Who is at risk?
All patients having cirrhosis.
It happens in non cirrhotics too.
What causes of cirrhosis commonly lead to hcc?
Hepatitis b related cirrhosis (most likely), hepatitis c, alcoholic cirrhosis, nash.
Is liver cancer curable?
Yes if diagnosed at an early stage.
Is there any treatment option for advanced hcc?
Yes there are options which can prolong the survival.
How to screen?
All cirrhotics need to get and ultrasound once a year and a blood test called serum alfa fetoprotein.
Liver cancer (hepatocellular carcinoma) most commonly affects patients with cirrhosis.
Can even occur in non cirrhotics.
More common in males.
Most commonly occurs in cirrhosis due to hepatitis b virus.
Other causes of cirrhosis that commonly lead to hepatocellular carcinoma (hcc)- hepatitis c virus, alcohol associated, non alcoholic fatty liver.
Is hcc curable?
Yes if detected at at early stage treatment options do exist.
If a patient is diagnosed to have hcc and it is at an advanced stage-- there are therapies today which can help to prolong the overall survival.
How to screen for hcc in patients of cirrhosis?
Most commonly available tests are abdominal ultrasound and serum alfa-feto protein.
When should a cirrhotic patient get screened for hcc?
Ideally every year with usg and if there is any worsening like sudden abdominal distension, weight loss over a month or so.
Liver disorders are very common. Gastroenterologists trained in liver diseases are known as Hepatologists.Symptoms of liver disease include jaundice, vomitting of blood(Hemetemesis), bleeding in the motions(also known as Melena or hematochezia),altered sensorium known as Hepatic encephalopathy(HE), Renal failure also known as Hepatorenal syndrome(HRS), Breathlessness (due to Hepatopulmonary syndrome and portopulmonary hypertension).
Let’s understand the liver disease point by point:
1. Hepatitis B: Hepatitis B is a virus which is usually acquired in four ways. Unprotected sexual intercourse with the infected partner, from infected to the child, infected needles, infected blood. It takes many years for the hepatitis B virus to cause liver damage. Once the liver is damaged it is called Cirrhosis or chronic liver disease. When liver is more then 80 percent damage, it causes blood vomiting also known as hematemesis, Ascites(water in the stomach), Jaundice, HE, HRS etc. Treatment depends on virus count which is calculated by HBV DNA PCR and other lab parameters. Once the treatment starts monitoring of viral count is done to document the effectiveness of the treatment. All the family members and sexual partners must get HbsAg screening done to detect early silent infection. All those who test negative, Hepatitis vaccination should be done, by three injections which provide them with 100% protection against the HBV infection.
2. Hepatitis C: Hepatitis C is a virus which is acquired by injection drug abuse and infected needles and blood. Transmission by unprotected sexual intercourse is possible but chances are very low. Hepatitis C virus damages the liver slowly and takes years before clinical symptoms of liver failure appear. Once the liver is damaged it is called Cirrhosis or chronic liver disease. When the liver is more than 80 percent damage, it causes blood vomiting also known as hematemesis, Ascites(water in the stomach), Jaundice, HE, HRS etc. All hepatitis C virus infected patients must be treated irrespective of virus count. Baseline virus count by HCV RNA is done to measure the effectiveness of the treatment. HCV Genotype is done for patients with cirrhosis. Vaccination is not available for hepatitis C but newer medicines(Direct acting antivirals DAA) for Hepatitis C can cure it with more than 95% certainty.
3. Acute viral Hepatitis: Sudden infection in the liver can be due to multiple causes but commonly is due to Hepatitis A and Hepatitis E, which are caused due to eating or drinking contaminated food and water. Rarely Hepatitis B and Hepatitis C can cause Acute hepatitis including Acute liver failure. Acute hepatitis presents with Jaundice, loss of appetite, generalised fatigue, vomiting and abdominal pain. Patients are usually treated on an outpatient basis but if they have severe vomiting, abdominal pain or altered sensorium, they are admitted for inpatient care and monitoring. Drugs or complementary and alternative medicines (CAM) such as herbal or bodybuilding protein supplements which contain steroids and heavy metals can cause acute hepatitis.
4. Liver transplant: Removing the damaged liver and to put a new liver in the patients is called Liver transplant. Liver transplant is major surgery and costs around 20 to 30 Lacs. Indications of liver transplant are an acute liver failure due to hepatitis viruses such as hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E, decompensated cirrhosis due to any cause including chronic hepatitis B and C, Drug-induced liver failure such antitubercular drugs(ATT). The donor for liver transplant is either a close relative (Living donor liver transplant LDLT) or a brain dead donor (deceased donor liver transplant DDLT).
5. Chronic liver disease or Cirrhosis: It is the end result of slow damage to the liver, where many liver cells are damaged and replaced by fibrosis. Apart from viruses such as Hepatitis B and Hepatitis C, Alcohol is one of the most common causes of cirrhosis.
Drinking alcohol for years together causes irreversible liver damage causing cirrhosis. Alcohol can cause acute severe hepatitis, acute liver failure and chronic liver disease. Patients with suspected heavy alcohol drink must-visit Hepatologist (Liver doctor ) for proper diagnosis of stage of liver damage and deaddiction programme. USG Abdomen, blood tests, endoscopy and Fibroscan is usually done to know the liver health.
Fatty liver is also known as non-alcohol fatty liver disease(NAFLD) is a lifestyle disorder due to lack of exercise, high fat diet, obesity and due to drugs. Fatty liver causes silent liver damage and if not recognised in time can cause irreversible liver damage and cirrhosis. The evaluation includes Liver function tests, Ultrasound abdomen, Fibroscan. Treatment includes daily moderate-intensity aerobic exercise, drinking coffee and a low-fat diet. Few medicines are available which help in the reversal of fatty liver.
Hepatic Steatosis, better known as Fatty liver is a term which describes the condition where fat gets built up in the liver. The liver is the second largest organ in the body and it plays an important function of processing everything we eat or drink and then filter out harmful elements from the blood. This process gets interrupted if there is too much in the liver. We generally call the liver as fatty, when fat accounts for more than 5 to 10 percent of the weight of your liver.
The problem of fatty liver is quite common, affecting around 10 to 20 percent of people living in America without cirrhosis or inflammation. According to the American Liver Foundation, the majority of the cases of fatty liver are detected between ages 40 and 60.
Symptoms of fatty liver
Basically one cannot associate any symptom with fatty liver, though once this situation arises, people might experience fatigue or unusual discomfort in the abdomen.
Excess fat in the liver can lead to its inflammation and in that case, you might come across symptoms such as:
Causes of fatty liver
The most common reason behind fatty liver is alcohol. On the other hand, fatty liver can also occur among people, who are non-alcoholic.
In those circumstances, the fatty liver gets developed when the body creates too much fat or is unable to metabolize fat fast enough. The excess fat gets stored in the cells of the liver where it gets accumulated to form fatty liver disease.
The common causes for fatty liver, other than alcoholism are:
Treatment for fatty liver
You are always at risk if you get diagnosed with the problem of the fatty liver through blood tests, MRI scan and liver biopsy. Though there is no medication or surgery possible for treating this problem a doctor would provide certain recommendations to reduce the risk factors. These include:
Non-alcoholic steatohepatitis is characterised by fatty liver along with inflammation and liver cell damage. The fat gets accumulated in the liver which is not caused by alcohol consumption. It is a type of NAFLD or non-alcoholic fatty liver disease, the other being simple fatty liver. Non-alcoholic steatohepatitis is a more serious condition when compared to the simple fatty liver because NASH can lead to cirrhosis or liver cancer.
Symptoms and Causes
Both the variants of NAFLD are asymptomatic. Hence, NASH does not produce any symptom which can often cause difficulty in diagnosing and detecting the disease. However, in certain rare cases, people may feel discomfort or pain in the upper right side of the abdomen. Due to the nature of the disease, the exact cause of NASH is not known and research concerning the same is still going on. However, doctors have identified certain conditions that make a person more prone to developing the disease. These conditions are:
Both NASH and NAFLD have no symptoms for which their detection becomes a problem. Similarly, treatment and prevention involve following a singular measure in losing weight. People who are obese or overweight are at the highest risk of developing NASH. Therefore, doctors recommend losing at least 3 to 5 percent of weight which leads to a reduction of fat in the liver. Ideally, losing 7 or more percent is recommended over a period of one year. It should be noted that losing weight through dieting and fasting can cause more harm than good.
The best method of weight loss is by trying to eat healthy by having small portion meals throughout the day instead of eating 3 big meals in a day. Such a routine should be followed along with regular physical exercises or activities to ensure steady weight loss and a healthy body weight.
Due to the absence of any medication that might help in preventing and controlling inflammation and deposition of fat in the liver, doctors are forced to go for a liver transplant in situations where NASH has resulted in cirrhosis which in turn may cause liver failure.
Alcoholic liver disease or cirrhosis is one of the most common disorders of the liver. Since the liver performs a vital function in the body, it is essential to maintain its health. There can be several causes for the cirrhosis of the liver. Here are some of the factors that you need to watch out for if you want to steer clear of alcoholic liver disease.
If alcoholic liver disease is left untreated, it can progress to Hepatitis A or cirrhosis. Therefore, it is essential that you seek treatment as soon as you are diagnosed with the condition, in order to limit the damage to your health.
Liver is a very important organ of your body. It is also the largest internal organ. Liver plays a pivotal role in food digestion, iron metabolism, regulation of blood clotting and removal of toxins from your body. Liver problems refer to the disruption of liver functions. There are various liver problems and diseases that you may encounter. Some of the liver problems are as follows:
The most common causes of the above-mentioned liver problems are
Different liver problems have different symptoms. But there are some common symptoms for all liver diseases. The most common symptoms are mentioned below
Homeopathy can treat liver problems very effectively. The following are some of the solutions offered by homeopathy for different liver problems
1. If you are suffering from the problem of fatty liver, your doctor may recommend you medicines like Lycopodium, Phosphorus, Nux vomica
2. If you suffer from the problem of liver enlargement then your doctor may recommend you medicines like Carduus Marianus
3. Chionanthus and Taraxacum are medicines advised for liver problems like jaundice
4. Natrum sulphuricum may be recommended to you if you are suffering from problems like Liver cirrhosis
Homeopathic treatment for liver problems is very effective since it treats the medical condition according to specific symptoms
How to manage a fatty liver?
1. Modern living has contributed to a common lifestyle condition called Non- alcoholic fatty liver disease. Even though it sounds like a scary thing to have, you can manage it- even reverse it- by managing your diet better. The principles of nutrition management in Non- alcoholic fatty liver disease include improving the quality of nutrition.
2. Maintaining a balanced diet and eating the correct portion sizes depending on one's activity profile and body weight. Carbohydrate to protein to fat ratio of 5: 2: 3 is advisable and so is the Mediterranean or anti-inflammation diet.
Important Changes you must make........
1. Increase intake of complex carbs ( grains, veggies, beans) with low glycemic index and limit simple carbs like milk, sugar.
2. Monitor the amount of oil and ghee used in cooking and at the same time decrease intake of fatty foods rich in saturated fats(butter, mayonnaise).
3. Incorporate adequate amount of protein from lentils, low-fat dairy, egg whites and omega 3 rich fish in the diet.
4. Limit intake of excessive salt.
5. Add sufficient amount ( at least 3 cups) of dark green, red, orange and yellow vegetables and fruits.
6. Include functional foods such as amla, turmeric, avocado, flaxseeds, sunflower seeds and walnuts in your diet.
7. Have more prebiotic and probiotic rich food items.
8. A combination of aerobic and anaerobic exercise improves insulin sensitivity and decreases the cardiovascular risk associated with fatty liver.
9. At least 30 min of moderate to vigorous-intensity aerobic exercise like brisk walking, swimming, cross-training, cycling five times a week.
10. At least 60 minutes of resistance exercise twice a week.
Non-alcoholic fatty liver disease is the most common form of liver disease as it affects about 80 to 100 million people in the US alone. It is described as a range of liver conditions which may affect people who either don’t drink alcohol or drink too little of it. The distinguishing feature of this disease is the presence of too much fat in the liver. It can occur in every age group. However, people in age groups of the 40s and 50s, who are susceptible to heart diseases because of diabetes and other lifestyle diseases, are the most vulnerable to this problem. Increased liver fat is not an isolated occurrence; it comes with reduced ability to use insulin, increased abdominal fat, high blood pressure, high triglyceride fat levels, etc.
Symptoms Of Non-alcoholic Fatty Liver Disease -
In the initial stages, there is no symptom. However, as the condition of the liver worsens it may give rise to an enlarged liver, pain in the right upper quadrant, fatigue, etc. One may also have other symptoms like swelling of the abdomen, dilation of blood vessels just below the skin, enlargement of breast tissues in men, enlargement of spleen, reddish appearance of palms, jaundice, etc.
Stages Of Non-alcoholic Fatty Liver -
Steatosis: Also known as simple fatty liver, Steatosis is the initial stage of the disease. It is regarded as a benign deposit of fat in the liver which is usually diagnosed during diagnostic tests done for other reasons.
Steatohepatitis: It is a serious form where the liver gets inflamed.
Fibrosis: If the inflammation of liver persists, it may give rise to scarring of liver tissue and the nearby blood vessels. However, the liver may still be able to work normally.
Cirrhosis: This is the most severe stage which occurs if you live with fibrosis for a long time. It leads to shrinkage of the liver and the liver becoming lumpy and scarred. This permanent damage can cause liver failure and also liver cancer. If you can improve your lifestyle in the meantime, you can prevent cirrhosis.
The most common complication of non-alcoholic fatty liver disease is fibrosis and cirrhosis. In fact, even fibrosis goes undetected most of the times. This is why liver damage is mostly diagnosed when someone is suffering from cirrhosis. Cirrhosis is also known as late-stage fibrosis of the liver. Cirrhosis is the response of the liver to various injuries like inflammation, fibrosis, etc. The liver always tries to counter the inflammation and in order to do that it gives rise to scarring. As the fight with inflammation continues, the fibrosis spreads and engulfs all of the liver.
If this process goes on unhindered, one can suffer from:
Build up of fluid in the abdomen
Drowsiness, slurred speech, confusion, etc.
Take Away -
Complications of non-alcoholic liver disease progress from no symptoms to the severe symptoms that can make an individual suffer from critical conditions like liver cancer or liver failure.
Human urine is a useful tool for the diagnosis and detection of several health conditions. The colour, smell and density of your urine can reveal a lot about the state of your health. Colour, especially, is a strong determinant of many ailments or concerns.
Here is a list of the health conditions you might be suffering from, based on the colour of your urine:
Your urine tells a lot about your health by its colour, odour and density. The colour is an essential determinant for detecting several health conditions, which may be simple or chronic in nature. In case of abnormal urine colour or appearance, you should consult a doctor without delay.