Liver Disorders - Diagnosis, Prevention and Treatment

Understanding Various Liver Disorders

Dr.Shamsudin  Mohamed Rela profile Authored by Dr.Shamsudin Mohamed Rela on 4 Jun 2014 - 11:05.

 

Liver is the largest solid organ in the body and carries out several vital functions, particularly carbohydrates, protein and fat metabolism. It also plays a role in fighting infections, neutralizing toxic substances and acts as a factory for the production of many essential proteins. Liver has an immense capacity to repair itself by regeneration. However, when the injury to the liver is recurrent, prolonged or very severe, the repair mechanisms are stretched beyond its limit, leading to the patient developing symptoms of liver disease.

Types of Liver Disease:

Liver disease can be classified into acute or chronic based on the duration of the illness. Roughly speaking, liver disease persisting for less than six month’s duration is usually acute and if present for more than six months, is usually a chronic condition.

Acute Hepatitis:

The causes for acute hepatitis are as follows:

o   Hepatitis A – spreads by contaminated water; infected patients develop fever, jaundice, vomiting and fatigue (tiredness). It usually resolves without any long term consequences. 

o   Hepatitis E- It is similar to hepatitis A and causes fever and jaundice. Hepatitis E infection can be dangerous and life threatening in elderly patients and pregnant women.

o   Drug induced liver injury: Intake of native medicines, certain pain killers, antibiotics, anti-tuberculosis drugs may cause liver injury and sometimes liver failure. Drugs should not be taken without doctor’s advice. Liver injury following tuberculosis treatment is not uncommonly seen in India. Patients who newly start anti-TB medications should get liver blood tests done at least twice a month during the initial few months of therapy.

o   Autoimmune hepatitis- Here the liver gets attacked by your own body and can lead to liver failure if not recognized early.

Other causes for acute liver injury include various infections such as Malaria, Dengue fever, Leptospirosis. 

Symptoms of Acute Hepatitis:

  • Fever
  • Nausea and vomiting
  • Diarrhea
  • Jaundice (yellow skin)
  • Flu like symptoms
  • Poor appetite
  • Tiredness
  • Abdominal pain

If you have any such symptom please seek medical advice as soon as possible. If identified and treated early, severe and permanent damage can be prevented.

Acute Liver Failure (ALF): ALF is a rare and a life threatening condition where the liver completely fails to function. This causes severe jaundice, blood that fails to clot and altered consciousness levels (due to toxins from the liver entering the brain). This is a very serious condition where almost 90 percent of patients die unless they are treated with liver transplantation. These patients must be identified early and should be managed only in the experienced units, where facilities for urgent liver transplantation are available.

Chronic Liver Disease (Chronic Hepatitis):

Progressive liver damage leads to cirrhosis, where the liver becomes smaller in size, firm and nodular. Common causes of chronic liver disease are as follows:

Hepatitis B Infection: In India, around 4 percent of the population carry hepatitis B virus. According to the WHO nearly 40 million Indians carry hepatitis B virus. It is 100 times more infectious than HIV. It spreads from mother to baby, through blood transfusion or sexual mode. Hepatitis B virus infection rarely produces any symptoms until late in the illness. Therefore, many of them are unaware that they carry the virus. Most patients get detected incidentally, when they have master health checkup, prior to blood donation or when one of their family members is diagnosed with hepatitis B.  Chronic hepatitis B infection leads to cirrhosis and liver cancer. Worldwide, hepatitis B infection is the commonest cause of primary liver cancer.

Precautions: Fortunately, there are effective treatments available these days, either in the form of injection or tablets. All patients with hepatitis B should undergo six-monthly abdominal ultrasound and a blood test (AFP) as a screening for liver cancer.

All family members of patients with hepatitis B should be screened for the virus. If they are negative, they should be vaccinated to prevent the viral infection. Viral testing should be done in standardized laboratory to avoid false negative reports.

Chronic Hepatitis C Infection: Around 1-4 percent of Indian population suffers from hepatitis C virus infection. It spreads by blood transfusion when not screened adequately and by sharing used needles and shaving razors. Sexual transmission is rare. Like hepatitis B, even here patients will be asymptomatic for decades.

Diagnosis: Detection is usually through master health check up, screening blood donors or family screening. Chronic hepatitis C infection leads to cirrhosis and its dreadful complications like liver cancer. Diagnosis is done through blood tests and abdominal scan. In addition to determining the stage of your liver disease and the amount of virus, subtype of the virus should be determined.

Treatment of Hepatitis C has taken a giant leap in the last 12 months. Traditionally hepatitis C infection was treated with Peg-Interferon and Ribavirin with a clearance rate of 40-80 percent. But, now more powerful drugs are available with a clearance rate of 90 to 100 percent.

Alcoholic Liver Disease (ALD):) Patients who consume excess alcohol over few years are likely to develop cirrhosis.  Alcohol consumption of over 90 mls of liquor or equivalent quantity of beer or wine will definitely lead to liver damage. People who drink lesser than this quantity can also develop cirrhosis. In addition, those who binge drink on the weekends are not spared.

Patients with ALD may develop 3 phases of liver damage. First is simple steatosis (fatty liver). Stopping alcohol at this stage completely reverses the liver damage to normal. The second phase is called ‘alcoholic hepatitis’. This is a serious condition where patients present with severe jaundice, altered consciousness, and sometimes fever.

These patients are highly prone for infection. Many patients with underlying alcoholic hepatitis may already have cirrhosis. These patients may require ICU care with adequate fluid balance, nutrition and supportive measures. Stopping alcohol at this point is still beneficial in reducing long-term damage. The third phase is the development of cirrhosis. Here the patient becomes malnourished and weak. He/she may develop fluid accumulation in the abdominal cavity, may vomit blood leading to liver failure and death. Please avoid alcohol!

Non-alcoholic fatty liver disease (NAFLD): NAFLD is a chronic condition characterized by accumulation of fat in the liver. It is the commonest cause of abnormal liver function tests in the community and affects 30 percent of the population around the world. It is much more common in patients with diabetes.

Diet Control: High calorie intake significantly contributes to the development of fatty liver disease. Therefore, diet rich in carbohydrates and saturated fats should be avoided. Most fast-foods and aerated soft drinks increase liver fat, worsen liver injury and should be avoided. Polyunsaturated fatty acid may improve liver enzymes and are recommended. Diet with low glycemic index, rich in fruits and vegetables with limited red meat consumption are recommended.

Autoimmune Hepatitis (as described above): You should meet a liver specialist at the earliest. Once the diagnosis is confirmed treatment should be initiated as soon as possible to prevent progressive liver damage and cirrhosis.

Primary Biliary Cirrhosis: PBC is a condition affecting smaller bile ducts where the liver is unable to excrete bile. Patients become jaundiced, develop severe itching and have extreme tiredness.

Primary Sclerosing Cholangitis: PSC is another condition affecting the larger bile ducts leading to severe jaundice, itching and recurrent fever.

Wilson’s Disease: In this genetic disorder, there is excess copper deposition in liver, brain and partly in kidneys. Therefore in addition to cirrhosis, these patients suffer from neuropsychiatric problems. If identified and treated early, we can achieve a normal life span.

Haemochromatosis: This is a genetic condition characterized by excess iron deposition in the liver and sometimes in the heart.

Vascular Disorders (Budd-Chiari Syndrome): Here the blood supply from the liver is blocked leading liver engorgement and lead to various liver related complications.

Cirrhosis

Cirrhosis is the end stage of any progressive liver disease where the liver shrinks in size due to excess scar formation. Here the liver function gets impaired and the blood flow to the liver is affected leading to a complication called portal hypertension. Due to its impaired function patients may have following symptoms.

Symptoms:

Patients with chronic liver disease and cirrhosis may not have any symptoms for years. Following are the common symptoms displayed by most of the liver disorders:

  • Fatigue (general or chronic)
  • Nausea and Vomiting
  • Swelling of the body
  • Muscle Weakness
  • Discoloration – eyes and skin turns yellowish
  • Dark coloration of urine (yellowish)
  • Discoloration of the stool (usually pale or tar-colored)
  • Appearance of blood in the stool
  • Consistent itching on the skin
  • Loss of appetite
  • Decreased sex desire
  • Rash/ butterfly shaped appearance of some blood vessels (especially on the face)
  • Excessive weight loss
  • Mental confusion
  • Blood in vomiting

Patients with cirrhosis should have a close follow up, because majority of its complications are life threatening, which may be:

  • Fluid accumulation
  • Bleeding from the gastrointestinal tract
  • Liver cancer
  • Malnutrition

Liver Cancer:

Liver cancer is the most dreaded complication of cirrhosis. Various modalities of treatment are available for liver cancer. Liver transplantationis the best curative option when the tumour is within certain accepted criteria. All patients with cirrhosis should undergo a six-monthly ultrasound abdomen and a blood test as a screening to detect liver cancer.

Investigations for Liver Diseases:

Most of liver disorders show-up significant symptoms only when the liver is extensively damaged. Thereforediagnoses of the liver disorder in early stages is quite tricky. However, liver disorder/s can be unintentionally or intentionally diagnosed during routine health checkups. Following tests are usually performed to diagnose the liver problems:

  • Assessment of medical history: Experts may ask several questions associated with health issues, these mainly include:

o   Intravenous drug usage

o   Traveling to other countries

o   History of blood transfusion

o   History or practice of unprotected sex

o   History of the other diseases and the medications taken

  • Liver function tests: This includes several blood tests which may give clues about liver problems or any other genetic condition that might be affecting the liver.
     
  • Blood count and clotting tests to assess the severity of liver disease.
     
  • Viral serology, autoimmune markers, liver cancer screening.
     
  • Imaging studies:Imaging modalities like ultrasound and CT scan are important to evaluate the severity of liver disease and tumor.
     
  • Liver biopsy: Biopsy is not required for all patients, but in some cases it may guide diagnosis and treatment.

Risk factors for liver diseases include:

  • Unscreened blood transfusion
  • Direct contact with other’s blood or body fluids (eg. while sharing the needle, razor blades, unprotected sex etc.)
  • Body piercing and tattoos
  • Several herbal products
  • Some medications (including paracetamol and anti-tuberculosis medications)
  • Unhealthy diet
  • Diabetes and obesity
  • Excessive and long term alcohol consumption
  • High cholesterol and triglycerides
  • Exposure to certain chemicals or toxic substances.

Treatment options for various liver disorders may vary as per the severity of the condition and the cause. Overall, various liver disorders can be treated using following modalities:

  • Medications and drugs: Some liver abnormalities can be treated with medications especially in the early stages.
  • Surgery (liver transplant): Some severe conditions like liver cirrhosis or liver failure require liver transplantation, where the damaged liver is removed and a healthy liver is transplanted.
  • Lifestyle modifications: Following are the recommended lifestyle modifications:

o   Consult your doctor before taking any herbal supplement.

o   Quit alcohol completely (if you are habituated to it).

o   Maintain a healthy weight.

o   Keep track of health changes, including skin color, stool color etc.

o   Eat healthy.

o   Go for routine check-ups to keep track on your blood pressure, sugar level and other health issues.

o   Take medications on time as recommended.

Practicing following measures may help to prevent the liver disorders:

  • Avoid alcohol consumption
  • Avoid direct contact with other’s blood and body fluids (by avoiding unprotected sex, needle sharing while taking drugs etc.)
  • Get hepatitis vaccines (hepatitis A and B)
  • Do not take any herbal supplement without doctor’s approval
  • Take medications (prescribed or over the counter) only under doctor’s supervision
  • Avoid direct exposure to aerosol sprays, certain chemicals, paint and insecticides
  • Keep track of your skin-color, eye color and stool color changes
  • Eat healthy and get regular exercise
  • Maintain a healthy weight.
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.