Dr Subhash Gupta, Chairman, Centre for Liver & Biliary sciences, Max Hospital Saket
With Westernization trending up among the Indian youth, poor lifestyle is attributing to an increase in the number of liver ailments. Keeping the liver in a perfect condition is very much important for all. Taking the decisions late in the case of health issues which show the symptoms of having liver disease is itself a reason for making it one of the chronic diseases in India.
According to the recent reports of WHO, around 45% of the global diseases and 60% of mortality rate is attributable to chronic diseases accounting for over 35 million deaths annually. Considering the statistics from the last few years, Liver related diseases are being recognized as one of the second chronic diseases which are becoming the reason for the increasing death rate in India.
The common symptoms of advanced liver disease are jaundice (yellow color of eyes), loss of appetite/aversion to food, feeling of weakness and lethargy, abnormal bleeding occurring after minor trauma and swelling in the legs. At very advanced stages of liver disease, ascites (accumulation of water in the abdomen), bleeding from intestine and altered mental status will occur.
Some of the common causes of cirrhosis have gradually disappeared such as chronic viral hepatitis B and C. Hepatitis B can be prevented by vaccination and if the person has already been infected, effective drugs are available for preventing progression of liver disease. The good news is that if an adult acquires the infection, over 95% chances are that the body will eventually get rid of the infection in 6 months’ time. Only in a very small number of cases, acute infection from hepatitis B can result in fulminant liver failure for which an urgent liver transplant will be needed.
Hepatitis C has also been controlled by the emergence of very effective antiviral medicines which can eliminate the virus from the body forever. However, even in those who have been treated successfully with antiviral therapy, they should continue to be under surveillance for development of liver cancer. Early detection of liver cancer will go a long way in its successful treatment.
Excessive alcohol consumption can become a modern day scrooge with many young people developing liver disease. Combined with diabetes, excessive weight and lack of physical activity it results in rapid progression of liver disease and subsequently liver cancer. Fatty liver disease is a precursor of cirrhosis and seems more common in those who are overweight, have diabetes and lack physical activity. An ultrasound report of fatty liver is very common and assumes sinister proportions if the liver enzymes are also elevated. Dietary carbohydrate restrictions and weight loss may help in correcting fatty liver disease.
The aims of treating a patient with liver disease are a) Knowing the cause of liver disease b) Knowing the extent of damage to the liver c) Knowing if the damage can be controlled/reversed with medication or is the damage beyond repair. A large majority of liver problems can be managed with medicines and lifestyle modifications, but this is only when the illness is detected early. Once the disease is advanced and has caused irreversible damage to the liver the only option that remains is that of a liver transplantation.
Liver transplantation has now become a well-accepted modality for the management of end stage liver disease, acute liver failure and liver cancer. Liver transplantation involves removing the diseased liver from the patient and replacing it with healthy liver either from a brain-dead donor or more commonly with partial liver from a healthy donor. Owing to the scarcity of brain dead or “cadaveric” organs, the available resource is that for a healthy individual to donate a part of his liver for the patient. Owing to the huge functional reserve of a healthy liver, the part of the liver remaining with the donor is sufficient to maintain normal functioning and the remaining liver grows back to its normal size soon after donation.