There are more than hundred kinds of liver diseases. Some common liver diseases are as follows- Fasciollasis which is a parasitic infection of the liver. Several drugs are effective for this disease. The drug of choice for treating Fasciollasis is triclabendazole. Bithionol is also used a successful treatment. Hepatitis is the inflammation of liver tissue caused by various viruses (viral hepatitis), by liver toxins (alcoholic hepatitis), autoimmunity (autoimmune hepatitis) or hereditary conditions. Hepatitis A does not usually progress to chronic state and rarely requires hospitalization. Hepatitis B can be acute and chronic. Here patients are treated with antiviral therapy. Injectable interferon alpha was the first approved therapy for chronic hepatitis B. there are some other medications too for chronic Hepatitis B. Hepatitis C is much more likely to pass to a chronic state. The ultimate aim of treating Hepatitis C is prevention of hepatocellular carcinoma. Hepatitis D is difficult to treat. Effective treatments too are lacking. Hepatitis E is similar to Hepatitis A and its treatment includes rest and ensuring adequate nutrition and hydration. In case of alcoholic hepatitis the first line treatment is treatment of alcoholism. But a severe case of alcoholic hepatitis is difficult to treat. Alcoholic liver disease is the hepatic manifestation of alcohol over consumption including fatty liver disease, alcoholic hepatitis and chronic hepatitis with liver fibrosis or cirrhosis. Most important part of the treatment is stop the intake of alcohol. In case of liver cirrhosis mostly transplantation is th only definitive therapy. Cirrhosis is actually the formation of fibrous tissue in place of liver cells due to variety of causes. Cirrhosis causes chronic liver failure. Fatty liver disease (hepatic steatosis) is a condition where large vacuoles of triglyceride fat accumulates. Treatment depends on the underlying cause of the disease. Gilbert’s syndrome is a genetic disorder. Typically no treatment is needed but if jaundice is significant phenobarbital may be used.
For the treatment of various liver diseases a number of different treatments are available. Triclabendazole is used for the treatment of Fascioliasis. The drug works by preventing the polymerization of the molecule tubulin. Nitazoxanide is effective in trails but is not currently recommended. Treatment for Hepatitis A and hepatitis E is generally supportive and includes procedures like providing of intravenous hydration and maintaining adequate nutrition. This disease rearely requires hospitalization. In severe acute cases of Hepatitis B patients are treated with antiviral therapy, with nucleoside analogues such as entecavir or tenofovir. Experts recommend reserving treatment for severe acute cases and not mild to moderate. chronic hepatitis B aims to control viral replication. Treatments includes Pegylated interferon which is dosed once a week. Lamivudine is used in areas where newer agent have not been approved or are too costly. Entecavir is safe and well tolerated drug and is a first line treatment choice. Currently used first line treatments include PEG IFN, Entecavir and Tenofovir. Hepatitis C treatment includes prevention of hepatocellular carcinoma and the best way to reduce long term risk of HCC is to achieve sustained virological response. Currently available treatments include PEG IFN, Ribavirin. In high resource countries direct acting antiviral agents are used which targets proteins responsible for viral replication. Hepatitis D is difficult to treat. Inferno Alpha has proven effective at inhibiting viral activity but temporarily. Hospitalization may be required in case of severe cases of Hepatitis E. Alcoholic hepatitis treatment includes pentoxifylline, corticosteroids etc. Treatment of alcoholic liver disease include Sylimarin but with ambiguous result. In case of serious cases of fatty liver disease insulin resistance, hyperlipidemia , and those that reduce weight are beneficial to liver. For patients having non-alcoholic steatohepatitis there are no available therapies. Damage from Cirrhosis cannot be reversed but further progression can only be delayed and complications can be reduced. A healthy diet is encouraged. Some convetional medicines are Corticosteroids and Ursodiol. Wilon’s disease is treated with chelation therapy. Liver transplantation becomes necessary if liver damage cannot be controlled.
In case of transplantation there are some criterias which are considered for the safety of the patients. Physical criterias and a solid support system before the surgery are very important factors. If any one is undergoing symptoms like nausea, vomiting, right upper quadrant abdominal pain, jaundice, fatigue, weakness and weight loss then it is better to check whether these are indicating towards liver diseases.
As there are many side effects of some drugs used for the treatment so it will be safe to check the eligibility before starting any treatment. Thus, it is advisable to consult a doctor for safety.
Common side effects of the drug Entecavir used for treating Hepatitis B are headache, nausea, high blood sugar and decreased kidney function. Severe side effects include enlargement of liver and high blood lactate levels. Tenofovir used to treat chronic hepatitis B has side effects like depression, rash, diarrhoea, weakness, pain and headache. Use of corticosteroids may be severe in some cases like it can cause anxiety, depression, can also cause sodium retention. Side effects of pentoxifylline which is used to treat alcoholic hepatitis are- belching, bloating, stomach discomfort, indigestion, nausea, dizziness, vomiting, flushing. Chelation therapy too has some side effects which are- dehydration, low blood calcium, harm to kidneys and lowered levels of dietary elements, etc.
There some after treatment guidelines that needed to be followed. After a patient has completed his/her treatment for Hepatitis C infection, the patient will require blood tests and doctor visits three to six months post-treatments. In case of cirrhosis a patient is generally taken care of by the liver specialist for a long term. Even if the patient is devoid of Hepatitis C infection, he/she will likely be monitored with some tests like blood test, imaging tests and upper endoscopy tests. If after completion of treatment virus remains, the patient needs to take a break and will be under watchful waiting and will be retreated if it is an option in future. It is instructed not to consume alcohol and stop smoking. Nicotine can make it more difficult to manage hepatitis B. many follow-up visits will be needed. After a liver transplant medicines are given like antimicrobial medicines, antirejection medicines, immune globin and steroid medicines. Maintaining a healthy weight is required and even some patients are given physical therapies. If a patient wants to become pregnant, it will be safe to wait for at least two years. Yearly skin exam is also necessary.
Different diseases of liver have different recovery time. Like for example in case of liver cirrhosis which is an end stage of liver, is mostly irreversible. And liver transplantation is the only therapy in that case. In rare cases, liver cirrhosis is reversible. In healthy patients (with Hepatitis B), 95-99 percent recover with no long lasting effects. Age and comorbid conditions can result in prolonged and severe illness. If a patient has clinical signs of ascites, peripheral edema, low serum albumin, etc, then they may require hospitalization. In many cases the treatment is curative but some therapies only aim to prevent further progression of diseases, reduce the symptoms of diseases or reverse the damage already done. So, treatment duration will vary based upon the disease and age and other health conditions of the patients.
Cost of treatment will depend on the health condition of the concerned patient. Liver transplantation is costly as it may amount to some lakhs. There are different kinds of kidney diseases and each require different treatment for different duration. Thus cost of treatment will also vary in each case.
Permanency of results depend on the disease. There remains a risk of rejection of the new organ in case of transplantations and patients may need to take immunosuppressive medications for the rest of their lives. Treatment of Hepatitis A in most cases are permanent. So is Hepatitis E treatment. In case of severe ailment hospitalization may be required and duration of treatment may get stretched.
Alternative treatments include variety of treatments. One of them is the ayurvedic treatment. Indian Echinacea, Yakrit Plihantak Churna improves liver function, Phyllanthus Niruri is a liver cleanser and liver detox capsules. Amla has liver protection properties. Licorice can cure ailments like non-alcoholic fatty liver disease. Amrith is known to clear toxin from the liver and strengthens its function. Some studies have shown that turmeric for its antiviral properties can be used prevent multiplication of viruses causing Hepatitis B and Hepatitis C. certain vegetables help liver secrete greater concentrations of important enzymes. Diet restrictions and life style modifications and de-addictions are some basic requirements to prevent and treat liver diseases.
Liver transplants are considered a safe procedure and has a high success rate. However, it is important for patients to follow proper aftercare instructions as given by the doctor. The liver helps process food and filter toxins and hence the patient’s diet must be carefully monitored after a transplant surgery. Weight gain after liver transplant can cause fatty liver disease and damage the sensitive transplanted liver.
Here are a few tips on the ideal diet to be followed after a liver transplant surgery.
Before consuming any kinds of foods and supplements, it is essential to consult with the doctor about the diet that needs to be followed. A proper diet and aftercare can do wonders in recovering from the surgical procedure.
A liver is the largest organ in the human body, weighing about 1.5 kg and has a significant role in terms of digestion and metabolism. It also helps remove toxins and fight infections. Therefore, when a liver fails, the overall health of an individual is significantly affected. Often a liver transplant is required where the affected liver is removed and a new liver from a donor, either living or deceased, is placed and sutured in place. The success rate, if done early and well, can be close to 80% at three years. Over a period of time, this new liver gets accepted by the body to perform various functions that were done by the original liver.
The people affected by the following diseases could benefit significantly from a liver transplant.
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.
In case you have a concern or query you can always consult an expert & get answers to your questions!
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:
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.
Diagnosis: If suspected of fatty liver, the following are done 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!
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.
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
In case you have a concern or query you can always consult an expert & get answers to your questions!