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LIVER CIRRHOSIS : CAN BE PRESENT EVEN IF YOU HAVE NO SYMPTOMS

   

A.What is Liver Cirrhosis?

It’s a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver. Liver which performs 500 important functions, all these get affected when there is liver failure due to cirrhosis.

      

B.What Causes Cirrhosis of the Liver?

Viral Hepatitis B, Hepatitis C,  Non Alcohol fatty liver disease( NAFLD ) , and Alcohol abuse are the most common causes of cirrhosis of the liver. Non Alcohol Fatty liver is associated with obesity , diabetes Altered cholesterol profile , hypothyroidism and Hypertension . Other less common causes are Wilsons disease ( metabolic defect of copper ), Autoimmune ( self harm) liver disease , Metabolic disorders such as Hemchromatosis and alpha 1 antiptrpsin deficiency .

VIRAL HEPATITIS B,C, ALCOHOL LIVER DISEASE AND NON ALCOHOL FATTY LIVER “ TRIPLE TICKING TIME BOMB”


A.What are the symptoms of Liver Cirrhosis ?

One can have Liver cirrhosis without any symptoms in the compensated stage whilst liver function is not affected. This is because Liver is a forgiving organ and can regenerate . At this stage routine blood tests such as LFTS ( Liver function tests ) and Ultrasound abdomen may be entirely normal. Early detection of Cirrhosis is possible with Fibroscan ( a non-inavsive bed side test to detect scarring /fibrosis of liver ) Fibroscan is painless, safe , quick, easy to perform and results are available instantly . This can be repeated periodically to monitor progress or improvement in underlying fibrosis.

Symptoms due to complicaions of Liver Cirrhosis seen in   Advanced stage

• Fatigue
• Recurrent infections, fever
• Swelling of feet, abdomen ( ascites )
• Jaundice
• Easy bruising
• Vomitng blood ( Hematemesis ), black stool ( Malena)
• Confusion, Forgetfullness, Altered sleep pattern( Hepatic Encephalopathy )
• Decreased Urine output ( Hepatorenal syndrome )
• Loss of appetite , loss of muscle mass/wasting

IF LEFT UNTREATED LIVER CIRRHOSIS CAN CAUSE LIVER CANCER

A.We would like to share a Story of one of our patients with Liver Cirrhosis:

“A 38 year old executive previously fit, was diagnosed to have fatty liver on routine health check 3 years ago. He noticed abdominal bloating and fullness after celebrating his anniversary. His wife told him not to worry suggesting that this could be due to overeating. During the course of the week he vomited blood and was therefore referred by his family physician to me for further evaluation. We performed an urgent endoscopy which confirmed presence of large varices (veins) in the food pipe which were causing the bleeding. Other investigations including blood tests and Sonography confirmed presence of advanced liver disease (cirrhosis) complicated with liver cancer. Also the bleeding from large veins was due to underlying liver cirrhosis. The cause of liver cirrhosis was hepatitis C and patient was unaware about this infection. The diagnosis came as a shock to the patient and family, especially since one week ago, he was apparently completely normal. I had to offer him a liver transplant as the treatment of choice due to late presentation. If he did not have liver cancer and was diagnosed early, we could have controlled his condition with medical treatment alone.” This story gives us an important message that Significant liver disease can be present without any symptoms, symptoms occur only in advanced stage of Cirrhosis . Therefore routine screening tests to assess for Liver health is very important to diagnose the disease early before onset of complications . Although there is popular quote: “Better late than Never” , I would like to add: “ Never Late is Better”

B.Who is at risk of Cirrhosis of Liver?

At least 1 in 5 Indians have some form of liver problem. It is a myth that most people who suffer from Liver disease take alcohol. However, Liver disease due to excess Alcohol is seen in 8 million Indians. On the other hand, approximately 42 million and 12 million Indians suffer from Hepatitis B and C respectively. Routine screening for Hepatitis B and C should be offered to those at risk such as: people with history of jaundice, family member with Hepatitis B or C, previous operations, blood transfusion, and tattoos, on dialysis, Health care workers . In India 144 million people suffer from Non-Alcohol fatty liver disease. Normal Liver should have less than 5% fat inside the liver, fat levels increase resulting in fatty liver which is due to obesity, diabetes, hypertension, high cholesterol or triglyceride and hypothyroidism Fatty liver progresses gradually, mostly without any symptoms and can cause cirrhosis with complications in a proportion of patients. Also Hepatitis B and C are silent and rarely produce any symptoms until they have reached an advanced stage.

C.YOU DON’T KNOW YOU HAVE IT UNTIL IT IS TOO LATE

How to prevent Liver Cirrhosis ?
• It is important to perform routine tests to assess liver health, even in absence of symptoms. Fatty liver when detected on an ultrasound should not be ignored. The tests include basic
liver function tests, sonography and Fibroscan (to help in detection of cirrhosis).
• We should get routine Hepatitis B and C blood tests , if negative, get the Hepatitis B vaccine, which include 3 doses taken at intervals (0, 1, 6months ). There is no vaccine for Hepatitis C.
• We should watch our Alcohol intake .
• Regular exercise and healthy diet will prevent all risk factors associated with fatty Liver .

1.What is Liver Cirrhosis? :

It’s a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

2.What Causes Cirrhosis of the Liver?

Hepatitis C, fatty liver, and alcohol abuse are the most common causes of cirrhosis of the liver, but anything that damages the liver can cause cirrhosis, including Fatty liver associated with obesity and diabetes, chronic viral infections of the liver (hepatitis types B and C) and many more.

3.Our Patient Story of Liver Cirrhosis:

“A 38 year old executive previously fit, was diagnosed to have fatty liver on routine health check 3 years ago. He noticed abdominal bloating and fullness after celebrating his anniversary. His wife told him not to worry suggesting that this could be due to overeating. During the course of the week he vomited blood and was therefore referred by his family physician to me for further evaluation. We performed an urgent endoscopy which confirmed presence of large varices (veins) in the food pipe which were causing the bleeding. Other investigations including blood tests and Sonography confirmed presence of advanced liver disease (cirrhosis) complicated with liver cancer. Also the bleeding from large veins was due to underlying liver cirrhosis. The cause of liver cirrhosis was hepatitis C which patient was unaware about this infection. The diagnosis came as a shock to the patient and family, especially since one week ago, he was apparently completely normal. I had to offer him a liver transplant as the treatment of choice due to late presentation. If he did not have liver cancer and was diagnosed early, we could have controlled his condition with medical treatment alone.”

4.Who are at risk of Cirrhosis of Liver?

At least 1 in 5 Indians have some form of liver problem. It is a myth that most people who suffer from Liver disease take alcohol. However, Liver disease due to excess Alcohol is seen in 8 million Indians. On the other hand, approximately 42 million and 12 million Indians suffer from Hepatitis B and C respectively. Routine screening for Hepatitis B and C should be offered to those at risk such as: people with history of jaundice, family member with Hepatitis B or C, previous operations, blood transfusion, and tattoos, on dialysis. Hepatitis B can be prevented by taking the vaccine. There is no vaccine for Hepatitis C. In India 144 million people suffer from non-Alcohol fatty liver disease. Normal Liver should have less than 5% fat inside the liver, fat levels increase resulting in fatty liver which is due to obesity, diabetes, hypertension, high cholesterol or triglyceride and hypothyroidism Fatty liver progresses gradually, mostly without any symptoms and can cause cirrhosis with complications in a proportion of patients. Also Hepatitis B and C are silent and rarely produce any symptoms until they have reached an advanced stage when patient may have jaundice, swelling of feet, abdomen, vomiting of blood or confusion. You don’t know you have it, until it is too late.

5.How to prevent it?

It is important to perform routine tests to assess liver health, even in absence of symptoms. Fatty liver when detected on an ultrasound should not be ignored. The tests include basic liver function tests (which can be normal even in cirrhosis), sonography and Fibroscan (to help in detection of cirrhosis). Fibroscan is a non-invasive, painless test that does not need any preparation, can be performed in few minutes and results are available instantly.

       jun 12th, 2016

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