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?

Problems are pancreas are common and are treated by gastroenterologists. There are two common pancreas problems -

1. Acute Pancreatitis: Sudden Inflammation of the pancreas is known as acute pancreatitis. It is usually due to Alcohol, gall stones, trauma, metabolic causes such as hypertriglyceridemia, and congenital causes such as Pancreas divisum. The patient presents with severe upper abdominal pain and vomiting. Patients require admission for IV fluids and analgesics. Nearly all patients recover from the pain and start eating within 3 to 4 days. Few patients with severe pancreatitis may develop kidney failure, respiratory failure or GI bleeding. Such patients require longer hospitalisation stay and critical care management. Recovery is usually uneventful but few patients develop peripancreatic fluid collection known as Pseudocyst or walled-off pancreatic necrosis(WOPN). In such cases, the patient requires additional treatment of fluid collection and requires internal drainage by Cystogastrostomy which is done by Endosonography (EUS) by a gastroenterologist. Some patients require ERCP (Endoscopic retrograde cholangiopancreatography) for evaluation of pancreatic ductal leak. EUS and ERCP are advanced endoscopic procedures done by a few gastroenterologists who are specially trained in such procedures.

2. Chronic pancreatitis: Long term irreversible damage to the pancreas is called chronic pancreatitis. It is usually due to Alcohol intake. It presents with upper abdominal pain, Diabetes mellitus and fat in stools (steatorrhea). The small duct in the pancreas called main pancreatic duct can have hard calcifications also known as stones, which obstruct the flow of pancreatic juice and cause severe abdominal pain. Treatment of chronic pancreatitis includes stopping alcohol intake to prevent further damage to the pancreas, medicines for pain, Pancreatic enzyme replacement therapy (PERT) and Endoscopy for those who do not respond to medical treatment. Endoscopy includes ERCP and plastic stenting to establish a flow of obstructed pancreatic duct and Endosonography (EUS) guided Celiac plexus block for decreasing pain. Patients who develop fluid collection such as Pseudocyst require internal drainage by Cystogastrostomy which is done by Endosonography (EUS)

In Brief About Types Of Pancreatic Disorders!

The quote 'Good day starts with coffee' suits a lot of people who love nothing more than a cup of coffee every morning. However, your morning tryst with a cup of coffee might not be a very healthy habit. Believe it or not, addiction to caffeine (in the form of coffee) is as harmful as addiction to any other drug. In fact, caffeine is a legal drug that slowly and gradually damages your gastrointestinal tract. Here are the negative effects of coffee on your digestive system:

Increases Acidity: Coffee is known to contain different kinds of oils, acids and caffeine. These compounds have an adverse impact on the digestive system. The stomach and intestinal linings get damaged due to the over-consumption of these compounds in the form of coffee. Moreover, as you take coffee, your stomach produces more hydrochloric acid for digestion. This causes acidity and hampers the HCL levels altogether. When we take coffee regularly for years in empty stomach, our body's capacity of producing proper amounts of HCL gets hampered. Often, HCL production gets reduced as well. This leads to indigestion of other food items and effects flatulence and produces unwanted gases due to the improper breaking of proteins and fats by the body.
Ulcers and Irritable Bowel Syndrome: Doctors believe that coffee acts as an irritant for patients of Irritable Bowel Syndrome (IBS), gastritis, Crohn's disease, colitis and ulcers. Coffee is responsible for the irritation of the lining of stomach and intestine. It is also noticed that certain enzymes present in the coffee beans are also harmful to the gastrointestinal tract.
Heartburn: Coffee is responsible for relaxing the esophageal sphincter muscle. The relaxation of this muscle hinders the process of digestion and causes acid-reflux, resulting in heartburn. It is known to have compounds that have diuretic, laxative and mineral blocking effects on the body.
Laxative Effects: Coffee stimulates the process of peristalsis or movement of food through the gastrointestinal tract. The peristalsis starts immediately after food is swallowed by the individual. The intake of coffee catalyzes peristalsis and consequently leads to emptying of the stomach even before the food is digested properly. The semi-digested food is sent to the intestine too early, causing injury to the intestine and hampering the absorption of nutrients.
Affects absorption of minerals: Caffeine reduces the ability of the stomach to absorb iron and also hinders the absorption of minerals like calcium, zinc and magnesium by the kidney. All these minerals help in digestion at different points and regulate the bowel movement.
Coffee is known to have benefits like reduction of constipation and sugar absorption. But, it also interferes with the smooth functioning of the digestive system. It has a tendency to increase stomach aches, disturb the fluid balance and the overall process of digestion.

Coffee and Your Digestion

The acids help the body dissolve the food particles and also break it down to more basic elements. However, when the body produces too much acid, it causes acid reflux which can cause discomfort. Too much acid within the body, which is also known as hyperacidity, can be caused by a multitude of factors.
Known and effective ayurvedic cures
Ayurveda considers acidity to be a'pitta' problem and it can be corrected by following certain simple steps. There are other food ingredients which are also used as remedial tools. Let's have a look at some of the dos and don'ts of ayurvedic remedies for acidity.

Don'ts for acidity according to ayurveda
1. Limit junk food and other foods, which are very heavy in fats and processed items: most processed foods and junk food usually made in stores contain unhealthy fats. The stomach needs to produce more acid in order to digest them and thus may end up causing acidity.

2. Stop excessive consumption of tea, coffee: stop consumption of caffeinated beverages such as tea, coffee and other caffeine injected drinks which may encourage the production of more stomach acids.

3. Stop the consumption of alcohol and cooperates: apart from being generally bad for health as both of these are known contributors of cancers, they can even affect smaller day to day functions and can lead to acidity.

4. Don't consume foods which are high in acidic content: if you tend to like food which is very high in acidic content, it is advisable to limit its consumption. Some examples of this are:

1. Vinegar
2. Curds
3. Pickles
4. Tamarinds
5. Sour citrus fruits
6. Salty fried foods

Dos for acidity according to ayurveda
There are multiple solutions for acidity in ayurveda which have been known cures for generations. Let's take a look at some of these.

1. Do have meals on time: it is best to not skip meals as this can cause the acidity levels within the stomach to rise if it doesn't have any food to digest. It is especially harmful to skip breakfast and then have a heavy lunch to compensate.

2. Do have amla or indian gooseberry: this is a very effective weapon against acidity and chewing a few morsels will easily cure the problems in your stomach.
Pomegranate juice: very small quantities of pomegranate juice on a daily basis will be very beneficial for a bad case of acid reflux.

3. Coconut water: drink coconut water as it is known to have properties to neutralize the stomach acids.

4. Aniseed: also known as saunf, you can chew them raw and slowly swallow with water for quick relief from acidity.

5. Jeera: jeera consumed with warm ghee and then mixed with rice tends to be very good for acidity as well.

Ayurvedic Remedies for Acidity

Diet and other lifestyle factors such as lack of exercise and high waist-hip ratio are seen to be the significant contributing factors of certain medical conditions, gallstones one among them. Gallstones have become a highly prevalent issue in India, with an increasing number of patients reporting abdominal pain and discomfort. And it is also seen to be more common in females than in males. If your doctor suspects this problem, then he would proceed with the diagnosis and treatment as applicable.

How are gallstones treated?
If gallstones are not leading to any signs or symptom, then in such cases the treatment is not required. However, if an individual suffers from any symptoms or a gallbladder attack, then the health care provider normally recommends undergoing surgery. This surgery is used for removing the gallbladder. Sometimes, the individual may not be in a condition to undergo surgery and, in such cases, conventional treatment may be used for curing the disorder.

The surgery for the removal of the gallbladder is known as the cholecystectomy and is one of the most common surgical interventions performed for people with gallstones. The gallbladder is not considered to be a significant organ in the human body. This means that an individual can easily survive without the gallbladder. As the gallbladder is removed, bile starts flowing out of the liver through common and hepatic bile ducts without creating any issues.

What are the surgical options required for removal of gallstones?
There are two types of surgeries used for removal of stones in the gallbladder. These are explained below.

Laparoscopic cholecystectomy: In this surgery, the surgeon makes small incisions in the abdomen for the insertion of a laparoscope, which has a tiny camera attached to it. This camera enables a magnified image to be sent to the video monitor so that the surgeon can see the tissues and organs clearly. At the same time, the surgeon uses certain instruments for carefully separating the gallbladder from the liver, bile ducts and other organs. Then the gallbladder is carefully removed through one of the small incisions. This is the most suitable options for the removal of the gallbladder since it is performed on an outpatient basis, which means that the patient can go home the same day.
Open cholecystectomy: This is done when the gallbladder has severe inflammation or infection or scars from different operations. This may also be performed at the time of the laparoscopic cholecystectomy. In such cases, the surgeon switches to open cholecystectomy as a safety means for the patient.
What to expect after the procedure?
A small percentage of the patients have softer and more frequent stools after the removal of the gallbladder. These changes in bowel habits are normally temporary, and they are required to be consulted with the expert.
Since the incidence of gallstones is found to be related to gallbladder cancer, it is essential to work with your doctor to avail proper treatment and avoid such dire complications.

Surgical Option To Remove Gallstones - Know Which One Will Be Better For You!

The largest internal organ in the body, the liver, is also one of the silent heroes, which performs close to 500 functions. It produces energy, fights infections, gets rid of wastes, and is a metabolic factory.

There are four major types of liver diseases out of which alcoholic liver disease accounts for about 40% of them. Other types include non-alcoholic liver disease, viral hepatitis and autoimmune (chronic) hepatitis.

Risk factors: The severity of drinking habit is directly proportional to the chances of developing alcoholic liver disease. People who consume more amount of alcohol are more likely to develop the disease. However, it is also not necessary that every person who consumes alcohol develops liver disease.

Following are obvious risk factors for developing alcoholic liver disease.

1. Alcohol dependency: While enjoying a drink is not barred, getting the body dependent on alcohol for regular functioning is definitely a no-no. The rate of developing the disease in people dependent on alcohol is as high as 70%.

2. Females: The way alcohol is metabolized in females could have an effect on the higher risk they face in developing alcoholic liver disease.

3. Obesity: Excessive weight puts additional stress on the metabolic effects of the liver and therefore has a higher tendency to develop alcoholic liver disease.

4. Family history: Strong familial history increases the risk of developing alcoholic liver disease.

Symptoms: The difficulty in diagnosing the disease lies in the fact that there are no clear-cut symptoms that can indicate the diagnosis. Initial general symptoms include fatigue, poor appetite, abdominal pain, nausea, weight loss, loss of energy, and red spider nevi (spider-like blood vessels) on the skin.

As the liver function continues to worsen, there are additional symptoms like swelling of the legs due to fluid accumulation, swelling of the abdomen, jaundice (yellow mucous membranes and skin), redness of palms, impotence, breast swelling, easy bruising, cognitive problems and clay-colored stools. This stage will see liver scarring and subsequent cirrhosis. The second set of symptoms is more diagnostic. An experienced practitioner will be able to suspect and diagnose the alcoholic disease with a detailed history and some liver function tests.

Treatment: If identified early and alcohol habits are reversed, the damages of the liver can be completely reversed. In addition, the following lifestyle changes are suggested:

1. Low-salt diet

2. Hepatitis vaccines (A and B)

3. Medications to manage fluid retention, spontaneous bleeding and infections as the case may be

4. Excessive fluid accumulation in the abdomen may require removal

5. Shunt in the liver to repair blood flow

6. If cirrhosis stage is reached, a liver transplant may be required

While there are many ways to manage alcoholic liver disease, prevention is the best way. Limiting alcohol consumption can definitely help in the prevention of the disease.

All About Alcoholic Liver Disease

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