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!

Nobody prefers to suffer from ailments such as Cirrhosis of liver. After all, it is difficult for a person, if his or her liver is not functioning properly. However, if in case a person is suffering from such kind of chronic ailment, then one can opt for Ayurvedic remedies, which do not have any side effects. 

Why it occurs?
In order to know how it is treated, it is essential to understand what causes cirrhosis of the liver and what it means to have this dreaded condition. While there is a range of causes for the chronic disease, fatty liver disease along with hepatitis B and hepatitis C are the most common causes of Cirrhosis of the liver. 

Alcohol consumption on an excessive level also bears its fair share of responsibility. As a matter of fact, Cirrhosis of the liver is caused on account of this sort of alcohol consumption and is responsible for more deaths than any other type.

Detoxifying your liver with Ayurveda
When it comes to the Ayurvedic way to treat this serious issue that is liver Cirrhosis, the main focus is on the complete and effective detoxification of the liver. One of the first things that is involved in this sort of treatment is a radical overhaul of the habits of the person whose quality of life is being seriously impinged on due to this disease.

De-addiction is a very important starting point. After all, it can be said to be only logical, that the treatment of a disease, which has been brought upon by the indulgence in a bad habit begins with the cessation of the habit.

Diet restrictions are also part and parcel of getting liver cirrhosis treated by making use of Ayurveda s deep and ancient body of knowledge. In many cases, doing so does mean giving up consumption of meat. In addition to this, other things, which are to be done from the point of view of dietary changes include, but are not limited to, avoiding hot and oily food which tends to be heavy on the digestive system of the person who is undergoing treatment. With the body under so much pressure in any case, it makes no sense at all to add more load.

While all this may seem to be very cumbersome, it is to be kept in mind what wonders Ayurveda can accomplish and how does it work in repairing the damaged liver of the patient who is undergoing this course of treatment. The end result makes all the sacrifices worth the effort.

Cirrhosis of the Liver - How Ayurveda Can Help Treat it?

In modern day societies of intense stress and work pressure, the average diet mostly comprises of street foods, packaged fast foods and processed foods. Such stress and overexposure to a lot of toxins (present in the processed food, fast foods, and street foods) disable the liver from performing its primary function of cleansing the toxic materials through the skin, the respiratory and the digestive system. Besides, this overexposure to toxins also disrupts bile formation, which hinders the absorption of necessary nutrients, resulting in a severe disruption in health. Also, liver is responsible for the proper functioning of the eyes, the brain, the kidneys and the joints in the body. Thereby, it is necessary to include these 7 foods in your diet which help to detoxify your liver from the excessive toxins and allow it to function properly.

    Avocado: Avocados contain a rich amount of the antioxidant glutathione, which helps the liver to fight against the toxins.
    Garlic: Garlic contains a rich amount of selenium and allicin, which helps to cleanse the liver. A little amount of garlic helps in the activating liver enzymes which in turn helps to eliminate the toxins from the body.
    Green tea: Green tea contains a rich amount of the plant antioxidant known as Catechin, which help the liver to function properly. It also helps to protect the liver from the toxins.
    Beets and Carrots: Beets and carrots contain a rich amount of beta - carotenes and plant flavonoids which help to regulate the overall function of the liver.
    Turmeric: A little amount of turmeric in your daily meal helps in the cleansing the liver by helping the enzymes to get rid of the toxic carcinogens.
    Green Vegetables: Green Vegetables like spinach, bitter gourd and chicory contains a rich amount of detoxifying components, which helps in the neutralization of heavy metals which in turn regulates the cleansing ability of the liver. Green vegetables also help in the simulation of the flow of bile.
    Grape Fruit: Grape fruit contains a rich amount of vitamin C and antioxidants which initiates the cleansing process of the liver. Grape fruit also help in the formation of enzymes that destroys toxins like carcinogens.

Cleanse Your Liver - 7 Natural Foods that Will Help You 

Liver is a very important organ of your body. It is also the largest internal organ. Liver plays a pivotal role in food digestion, iron metabolism, regulation of blood clotting and removal of toxins from your body. Liver problems refer to the disruption of liver functions. There are various liver problems and diseases that you may encounter. Some of the liver problems are as follows:

Hepatitis A, B, C, D, E
Liver cirrhosis.
Fatty liver
Liver cancer
Wilson disease
Jaundice
The most common causes of the above mentioned liver problems are

Fatty liver is generally caused due to obesity
Hepatitis A, B, C is caused due to viral infections
Consuming excess alcohol can cause liver cancer
Liver diseases like Wilson disease is caused due to genetic problems
Different liver problems have different symptoms. But there are some common symptoms for all liver diseases. The most common symptoms are mentioned below

Body fatigue
Pain in the abdomen
Change in urine and stool color
Nausea
Queasiness
Loss of weight and appetite
Yellowish discoloration of skin, eyes and nails.
Homeopathy can treat liver problems very effectively. The following are some of the solutions offered by homeopathy for different liver problems
1. If you are suffering from the problem of fatty liver, your doctor may recommend you medicines like Lycopodium, Phosphorus, Nux vomica
2. If you suffer from the problem of liver enlargement then your doctor may recommend you medicines like Carduus Marianus
3. Chionanthus and Taraxacum are medicines advised for liver problems like jaundice
4. Natrum sulphuricum may be recommended to you if you are suffering from problems like Liver cirrhosis
Homeopathic treatment for liver problems is very effective since it treats the medical condition according to specific symptoms

Liver Problems - How they Can be Treated with Homeopathic Remedies?

The human body s ability to manage the fats consumed and the way the liver functions to handle this in the overall metabolism setting are dependent on choline. Choline, which is present mostly in the form of Vitamin B12, is available in plenty in most of the foods consumed by people regularly. The issue arises when the body system fails to absorb choline nutrient from the food consumed. There are also cases where the dietary intake does not possess adequate choline in it.

Natural Difficulty in Absorbing Choline
There are certain conditions in which the system finds it difficult to absorb choline though the diet may contain the nutrient. People who have just undergone a by-pass surgery or those who have had a kidney transplant done or if there is already a liver problem like cirrhosis face this issue. There are other reasons also which can lead to choline deficiency, such as the prolonged intake of anti-convulsant drugs and so on.

How to Detect or What are the Symptoms?
Some apparent symptoms can lead the GP to ask for more tests to establish that the person does have choline deficiency. In normal person, even high blood pressure could be caused due to choline deficiency. Then in many cases, a blood test for any other condition might reveal very low levels of VLDL (Very Low-Density Lipoprotein). This substance in the blood is used by the liver to transport fats and naturally, if VLDL is below a certain threshold the person is bound to be suffering from choline deficiency. High level of cholesterol is another symptom. It has to be understood that choline is also essential for the human brain to be functioning at its active best. Deficiency of choline can lead to an early setting in of dementia. Of course, any patient with liver and kidney related condition reaching the doctor will be checked for choline deficiency since these are closely related.

Where to Get Choline from?
The next obvious question is which foods can get you choline easily and you won t suffer from a deficiency. As mentioned there are plenty of food items of daily consumption which have choline in them. The most frequently recommended are the yolk of the egg. Pastured eggs are recommended and though even one egg can give some 115mgms of choline, you can make a couple of eggs a part of your daily breakfast menu. The other suggestion is raw liver as in beef liver which is quite rich in choline. Those who consume only vegetarian foods can always eat a lot of green vegetables like cauliflower, cabbage and also nuts and legumes (soaked) and milk and yoghurt are all good for choline intake.

Choline is an essential nutrient in the human body and is critical to the growth and development of cognitive functions and its deficiency can lead to many serious conditions, including liver impairment and brain disorders. There are plenty of foods rich in choline and should be consumed regularly.


Choline Deficiency - Signs You Are Suffering From It + Sources Of Choline!! 

The build-up of fat in the liver may lead to the development of a condition known as nonalcoholic steatohepatitis or NASH. This condition is not related to the consumption of alcohol and the inflammation is due to the buildup of fats in the liver. In most cases, there are no symptoms till the stage when the fat deposition causes inflammation and damages the liver cells. This also hinders the normal functioning of the liver and if not treated, it may lead to an extreme condition known as cirrhosis. However, NASH does not always get worse and with some precaution, it can be treated.

The cause behind the development of this disease is not alcohol consumption and it could be some environmental factor that triggers liver inflammation or heredity might be another reason. However, the risk of developing this disease is high for people who are obese, have metabolic syndrome, have high cholesterol or are resistant to insulin.

There are hardly any symptoms of NASH that are seen in the early stage of this condition. However, at a much-progressed stage, the following symptoms may be seen:

Weight loss
Fatigue and weakness
Upper abdomen pain
Diagnosing NASH requires undergoing several tests that include a blood test, a CT scan, an MRI scan and also an abdominal ultrasound.

Benefits of Ayurvedic remedies in managing NASH



There are remedies which help in detoxification of the liver. They also enhance the body s capacity to digest fats and prevent it from accumulating in the liver.
A few remedies are rich in vitamin C content as they are very effective in treating liver problems.
Some remedies are packed with the antioxidant and vitamin C. And, it is this vitamin C that helps the liver in producing the enzyme, glutathione, which neutralizes the toxins and detoxifies the liver of all of the toxins.
Some remedies contain catechins, which are known to enhance the functioning of the liver. They are great for blocking the fat stored in the liver and works wonder in fighting against diseases associated with the fatty liver disease.
There are some fruits that are effective in treating fatty liver diseases. These fruits burn the dietary fat rapidly and also improves the functioning of the liver if consumed regularly.
Some Ayurvedic remedies are a storehouse of the fat-soluble Vitamin E, and are known to protect your liver against the accumulation of fats and will keep your liver healthy.
Apart from including these natural ingredients in your diet, you will also have to reduce your body weight, reduce cholesterol level, control your diabetes, exercise regularly and stop consuming alcohol. However, home remedies are just supportive, but not a complete line of treatment for NASH so you cannot depend completely only on them. As mentioned NASH can disturb your normal liver functioning and if not treated it can lead to liver cirrhosis so take proper Ayurvedic treatment under the guidance of an Ayurvedic doctor.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Nonalcoholic Steatohepatitis (NASH) - Home Remedies That Can Help Treat It!

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