Letting the liver live

Dr D Nageshwar Reddy, Chairman and Chief of Gastroenterology, AIG, talks about liver cirrhosis

Recently, filmmaker Nishikant Kamat, best known for directing the thriller drama remake Drishyam, died after battling liver cirrhosis for two years. As per a letter from the hospital in which he was admitted, he’d been admitted to the hospital on 31 July, with complains of fever and excessive fatigue. Despite responding well to antibiotics and supportive medication and the dedicated care from the various specialists in the hospital, Nishikant’s condition deteriorated eventually, and he succumbed to his illness on 17 August.

Liver cirrhosis is a condition in which the liver doesn’t carry out its functions because of longterm damages to it, which scars the liver tissues. While it is known that hepatitis and chronic alcohol abuse are its common causes, no one knows for sure how many people have cirrhosis. This is usually because most people do not know they have it until the condition becomes serious. Cirrhosis of the liver can be fatal.

Dr D Nageshwar Reddy, Chairman and Chief of Gastroenterology, Asian Institute of Gastroenterology, explains that a third of liver cirrhosis patients are asymptomatic in the early stages in that some of them are diagnosed on ultrasound to have a fatty liver while some others have only show low platelets, another sign of liver disease.

Dr D Nageshwar Reddy goes on to remind us how the liver, one of the largest organs in the body, produces proteins and

protects

Doctors strongly recommend that people with cirrhosis cut back on their alcohol consumption or stop drinking altogether

itself and other organs by detoxifying the toxins such as alcohol. “In fact, the food, medicines and whatever enters the body through the mouth goes to the liver for metabolism,” explains the doctor. “The scar tissue in a damaged liver blocks the flow of blood through the liver and slows the organ’s ability to process nutrients, hormones, drugs and natural toxins.”

CAUSES AND SYMPTOMS OF LIVER CIRRHOSIS

Common causes of the condition are alcohol consumption, hepatitis B, hepatitis C and fatty liver. However, the symptoms come on gradually as the liver loses its ability to work properly.

“Some of the common symptoms of liver cirrhosis are reduced appetite, fatigue, swelling of legs, yellowing of eyes and urine, darkening of the skin, and itching,” points out Dr

Nageshwar Reddy. “As the disease progresses, patients may develop swelling of the abdomen, blood vomiting, abnormal behaviours, irritability and altered sleep patterns.”

TREATMENTS AND INCURABILITY

What tips the scale for a patient is that treatment for the condition is based on the stage and cause of cirrhosis. And, sadly, while early diagnosis and treatment can stop or delay its progress, minimise damage and reduce complications, cirrhosis of the liver is incurable.

Dr Nageshwar Reddy further explains. “lf diagnosed in its early stages, therapy for cirrhosis mainly involves drugs and proper diet along with regular surveillance, ultrasound of the abdomen and endoscopy,” the doctor states. “However, for diagnosis in a later stage, liver transplant is the only option. There are also other therapies such as plasmapheresis, faecal microbial transplantation and liver regenerative therapy.”

However, the doctor cautions that before initiating therapies such as plasmapheresis, faecal microbial transplantation and liver regeneration therapy, stringent criteria needs to be fulfilled.

LIVER CANCER AND TREATMENT

The goal of treatment, as per Dr Nageshwar Reddy, is to slow or reverse the cause of the liver disease, prevent, identify and treat the symptoms and complications of cirrhosis, and lastly, to determine if and when a liver transplant is needed.

“If the cirrhosis is not diagnosed and treated well in time, liver cancer can develop in the later stages of the disease,” says the doctor.

But the cancer seems treatable. “We can burn cancer with drugs, radiation or heat therapy. We can also cut and remove cancer if it is small, and in some cases, liver transplant can be done, which is why regular surveillance is required. If the cancer is advanced, then we can treat with drugs (chemotherapy),” the doctor adds.

At the moment, there is no way of reversing the cirrhosis of the liver. Common causes of the condition are alcohol consumption, hepatitis B, hepatitis C and fatty liver. However, the symptoms come on gradually as the liver loses its ability to work properly.

— Dr Nageshwar Reddy