweets.

5 Homeopathic Remedies for Fatty Liver

Fatty liver or fatty liver disease refers to the accumulation of fat cells in the liver. The liver typically contains some amount of fat. The liver tends to convert usual food into protein, fats and sugar. Some fat in your liver is normal. However, in case that it makes up more than five to ten percent of the organ's weight, you may have a fatty liver.

The basic fatty liver is otherwise called steatosis. Over the top fat in the liver can cause the liver to get swollen and lead to liver damage. Fatty liver aggravation can be brought on by excessive alcohol abuse in which case the condition is known as alcoholic steatohepatitis. However, it can also be brought about by obesity and is then known as nonalcoholic steatohepatitis or NASH. As the ailment advances, liver irritation can prompt cirrhosis and liver failure.

Ayurveda is an old Indian medical system that makes use of herbs existing in nature to create homegrown cures using the intrinsic power present as a part of these herbs. Ayurveda uses the intrinsic power of normal herbs to bring results when it comes to curing various ailments. The herbs are natural and are hundred percent safe. They enhance the body s digestive system and help recover from various diseases and

disorders. The herbs enhance the immune system and strengthen the body in a healthy way.

Here are a few methods to treat fatty liver with Ayurveda:

Terminalia (Arjuna): The herbs of Arjuna have been used since ancient times for its radiant properties. It has unique healing effects on the heart as it tones the cardiovascular muscle and in this way protects it as well. It does so by reinforcing the cardiovascular muscles.

Boerhavia Diffusa (Punarnava): Punarnava is a brilliant Ayurvedic herb with diuretic properties and builds the renal blood stream. It has astringent, sharp, mitigating and calming properties.

Phyllanthus Niruri (Bhumi Amla): It is an exceptionally effective herb appropriate for the management of Hepatitis B and different types of Hepatitis. It has been utilised as a soothing agent for the kidney and liver damage. It is fit for taking out poisons and toxins from the body.

Andrographis (Echinacea): Andrographis is well known for its superb effects on the immune system. It boosts the immunity of the body. It has incredible control over the inflammatory responses in the body. Echinacea is found to have antimicrobial properties that function admirably in infective conditions. It gets rid of distinctive types of diseases and infections.

Cinnamomum Zeylanica(Dalchini): It is a typical Indian herb utilised mostly in each Indian kitchen. Its regular use reduces breathlessness and reinforces the heart muscles, vascular framework and acts as an antioxidant. Cinnamon  is also known to control nausea, sickness and diarrhoea.\

Fatty Liver - Effective Ayurvedic Ways to Treat it

The liver is the second largest organ in the human body. Everything that is consumed goes through the liver and gets metabolized. Generally the liver consists of fat accumulation, in the range of 2%, but when it reaches close to 10%, the condition is termed as fatty liver. Progression of fatty liver can lead to cirrhosis and eventually liver failure. The liver has an amazing ability to regenerate itself if a part of it is damaged. 

However, if the damage is cumulative, then the repair becomes difficult. Another point to note is that the liver can be resected in parts to ensure that the non-affected liver continues to be available to take care of the metabolism.

Causes: There are two main types of fatty liver:

Alcoholic fatty liver: This is the most common type and is seen in heavy drinkers.
Non-alcoholic steatohepatitis (NASH): The causes for this type are not clear, but obesity, diabetes, and hyperlipidemia are some causes for NASH.
Symptoms: Fatty liver develops over years, and the symptoms are both vague and appear randomly. These can be attributed to any general illness, and so diagnosis is often delayed.

Unexplained weight loss
Jaundice
Loss of appetite
General malaise
Dull pain in the right upper quadrant of the abdomen
Overall physical weakness
Ascites or fluid accumulation in the abdomen
Increased tendency to bleed
Abnormal liver enzyme levels
Diagnosis: If suspected of fatty liver, the following are done to confirm the diagnosis.

Blood tests to check for liver enzyme levels.
Imaging studies including x-ray, CT and/or MRI scan
Biopsy to confirm the diagnosis
Treatment: Fatty liver is a completely reversible condition. If a person with alcoholic fatty liver quits drinking for about 8 to 10 weeks, the damage can be totally reversed.

If there is no history of alcoholism but obesity, then switching to a non-fatty diet with lots of fresh fruits and vegetables, multigrain, dairy products, etc., can help in controlling fat accumulation and use the stored fat. Increasing the levels of physical activity also helps in burning stored fat.

As noted, the liver is capable of self-repair and self-regeneration, so if further triggers are stopped, it can heal itself.

If fatty liver is not controlled, it can develop into cirrhosis and liver failure. If it reaches liver failure, then survival rates and prognosis look very gloomy.

Prevention: Fatty liver disease can be prevented by controlling alcohol intake, adopting a healthy lifestyle, eating non-fatty and non-sugary products, and maintaining an active and healthy lifestyle.

Monitor health periodically to check on liver function, diabetes, and cholesterol levels.

Fatty Liver - All You Need To Know!

With the growing market for organic products, there is a widespread confusion on which product to choose. The same dilemma holds good in selecting the type of bread. White bread or Brown Bread? People are not sure which one to eat to stay healthy. A few quick facts about the two types of bread and which one should be consumed to stay healthy, are given below

White Bread
White bread is made out of refined wheat flour that has nothing to offer for the body. During the process of making white bread, the bran and wheat germ is removed from the wheat flour and Potassium Bromate, Benzoyl Peroxide or Chlorine Dioxide gas are used for bleaching to generate the whiteness. Potassium Bromate is highly dangerous if consumed in large doses. Chlorine dioxide is also used as a pesticide and is considered hazardous to the environment. When a large amount of white bread is consumed, the refined carbohydrates generate high levels of insulin thus, resulting in higher chances of weight gain. In spite of being globally popular, white bread is highly unhealthy for your body. It is completely devoid of nutrients and it is as harmful as table sugar for the digestive system.

Brown Bread
The American Academy of Pediatrics has revealed that whole wheat brown bread is rich in nutrients compared to the white bread. One major factor contributing to the above-mentioned fact is the amount of fiber present in whole wheat brown bread. The increased fiber content slows down the digestion process and thereby, reduces the effect on blood sugar and production of insulin. Other nutrients that are present in brown bread include vitamin B6, E, Folic acid, Zing, Copper and Manganese. Brown bread has lesser amount of calcium as compared with brown bread. Many manufacturers claim that they produce brown bread with the same amount of calcium as in white bread. Whole wheat bread contains Phytonutrient also called as plant lignans that have been observed to protect against heart diseases and breast cancer.

Things to consider while buying Brown Bread
The declining demand for white bread has forced a lot of manufacturers to use caramel as a coloring agent to darken white to brown bread. So buyers need to carefully look for the ingredients mentioned in the packing to ensure that they are buying the right product. It is important to check the first ingredient to see whether it is whole wheat or whole meal flour. If the word "enriched" is used, it means that the same flour used for white bread is used. Look for the bread with the minimum ingredients to ensure that you get maximum nutrients and very little additives. Also, make sure the amount of the following ingredients are as given below; sodium should be lesser than 401mg, saturated fat should be 1gm and fiber needs to be 4gm per 2 slices of serving.

To conclude, when it comes to organic and fitness oriented scenarios, brown is always better than white.

White Vs Brown Bread - Which One Should You Eat ?

Don't wait any longer, manage your Fatty Liver Diet online with a Lybrate doctor today

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