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March 06, 2018 Tuesday 03:55:38 PM IST
VITAL LEVER

Liver is the largest gland in the body and is located in the upper right quadrant of the abdomen beneath the rib cage. The human liver is in reality a wonderful chemical plant that helps to convert everything we eat into living energy. It is the primary metabolic organ for proteins, fats, and carbohydrates. Blood flows directly from the intestine to the liver, where it filters out toxic materials before letting the purified blood enter systemic circulation.

 

Any injury to the liver can compromise many of these functions. However, our liver has a unique ability to regenerate. Moreover, it has a vast functional reserve. It can carry on without symptoms even with its functional capacity reduced to half.

 

Liver damage can be acute or chronic. Acute liver injury usually manifests as hepatitis and the main symptom is jaundice. (Jaundice refers to the yellow discolouration of the eyes and urine.)

 

Chronic low-grade injury over several years leads to scarring of liver tissue causing a condition called liver cirrhosis. When the liver becomes cirrhotic it loses its smooth outline and becomes nodular. Hepatitis refers to inflammation of the liver. The inflammation can be caused by viral infection, excess fat in liver, or autoimmune diseases.

 

HEPATITIS A & E

 

There are four more common types of viral hepatitis: Hepatitis A and E that are caused by contaminated food and water; and Hepatitis B and C that are blood-borne. There is usually a rise in number of patients coming with food- and water-borne hepatitis during summers. It is easy to avoid infection by stop having food and water from roadside stalls.

 

Patients with acute Hepatitis A turn up with fever, abdominal pain, nausea, vomiting, loss of appetite, and dark coloured urine. Patients coming with these symptoms must get tested for hepatitis.

 

There is a chance this gets confused with malaria or typhoid. Taking paracetamol indiscriminately can actually worsen liver injury. Although Hepatitis A and E are self-limiting diseases that have no long-term effects on liver, in serious cases they can cause liver failure.

 

One in 1000 patients may contract liver failure through Hepatitis A where a transplantation is the only life-saving measure. Otherwise benign hepatitis A can be lethal in patients with an underlying liver disease such as cirrhosis. Hepatitis E can be quite severe in pregnant women.

 

HEPATITIS B & C

 

More than 325 million people worldwide are living with chronic Hepatitis B or Hepatitis C infections. These patients are at risk for slow progression to chronic liver disease, cancer, and death. Hepatitis B and C are transmitted by unprotected sex, sharing of needles in IV drug abusers, unhealthy and unscientific tattooing techniques, transfusion of blood products etc. Hepatitis B and C are also more prevalent among those undergoing dialysis.

 

Hepatitis B is also known to transmit from mother to her new-born, hence the mandatory monitoring of pregnant women and vaccination of the new-born. Universal Hepatitis B vaccination can reduce the burden of people living with the disease and progression to cirrhosis later in life. Today, oral drugs with a cure rate of 95% are available for Hepatitis C.

 

ALCOHOLISM & LIVER DISEASE

 

When we talk about liver injury, one cannot forget the issue of alcoholism. Kerala has the highest per capita alcohol consumption rate in our country.

 

Alcohol is a direct hepatotoxin and can cause liver cirrhosis when there is prolonged exposure. An average daily consumption of 50 grams can cause cirrhosis in men within 5-10 yrs. In women this dose is even lower. Fifty grams roughly corresponds to three large pegs of liquor.

 

Over the years of my medical practice I have noted two things. People claim toddy, beer, and wine are harmless as they contain less amount of alcohol, roughly around 5-10%. This is actually less than the percentage of alcohol in hard liquor, such as whiskey, brandy, or vodka. But the amount of alcohol in a single bottle (750 ml) of beer is almost equivalent to that in 3 small pegs of whiskey!

 

The old notion that one is safe if alcohol is had alongside food does not hold true. Alcoholic injury to liver cannot be prevented by the use of high protein and nutritious food. Whenever a person consumes alcohol the liver sustains a little injury. With further exposure to the beverage, the damage is perpetuated.

 

An occasional peg or two may not harm a person. But the problem arises when the spirit overpowers the individual’s will power and s/he becomes an addict. To minimise the injury to the liver, the least a person can do is to abstain from alcohol for

at least 24 hours so that the liver can overcome the hazardous effects of alcohol. Today we are witness to an epidemic of lifestyle diseases, such as obesity, diabetes, hypertension, and hypercholesterolemia, all owing primarily to unhealthy food habits and sedentary lifestyles.

 

Fatty liver is the hepatic manifestation of a metabolic syndrome. You are more likely to develop fatty liver if you are overweight, diabetic, or have high blood cholesterol. Twenty percent of people with fatty liver can contract liver cirrhosis within 20 years. If you have fatty liver, the most effective way to prevent progression to cirrhosis is to exercise regularly and lose excess weight.

 

An easy way to calculate your ideal weight is by measuring your height in centimetres and then subtracting 100 from it. This should give you your ideal weight in kilograms. It has been shown in studies that if you manage to lose 15% of your weight, fatty liver can disappear.

 

Most importantly, one must cut down on alcohol, eat plenty of fruits and vegetables, and avoid refined sugars and saturated fats. So, minimise consumption of chocolates, cakes, and biscuits.


Dr. John Menachery

The writer is Consultant Hepatologist at Rajagiri Hospital, Kochi, Kerala.

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