Liver Disease – A complete guide for the patients

Introduction

Just like any other organ of the human body, the liver is also of vital importance. It plays an important role in the proper and smooth functioning of the whole body. Its major functions are to produce healthy proteins, prevent blood clotting that can be caused by variations in cholesterol levels, maintains a balance between glucose level, etc. But, in the USA, a major cause of death is liver disease, which is also known as the hepatic disease, and the death rate is increasing rapidly. A few years back, a study was conducted in the year 2007 by centers for disease control and prevention, which shows the statistics that 2% of adults in 4.5 million population of the U.S were diagnosed with some incurable liver disease that causes a high death rate of 41,743 people.

Chief of the division of gastroenterology, Dr. Nezam Afdhal, in hepatology and nutrition at Beth Israel Deaconess Medical Center in Boston said that in the United States, the widespread obesity and diabetes presented in many individuals, majorly cause an increase in the growth of cirrhosis and fatal liver disease. Other targets of this deadly disease are elderly people.   

By visualizing this alarming rise in the number of patients affected by either some liver diseases or NAFLD, medical director of hepatology and liver transplantation, Dr. Richard Gilroy, at Intermountain Healthcare in Salt Lake City has referred this deadly disease as a tsunami, that is heading towards the mankind. 

In BMJ, a medical journal, data of the research for the year 1999 and 2016 was published that shows that in this present century, 65% of Americans were killed by cirrhosis. To further explain this percentage in numerics, 20,661 people were died in the year 1999 due to some liver disease, and this figure increased up to 34,174 for the year 2016. 

Apart from all this data of liver disease, liver cancer also cause a high death rate in the year 1999 to 2016. In the same research publication of BMJ, data was observed that shows the increase of 5,112 to 11,073 deaths in this same time period because of liver cancer. It was expected that any person that was infected with some liver disease and has a chronic infection with hepatitis B and C and NAFLD, cirrhosis, etc. has a chance of developing liver cancer afterward. 

Types of liver diseases

The most world-known type of liver disease that is caused by the gradual and slow damages to the liver over the years is known as chronic liver diseases, and if the disease is increasing its intensity towards the severity, it will indicate cirrhosis- failure of the liver.  

In contrast to this slow-growing disease, another major type is known as acute liver disease. This is caused by an overdose of a drug, acetaminophen (Tylenol), for example. This is the most deadly type that occurs all of a sudden and can cause the liver to stop functioning within 1 to 2 days. 

Further major types are:

  • Nonalcoholic fatty liver disease, commonly known as NAFLD, due to the significant rise in obesity and diabetes levels.
  • Alcoholic fatty liver disease, or alcoholic steatohepatitis, due to an excess amount of fat stored in the liver, majorly because of consuming too much alcohol. 
  • Viral hepatitis –liver inflammation, high levels of hepatitis B, and C.

Other less common types are:

  • Autoimmune hepatitis- that is caused by the insignificant attack of the body’s immune system on liver cells.
  • Alagille syndrome- this is the genetic disorder initiated by liver damage.

Causes of liver diseases

There are different reasons for the cause of liver disease, and all are quite variable throughout. However, some of the major causes which are observed are:

  • Diabetes
  • Hepatitis A, B, and C
  • Genetics
  • Obesity
  • Immune system problems
  • Alcohol overuse and abuse

Symptoms of liver diseases

The scariest thing about liver disease is that it occurs silently. Usually, a person that is suffering from any liver disease will not show any noticeable alarming signs outwardly until his/her disease has reached a 3rd or 4th stage. 

Dr. Afdhal has also quoted this as the scariest fact about liver disease. He further mentioned that nobody could make a guess about this deadly disease at the early stages. It works in a way that this illness is slowly building inside, and you will only notice when it is at an alarming stage of chronic liver disease. 

However, the initial warning symptom that should not be ignored is prolonged fatigue or extreme tiredness of a person for an extended period of time. 

Other symptoms of liver diseases are:

  • Dark-colored urine.
  • A white or black tarry stool
  • Stomach upset and always having or feeling nausea 
  • Jaundice – having an extreme yellow color of skin or eyes
  • Swelling of legs, feet, ankles
  • Easily getting bruises
  • Continous pain or swelling (ascites) in the abdominal area 
  • Extreme weight loss in a short period of time
  • A continuous decrease in appetite 
  • Always in a state of confusion or uncertainty 

Diagnosis

By visualizing the sensitivity of liver disease and its easy to neglect symptoms, many people believe that it is very difficult to identify this disease at an early stage. But this is not the common case. 

The medical director of digestive health clinics and liver transplantation, Dr. Alan Gunderson at the University of Iowa Health Care, said that it is very important to identify a liver disease at an early stage as this will provide an opportunity to change the unfortunate of the upcoming future. 

Normally any blood tests that are done for the routine health checkups provide an initial indication of liver disease. This helps to perform further liver function tests to make sure about the proper functioning of the organ; for example, it may have any abnormal functioning such as an excess release of enzymes like aspartate aminotransferase and alanine aminotransferase in case of the affected liver. But many other experts say that further tests should be done to detect liver disease.

Screening and lab tests to find liver diseases

The American Diabetes Association (ADA) has observed that NAFLD is majorly an outcome of variations in diabetes. Their experts say that any patient who is either having Type 2 or has prediabetes should undergo additional tests to evaluate for nonalcoholic steatohepatitis and liver fibrosis. This could help to primarily indicate chronic disease and perform an ultrasound for elevated liver enzymes (alanine aminotransferase) or fatty liver. To further clarify this, the ADA introduces its own evidence-grading system that “C” indicates reassuring pieces of evidence that are taken out from poorly controlled or uncontrolled studies.  

At the same time, the Preventive Services Task Force of the United States has put forward their conscripted guidance to get the public response on it. They claim that if this technique is adopted, it would help to indicate specific adults, from 18 to 79 years of age, should be screened for hepatitis C virus infection. 

However, many experts claim that all these standardization and agreements are not enough to screen for liver disease. Additionally, comprehensive screening should be performed to discover any crucial disease.  

Apart from all these above-mentioned techniques, blood tests, ultrasound, MRI, CT scans are also in practice to identify how much damage is caused to the organ. In severe cases, by performing a biopsy, some tissues of the liver are removed and are examined to assess the causes of liver damage.

Treatment options

There is no one specific treatment to cure this disease. It varies from one person to person, depending on their specific condition.

The recent and most significant progress in the medical field is the development of productive medications. Dr. Afdhal in support of this effective medicines has mentioned that if any person suffering from hepatitis C take one tablet per day for eight to twelve week will have 95 to 98% of chances to cure this illness. 

The medical director of liver transplant and head of the hepatology section, Dr. James Trotter, at Baylor University Medical Center in Dallas, has mentioned that similar medications are also available for hepatitis B, but it does not fully cure the illness of its roots. Instead, it continuously weakens the virus. In addition to these medicines, the patient also requires to undergo antivirals treatments to stop the deadly effects of hepatitis B on the liver. 

But if the disease is spreading and getting more advanced, then the treatment should mainly focus upon addressing the main cause behind its spreading and try to prevent it from further damaging the organ. To get the patient in a controllable state, different medications could be prescribed to reduce the effect of different symptoms like swollen feet, ankles, and legs. For other cirrhosis complications like hepatic encephalopathy, different medicines can also be used. 

In the case of acute liver disease, if there are some chances of liver failure, the doctor should give laxative to the patient to get rid of toxins from the body as soon as possible.

In extreme cases, when there are no chances for the disease to be upturned and liver failure is confirmed, a liver transplant is suggested. It is a type of surgery in which the doctors replace the diseased or damaged liver with the healthy liver of a matched donor. 

Apart from all these medical treatments, the most authentic and useful way is to change the lifestyle of the affected person. To further explain this, Dr. Trotter said that if any person is diagnosed with a fatty liver, that is mainly because of the excess amount of fat presented in the liver, should try to lose some weight. However, if the illness is severe and it is not possible for a person to lose superfluous pounds of weight, then they could have bariatric surgery, but that should also be prescribed by the respective doctor.  

How to prevent getting liver diseases

The number one technique to save oneself’s from any of these fatal liver diseases is to adopt some preventions to lessen the chances of liver disease. You can protect yourself from developing a liver disease by following the below-mentioned few tips:  

  • Take healthy food items, for example, a Mediterranean diet. It consists of low carbs and high in plant-based food items, and also some exercise to lower the chances of diabetes. 
  • Keep a healthy weight level.
  • Do not consume alcohol in excess amounts.
  • If you are in the baby boomer age group or working as a health care worker, get regular check-ups to test for hepatitis C to eliminate the doubt.
  • Make sure to have vaccinations for hepatitis A and B just to be on a safer side.
  • Avoid sharing injection needles and IV drugs if you are currently prescribed with one
  • Strictly follow the limit of drug dosages, even for paracetamol or acetaminophen
  • If you are going to have a tattoo, make sure that the artist is strictly following the health regulations. 
  • During sex, make sure to use a condom and try not to touch another person’s bodily fluids or blood.
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