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?

The liver can be transplanted either from the living-donor or from the deceased donor. Liver transplant surgery includes the transplantation of a part of the liver from the donor to the donee who has a damaged liver and does not function well. Living-donor liver transplant is more common especially among children as the number of liver donee are more than the available deceased donors of the liver.

Living liver donors are the alternative for the donee waiting for a liver transplant from a deceased person. The remaining liver of the living donor, after the transplant, regenerates itself and reoccurs to its usual capacity and volume within a few months post the surgery. The donated part of the liver to the donee also regenerates and restores to its normal functioning.

Most often, the living-donor of the liver is a close relative or friend. Everyone or anyone cannot donate a liver but only those can who have the matching liver depending on age, organ size, blood type, and other health and medical factors. Both the donor and the donee have to go through a thorough medical examination before the transplant to know the potential outcome and risk involved.

Procedure-
For the transplant, the donor is first operated and the required part of his/her liver is removed. The donee s damaged liver part is then replaced by the healthy liver part of the donor. Both the donor s and the donee s operated liver is then attached with the bile duct and the blood vessels. Both the patients are kept under observation for some days for the medical team to know if they are having any health issue due to the transplant. The operated liver regenerates itself within certain months and starts functioning normally.

Precautions for the Donor-
Although the donor can go back to normal life routine a few months after the transplant there are a number of precautions that should be taken into account to avoid any health issue or liver damage.
  Avoid smoking.
  Avoid consumption of alcohol.
  Eat on time or do not starve or overeat.
  Avoid having heavy meals.
  Avoid heavy exercise or weight lifting or physical work.

Take Away-
Liver transplant is a surgery conducted to remove the damaged or injured liver of the patient with the healthy liver of the donor. The donor of the liver can either be deceased or living depending upon the availability of the donor and the severity of the donee.

Various lab tests and examinations are conducted on the donor and the donee to confirm their match and assess potential complications before the transplant. The donor is usually someone close to the patient or the donee whose liver has been matched depending upon various factors. As the liver regenerates within a few months, the donor can lead a normal life after the transplant.

Know How To Choose A Liver Donor For Liver Transplant! 

Sugar is the trigger to most of the diseases an adult faces in present times. Sugar is not only harmful for adults, but can pose severe threats to the health of a child as well, if not administered in monitored proportions. But again, sugar is indispensable when it comes to sweetening your drinks and desserts. In order to prevent yourself from the health hazards of sugar, you should know more about its scope and effects.
1. Sugar can lead to a fatty liver: Fatty liver is a troubling issue faced by many across the globe. It is wrong to think only alcoholics are subjected to this health condition. People who exercise little and consume huge amounts of fructose are also exposed to the threat of this disease. When a person doesn't do enough to burn up the existing amount of glycogen in his or her liver and take in fructose repeatedly, the liver turns that fructose into fat, impairing one's liver capabilities to a great extent.

2. Sugar may make you resistant to Leptin: Leptin is a hormone released by your fat cells. The hormone is particularly necessary as it sends signals to your brain telling it you are full and won't be requiring any more food. Fat people have more number of fat cells and thus additional Leptin too. The Leptin becomes inactive due to the effects of heightened blood triglycerides and insulin, both of which counter its functioning.

3. It is addictive and there lies the key to temptation: Sugar is enormously addictive. If you like sweetened products, you will find it hard to resist your cravings for cakes, cookies or chocolates. Sugar accelerates dopamine secretion; this hormone makes a person feel good. Dopamine is the hormone released on the consumption of drugs such as cocaine.

4. Calories in sugar are not balanced out with any mineral or vitamin: Because of its lack of nutrient value, sugar is said to have empty calories. Food items rich in sugar tend to make a person lethargic and slackened while depriving them of essential minerals and vitamins. It is therefore, best to not allow children to have pastries, chocolates or puddings in excess.

5. Sugar leads to extensive tooth decay: Sugar can accumulate on your teeth if you are having too many sweetened food items. This causes your teeth enamel to wear away, making it more prone to cavities and dental caries.

Why You Should Stay Away From Sugar?

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

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

The liver is the largest internal organ in our body which performs multiple functions and it is the only gland that can regenerate quickly when it is healthy. The main role of the liver is to clean and filter blood coming via digestive tract previous to it flows to remaining body parts. Liver failure results in reduced ability of blood clotting, thereby causing severe problems in case of injuries. Apart from that, alcohol and viruses are also significant factors that stop the liver from functioning properly.

Liver Transplantation
Liver Transplantation enables even the people at the final stage of liver failure to lead longer and happier life. The success rate of Liver transplantation has increased drastically due to advanced surgical techniques. Liver transplant is the best option when the liver is damaged partially or entirely. It is a surgery that involves replacing a failed liver in a recipient with a healthy liver of a donor.

Who should go for it?
The main cause of liver failure in infants is Biliary Atresia. This occurs when bile ducts are absent or partially/fully blocked. Whereas in adults, liver disease is caused due to Cirrhosis - a condition in which liver is scarred and becomes dysfunctional in the worst case. Most common reasons for Cirrhosis are Hepatitis B and C, genetic disorders, alcohol consumption, toxic metals and obesity. One should immediately seek advice from a doctor when he/she suffers from following symptoms:

Fatigue
Nausea
Weakness
Weight loss
Jaundice
Fever
Abdominal Pain
Itchy Skin
Liver Transplantation Surgery
Two kinds of the liver transplant are available: 

Deceased donor transplant 
Living donor transplant
There are not enough deceased donor livers available to match all the liver transplant needs. Any living donor with a matching liver can donate a part of their organ to the person undergoing the liver transplant. As the liver can regenerate itself to its normal size in healthy people within a few months, there are no side effects of donating a part of the liver. A thorough physical and mental health examination will be performed for both the donor and the recipient to ensure that they can cope with the process and are aware of the risks involved. This includes psychological tests and blood tests. Patients are added to a waiting list as per their priority score. The score is assigned to a patient based on three blood samples creatinine, bilirubin and INR.

The priority score is termed as MELD (model of end-stage liver disease) in adults and PELD (pediatric end-stage liver disease) in children. The patient cannot undergo liver transplant if he/she has contracted cancer in any other part of the body or is suffering from heart disease or severe infections.

During the liver transplantation procedure, the surgeon removes some part of the liver from a donor and replaces damaged liver in the recipient with it. Both recipient's and donor's liver re-grow rapidly and reach normal size within months. As per statistics, recipients who receive the liver from living donor have a higher survival rate than those who receive it from deceased donors.

After surgery, both donor and recipient should maintain healthy and clutter-free life and follow strict diet rules and get vaccinated as per the chart provided by the doctor. They also need to avoid consumption of alcohol entirely and talk to a medical practitioner before taking any medications.

Liver Transplant Surgery - Who Should Go For It?

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