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Cirrhotic Ascites Tips

Ascites

Dr. A.A Khan 93% (1041 ratings)
MBBS,CCA,DCA,AASECT,FPA,AAD,F.H.R.SM.I.M.S
General Physician, Bangalore
Ascites

Drinking ayurvedic tea has been in practice for thousands of years, and can provide a wide range of benefits to those who regularly consume it.

What is ayurvedic tea?

Ayurvedic teas are traditional herbal teas prepared in ayurvedic medicine, the traditional indian approach to health and wellness. Ayurvedic teas come in three main types, vata tea, pitta tea, and kapha tea. These three teas consist of different herbal elements and they are believed to detoxify and cleanse the body in very specific ways. These ayurvedic teas are famed for being able to increase health and longevity, along with a number of otherhealth benefits. Provided you aren’t specifically allergic to any ingredients and have spoken to your doctor about any dangers of taking these herbal tonics, these teas should be completely safe to consume.

Ayurvedic tea benefits

The most impressive health benefits of ayurvedic tea include its effects on memory, digestion, and weight loss, among many others. Despite being a caffeine-free beverage, it can still help to improve the metabolism and optimize fat-burning by the body, and can also improve digestive efficiency, preventing the build-up of toxins in our gastrointestinal system. The anti-inflammatory nature of these types of tea is also excellent for chronic conditions, as well as preventing chronic inflammation, which can lead to oxidative stress and damage from free radicals.

Various studies on these teas also show that they can have effects on cognitive health and lower your risks of neurodegenerative diseases, such as alzheimer’s disease and parkinson’s.

How to make ayurvedic tea?

As mentioned, the three main types of ayurvedic tea are vata tea, pitta tea, and kapha tea. Depending on who is preparing these blends, the amounts of these herbal ingredients may vary, but the basic recipes rarely do. As with any other herbal tea, these herbs are allowed to steep in water for varying amounts of time before being served.

3 people found this helpful

Ascites - How Ayurveda Can Help You Treat It?

Dr. Srinivasa Debata 92% (320 ratings)
Bachelor of Ayurveda, Medicine and Surgery (BAMS), BTCM, DTCM
Ayurveda, Bargarh
Ascites - How Ayurveda Can Help You Treat It?

Ascites refers to the accumulation of fluid in the abdominal cavity, which causes the abdomen to swell. The fluid retention can be caused by heart failure, liver cirrhosis, liver disease, kidney failure, or congestive heart failure. The disease does not have any symptom if it is in early stages but if it is moderate or advanced then the patient may experience specific symptoms such as abdominal heaviness and stiffness, bloating, shortness of breath, wheezing, edema of feet, and dilated veins.

Ascites can only be diagnosed through an ultrasound examination or blood or urine test and then the doctor prescribes medicines to cure the disease. There is a host of allopathic medicines to cure this liver disease but they are harsh and can also have side effects. In such a scenario, Ayurvedic medicines offer to be a better solution as they do not have side effects and also cure the disease completely, ensuring a permanent relief.

  1. Virechana: A part of panchakarma, virechana is a detoxification therapy that brings out the toxins accumulated in the body. It is highly effective in ascites (Jalodara) as it acts as a purgative therapy. In this therapy, the patient is made to consume purgative herbs after cleansing their system through vomiting. This induces excretion of toxins including the fluid retained in the abdominal cavity.
  2. Gokhru: Puncture spine or Gokhru can be very effective in ascites as it has anti-inflammatory properties that reduce swelling of the abdomen. It also acts as a diuretic, increasing urine secretion from the body that helps flush out the toxic fluid accumulated in the abdominal cavity.
  3. Triphala: A mixture of bibhataki, haritaki, and amlaki, triphala is a very effective detox herb. It carries laxative properties and thus, helps to remove the fluid from the body. Gentle in nature, it also regulates the bowel movement and relaxes the liver muscles.
  4. Punarnava (Boerhavia diffusa): This herb is very effective in controlling the swelling and fluid retention in the abdomen. It possesses anti-inflammatory and diuretic properties which relax the liver walls and also flush out toxins from the abdominal cavity by increasing the flow of urine in the body.
  5. Shilajit: An energetic and nutritive Ayurvedic medicine, it is very helpful in restoring the immunity of the body. It checks for fluid accumulation in the abdominal cavity. It is very effective in those patients who feel fatigue or weakness due to ascites. It gives relief in bloating too.

Ascites is a painful liver disease that can hamper the life of the patient to a large extent. So, its timely diagnosis and treatment are necessary. If the patient decides to go for Ayurvedic remedies, then it is advised that they consult a certified Ayurveda practitioner. A certified practitioner will do accurate diagnosis and prescribe the best remedy to cure the disease. In case you have a concern or query you can always consult an expert & get answers to your questions!

4983 people found this helpful

Liver Cirrhosis - Ways That Can Help You Deal With It!

Dr. Sandeep Jha 90% (403 ratings)
DNB (Surgical gastroenterology, MS( General Surgery), MBBS, Fellowship in Minimal Access Surgery, Diploma in Minimal Access Surgery, Fellow of International College of Robotic Surgeons
Surgical Gastroenterologist, Delhi
Liver Cirrhosis - Ways That Can Help You Deal With It!

Liver Cirrhosis is a medical condition that results in severe scarring (often permanent and irreversible) of the liver. While there can be a myriad of factors giving rise to cirrhosis (such as repeated liver injury or unhealthy diet), the most common triggers include Hepatitis B, Hepatitis C, Alcohol, NASH (non-alcoholics teatohepatitis ). In addition to interfering with the healthy functioning of the liver, cirrhosis also gives rise to many serious and life-threatening complications such as Blood vomiting, Jaundice, Ascites (a condition characterized by an increased build-up of fluids in the abdomen), Hepatic Encephalopathy, Edema, Splenomegaly. In some men, cirrhosis can even give rise to Breast enlargement and Testicular Atrophy. 

Preventive measures to manage Cirrhosis and the associated complications 
In the case of cirrhosis triggered by Hepatitis, medications are used to treat the viral infection thereby avoiding any further liver damage. 

  1. In people with cirrhosis resulting from alcohol abuse, the effectiveness of the treatment depends on how quickly a person can give up drinking (In some cases, the affected individual may have to undergo rehabilitation programmes to stop drinking). In addition to drinking, it is also beneficial to quit smoking as well. 
  2. For excess fluid retention on the body, in addition to the medications (such as diuretics and antibiotics), doctors often recommend a low-sodium or low-salt diet. The use of a TIPS (Transjugular Intrahepatic Portosystemic Shunt) can also contribute to slow down the fluid build-up in the body. 
  3. Medications may also be used to treat a host of serious complications (triggered by cirrhosis) such as Hepatic encephalopathy, weakness, itching, bruising, infections to provide some relief. 
  4. However, in case of severe or complete liver damage and failure (advanced cirrhosis), a liver transplant may be recommended. A liver transplant, as indicative of the name, involves replacing the damaged or diseased liver of the recipient with a healthy liver from the donor. 

Unfortunately, once the liver has been scarred, there is little that can be done to reverse the damage. However timely diagnosis and treatment in the form of liver transplant can ensure long-term survival in these life-threatening illness. Cirrhotics should be under regular follow-up to prevent development of complications and timely referral for transplant. A damaged , cirrhotic liver is a fertile ground for development of hepatocellular cancer(HCC). 

Routine imaging on follow-up is important to diagnose HCC at an early, curable stage. These patients require liver transplant at the earliest. Also regular upper GI endoscopy and variceal banding should be done to prevent development of life-threatening hematemesis ( Varieal bleeding ).

Severity of Cirrhosis can be estimated by two scoring tools easily available on the smartphones. Child Turcotte pugh(CTP)’s scoring system , Child’s Stage and MELD scoring system . CTP score of >7 , Child B or MELD > 15 are candidates for liver transplant. Patient with decompensation(Hepatocellular cancer , Upper GI Bleed, Encephalotpathy, Refractory ascites, Hepato-renal syndrome, Hepatopulmonary syndrome) are candidates for liver transplant. 

Some other healthy modifications to control cirrhosis include

  1. Choose your foods with care. Avoids foods that are high in sodium or are salty. Processed, canned, smoked, Barbecued foods, baked beans, ham, salami, bacon, caffeinated beverages, are best left avoided.
  2. Increase your intake of fresh fruits, vegetables, foods rich in proteins. Having a large meal may be difficult in the case of cirrhosis. Instead, have small meals at regular time intervals. 
  3. Some of the medicines such as Aspirin, NSAIDs (Advil, Aleve), Tylenol, can aggravate the liver damage. Thus, never have these medicines without consulting a physician. 
  4. It is also necessary to get vaccinated against some of the viral infections including Hepatitis (A and B), influenza, pneumonia.

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

3626 people found this helpful

Alcoholic Liver Disease - Know The Symptoms!

Dr. Vibhu V Mittal 85% (10 ratings)
MBBS, MD - Medicine, DM - Gastroenterology
Gastroenterologist, Ghaziabad
Alcoholic Liver Disease - Know The Symptoms!

The liver is the center of metabolism, which is involved in removing various toxins from the body. Alcohol is one of the toxins that gets eliminated via the liver, and when a liver is exposed repeatedly to alcohol, it gets inflamed, scarred, and results in reduced functionality. This is known as an alcoholic liver disease and affects about 40% of all heavy drinkers. The affected age group is often 40 to 60, males more than females, though females who are heavy drinkers tend to have severe alcoholic liver disease.

Heavy drinking is when a person has more than 5 drinks within a few hours at least 5 times a month. For women, it is more than 4 drinks within a few hours at least 5 times a month.

Symptoms: Alcoholic liver disease is a chronic condition, and there are no overnight symptoms. However, over a period of time, the person will present with the following:

  1. Jaundice (yellowing of the skin and the whites of the eyes)
  2. Unexplained weight loss
  3. Fluid build-up in the abdomen
  4. Itching of the skin
  5. Gastrointestinal bleeding
  6. Black, tarry stools.

Diagnosis: When a person presents with these symptoms, the doctor can get suspicious and the diagnosis of alcoholic liver disease is confirmed by:

  1. A detailed medical history with focus on history of alcohol consumption.
  2. Liver enzyme testing, which often shows elevated liver enzymes.
  3. Liver biopsy to confirm the diagnosis.

Complications: If left untreated, the liver can continue to undergo inflammation, further affecting its function. Overall metabolism is severely affected. The fluid build-up in the abdomen (ascites) could be dangerous. Jaundice can reach lethal levels, and so intervention is very essential.

Treatment: The point to note is that if identified early on, the condition can be reversed if some key steps are taken:

  1. A person can be made to quit drinking, and this can stop further damage. In many cases, this also helps reverse the damage that is already done. This could require some psychological counseling and group therapy too. This needs to be sustained for the person to recover.
  2. Diet changes: Switch to a low-sodium diet, with less of packaged foods. Eat more of fresh fruits and vegetables. Include vitamin and mineral supplements to improve overall liver function.
  3. Steroids: The liver undergoes inflammation constantly, and so steroids can help fight this inflammation. They are often given in small doses at a regular frequency.
  4. Antibiotics: If the liver is infected (alcoholic hepatitis), then antibiotics may be required.
  5. Ascites is treated with drainage of the fluid.

Periodic monitoring is essential to prevent relapse and complete recovery.

Try Surgery For Portal Hypertension!

MS - General Surgery, DNB - Surgical Gastroenterology, Fellow HPB Surgery & Liver Transplant
Surgical Gastroenterologist, Ernakulam
Try Surgery For Portal Hypertension!

There are veins which carry blood from the various digestive organs to the liver. When there is an obstruction in the free flow of blood in the liver, it increases the pressure and is known as portal hypertension. This increased blood pressure stresses the blood vessels in the esophagus, stomach, and other digestive organs and results in internal bleeding.

What causes portal hypertension?
Cirrhosis is the most common cause of portal hypertension. The cirrhosis could be a result of excessive consumption of alcohol, chronic hepatitis, or thrombosis in the liver vessels. Blood clots in the portal vein are schistosomiasis ( a parasitic infection) are some other causes of portal hypertension. It is also important to know that in some cases, the causes of this condition remain unknown.

What are the symptoms?
Although, the symptoms of portal hypertension may not be very evident until you identify that there is some damage in the liver. the chances of developing a portal hypertension are increased if you suffer from a liver disease.

  • Ascites, which is fluid accumulation in the abdominal cavity
  • Bleeding in the abdominal vessels
  • Blood in the stools and/or vomitus (black tarry stools or blood in the vomitus)
  • Reduced platelet count
  • Encephalopathy, fluid accumulation in the brain, which can lead to confusion and other issues

How can it be managed?
Once diagnosed, treatment of portal hypertension is at two levels.
At the first level, dietary and lifestyle changes and medical treatment should suffice.

  1. Alcohol, a street drug, and tobacco use should be completely stopped. Sodium and protein intake should be reduced.
  2. Avoid taking any over-the-counter medications without consulting a medical personnel.
  3. Have a good, balanced nutrition
  4. Medications like propranolol are given to control blood pressure
  5. Medications are also given to prevent internal bleeding
  6. If there is encephalopathy, then lactulose is given to clear confusion
  7. The ends of the bleeding vessels are tied and cut off (ligated) endoscopically, and this is known as sclerotherapy. Alternately, bands may be applied to the cut vessels to prevent further bleeding. This is known as banding.

If this first line does not work, then the next level of interventional therapy is initiated.

  • TIPS, which is a transjugular intrahepatic portosystemic shunt, which is a shunt that is placed into the liver to reduce pressure.
  • Distal splenorenal shunt (DRSR) is when a shunt or link is created between the splenic vein and the left kidney vein. This also helps control variceal pressure and bleeding.
  • Both these shunts are widely performed and require follow up once in 6 months to ensure they are performing well and without any blockages.

Other options:

  • In cases where a shunt is not possible, then devascularization is done. This involves removal of the bleeding varices.
  • The fluid in the abdomen may be removed surgically by paracentesis.
  • As a last option, a liver transplant surgery may also be considered.

So, while portal hypertension definitely is a serious medical condition, there are different levels of treatment. The important thing is to alert yourself once any symptoms set in. Early intervention always ensures minimal intervention and good prognosis.

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

2707 people found this helpful

The Surgical Treatment For Portal Hypertension!

Dr. Siddharth Jain 91% (95 ratings)
FELLOWSHIP IN HEPATOBILIARY AND LIVER TRANSPLANT SURGERY, Fellowship in Abdominal Multi Organ Transplant Surgery, MS - General Surgery, MBBS Bachelor of Medicine and Bachelor of Surgery
Gastroenterologist, Delhi
The Surgical Treatment For Portal Hypertension!

There are veins which carry blood from the various digestive organs to the liver. When there is an obstruction in the free flow of blood in the liver, it increases the pressure and is known as portal hypertension. This increased blood pressure stresses the blood vessels in the esophagus, stomach, and other digestive organs and results in internal bleeding.

What causes portal hypertension?
Cirrhosis is the most common cause of portal hypertension. The cirrhosis could be a result of excessive consumption of alcohol, chronic hepatitis, or thrombosis in the liver vessels. Blood clots in the portal vein are schistosomiasis ( a parasitic infection) are some other causes of portal hypertension. It is also important to know that in some cases, the causes of this condition remain unknown.

What are the symptoms?
Although, the symptoms of portal hypertension may not be very evident until you identify that there is some damage in the liver. the chances of developing a portal hypertension are increased if you suffer from a liver disease.

  • Ascites, which is fluid accumulation in the abdominal cavity
  • Bleeding in the abdominal vessels
  • Blood in the stools and/or vomitus (black tarry stools or blood in the vomitus)
  • Reduced platelet count
  • Encephalopathy, fluid accumulation in the brain, which can lead to confusion and other issues

How can it be managed?
Once diagnosed, treatment of portal hypertension is at two levels.
At the first level, dietary and lifestyle changes and medical treatment should suffice.

  1. Alcohol, a street drug, and tobacco use should be completely stopped. Sodium and protein intake should be reduced.
  2. Avoid taking any over-the-counter medications without consulting a medical personnel.
  3. Have a good, balanced nutrition
  4. Medications like propranolol are given to control blood pressure
  5. Medications are also given to prevent internal bleeding
  6. If there is encephalopathy, then lactulose is given to clear confusion
  7. The ends of the bleeding vessels are tied and cut off (ligated) endoscopically, and this is known as sclerotherapy. Alternately, bands may be applied to the cut vessels to prevent further bleeding. This is known as banding.

If this first line does not work, then the next level of interventional therapy is initiated.

  • TIPS, which is a transjugular intrahepatic portosystemic shunt, which is a shunt that is placed into the liver to reduce pressure.
  • Distal splenorenal shunt (DRSR) is when a shunt or link is created between the splenic vein and the left kidney vein. This also helps control variceal pressure and bleeding.
  • Both these shunts are widely performed and require follow up once in 6 months to ensure they are performing well and without any blockages.

Other options:

  • In cases where a shunt is not possible, then devascularization is done. This involves removal of the bleeding varices.
  • The fluid in the abdomen may be removed surgically by paracentesis.
  • As a last option, a liver transplant surgery may also be considered.

So, while portal hypertension definitely is a serious medical condition, there are different levels of treatment. The important thing is to alert yourself once any symptoms set in. Early intervention always ensures minimal intervention and good prognosis.

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

2537 people found this helpful

Fatty Liver - All You Need To Know!

Dr. Vibhu V Mittal 85% (10 ratings)
MBBS, MD - Medicine, DM - Gastroenterology
Gastroenterologist, Ghaziabad
Fatty Liver - All You Need To Know!

The liver is the second largest organ in the human body. Everything that is consumed goes through the liver and gets metabolized. Generally the liver consists of fat accumulation, in the range of 2%, but when it reaches close to 10%, the condition is termed as fatty liver. Progression of fatty liver can lead to cirrhosis and eventually liver failure. The liver has an amazing ability to regenerate itself if a part of it is damaged.

However, if the damage is cumulative, then the repair becomes difficult. Another point to note is that the liver can be resected in parts to ensure that the non-affected liver continues to be available to take care of the metabolism.

Causes: There are two main types of fatty liver:

  1. Alcoholic fatty liver: This is the most common type and is seen in heavy drinkers.
  2. Non-alcoholic steatohepatitis (NASH): The causes for this type are not clear, but obesity, diabetes, and hyperlipidemia are some causes for NASH.

Symptoms: Fatty liver develops over years, and the symptoms are both vague and appear randomly. These can be attributed to any general illness, and so diagnosis is often delayed.

  1. Unexplained weight loss
  2. Jaundice
  3. Loss of appetite
  4. General malaise
  5. Dull pain in the right upper quadrant of the abdomen
  6. Overall physical weakness
  7. Ascites or fluid accumulation in the abdomen
  8. Increased tendency to bleed
  9. Abnormal liver enzyme levels

Diagnosis: If suspected of fatty liver, the following are done to confirm the diagnosis.

  1. Blood tests to check for liver enzyme levels.
  2. Imaging studies including x-ray, CT and/or MRI scan
  3. Biopsy to confirm the diagnosis

Treatment: Fatty liver is a completely reversible condition. If a person with alcoholic fatty liver quits drinking for about 8 to 10 weeks, the damage can be totally reversed.

If there is no history of alcoholism but obesity, then switching to a non-fatty diet with lots of fresh fruits and vegetables, multigrain, dairy products, etc., can help in controlling fat accumulation and use the stored fat. Increasing the levels of physical activity also helps in burning stored fat.

As noted, the liver is capable of self-repair and self-regeneration, so if further triggers are stopped, it can heal itself.

If fatty liver is not controlled, it can develop into cirrhosis and liver failure. If it reaches liver failure, then survival rates and prognosis look very gloomy.

Prevention: Fatty liver disease can be prevented by controlling alcohol intake, adopting a healthy lifestyle, eating non-fatty and non-sugary products, and maintaining an active and healthy lifestyle.

Monitor health periodically to check on liver function, diabetes, and cholesterol levels. In case you have a concern or query you can always consult an expert & get answers to your questions!

1768 people found this helpful

Diet And Nutrition Tips For Liver Cirrhosis Patients

Dt. Neha Suryawanshi 91% (14814 ratings)
M.Sc. in Dietetics and Food Service Management , Post Graduate Diploma In Computer Application, P.G.Diploma in Clinical Nutrition & Dietetics , B.Sc.Clinical Nutrition & Dietetics
Dietitian/Nutritionist, Mumbai

Diet and nutrition tips for people with cirrhosis

Malnutrition, a common complication in liver cirrhosis, is associated with poorer outcome. Consequently, a diet that provides 25 to 40 kcal/kg body weight a day is usually prescribed. Nutrition therapy, particularly with branched-chain amino acids, can also help support patients who are losing weight due to poor appetite and may improve survival.

Cirrhosis prevention or management:

Low-fat diets: Excess dietary fat may encourage cirrhosis progression. High intakes of total fat, saturated fat and polyunsaturated fat have been implicated. High-fat diet can worsen cirrhosis as it contributes to fatty liver disease which is another cause of cirrhosis. No more than 30 percent of your calories should come from fat.

Antioxidants and b-vitamins: Cirrhotic patients have significant reductions in antioxidant enzymes and lower blood levels of certain antioxidant nutrients, such as carotenoids, vitamin e, and zinc. Due to a reduction in food intake and documented deficiencies of several nutrients in cirrhosis, patients should take at least a multiple vitamin with minerals that meets 100% of the dietary allowance for all vitamins and minerals.

Branched-chain amino acids and enteral feeding for malnourished patients -protein-energy malnutrition is common, occurring in 65% to 90% of patients with cirrhosis. Enteral feeding is also the recommended route for artificial nutrition in cirrhosis, and is associated with improved liver function and a lower hospital mortality rate.

Limit salt: Salt retains water, which can cause further problems for cirrhosis patients. It is important that you limit your salt intake to less than 2, 000 mg a day or less. You can do this by avoiding salty foods, cooking for yourself, reading food labels carefully, avoiding fast-food restaurants, and reducing your intake of red meat.

Watch your calories and protein: Cirrhosis patients may need additional calories and protein as they may lose their appetite or experience nausea or vomiting, leading to weight loss. Eating smaller, more frequent meals may help combat this while replenishing lost nutrients, calories, and protein. Protein should come from plant sources as meat-sourced protein is hard for your liver to filter through.

Avoid alcohol: In many cases, alcohol is a main cause for cirrhosis, so continuing to drink will worsen your condition. Avoid alcohol at all costs.

Avoid caffeinated beverages: Caffeinated beverages have been found to worsen liver disease.

Weight loss due to loss of appetite and other factors lifestyle changes to reduce cirrhosis symptoms.

Maintain a healthy weight. Some forms of liver disease, including cirrhosis, are linked to fat accumulation.

Reduce your risk of developing hepatitis. Do not share needles, ensure you are vaccinated, and be aware of the risk of hepatitis when traveling to foreign countries.

Avoid infections. Cirrhosis makes it difficult to fight off infections. Avoid people who are sick and wash your hands frequently.

Don’t smoke. This is toxic to the liver.

Don’t do illicit drugs. These too increase your risk of hepatitis and infection.

Manage other health conditions. Control blood pressure, cholesterol, and diabetes as these can all take a toll on your liver, worsening your disease.

Avoid harmful medications: Medications are processed through the liver, so certain drugs can worsen your condition.

1 person found this helpful

Liver Transplant - FAQs Solved!

MBBS, DNB ( General Surgery)
Liver Transplant Surgeon, Pune
Liver Transplant - FAQs Solved!

1. What are the symptoms of liver disease? When to see a doctor?

Most of the liver diseases present with similar symptoms with some variations. Some of the common symptoms can be loss of appetite, nausea and vomiting, vomiting of blood, jaundice(yellowish discoloration of the eye), abdominal pain, itching, distension of abdomen( accumulation of fluid- ascites), swelling of lower limbs, weight loss, altered sensorium, confusion, and in a late stage- coma.

2. Can liver disease be prevented?

Liver is a crucial body organ which is responsible for processing essential nutrients from the food you eat, synthesizing bile and most importantly removing harmful toxins from the system. To ensure that your liver keeps performing its functions, you need to follow a healthy lifestyle.

Some of the liver diseases are metabolic and hence inherent at the time of birth and manifest later. However, some of the more common liver diseases are preventable like alcohol induced liver disease, fatty liver induced liver disease (NAFLD), Hepatitis A, B and C.

3. What is liver transplantation? What is the average cost of liver transplantation?

Liver transplantation is the treatment for end stage liver disease in both adults and children. In this operation, the diseased liver is removed and replaced by a healthy one. The success rate for the operation is high and terminally ill patient can return to normal lives.

The average cost of liver transplantation is Rs 18 to 20 Lakhs at Sahyadri specialty hospital, Pune Maharashtra. The cost of investigations of the donor and recipient is Rs 90,000. When patients are too sick and require prolonged stay following liver transplantation, the cost of treatment can escalate; hence it is advisable to patients to have the liver transplantation before they develop complications secondary to the liver disease (Cirrhosis).

Most of the patients seek help at a very late stage or referred late to a Surgeon. It is advisable for patients to seek the opinion of a Surgeon at a very early stage of the disease. The patient needs to take medicines for the rest of his life to prevent rejection of the new liver. The cost of medicines and the investigations in the first year is approximately Rs 10-15000/-. The number of medicines and the frequency of blood investigations are much less after the first year of liver transplantation.

The cost of liver transplantation in India is one-twentieth when compared to USA, UK and other European Countries.

4. When should a liver transplant be performed?

When a person’s liver is severely damaged and cannot function properly or complications may develop and liver transplantation should be considered. Conditions like hepatic coma, massive upper gastrointestinal bleeding, and liver cancer is the best treated by complete removal of the liver (cirrhotic liver).

In general, when a patient needs a new liver, the earlier the operation, the higher the success rate is.

Urgent liver transplantation is recommended in patients who have acute liver failure and this could be due to many reasons. The common conditions are Hepatitis B, Hepatitis A, Hepatitis E and drug induced. In such patients, liver transplantation is urgently needed in order to save the life of the individual.

5. What are the advantages/benefits to the recipient of getting a living donation vs cadaver?

A new liver can come from either of the two sources: A living donor or a brain-dead deceased donor.

Living donor transplantation:

It is technically feasible to remove part of the liver from a living person and transplant it to a patient who needs a new liver. The operation has now been done since 1989. Depending on the size matching of the donor and recipient, either the left side (about 35-40%) or the right side (60-65%) of the liver will have to be removed. The liver remnant in the donor will grow to its original size in 6-8 weeks time.

This process helps in an earlier transplantation before the recipients’ conditions deteriorates. It is a planned procedure whilst cadaver liver transplantation is an emergency procedure. It avoids the risk of death while waiting for a deceased donor liver graft(40% overall and 75% for patients in Intensive care units). The survival rate of a living donor transplant is over 90%.

There are risks like complications of the investigations and surgical procedures but the possibility of donor death rate is of 0.2-0.5%. Seventeen donor deaths have been reported in Brazil, France, Germany, Egypt, Hong Kong, Japan, USA and India.

Cadaver transplantation:

This is well established in the Europe and USA. Unfortunately, the availability of deceased donor liver is not very often in India. Depending on your blood group, you may have to wait for 0 to 6 months before you get a new liver.

During this waiting period, you may develop complications like spontaneous bacterial peritonitis (infection of the fluid in the abdomen) which, if repetitive may produce severe adhesions in your abdomen rendering liver transplantation difficult if not impossible.

It is important for everyone to register for organ donation, so that when we die, this noble act will help many people to lead normal lives. In the Western world the organ donation rate is between 15-18/million population where as in Indi it is less than 1/million.

6. Who can be a suitable living donor?

The most important criteria is that the donation of portion of the liver is done voluntarily. The donor has to be less than 50 years of age, body mass index of less than 25 and is a near relative of the recipient. Both the donor and the patient should have the same Blood group or O Blood group.

Besides, the potential donor should understand clearly that

  • The donor operation carries complication rate of 10-15%.
  • The recipient is successful in 90-95%, which means that there is 5-10% chance of dying.
  • The donation is done out of his/her own wish and without any coercion.
  • There is no financial gain related to the act of donation.
  • The donor has the right to withdraw at any time without the need of giving any reasons to do so.

7. Which patients are excluded from liver transplantation procedure?

Patients who have cancer in another part of the body, active alcohol or illegal drug abuse, active or severe infection in any part of the body, serious heart, lung or neurological conditions or those who are unable to follow doctors’ instructions are excluded generally.

8. What are the risks to the recipient from the surgery?

The overall success rate of liver transplant is over 94% and the majority of recipients can return to normal activities and achieve 95% of their quality of life which they had prior to liver disease. Since the recipients’ body may reject the new liver, it is essential for them to take immunosuppressive medications and continue follow up at the liver transplant clinic. They will need to continue these medications for life, at a reducing dosage.

The risk for the recipient is the return of the original problem that necessitated the liver transplant in the first place, e.g. hepatitis C, recidivism (return to alcoholism), noncompliance of medications. The other complications that can arise are thrombosis of blood vessels going into or out of the liver, primary or delayed graft non-function, bile duct complications, renal failure and other infections.

9. What are the side effects of having a liver transplant?

After a successful liver transplantation (95% of patients) – the patient is advised to take care of infections and to take anti-rejection medicines for life. The patient can return to normal quality of life and can return back to work in three months time. The patient has to regularly follow up with the surgeon in the first year and later at regular intervals as advised by his doctor. He will require blood tests to determine that his liver functions and to adjust his medications in the beginning and later the tests are infrequent. The patient is advised not to take any herbal or alternative drug treatment.

The transplant patient is assessed regularly for various complications like rejection, infection, narrowing of blood vessels etc., and appropriate treatment is initiated. Post transplantation, he is under the guidance of his doctor throughout his life. Any health problems that do come up have to be investigated and treated, though they are infrequent.

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

1870 people found this helpful

Gastric Cancer - In a Nutshell!

Dr. Pritam Mohapatra 96% (1373 ratings)
Post Doctoral Research (Ph.D.) (A.M) (Oncology), Integrative Oncology For Physicians (MSKCC, N.Y, USA), Doctor of Natural Medicine (N.D/ N.M.D), PG Diploma In Clinical Counseling, PG Diploma In Oncology & Haematology (A.M), Ayurveda (I) Certification, Clinically Relevant Herb-Drug Interactions (CME) (Cine-Med Inc. USA), Advanced Strategic Management (APSM), B.E (Computer Sc. & Engg.), Certificate Course in Homeopathic Oncology
Alternative Medicine Specialist, Bhubaneswar
Gastric Cancer - In a Nutshell!

Gastric (stomach) cancer occurs when malignant cells form in the lining of the stomach. By far, it is known to be the second most common cause of cancer-related deaths not only in Asia but also worldwide. Though it can affect both male and female populace, it is seen more commonly in men and in people aged 50 years or older.

  1. Type: Gastric cancers can present as one of the following types - 

    1. Adenocarcinoma: Begins in the glandular cells lining the inside of the stomach. This forms a majority of the stomach cancers.
    2. Lymphoma: Begins in immune system cells present in the walls of the stomach. Occurrence of lymphoma, in the stomach, is rare.
    3. Carcinoid Tumor: Begins in hormone producing cells of the stomach.  Occurrence of carcinoid cancer, in the stomach, is rare.
    4. Gastrointestinal Stromal Tumor (GIST): begins in nervous system cells of the stomach. Occurrence of GIST, in the stomach, is rare.
  2. Gender: It affects both male and female populace.

  3. Etiology: The factors that are associated with increased risk of gastric cancer include the following mostly –

    • ‘Helicobacter Pylori’ bacterial infection in the stomach is a common cause of gastric cancer of both the intestinal (expanding) & diffuse (infiltrative) type. Furthermore, studies indicate that high salt intake is synergistic with H. Pylori infection in the manner that it is likely to increase the risk of gastric cancer that is induced by H. Pylori bacteria.
    • Smoking, consuming alcohol, red meat, salty/ smoked/ processed foods, low intake of fruits and vegetables, diets rich in nitroso compounds, eating foods contaminated with aflatoxin fungus etc all.
    • Atrophic gastritis characterized by chronic stomach inflammation is known to increase the risk multi-fold. Chronic gastric inflammation can lead to atrophy of the gastric mucosa, metaplasia, dysplasia and finally carcinoma.
    • History of pernicious anaemia, gastric ulcers, adenomatous gastric polyp etc all.
    • Family history of gastric cancer. Several familial syndromes that have been associated with a pre-disposition to gastric cancer include familial adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome and e-cadherin mutation (diffuse type)
    • Blood group A, Obesity etc all are known to be associated with diffuse or cardia gastric cancer.
    • Low socioeconomic status - persistent lifestyle issues/ irregularities including high stress coupled with an improper diet/ dietary pattern.
    • Epidemiological evidence is indicative of a risk or pre-disposition to gastric/ stomach cancer for people suffering from diabetes mellitus (DM).
    • Very high dose ionizing radiation exposure is an uncommon risk for gastric cancer.
  4. Features: There are often no early stage symptoms. Early stage symptoms, if any, are non-specific and are likely to be ignored, thus delaying the diagnosis most often. Hence, gastric/ stomach cancer is often detected at an advanced stage where the disease is either locally advanced or metastatic. The various presentations (of signs & symptoms), by stage (early or advanced), of gastric cancer are as enumerated below:

    1. Early Stage – can present with one or more of the following non-specific symptoms/ signs -

      • Dyspepsia (Indigestion),
      • Stomach/ Epigastric discomfort,
      • Bloated feeling after eating,
      • Mild Nausea/ Vomiting,
      • Blood in Vomit (Haematemesis),
      • Heartburn,
      • weight loss (Cachexia)
      • Anaemia,
      • Occult blood in stool/ Melaena,
    2. Advanced Stage – presents with one or more of the following symptoms/ signs -
  5. Screening: Is generally recommended for asymptomatic populations in high incidence areas or as surveillance for high risk individuals. The goal of screening, as usual, is to be able to detect & diagnose gastric cancer at an early stage which is potentially curable. It is mostly endoscopic/ radiologic.
  6. Diagnosis: Following are the diagnostics employed in gastic cancer -​

    • Physical Examination: May be remarkable for palpable abdominal mass, weight loss (cachexia), abdominal distension, ascites, hepatomegaly, lower extremities edema and lymphadenopathy for gastric cancers in the advanced stage. For early gastric cancers, however, physical examination is largely uninformative.
    • Blood: Hb- may be low, ESR – raised, tumor markers CEA & CA-19-9 could be raised sometimes in adenocarcinoma but are not frequently elevated. Abnormal blood test results may be indicative of malignancy, but a follow-up gastroscopy/ biopsy is always the gold standard for accurate diagnosis.
    • Stool: Occult blood may be +ve
    • Barium Meal X-Ray: Could show a filling defect at the site of the carcinoma/ cancer growth.
    • Gastroscopy/ Biopsy: Clinches the diagnosis.
    • Endoscopic Ultrasound: Maximizes tumor staging as it helps determine the depth of invasion of the tumor.
    • CT Scan: Of chest, abdomen & pelvis helps detect metastatic disease, if any, and also helps stage the disease (TNM) appropriately.
    • Bone Scan: Helps detect osseous metastasis (bone mets), if any.
  7. Treatment: Conventional treatment includes surgery, chemotherapy and radiotherapy as contextually appropriate. Surgery (i.e. gastrectomy either sub-total or total), with an adjuvant chemotherapy and/ or radiotherapy as contextually relevant, is the only treatment that is known to cure the disease in light of the prognostic indicators as briefly enumerated in the section below. Chemptherapy and/ or radiation alone cannot be curative. Mostly, it can improve symptoms, and may prolong survival. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as feasible contextually.
  8. Prognosis: For gastric cancer is variable. Preventive measures, earlier diagnosis and right early treatment is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage gastric cancer are more. The cure/ recovery chances are influenced by the grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. Distal tumors are known to be cured more often than the proximal ones. Again, intestinal-type gastric cancers are known to have a better treatment outlook in comparison to the diffuse-type gastric cancers.

  9. Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an adherence to a relative Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising, de-stressing and relaxation is highly recommended for reducing the risks of many cancers including gastric cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. The consumption of alcohol, if any, has to be strictly in moderation, and is best avoided in a high risk scenario. Smoking is to be avoided too. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly. Not only it is important to eat healthy, but also it is equally important to eat properly. Insufficient chewing, eating until full, eating meals within a short time etc all are best avoided so as to ease off digestive burden on the stomach/ other organs in the GI tract. Last but not the least, consumption of clean and filtered water, natural probiotics like freshly prepared yogurt/ butter milk, maintenance of cleanliness & hygiene including oral hygiene etc. all can help guard against H. Pylori infections. Breastfeeding is known to be protective against H. Pylori infections too.

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