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 term cirrhosis refers to liver scarring due to various diseases and conditions such as chronic alcoholism and hepatitis. Each time the liver gets injured, it tries to repair itself, resulting in the formation of the scar tissue. With the progression of cirrhosis, a number of tissues generate making the task of liver difficult. Since the liver is an important organ of the body due to its functionalities such as detoxification and nutrient generation, reduced function of liver poses a serious threat to the body.

Symptoms of liver cirrhosis:
Unfortunately, cirrhosis doesn t portray any conspicuous symptoms that can be easily identified until the scarring has reached a level of threat. Some of the common signs and symptoms of this disease include fatigue, nausea, itchy skin, drowsiness, enlarged breasts, testicular atrophy, fluid in the abdomen, bleeding from the mouth, leg swelling, redness in palms etc.

Causes of liver cirrhosis:
There could be an array of reasons for the occurrence of liver cirrhosis. The major causes include an accumulation of fat in the liver, chronic alcoholism and chronic hepatitis. Some of the other reasons include cystic fibrosis, bile duct deformation, Wilson s disease, hemochromatosis, schistosomiasis, continuous consumption of medicines such as methotrexate, a disease involving glycogen storage and Aalagille syndrome.

Complications involved in liver Cirrhosis:

High blood pressure: Cirrhosis results in slow blood movement through the passage of the liver resulting in an increased pressure on the vein that is responsible for carrying blood from the intestine to the liver. This increases the blood pressure in the body.
Swelling of abdomen and legs: Portal hypertension can result in accumulation of fluid in the leg and the abdomen due to the liver s inability to producing an important protein known as the albumin.
Spleen enlargement: Portal hypertension is responsible for changing the shape of the spleen. Decreased count of WBC and the platelets indicate towards portal hypertension and cirrhosis.
Bleeding: Portal hypertension doesn t let the blood flow in its normal path. It directs the blood to flow through smaller veins. The veins, in turn, swell and burst to cause a massive amount of bleeding.
Apart from these some of the other complications involve jaundice, liver cancer, infections, bone diseases and liver failure.

Diagnosis:
Liver cirrhosis doesn t get detected easily. It is often diagnosed with a routine blood test. Some of the lab tests that can help to identify cirrhosis include blood work to check organ function of liver and kidney. Your doctor might suggest other tests such as MRI scan, CT scan or liver biopsy.

Treatment:
Treatment for the underlying cause of liver cirrhosis is done to keep the disease under control. A doctor might treat you for weight loss, alcohol dependency, complications related to hepatitis, portal hypertension and hepatic encephalopathy. For advanced cases where the liver stops functioning, a doctor might suggest a patient go for a liver transplant.

Liver Cirrhosis - What You Must Know About It?

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?

The liver performs over 500 functions and is considered to be one of the most important organs in the human body. The functions liver perform include regulating cholesterol and blood sugar, filtering out blood toxins, storing energy and making hormones and proteins. There are many diseases which liver can catch and most prominent being alcoholic liver disease

When a person consumes alcohol in excess, it leads to building up of fats, inflammation and scarring of the liver   which results in alcoholic liver disease.

The damage that occurs due to this disease in the liver can affect the whole body. Since the liver is generally highly effective in repairing and regenerating itself so the damage takes longer to come into notice. It often becomes distinctive by the time the damage is already irreversible.

This disease usually takes place in people between 40 and 50 years of age. This disease is most commonly seen in men. Certain cases have been seen where people may have inherited the risk for the disease.

Liver disease related to alcohol consumption fits into following 1 of 3 categories:

Fatty liver: This takes place due to acute consumption of alcohol. This state is generally reversible if alcohol isn t consumed.
Alcoholic hepatitis: This is an acute type of alcohol-induced liver injury which takes place when alcohol is consumed excessively over a long period of time. It can lead to liver failure and death as well.
Cirrhosis: Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by over consumptions of alcohol. It can also occur due to other reasons as well.
Some Facts about Alcoholic Liver Disease

It is the main cause of chronic liver disease in Western nations and the third most common cause of liver transplants.
Staying away from alcohol is the only way to the patient s recovery.
Jaundice and tremors are the most common symptoms of this disease.
Medication, lifestyle changes, and surgery are some available treatments.
Early signs of the Disease
The early signs of alcoholic liver disease are not much noticeable and affect many systems in the body.

Pain in the abdomen
Nausea and vomiting
Diarrhea
Decreased appetite
If these signs are left unattended and the patient continues to consume alcohol, it can lead to a faster damage to the liver.

The symptoms of this disease become noticeable usually during the later stage of liver disease. The symptoms of this disease include:

Jaundice
Edema or swelling of the lower limbs
A build-up of fluid in the abdomen, known as ascites
Fever and shivering
Extremely itchy skin
Clubbing of fingernails
Loss of weight
General weakness
Blood in vomit and stools
Bleeding and bruising more easily
More sensitive reactions to alcohol and drugs
In most patients with the alcoholic liver disease, the illness is not severe. You may not require hospitalization immediately as long you take necessary precaution like stopping the consumption of alcohol, take good nutrition and follow the advice of the doctor. However, in more severe cases, the doctor may be able to suggest the best line of treatment.

Alcoholic Liver Disease - Know The Symptoms!

The liver is a vital organ in our body because it performs many important functions. This includes filtering harmful substances in our blood, producing bile to facilitate digestion of food, storing energy and nutrients as well as producing hormones and enzymes that the body uses for performing essential functions. However, too much consumption of alcohol can affect the liver, lead to serious consequences related to our health, and also result in an alcohol-related liver disease (ALD). An ALD may, in turn, cause disruption of the digestion process and weaker immune system. It may even increase the risk of developing cancer.

Causes:

As the name suggests, the prime cause behind the development of alcohol-induced liver disease is the consumption of alcohol for a long duration. However, some of the other causes behind the development of alcohol-induced liver disease include the presence of an existing liver disease such as fatty liver or hepatitis, inherited liver disease, or a liver disease induced due to excessive or prolonged consumption of certain drugs.

Alcohol-induced liver diseases (ALD) can be of three types. 

Alcoholic fatty liver disease: Alcoholic fatty liver disease or steatosis occurs due to the deposition of fats in the liver, which is an end result of excessive alcohol consumption.
Alcoholic hepatitis: Too much of alcohol consumption can also lead to liver inflammation, which is called alcoholic hepatitis.
Alcoholic cirrhosis: This alcoholic-liver disease occurs when the liver is scarred due to excessive consumption of alcohol. In this case, the healthy and soft liver tissues are replaced with dead and hard tissues.
Symptoms: Some of the signs and symptoms, mostly related to ALD, are not noticed in the initial stage. It is only after a few years that the symptoms may appear. Some of the common symptoms include abdominal pain, loss of appetite and weight loss, swelling in the abdomen as well as the legs, feet, and ankles, a yellowish appearance of the skin, itchy skin with hair loss, and bleeding and complications such as liver cancer or ascites.

Diagnosing alcohol-related liver disease is based on your history of alcohol consumption. But, there is no single test that can detect this type of disease, so a combination of tests will be suggested by your physician before a specific type of alcoholic liver disease is diagnosed.



Ayurvedic Treatment

Ayurveda is known to be greatly beneficial for the treatment of alcohol-induced liver diseases. The use of natural ingredients like herbs can not only treat the liver disease but also promote the overall well-being of the liver. The treatment will include abstinence from alcohol, as it is very important when it comes to undoing the damage that alcohol has caused to your liver.

There are some home remedies also which are only supportive in case of Alcoholic fatty liver, but if you are suffering from alcoholic hepatitis and ALD related liver cirrhosis you must need proper line of treatment under a well experienced and expert Ayurvedic doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!

Alcohol Related Liver Diseases - Ways Ayurveda Can Help With It!

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! 

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