Pregnancy is a time when your body undergoes a plethora of changes, both emotionally and physically. In such a situation, an acute liver failure only triggers further complications, threatening to affect both the mother and the fetus. The ambit of liver diseases range from mild complications to those that can be life threatening. Acute liver failure or ALF, as it is commonly known as in medical parlance is a condition which is caused when then there is a sudden impairment of the ability of the blood to clot. In spite of the erratic nature of the ailment and its ability to affect anybody with a complete disregard of the individual, s pre-existing history of liver problems, there are certain causes that are said to propel it. Some of them are-

Eclampsia with liver infraction: This is an extremely rare condition. Generally, eclampsia refers to the occurrence of convulsions in pregnant women, mostly in those who suffer from high blood pressure. Those women who suffer from eclampsia along with liver infraction are more susceptible to have a liver failure.
Hepatic rupture: Much like eclampsia, hepatic rupture is also caused in women who have high blood pressure. This heightens the risk of an impending liver failure in pregnant women.
Fatty liver: Sometimes excess of fat develops in the liver deterring its functioning. This is not only detrimental to your health but also poses a great danger in triggering a liver failure.
In spite of these, there have been multiple treatments which have developed to manage and curb it. Some of them are-

Remedial measure for coagulation: The inability of blood to clot blood is known as coagulation which is extremely fatal and one of the primary causes that leads to liver failure. Therefore timely and potent intervention of medicine is important to prevent that and in turn diminish the possibility of liver failure.
Volume replacement: Volume replacement refers to the condition where fluids are resuscitated or replenished into the body, those that were lost but at the same time are mandatory for the proper functioning of the body.

Acute Liver Failure in Pregnancy

Just like the name suggests, Non-Alcoholic Fatty Liver Disease (NAFLD) is a set of diseases that can affect the liver due to excess accumulation of fat. One common disease that arises from this condition is known as nonalcoholic steatohepatitis. This can lead to cirrhosis as well. NAFLD is very common in the Western Countries affecting close to 100 million people annually. Although it can occur in any age group, the most affected age group being the one between 40-50 million. With this condition, the risk of getting other diseases such as cardiovascular problems and type 2 diabetes increases considerably.

Symptoms: Non-alcoholic fatty liver shows symptoms such as fatigue, enlarged liver, and pain, discomfort in the upper abdomen. Some other symptoms that have been witnessed in patients suffering from NAFLD include the development of breasts in men, swelling of the abdomen, red palms, jaundice, swelling of the blood vessels etc.

Causes: Experts have not been able to identify the exact causes of NAFLD. However, it is pretty evident that this condition only arises when the liver fails to produce bile which is responsible for digesting the fat cells. The fat in turn deposits in the liver cells resulting in NAFLD. Some of the possible causes include the following:

The resistance of insulin
Type 2 diabetes
High level of triglyceride in the blood
Obesity
Risk Factors: There is a wide array of risk factors that can pose a threat of NAFLD. Some of them include metabolic syndrome, high cholesterol, hypothyroidism, type 2 diabetes, hypopituitarism, obesity, polycystic ovary syndrome etc.

Complications: The major complications of NAFLD is liver cirrhosis. This is a condition that results in scarring of the liver cells resulting in fibrosis. Some other complications include fluid accumulation in the liver, liver cancer, swelling of the vein etc.

Diet: A mediterranean diet is a perfect diet suited for patients suffering from NAFLD. It includes nuts, fish, vegetables, grains, fruits and olive oil. Fat should be eliminated from the diet by a significant bit. It is important to add the right kind of fat in the diet. Omega-3 fatty acid available in flaxseed oil, leafy vegetables, and nuts fits the bill. Studies have shown that vitamin D and E helps a great deal in fighting liver diseases. Some other food items that should be included in the diet are green-tea, red grapes, Brazil nuts, raw garlic, wolfberry etc.

Treatment: Once the disease is diagnosed, a doctor s first endeavour is to ensure that the patient loses weight through a combination of diet and exercise. Vaccination against hepatitis A and B is the next step that a doctor would ideally suggest. For patients who are suffering from cirrhosis, a liver transplant is the only viable option to increase mortality.

What Are The Reasons Behind Non-Alcoholic Fatty Liver Disease?

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

A liver transplant surgery involves surgically substituting a problematic liver with a healthy liver from a different person. Usually, the healthy liver is taken from a person who has recently passed away. In some cases, a living person may also give away part of the liver. Usually, living donors are members of the family or someone who has a good blood type match. The liver regenerates lost tissues after a surgery; hence, the donor s liver becomes normal within a few weeks of surgery.

You may require a liver transplant if your liver does not function optimally, owing to the below mentioned conditions:

    Cirrhosis: This is a chronic disease of the liver wherein, scar tissues replace healthy tissues in the liver, thus, not allowing the liver to function optimally.
    Metabolic disease: Disorders that modify the activity of the chemicals in the body
    Acute hepatic necrosis: This is a disorder that causes the healthy tissues in the liver to die
    Autoimmune disorders or liver cancer: Autoimmune disorders can cause healthy tissues in the liver to die as the immune system in the body starts attacking healthy tissues. Formation of malignant tumors in the liver can impair liver functioning.

Procedure
You have to undergo certain procedures before the surgery is conducted; a general health exam, imaging tests, blood tests and a psychological exam are conducted before the surgery. Based on the functioning of the liver and some other factors, your suitability for the transplant will be determined.
The procedure begins with general anesthesia, following which an incision is made in the abdomen. The liver is then removed and replaced with a healthy one. Once the procedure is completed, the surgeon closes the incision with stitches.

Aftercare
Once the procedure is done with, you are kept in the intensive care unit for a few days. The doctor will monitor your progress and put you on medications. After the recovery, you will have to undergo check-ups at regular intervals. You may also have to take medications such as immunosuppressant to prevent your immune system from attacking the liver.

Liver Transplant Surgery - How Best To Care for it Post Surgery?

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)?

Liver transplant in the only curative option available for patient who develop cirrhosis of liver due to any cause ( Chronic Hepatitis B , Chronic Hepatitis C, Alcoholic Cirrhosis, NASH etc). Once patient has been diagnosed with cirrhosis it can not be reversed with any non-surgical treatment . Over a period of time patient may develop worsening in liver function resulting in complications of cirrhosis (bloody vomitus, black stools, jaundice , altered sensorium, renal dysfunction, abdominal swelling etc) labeled as  decompensated cirrhosis . These patients require Liver transplant at the earliest and should be reffered to a liver transplant centre immediately. Ideally all patient diagnosed with cirrhosis should be under the follow-up of a gastroenterologist/Hepatologist. The source of graft liver can be from two sources namely from a deceased brain-dead donor or a Living-related donor and termed respectively as DDLT ( Deceased donor liver transplant) and LDLT ( Living Donor Liver Transplant) . However both DDLT and LDLT have nearly 90% success rate and both the procedures have their own benefits and lacunaes. Also the decision to go for DDLT and LDLT may vary for any particular patient. 

Before the Liver transplant 

All recipient and Living donor go thorough evaluation before the transplant process that includes blood investigations, Imaging studies, Cardiac and pulmonary fitness tests, multidisciplinary consultation before the clearance for liver transplant is achieved. The healthcare provider will explain the entire procedure. The healthcare provider is also supposed to answer all your questions. You would be needed to sign a consent form that allows the doctor to do the surgery. Eating food is not allowed at least 8 hours before the surgery. If you cannot stay relaxed before the surgery, a sedative will be given. 

After the Liver Tranplsant 
The recipient surgery lasts for anywhere between 12-16 hrs and donor surgery for 8-12 hrs. After the surgical procedure is complete, you will be taken to the intensive care unit (ICU)and will be closely watched for several days. 

Immediately After the Surgery 
You will most likely have a tube in your throat. This is so that you can breathe with the help of a machine (a ventilator) until you can breathe on your own. The ventilator tube will be removed on next morning when all parameters are found to be satisfactory. All parameters are monitored by round the clock critical care doctors and staff for a few days. The recipient has to stay in the hospital for three weeks and the donor is discharged in one week. 

Blood samples will be collected on a regular basis to check the functioning of the new liver. Antibiotics will be infused via IV channels to prevent you from infections. The area where the operation was done should always be kept clean after you have reached home. Any stitches or surgical sutures will be removed at a follow-up visit.

Complications that may arise 
Blocked blood vessels to the new liver, bleeding, an infection, leakage of bile or blocked bile ducts, or the new liver not working for a short time right after surgery are a few complications that may arise. Not to aggravate the condition, in the case of a complication, it is imperative to visit your doctor.

Liver Transplant - What To Expect Before & After The Procedure?

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