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Your Liver and You
The liver is an incredible organ. It performs over 500 different functions in the body without as much as a whisper. The primary functions of the liver range include metabolic functions, synthetic functions, immunological functions, nutritional functions, and excretory functions among others. That being said, I doubt if you will be able to recall any of these functions off hand. Why? That’s because the Liver has been likened to a central processing unit or a veritable workhorse or a mythical Atlas holding up the burden of the whole body. You rarely hear it complain because it endures and endures until it finally has no reserves. And once it starts failing, other organ systems start failing like a domino effect.
The liver is a unique organ. It has an almost endless ability to regenerate unlike any other vital organ in the body and it repairs itself after almost every insult. Almost! Because there are two situations from which the liver is unable to recover. The first is the cumulative damage over years and decades of damages that reduces the liver to a hard, shrunken, scarred nodular mass with grossly distorted architecture that does not allow any further regeneration. The second is the acute, rapid insult where the damages overwhelm or overpower the liver’s ability to regenerate. The first response to any insult is hepatocyte necrosis followed by regeneration and fibrosis(random deposition of reparative collagen fibres). When this fibrosis takes over the whole liver, it leads to a condition called Cirrhosis. If you are looking for a liver hospital in Delhi then consult Manipal Hospital, we focus on the comprehensive care and management of various liver conditions including congenital conditions, Liver fibrosis, liver failure, etc.
Causative factors for cirrhosis are numerous, however, the most common etiologies are Hepatitis C virus, Hepatitis B virus, Alcohol-induced, Non-alcoholic steatohepatitis (Obesity), and Primary Cancer of the liver, Biliary atresia (congenital biliary tract disease in children) amongst others. Up to 10-15% of patients with cirrhosis requiring transplantation are cryptogenic which means that no identifiable cause for liver failure could be found.
Transmission of Hepatitis C virus most commonly occurs due to repeated percutaneous contact with infected blood products during blood transfusion and intravenous drug abuse. Any blood or blood product transfusions received before the early 1990s could be potentially infected since screening for hepatitis C virus during the collection of blood products was instituted only after that period. Since then, improved testing has led to drastic reductions in risk, down to less than 1% after 1993. However, anyone who had a blood transfusion prior to that time is at risk of having been infected. Less common modes of transmission of Hepatitis C are needle stick injury to health care workers, Tattooing, ear piercing, acupuncture therapy, contaminated medical equipment, sexual practices and childbirth amongst others. Cirrhosis develops on an average in 3-24% of patients within 20 years after the onset of HCV infection. The risk of development of liver cancer in these hepatitis C related cirrhosis patients is between 7-30 %.
Transmission of Hepatitis B happens when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. This transmission can occur during childbirth (from an infected mother to her baby), during intercourse with an infected partner, sharing needles, syringes, or other drug-injection equipment, sharing items such as razors or toothbrushes with an infected person, direct contact with the blood or open sores of an infected person, exposure to blood from needlesticks or other sharp instruments. The estimated annual frequency of developing decompensated cirrhosis in HBV-associated cirrhosis is 5% to 8%, whereas that of HCC is 2% to 4%. With Hepatitis B infection, liver cancer can occur with or without the presence of cirrhosis.
Alcohol is one of the major causes of cirrhosis. Chronic alcohol abuse can result in a spectrum of liver injuries that ranges from mild fatty infiltration to cirrhosis and hepatocellular carcinoma. Fat accumulation in liver cells, the earliest and most predictable response to alcohol ingestion, is seen in 90% of heavy drinkers. cirrhosis can develop within 5 years in 10% of patients who continue to drink heavily. Daily intake of alcohol that exceeds the threshold for alcoholic liver disease is roughly 40-80/day in men & 20-40/day in women for more than 10 years. This measure roughly equals 3-6 cans of beer or 3-6 glasses of wine or 3- 6 drinks of hard liquor per day in men and roughly half of that in women over 10 years.
The global obesity epidemic has dramatically increased the prevalence of nonalcoholic fatty liver disease (NAFLD), such that it is the most common cause of chronic liver disease in the Western nations. Many of the so-called cryptogenic categories of cirrhosis may turn out to be obesity-related. The best estimates to date predict an approximately 11% rate of progression of NAFLD to cirrhosis over a 15-year period. Data suggest that hepatocellular carcinoma will develop in approximately 7% of patients with NASH (Nonalcoholic steatohepatitis) cirrhosis over 6.5 years of follow-up.
Manipal is one of the best Gastroenterology hospital in Delhi for offering best-in-class medical facilities. The team of gastroenterologists in Delhi has performed more than 35,000 laparoscopic procedures with high success rates.
Exposure to these etiological factors like viruses, toxins, obesity, alcohol, congenital conditions, metabolic derangements, autoimmune disorders, biliary tract diseases, drugs etc over a prolonged period of time(1-3 decades) usually results in end-stage liver disease referred to as CIRRHOSIS. Cirrhosis is usually an irreversible change from where restoration of normal liver function is impossible. Usually, there is a gradual deterioration in the patient’s condition with symptoms such as altered sleep cycle, irritability, confused state of mind, bloody vomiting, black stools, mental deterioration, abdominal swelling, abdominal pain, jaundice (usually referred to as “decompensated cirrhosis” in scientific terms ) with significantly reduced life expectancy from 1to 5 years. Besides the gradual clinical deterioration, the diseased (cirrhotic) liver is a hotbed for the development of hepatocellular carcinoma( liver cancer).
Once this point of no return (decompensated cirrhosis) is reached, there is only one CURE and that is Liver Transplantation. Other measures to prolong life, improve the quality of life or minimize the troublesome symptoms are available, however, it's important to realise that only Liver Transplantation is going to cure the patient. It's important to acknowledge its inevitability and this step towards realisation helps the patients to process the enormous implications of this decision. Its implications range from emotional, psychological, lifestyle modifications, impact on family dynamics, and professional and financial amongst others.
Consultant - HPB Surgery & Liver Transplant
Manipal Hospital, Dwarka, Delhi
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