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!

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

Potassium is an essential mineral which is known as an electrolyte. Electrolytes are responsible for maintaining the ionic balance of your body. Other electrolytes are sodium, calcium, magnesium, phosphate, chloride. These electrolytes bear an electric charge which manages the electrical activity of your health system. Potassium also helps the muscles of the body to function properly. In fact, it has its contribution in regulating blood pressure; a crucial role for a healthy heart.

Potassium deficiency is a kind of medical condition which is known as hypokalemia. The normal level of potassium in the human body should be in between 3.5-5.0 mmol/L. But the deficiency in potassium can cause severe problems including muscle weakness, nerve disorders, heart problems, etc. Kidney is the organ which is known to manage the potassium balance by removing the extra potassium through urine.

Causes of potassium deficiency:

Lack of potassium in diet
Dehydration
Diarrhoea
Too much sweating
Several medicines also cause potassium deficiency

Signs of potassium deficiency:

You are getting wiped out too often: Like it is discussed before that potassium is responsible for your muscles to work actively. Each and every cell needs the required amount of potassium to work effectively. So, a little deficiency of potassium can leave you exhausted throughout the day. If your normal working routine leaves you exhausted and if you are sweating too often, then there is a chance that you are suffering from hypokalemia.
High blood pressure: Potassium plays an important role in maintaining the blood pressure by helping in relaxing the blood vessels. Low potassium can cause the blood vessels to get constricted, due to which your blood pressure increases.
Muscle weakness: Potassium plays a significant role in building the strength of your muscles. Lack of potassium can easily cause muscle weakness, aches and spasms.
Irregular heartbeat: Anything regarding your heart problem can scare you badly; especially when you experience sudden skipped heart rate or when your heart rate doubles. Low potassium can cause such palpitations and skipped heartbeat.
Feeling dizzy: Lack of potassium in your body can slow down your heart rate and make you feel dizzy or you may feel that you are going to faint. Though many other medical conditions can be responsible for such symptoms but hypokalemia is one of them.
Constipation: Potassium deficiency can affect your overall health. You might encounter symptoms like bloating, abdominal cramping etc.
Numbness and tingling: Potassium is significant in keeping your nerves healthy. Potassium deficiency can make you experience numbness, needle sensations on your feet, wrist, etc.
These are the signs that people encounter when they suffer from hypokalemia. Hypokalemia can make you feel extremely sick and it causes several diseases which are discussed above. It is always advisable to visit a doctor when you encounter any of these above mentioned symptoms.

Potassium Deficiency - 7 Signs You Are Suffering From It!

The most common dietary problem that every vegetarian comes across is protein deficiency. It was a widely acknowledged fact that animal products are the best protein sources. However, it is no longer so, and vegetarians everywhere can now rejoice!

Here are the 13 best sources of protein for vegetarians:

Green peas: Green peas are legumes, which are a very good protein source. They contain 7.9 grams of protein per serving.

Quinoa: Grains usually contain very little protein, but quinoa is unique. It contains 8 grams of protein per serving, and contains all nine important amino acids that your body needs for repair and growth.

Nuts and nut butter: Nuts are a good source of proteins and healthy fats. However, eat them with caution, as they do contain 160 calories per serving. Butter made from nuts like peanut butter and almond butter is also a good source of protein.

Beans: Beans are available in a variety of colours and shapes, but all of them have one thing in common that is the high level of protein.

Chickpeas: Chickpeas are also from the legume family, so they also contain high amounts of protein; 7.3 grams of protein in only half of a serving.

Tofu and tempeh: Tempeh and tofu are both soy products and they have the highest amount of vegetarian proteins, about 15-20 grams per serving.

Edamame or soybean: Edamame or soybean is excellent for snacking. They contain 8.4 grams of protein in just half a cup.

Leafy greens: Vegetables usually do not contain much protein, but eating green vegetables will significantly add to your protein consumption. For example, you can eat one cup of cooked broccoli as that contains 8.1 grams of protein.

Hemp: Blend hemp seeds in smoothies or baked goods to get your daily dose of protein. Hemp contains 10 grams of protein per tablespoon.

Chia seeds: Chia seeds contain 4.7 grams of protein per two tablespoons, making them excellent sources of protein.

Seitan: This is a meat substitute made from wheat gluten and it contains 36 grams of protein per serving (about half a cup).

Non-dairy milk: Milk made from soy (best non-dairy protein source), almond, rice and hemp are good dairy substitutes.

Unsweetened cocoa powder: This will surprise you, but bitter cocoa contains nearly 1 gram of protein per serving (1 tablespoon)! 
All the above-mentioned food items are the best source of proteins for vegetarians. So, enjoy them with no worry.

Know Excellent Sources Of Protein For Vegetarians!

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)?

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

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