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Overview

Liver Disease: Treatment, Procedure, Cost and Side Effects

What is the treatment?

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.

How is the treatment done?

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.

Who is eligible for the treatment? (When is the treatment done?)

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.

Who is not eligible for the treatment?

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.

Are there any side effects?

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.

What are the post-treatment guidelines?

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.

How long does it take to recover?

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.

What is the price of the treatment in India?

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.

Are the results of the treatment permanent?

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.

What are the alternatives to the treatment?

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.

Safety: Medium Effectiveness: Medium Timeliness: Medium Relative Risk: High Side Effects: Medium Time For Recovery: Medium Price Range: Rs.1000-Rs.7 lakhs

Popular Health Tips

Diet To Follow After A Liver Transplant Surgery!

MBBS, MS - General Surgery, FRCS (edinburgh), MD - R & D, FRCS Intercollegiate
Liver Transplant Surgeon, Bangalore
Diet To Follow After A Liver Transplant Surgery!

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.

  • Avoid alcohol: Alcohol is a big no-no after a liver transplant surgery. In addition to not drinking any type of alcohol, patients should also abstain from any food cooked in alcohol or wine.
  • Avoid pomegranates and grapefruits: Fruits are very good for recovery but certain fruits such as pomegranates and grapefruits should be avoided. This is because they may have an effect on the immunosuppression medications being prescribed to keep the body from rejecting the donor liver.
  • Eat plenty of vegetables: Vegetables are essential during recovery process after a transplant surgery. This gives the body the necessary nutrition it requires and also acts as a good source of fibre.
  • Eat lean meatLean meats like poultry and fish act as rich sources of proteins. This helps the body speed up the recovery process. Other forms of protein include soy, eggs, legumes and nuts. Avoid fatty meats as these are difficult to digest and can put a strain on the liver.
  • Drink plenty of water: Water helps in hydrating the body and is essential during recovery from a major surgery such as a liver transplant. Water also helps improve blood circulation and eases the filtration of toxins. Patients should ideally drink 8-10 glasses of water a day.
  • Limit sugar consumption: One of the side effects of medication prescribed after a liver transplant includes high blood sugar. To avoid this, limit your consumption of sweets and sugars. Avoid cakes, jams, jellies, packaged juices and chocolate.
  • Have plenty of fibre: Fibre helps ease digestion and helps control cholesterol levels. An increase in cholesterol levels may be due to the medication being prescribed. Hence eat plenty of fibre. This could be in the form of whole grain foods, vegetables and fruits. As far as possible avoid processed foods.
  • Get enough calciumMedication prescribed after a liver transplant may make the patient’s bones lighter. This can increase the risk of conditions such as osteoporosis. To counter this, it is important to get enough calcium.

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.

 

 

Which Category of Patients Need A Liver Transplant?

MBBS, MS - General Surgery, FRCS (edinburgh), MD - R & D, FRCS Intercollegiate
Liver Transplant Surgeon, Bangalore
Which Category of Patients Need A Liver Transplant?

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.

  • Chronic liver failure: This is not easily identifiable and the condition develops over a period of time, usually over years. Chronic liver failure is produced by many conditions, the most common being cirrhosis. Due to chronic alcohol abuse, the liver tissue undergoes scarring. This scarred tissue replaces the normal liver tissue and the liver functions are affected. This leads to poor metabolism, indigestion, toxin accumulation, etc. The most typical symptoms include accumulation of fluid in the abdomen and black, tarry stools. Once diagnosed, evaluation is done to find out the MELD score. This determines the severity of cirrhosis and overall prognosis. For most cases of severe cirrhosis, transplant is almost a definitive treatment with 3-year survival rates of close to 75%.
  • Nonalcoholic steatohepatitis (NASH): People who are not alcohol abusers, but have a fatty accumulation within the liver, often face a liver failure. This again can require a liver transplant.
  • Biliary conditions: The bile ducts transport the bile that is produced in the liver to the stomach. If these are not functioning properly, either due to cirrhosis, blockage, or improper development, then a liver transplant may be required. This is often done in younger patients, less than 15 years old.
  • Congenital conditions like hemochromatosis and Wilson’s disease: These are genetic conditions, often identified in children, and require a transplant at a young age. A full liver transplant may not be required in these cases.
  • Acute liver failure: This is often a side effect of medications and can onset within a few weeks. This can necessitate a liver transplant as in most of the cases, the patients are young.

 

 

The Increasing Problem Of Liver Tumours In India!

General Surgeon, Bangalore
The Increasing Problem Of Liver Tumours In India!

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!

3294 people found this helpful

Fatty Liver - All You Need To Know!

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

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

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

Popular Questions & Answers

My uncle s age is 55 years old. and his liver has damage. He is addicted of alcohol. I want to know which treatment is the best for him. Please tell me.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
If he has no control in spite of the liver problem, then he needs to be admitted for rehabilitation. If you think that he will find it very difficult, then admit him to a hospital and go for de-addiction first: which normally lasts for about two weeks. Then follow that up with addiction counseling from a professional for at least three years to completely get rid of the habit. If this is also not enough, then admit him into a de-addiction center and let him stay there for at least 6 months and after that attend counseling with a professional. There are medicines that help with the drinking just to ease the initial craving. Ultimately, it is his will power and the support that he receives from the medical fraternity and his close and dear ones. He must also learn to substitute and deal with the oral need, a rigid value system, the script issue, and of course look at all the genetic factors to plan a strategy not to get into what is called ‘cross addictions’ i.e. Another form of addiction that may appear alright but is in fact as bad as the primary addiction. The center or hospital and the counselor will advise and guide him on several measures and precautions he will need to take to stay with his resolve. Even after the rehabilitation he must attend AA meetings and continue this support for a long time. His family will also need to attend some sessions and go for Al-anon meetings for their co-dependency issues. He cannot be treated in isolation because the family has gotten used to his drinking and have made some unhealthy adaptations to somehow cope. His children will also have to attend meetings to work out their issues because of the father’s habit. In fact, they are all suffering from the Adult Children Of Alcoholics Syndrome (ACOAs), which in effect means that they are genetically predisposed to alcoholism or can have cross addiction problems and they will have similar traits of the abusing alcoholic but in a milder form. There are special support groups for them all over the world. Should they touch or indulge in alcohol or any addictive substances or behaviors, they could also become full-fledged addicts themselves. If your uncle refuses to go for rehabilitation, then some centers have a method of picking him up when he is totally sloshed and is not able to fight back effectively. They will need the family’s written consent before willing to take him in this manner. Make a serious plan with the wife and children and whoever else’s support he can get and act on it fast.

Dear Sir, I have been suffering diabetes for 9 years. Recently my blood sugar is out of control, fasting 9+ & after meal 12-14. I am taking medicine commit XR-500, Linux 5, compared Mr. 60. Also I take Tab. ecosprin 25 & Seloment for BP. Recently I have done ECG for whole abdomen and found Fatty Liver Gr-II. Pls advice me about Diabetes & Fatty Liver Gr-II. Regards Poshirul Islam.

MBBS, CCEBDM, Diploma in Diabetology, Diploma in Clinical Nutrition & Dietetics, Cetificate Course In Thyroid Disorders Management (CCMTD)
Endocrinologist, Dharwad
Hello, Thanks for the query. Both fasting and PP blood glucose levels are high, suggesting improperly controlled diabetes. Ideally fasting glucose should be < 100 mg, PP 150 to 170 mg & HbA1c% < 6.8. Therefore, there is a need for upgrading the treatment with additional drugs, plus a look has to be given to your diet and exercise. So please come in a private conversation with all the details like HbA1c%, diet pattern and extent of exercise. Fatty liver is invariably seen in oersons having excess weight and uncontrolled diabetes. Thanks.

My age 26. I have gall bladder stone (size 8.7 mm) and fatty liver. Do I go for a surgery? Or is it curable by diet, exercise & medicine? What should be my diet chart?

MBBS, MS - General Surgery, MCh - Urology
Urologist, Trivandrum
Gall bladder stone if causing pain, gall bladder with the stone has to be removed. Exercise and reducing fatty food will benefit. Gall bladder stone are dealt by gastroenterologist.

It was identified through USG Abdomen that I am suffering from Grade-1 fatty liver. Kindly advise medication. In the said abdomen scan it is found that 2 to 3 mm stones are there in gall bladder. Kindly advise the suitable medication.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology, Positive Psychiatry and Mental Health
Psychologist, Palakkad
Fatty liver Major risk factors include obesity and type 2 diabetes, though it's also associated with excessive alcohol consumption. It usually causes no symptoms. When symptoms occur, they include fatigue, weight loss and abdominal pain. Treatment involves reducing the risk factors such as obesity through a diet and exercise program. It is generally a benign condition, but in a minority of patients, it can progress to liver failure (cirrhosis). Your doctor know about you better and you should get medicines from your doctor face to face.
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Table of Content

What is the treatment?
How is the treatment done?
Who is eligible for the treatment? (When is the treatment done?)
Who is not eligible for the treatment?
Are there any side effects?
What are the post-treatment guidelines?
How long does it take to recover?
What is the price of the treatment in India?
Are the results of the treatment permanent?
What are the alternatives to the treatment?
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Fatty Liver Diseases
It s normal to have small amounts of fat in your liver, but too much can become a health problem.Early stage fatty liver is diagnosed when the proportion of liver cells that contain fat is more than 5 percent. This is often diagnosed by looking at small samples taken from the liver under the microscope.
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Fatty Liver
Fatty liver becomes harmful to the liver when it progresses. It s believed that the excess fat in the liver, along with certain medical conditions, increases inflammation. The most common cause of fatty liver is alcohol use disorder and heavy drinking.
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Things About Liver Transplant
A liver transplant is an operation that replaces a patient's diseased liver with a whole or partial healthy liver from another person.It is a treatment option for end-stage liver disease and acute liver failure, although availability of donor organs is a major limitation.
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Fatty Liver
Fatty liver, or hepatic steatosis, is a term that describes the buildup of fat in the liver. The most common cause of fatty liver is alcohol use disorder and heavy drinking. Higher body weight, a high processed sugar diet, high triglycerides, diabetes, low physical activity, and genetics all play a role.
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Fatty Liver
My name is Dr. Sanjay Jain, I am a senior consultant in the department of Gastroenterology and Hepatology at Indraprastha Apollo Hospital, Sarita Vihar in Delhi.

Today I like to talk about a very common condition called fatty liver I am sure most of you have heard about it and increasingly one an ultrasound is done the awareness about fatty liver is increasing. I want to tell you that most of the time people just tend to ignore when they are found to have fatty liver and that should not always be the case. Broadly speaking you can see there are two types of fatty liver one is a benign sort of fatty liver, where just ultrasound has picked up the extra fat in the liver. But all the blood test for the liver and another test to find out while more in the liver is normal. Most of these patients don't need to worry too much about it but of course, they need to take care of the extra fat in the liver. But the other group in which where the liver function test shows there is swelling in the liver which means a sort of Hepatitis and in this particular context it's called steatotic hepatitis that means fats induced hepatitis. These are the people whose lower functional test are not normal, they have got an ongoing swelling in the liver because of the extra fat deposited there and they are at the higher risk of liver-related complications. These people must get hold of the Gastroenterologist or their physician, they would need a detailed liver evaluation and most likely some treatment also. Regarding the causes of fatty liver, the two most common cause are alcohol and obesity, other common causes being diabetes, hypothyroidism etc. We have few drugs which are available now which can help in this condition rather than telling you the name of the drugs, I would like you, people, if you have found a fatty liver must see a doctor find out whether it is just benign incidental finding or it needs to be taken up further and act accordingly.

If you have any query about fatty liver or other gastroenterological problem you are most welcome to get in touch with me through lybrate.com.
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