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!

Cirrhosis of the liver is a chronic and progressive condition in which the liver gets damaged and healthy liver tissue is replaced with scar tissue, ultimately causing dysfunction of the liver. Liver damage obstructs the circulation to the liver and also hinders the processing of nutrients, hormones, drugs, toxins as well as the production of proteins and other substances made by the liver. Liver cirrhosis is caused due to hepatitis C, fatty liver, alcohol abuse, viral infections, inherited diseases, and as a toxic reaction to drugs and environmental waste products. The modern management of this condition involves diet modification, reduction in salt intake, total abstinence from alcohol, and avoiding all the causative factors of this condition.

Cirrhosis of liver causes multiple symptoms in the body including fluid collection in the abdomen, bleeding varices in the stomach, chronic heart failure, damage to the central nervous system, and various metabolic disorders in the body. Advanced cirrhosis of liver is ultimately fatal.

Ayurvedic Treatment

It is therefore of prime importance to commence treatment at the earliest possible. It is of utmost importance to treat the known cause of the condition. Ayurvedic herbal medicines have a definite action on the hepatic cells and can effectively treat inflammation within the liver. Ayurvedic medicines can also treat infection as well as metabolic dysfunction of the liver, and protect it from the toxic effects of drugs and environmental wastes. Ayurvedic medicines can therefore be effectively used to treat all the known causes of liver cirrhosis.
Liver damage causes healthy cells to be replaced with scar tissue. This is preceded by a process of inflammation, swellingand gradual death of the liver cells. Early institution of Ayurvedic treatment can help dramatically reduce inflammation and swelling and thereby preserve the liver cells and prevent unnecessary damage. Even in the early phase of scar deposition. Ayurvedic herbal medicines can help remove scar tissue, minimize permanent liver damage, and help regenerate damaged or near-dead cells Ayurvedic herbal medicines, therefore, form a comprehensive treatment therapy for liver cirrhosis.
The other symptoms resulting from liver cirrhosis such as ascites, esophageal varices, congestive cardiac failure and metabolic disorders start improving automatically when the obstruction in the liver is treated and removed. However, Ayurvedic medicines can treat these symptoms independently too, if these are observed to be severe in the affected individual and require urgent medical care. Improved functioning of the liver also helps to improve the overall metabolism and nutrition of the body and metabolize toxic substances within the body. Prompt and aggressive Ayurvedic treatment, therefore, helps comprehensively treat liver cirrhosis and significantly reduce morbidity and mortality resulting from this disease.
Cirrhosis can also adversely affect the central nervous system and cause psychotic symptoms and permanent nerve damage. Prompt treatment with Ayurvedic herbal medicines also helps to preserve the brain function and treat the associated symptoms. If required, brain damage can be treated separately with herbal medicines which strengthen the nervous system and help rejuvenate nerve cells. Medicines which act on the nervous system also help improve confidence and self-control and are therefore equally useful in helping the affected individual abstain completely from alcohol, which is a known and predominant cause of cirrhosis.
Depending upon the severity of the condition, most individuals affected with cirrhosis require regular and aggressive Ayurvedic herbal treatment for periods ranging from six to eighteen months, in order to obtain significant benefit and a possible complete cure from the condition. Ayurvedic treatment thus has a definite role to play in the management and treatment of cirrhosis.

Cirrhosis Liver - Ayurvedic Remedies That Can Help!

Healthy living is the key to a happy life, there are plenty of ways to lead a healthy life. An effective one is to include kidney beans as a part of your diet because as per Ayurveda, legumes should be part of almost every meal of the day as they are a rich source of protein. Kidney beans as you must be aware is a type of bean that gets its name from its shape, which is like a kidney. These are readily found throughout the year both in dry as well as in canned form.

What health benefits do they offer?
With the help of the kidney beans, you can prepare many delicious dishes which you can enjoy and at the same time enjoy the health benefits as well. Kidney beans offer a lot of health benefits which are being discussed below.

Excellent source of fiber: Kidney beans are an excellent source of both soluble and insoluble fiber. Most importantly, the fiber present in the kidney beans helps in the lowering the level of cholesterol in the blood. According to Ayurveda, kidney beans are extremely helpful in the prevention of many disorders of the digestive system. It helps in keeping the digestive system absolutely clean and free of problems. In addition to this, the fiber content in kidney beans is extremely good for patients suffering from diabetes since it can keep the blood sugar under control.
Good source of energy: Kidney beans help in the replenishment of iron in the body which is the integral component of hemoglobin in the blood. The iron is the key enzyme for the production of energy and metabolism in the body. Thus, kidney beans are an excellent source of energy. Moreover, kidney beans also promote the slow burning of the complex carbohydrates thereby providing energy to the body while stabilizing the level of sugar in the blood. These beans are also a good source of the trace mineral manganese which acts as the vital cofactor in energy production in the body.
Good for heart and memory: Kidney beans contain significant amount magnesium and folate which helps in the lowering of homocysteine which reduces the risk of heart attack, peripheral vascular disease or stroke. The rich supply of magnesium in the kidney beans provide great benefits to our cardiovascular system. These beans are also rich in vitamin B1 or Thiamine which are extremely good for the brain cells and cognitive function.
Since kidney beans provide numerous such benefits, you can make it a part of your diet. In case you have a concern or query you can always consult an expert & get answers to your questions!

Kidney Beans (Rajmah) - Are They Good For Your Health?

The liver is a key organ in metabolism and will have some amount of fat. However, excessive fat accumulation in the liver can be abnormal and is referred to as fatty liver. If the fat content exceeds anything more than 5% to 10% of the liver s weight, it would be referred to as fatty liver.

Types - There are mainly two types based on causes:

Alcoholic fatty liver: This is very common in people who consume excessive amounts of alcohol. Even a one-off instance of binge drinking can cause increased fat accumulation in the liver, but it would not produce any symptoms though. Preexisting hepatitis, pregnancy, obesity, and genetic predisposition may also lead to alcoholic liver disease.
Non-alcoholic liver disease: This is the less common type of fatty liver, and there would be no alcoholic abuse history here. However, there could be genetic predisposition, obesity, autoimmune liver disease, malnutrition, which can lead to this condition.
Symptoms

Fatty liver disease is a chronic condition with insidious onset (meaning to say, the exact time of onset cannot be pinpointed). However, as the disease condition progresses, symptoms will become evident, which can trigger a medical evaluation to identify the fatty liver. Some of the symptoms include:

Excessive fatigue and weakness
Unexplained weight loss
Loss of appetite
Nausea
Trouble focusing and concentrating
Impaired judgment
Constant, slow enlargement of the liver can cause pain in the right upper quadrant of the abdomen (where the liver is)
There could be jaundice, where the skin and the white of the eyes turn pale yellow
Symptoms of liver failure, including increased levels of proteins in the chemical tests.
Diagnosis

As noted earlier, it is not easy to identify liver disease, as there are no specific symptoms. However, the above symptoms could point to a potential fatty liver.

Blood tests, especially for liver enzymes
Ultrasound, where the liver is imaged to look for any structural changes
Biopsy, where liver tissue is extracted to confirm the diagnosis of fatty liver
Treatment

There is no specific treatment for fatty liver. It can be managed through the following, where symptoms reduce in severity, and overall prognosis improves.

Diabetes control: There is a relation between how well diabetes is controlled and severity of fatty liver. Improving diabetes control ensures fatty liver does not progress.
Alcohol: Cutting down or even better quitting alcohol, definitely helps improve symptoms. If it is alcohol induced fatty liver, alcohol should be stopped.
Weight management: Obesity and fatty liver are related, so weight management is essential.
Healthy diet: Eating a healthy diet and regular exercise regimen also helps improve symptoms of fatty liver.

Fatty Liver - Signs You Are Suffering From It!

In general, fatty liver is considered synonymous with alcoholic liver disease. However, in reality it is not so. Fatty liver just indicates the presence of fat in the liver. It may or may not be harmful for the patient. Fatty liver is harmful only when it starts to damage the liver cells. Simple fatty liver does not cause inflammation, but when it starts doing so, it does not remain a simple fatty liver anymore.

Types of Fatty Liver Disease

There are two types of Fatty liver disease: Alcohol Related Fatty Liver Disease and Non-alcoholic Fatty Liver Disease.

Alcohol Related Fatty Liver Disease

Fatty liver does not always beget symptoms, although the liver may be enlarged. One may also feel discomfort or pain in the upper right quadrant of the abdomen. However, one can prevent alcoholic liver disease, since fatty liver owing to alcohol consumption usually gets better after stopping alcohol abuse. However, if a person doesn t do that, ALD can progress to more serious stages, like alcoholic hepatitis and alcoholic cirrhosis.

Alcoholic Cirrhosis
Alcoholic Cirrhosis occurs when there is formation of scar tissue in the liver. It can cause symptoms like bleeding, confusion, changes in mood and enlargement of spleen. Scar tissue formation can even lead to fatal liver failure.

Alcoholic Hepatitis
Alcoholic Hepatitis occurs when there is a swelling of the liver. It can precipitate nausea, fever, abdominal pain, vomiting, jaundice etc.

Non-Alcoholic Fatty Liver Disease

This is of two types: Simple Fatty Liver and Non-alcoholic Steatohepatitis.

Simple fatty liver just indicates the presence of fat in the liver without inflammation. On the other hand, Non-alcoholic steatohepatitis is a much worse form of fatty liver. This indicates that there is fat as well as inflammation in the liver. Even some of the liver cells may have become damaged. It can cause the following problems:

Formation of scar tissue in the liver, called fibrosis.

Severe fibrosis can lead to cirrhosis in advanced stages. Cirrhosis can lead to liver failure

Liver cancer

Causes of Fatty Liver

In alcoholic fatty liver disease, the prime cause is consuming too much alcohol. Alcohol may precipitate fatty liver by promoting obesity, malnourishment and even chronic hepatitis.

For non-alcoholic fatty liver disease there may be a number of factors:

Obesity

Insulin resistance

High levels of LDL cholesterol or low levels of HDL cholesterol

Diabetes

Conditions that may precipitate Type 2 diabetes 

High blood pressure

High blood sugar

Symptoms of Fatty Liver

There is hardly any symptom of fatty liver disease. At most, one can feel pain or tiredness in the right upper quadrant of the abdomen. However, if fatty liver has advanced to cirrhosis, fibrosis or hepatitis, there can be a number of symptoms. Some of these symptoms are:

Swollen abdomen

Enlarged blood vessels under the skin

Abnormal breast size in men

Redness in palms

Yellowing of skin and eyes.

Treatment

For alcoholic fatty liver disease, the best treatment is cessation of drinking when the fatty liver has still not progressed to more serious forms. For non-alcoholic fatty diseases, weight loss is an effective treatment. If there is Cirrhosis or Liver Failure, liver transplant is the only option.

As the treatment may vary from patient to patient, it is important that one should always consult a doctor before going for any option.

Fatty Liver - Types & Treatment Of It!

The liver is the place where all the toxins sit. Drugs, preservatives, alcohol, body toxins, chemicals are all metabolized in the liver. The basic function of the liver is to clear all the toxins from the body. When the liver receives too many toxins and it is unable to take so much burden, then the liver will give up. Gradually, the liver cells will be replaced with scar tissue. The liver tissues die completely. This condition or this stage is called cirrhosis of the liver.

What are the major causes of cirrhosis of the liver:
There can be many different causes for cirrhosis of the liver. Some of the major causes of this liver disease include:

People who consume a lot of alcohol for more than 10 to 12 years will have to face this problem. In the initial stage, it is going to be fatty liver, but at the later stage, the liver will be filled with fat and that disrupts the functioning of the liver. In the final stage, the liver function stops.
Hepatitis is one of the major reasons for cirrhosis of the liver. It is Hepatitis A that causes this health issue, others can also cause this problem.
Too many drugs for treating other health conditions.
Diabetes, obesity or other non-alcoholic fatty liver problems.
Symptoms of Cirrhosis of the Liver:

Jaundice
Weight gain or weight loss
Redness of palms.
Enlarged spleen
Clubbing of fingers
Fatigue or weakness
Patches on the skin
Menstrual cycle problems in women
Treatment for Cirrhosis of the Liver:
If cirrhosis of the liver is diagnosed at the early stage, then doctors will be able to treat it by finding the actual cause behind it. For example, if it is due to alcohol abuse, then giving up alcohol along with prescribed medication can help. If it is due to an overdose of some drugs, then it is important to find out the drugs and find an alternative for those medicines if they are to be taken.

Most of the time, modern medicine can only help by treating patients based on the symptoms. It provides relief from those symptoms and helps to avoid complications. But Unani medicine can help you treat this problem naturally without having to face any kind of complications.

Treating Talayyuf-e- Kabid (Cirrhosis of the Liver) with Unani medicine:
Unani medicine is a medicine made of natural herbs which will strengthen the liver tissues and will also help in restoring the size of the liver. You will find a number of medicines that can protect and heal the liver and also restore it to its normal shape and size.

Treating Talayyuf-e- Kabid (Cirrhosis Of Liver) With Unani Medicine

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