World Liver Day: Symptoms of liver disease and ways to treat it

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In India, liver disease affects millions of patients every year and is the tenth most common cause of deaths as per the World Health Organization. Around 10 lakh patients with chronic liver disease are newly diagnosed every year in India. Further, liver cancer accounts for the fifth most common cause of cancer and the third most common cause of cancer-related deaths. Unfortunately, despite such grave significance, people are less sensitised about liver diseases and ways to prevent them. World Liver Day is observed every year on 19th April, to spread awareness about liver diseases and for ensuring liver health.

The liver is the largest internal organ of our body, responsible for many important functions like processing nutrients, filtering the blood, producing bile, regulating hormones, maintaining blood sugar levels, blood clotting and fighting infections. Hence, any injury to the liver that goes unchecked can pose threat to our lives. The most common injury is alcohol leading to alcoholic liver disease (ALD), the proportion of which has increased over the years, with various studies showing prevalence ranging from 43.5% to 72%. However, a large proportion of non-alcoholic patients show similar injury as ALD, wherein too much fat is stored in liver cells called ‘non-alcoholic fatty liver disease’ (NAFLD).

The disease seen in 1/3rd of Indians is more prevalent in those with diabetes, obesity and/or high lipids. NAFLD is now recognized as a multisystem disease and has been associated with increased cardiovascular disease, chronic kidney disease, osteoporosis, and extrahepatic malignancy. India has become the first country in the world to identify the need for action for NAFLD and advocated the integration of NAFLD with NPCDCS. Viral hepatitis is affecting 325 million people globally and nearly 1.4 million deaths per year. India has the second-highest number of Hepatitis B virus cases in the world. Other causes of liver disease are Drug-induced liver injury, Autoimmune related liver disease and Genetic causes.

Liver diseases are silent killers as the poor liver keeps tolerating all the stress until it is fairly advanced and damaged to a point of no return which we call liver cirrhosis. In the initial fatty liver stage, patients are generally asymptomatic or have some non-specific symptoms like nausea, vomiting, bloating, general weakness and fatigue or decrease in appetite. As the disease progresses, patients may have symptoms of liver failure like jaundice, distention of the abdomen (ascites), swelling of legs, blood vomiting, black stools and/ or altered sensorium. Around 3-5% of liver cirrhosis develops liver cancer each year.

Management of cirrhosis is the treatment of the cause and of complications of cirrhosis. Despite major advances in treating liver diseases, once a patient develops liver failure, the only recourse left to the patient is Liver Transplant (LT). Because of the stigma and beliefs attached to organ donation in our country only 1% population is able to undergo LT. Thus, there is an urgent need to increase awareness among the general population so that disease can be identified and curtailed at an early stage.

Following are the six smart moves for a healthy liver and healthy life.

Alcohol abstinence: The risk of ALD not only increases after years of drinking too much, but binge drinking is equally or rather more dangerous. Thus, complete abstinence from alcohol is the mantra for a healthy liver.

Weight loss: Lifestyle modification is critical to reverse the course of liver diseases. An easy way to identify your ideal weight is to subtract 100 from your height (in cms). Patients in the high-risk group should target weight at least 5% less than this ideal weight. In this regard, a combination of regular physical activity (at least 45 minutes) and dietary modification is effective. You should have a hypocaloric diet with a good amount of fibres and fruits, and fewer carbohydrates and sugar. Turmeric and coffee have a good role in liver protection.

Strategy for Hepatitis:

Universal vaccination for Hepatitis A and B

Usage of barrier contraceptives (e.g. condoms) and safe sexual practices.

Avoid sharing drug needles, razors or toothbrushes; vigilant screening of blood and blood products, mandatory testing of tissue and organ donors and screening of pregnant mothers.

Early use of antivirals for Hepatitis B and C, when indicated

Avoid herbal supplements and over the counter medicines. You should not try local tactics to control liver disease, which in many cases may harm you.

Regular Health Checkup: Prevention is better than cure. A regular health check-up is the easiest and apparently the best way to eliminate any disease. Liver diseases can be picked up early by tools such as Fibroscan.

Consult a liver specialist: Timely testing and treatment must be ensured. Only take medication that is prescribed by a physician and under regular observation.

The article has been authored by Dr. Lovkesh Anand, Consultant – Gastroenterology, Manipal Hospitals

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