Why Organ Donation

FAQ

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To know more about the Liver Condition & Treatment

Q: What does the liver do?

The liver is like a big chemical laboratory and a substance purifier, and it does lots of things.
Among other things, it aids in nutrition and handles the nutrients that have been absorbed by the gut from food and helps in digestion by secreting bile.

It removes waste and other harmful substances from the blood, and is responsible
for the metabolization of drugs/ medications, and other harmful substances
that we take. It makes proteins like albumin and clotting factors (These
help in the clotting process), and other important hormonal substances responsible
for maintaining the body equilibrium. It also functions as a storehouse of
reserve energy, sugars, fat and other vitamins and minerals.

Q: What are some common liver disease symptoms?

Some common liver disease symptoms include the following, each of which are described briefly below:

  • jaundice
  • cholestasis
  • liver enlargement
  • portal hypertension
  • esophageal varices
  • ascites
  • liver encephalopathy
  • liver failure

Q: What is jaundice?

Jaundice is a yellow discoloration of the skin, mucous membranes, and whites of the eyes due to abnormally high levels of bilirubin (Bile pigment) in the bloodstream. Urine is usually dark because of the bilirubin excreted through the kidneys.

Jaundice is of 2 types:

  • Due to liver disease when the liver is unable to excrete bilirubin.
  • Due to blockage in the ducts carrying bile from the liver to the intestine.

Q: What is portal hypertension?

Portal hypertension is abnormally high blood pressure in the portal vein, which supplies the liver with blood from the intestine. Portal hypertension may be due to increased blood pressure in the portal blood vessels, or resistance to blood flow through the liver. In Cirrhosis the resistance to blood flow through the liver increases. Portal hypertension can lead to the growth of new blood vessels (Called Collaterals) that connect blood flow from the intestine to the general circulation, bypassing the liver. When this occurs, substances that are normally removed by the liver pass into the general circulation. Symptoms of portal hypertension may include:

  • ascites - fluid build-up between the tissues lining the abdomen and abdominal cavity
  • bleeding of the varicose veins at the lower end of the esophagus and in the stomach lining
  • Splenomegaly (Increases size of the spleen)

Q: What are esophageal varices?

Esophageal varices are dilated blood vessels within the walls of the lower part of the esophagus that are prone to bleeding. They can appear in individuals with severe liver disease. A diseased liver can cause portal hypertension, which is high blood pressure in the portal vein. The portal vein supplies the liver with blood. Over time, this pressure causes blood vessels to grow, called collateral blood vessels. Some of these collateral vessels form esophageal varices, which act as channels to divert the blood under high pressure. The extra pressure in these vessels causes them to dilate and become tortuous. These vessels can eventually reach the lower esophagus and stomach and are prone to rupture.

Q: What is ascites?

Ascites is fluid build-up in the abdominal cavity caused by fluid leaks from the surface of the liver and intestine.

Q: What is liver failure?

Liver failure is severe deterioration of liver function. Liver failure occurs when a large portion of the liver is damaged due to any type of liver disorder. Symptoms may include:

  • jaundice - yellowing of the skin and eyes.
  • tendency to bruise or bleed easily
  • ascites - fluid build-up in the abdominal cavity.
  • impaired brain function
  • general failing health
  • fatigue
  • weakness
  • nausea
  • loss of appetite

Q: What is Hepatitis?

Inflammation refers to a process that can affect any part of the body that is injured, and it leads to that part becoming red, hot, swollen and painful. Hepatitis means inflammation of the liver.

Hepatitis A, B, C and E viruses are common causes of hepatitis in India. The hepatitis A virus and the hepatitis E causes acute viral hepatitis (Or water borne jaundice). It enters the body through things we eat or drink. It is almost always self-limiting and does not have any long-term health implications once the acute inflammation has settled. However sometimes these may be lethal if the liver becomes extensively damaged.

Hepatitis B and C are more serious conditions. One usually gets these infections sexually from an affected person, or from transfusion of contaminated blood, or from the use of dirty syringes and needles which have been used by an infected person. A blood test can tell if one is infected. The B and C viruses cause a mild acute hepatitis but this usually settles down, and they do not cause much immediate damage to the liver. But the viruses persist in the liver, and over a period of years will cause chronic inflammation of the liver, leading to cirrhosis and to the development of liver tumours.

Patients diagnosed as having Hepatitis B or C should see a liver physician and discuss receiving anti-viral medical treatment. There is a vaccine that can make one immune to Hepatitis B.

  • jaundice - yellowing of the skin and eyes.
  • tendency to bruise or bleed easily
  • ascites - fluid build-up in the abdominal cavity.
  • impaired brain function
  • general failing health
  • fatigue
  • weakness
  • nausea
  • loss of appetite

Q:What is Liver Cirrhosis?

Chronic damage to the liver over a long period of time can lead to parts of it becoming scarred and shrunken, while other parts, trying to compensate, grow in the form of nodules (Or lumps). So the whole liver, which is normally soft and has a smooth surface, becomes quite hard and lumpy. This is called cirrhosis.

Q: How does one get cirrhosis of the liver?

Alcohol abuse in the best-known cause of cirrhosis, but cirrhosis can also develop due to lots of other reasons. Chronic viral hepatitis B and C can lead to cirrhosis. So can autoimmune conditions like primary biliary cirrhosis or primary sclerosing cholangitis (These are diseases where one's own immune system ends up attacking the liver or the bile ducts). Long-term obstruction to the flow of bile can cause secondary biliary cirrhosis. There are several other possible causes of cirrhosis, which we have not listed here.

Q: What is Liver transplantation?

Liver transplantation (Removing the damaged liver and putting in a new one) is a treatment for liver failure. This may be done for acute (Happening suddenly) liver failure caused by severe damage to the liver by a drug (E.g. viral hepatitis, paracetamol overdose) or for chronic (Long standing liver problem) liver failure in cirrhosis. Not every person with liver failure is suitable for a liver transplant. There are eligibility criteria to be met and a complex vetting process to be gone through before a patient is deemed suitable for a transplant. The nature and severity of the liver disease, the age and overall fitness of the patient, and the availability of suitable organs are the major considerations in this process.

Q: How does one get a new liver?

The new liver that is transplanted may come from a dead person (Cadaveric Transplant) or from a living donor, usually a family member. In a cadaveric transplant the entire liver is usually put into the recipient (Though in some instances, especially child recipients, one adult liver can be split into two, and used for two recipients). In the case of a living donor, only a part of the donor's liver is removed.

Q: What are the risks of the liver transplant operation?

The operation itself is a major undertaking, and there is a significant risk of immediate complications and even death.

The major complications may include bleeding requiring massive blood transfusion, infections after the operation, sepsis, renal failure, cardiac and pulmonary (Breathing) problems and other biliary or wound complications.

In the aftermath of the operation, the patient's own immune system will attack the new liver – a process called rejection. So the patient has to be put on immuno-suppressive drugs. If the immune system is not adequately suppressed, and the patient suffers a graft rejection, the new liver will not work properly. On the other hand, suppression of the immune system makes the patient vulnerable to infections. So a fine balance has to be achieved between rejection on the one hand and infections on the other..

Q: What is the best treatment for liver cancer?

Specific treatment for liver cancer will be determined based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance of specific medicines, procedures, or therapies
  • Expectations for the course of the disease
  • Clinical situations

Treatment may include:

  • Surgery: In some cases surgery may be used to remove cancerous tissue from the liver. However, the tumor must be small and confined.
  • Radiation therapy: Radiation therapy uses high-energy rays to kill or shrink cancer cells.
  • Chemotherapy: Chemotherapy uses anticancer drugs to kill cancer cells.
  • Liver transplantation: In the presence of underlying cirrhosis or chronic liver disease.

Treatment options are described here in a very general sense, and individual patients should discuss their treatment with their own medical team. It is important that a patient with a liver disease or liver tumour is seen by a medical team that specializes in the treatment of liver disease.




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