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“(Authored article by Dr. Manish Srivastava, Consultant, Surgical Gastroenterology and Liver Transplant Department, Jaypee Hospital, Noida)”
New Delhi, April 18,2018:
The liver is the largest as well as one of the most important solid organ of the body. When a liver is working well, it purifies the blood, helps in digestion and fights infection. It is vital to the body’s metabolic functions and immune system as it converts food nutrients into products that are required for the proper functioning of the body. The liver is also a detoxifying organ. Complications like liver disease can be serious and even fatal.
The liver can be damaged in a variety of ways:
- Cells can become inflamed.
- Bile flow can be obstructed.
- Cholesterol or triglycerides can accumulate.
- Blood flow to the liver may be compromised.
- Liver tissue can be damaged by chemicals and minerals, or infiltrated by abnormal cells, like cancer cells.
General symptoms of liver disease include the following:
- Abdominal pain (located on the right side of the body, beneath the ribs)
- Abnormal stools
- Flu-like symptoms (e.g., fatigue, nausea, vomiting, muscle or joint pain, fever)
- Loss of appetite
- Swelling of abdomen and/or legs
- Bleeding and bruising more easily
- Dark urine
- Jaundice (i.e., yellowing of skin/eyes)
- Sensitivity to medications (e.g., experiencing stronger side effects)
STAGES OF LIVER DISORDER/DISEASE
Even with a wide range of conditions diagnosed as liver disease, the stages and damage to the organ are consistent. From the beginning of the condition to advanced liver disease, the damage progresses in these four stages:
Stage 1: Initial Stage of Liver Disease
With any condition causing liver disease, the first step includes inflammation of the liver or bile duct. This inflammation causes abdominal pain as the body tries to fight the infection or irritation. If left untreated, this inflammation can cause damage to the liver, making the condition worse. In this beginning stage, unlike some conditions in advanced liver disease, the symptoms and inflammation is treatable to prevent the second step of the disease.
Stage 2: Fibrosis of the Liver
Many times, symptoms of liver disease aren’t present until this stage or the next. In the fibrosis stage, damage or scarring from the first stage begins to block the normal blood flow of the liver. In this stage, the liver isn’t functioning correctly, but through treatment, it may be able to heal and prevent any further progression of the disease.
Stage 3: Cirrhosis of the Liver
A chronic condition, cirrhosis of the liver creates permanent scarring that blocks the blood flow. This dangerous stage causes other serious conditions and symptoms that increase the severity of the liver disease and is recognized as one of the leading causes of death in the US. For this stage of the disease, doctors focus treatment on managing the symptoms in order to prevent the most advanced liver disease stage.
Stage 4: Liver Failure and Advanced Liver Disease
In the final stage of the disease, liver failure signals the end of all normal liver function. The patient now requires immediate medical attention to prevent death. Symptoms of liver failure include vomiting, diarrhoea and fatigue as well as the symptoms from stage 3. While the progression from cirrhosis to failure can take years, the damage is irreversible and leads to eventual death.
The key to treating liver disease is to diagnose the condition as early as possible. If you experience any of the symptoms in these stages, seek medical help immediately.
DIAGNOSIS
The in depth diagnosis of liver disease usually involves medical history and physical examination of the patient. In alcohol abused patient, it becomes little difficult to trace the medical history. Blood tests are crucial in assessing liver inflammation and function.
Liver function and other tests
Liver functions tests (LFT): are used to screen for, detect, evaluate and monitor liver inflammation and damage. It helps to determine the health of the liver by measuring the levels of proteins, liver enzymes, or bilirubin in the blood.
Renal Function Tests (RFT): is mainly done to evaluate kidney function and aid in the diagnosis of kidney disease and to monitor the progression of renal insufficiency.
Complete Blood Count (CBC): Liver blood tests are designed to show evidence that abnormalities such as inflammation, liver cell damage, has or is occurring within the liver.
PT INR: Blood clotting function may be occur due to the inadequate production of protein and is sensitive for liver function.
Ammonia Blood test: Ammonia blood level assessment helps to give a clearer picture to the patient about the potential cause for the liver failure.
A variety of imaging tests
Ultrasound: uses sound waves to produce images, but cannot show blood flow. For this Doppler ultrasound is used to measure and visualize the actual blood flow. This is a non-invasive widely available image test that can provide information about the appearance and the blood flow of the liver.
CT and MRI scans: Computerised axial tomography (CT) and magnetic resonance imaging (MRI) are generally only used to determine changes in the liver in advanced cases of liver disease or to further image a growth in the liver.
Viral Infection Test
Hepatitis B: Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). The disease is generally consists of liver enzyme tests. Hepatitis B antigens and antibodies helps to detect if the person is affected by the virus or not. This test also show if the patient have been immunized and provide information about long-term (chronic) infection.
Hepatitis C: Hepatitis C tests are used to screen for and diagnose a hepatitis C virus infection and to guide therapy or monitor the treatment of HCV infection. It detects the presence of antibodies to the virus, indicating exposure to HCV.
TREATMENT
Treatment for liver disease depends on the diagnosis. Some liver problems can be treated with lifestyle modifications, such as stopping alcohol use or losing weight, typically as part of a medical program that includes careful monitoring of liver function. Other liver problems may be treated with medications or may require surgery.
Treatment for liver disease that causes or has led to ultimately liver failure may require a liver transplant.
DIET AND LIFESTYLE CHANGES
The treatment for liver pain will depend on what’s causing it. Treating liver disease will probably start with addressing what you eat and drink. The liver is one of the few organs in the body that can repair and regenerate itself.
Other lifestyle changes, such as losing weight and lowering your cholesterol, are other first lines of defence when it comes to treating the cause of liver pain. Non-alcoholic fatty liver disease (NAFLD) is managed almost exclusively by modifying your diet and exercise routine. Alcohol is directly toxic to liver cells and can cause liver inflammation, referred to as alcoholic hepatitis. In chronic alcohol abuse, fat accumulation occurs in liver cells affecting their ability to function.
