Know your liver- How to maintain Liver health

Sunday, Aug 01, 2021 08:00 [IST]

Last Update: Sunday, Aug 01, 2021 02:24 [IST]

Know your liver- How to maintain Liver health

Dr. Parvati Nandy, Prof. & HOD, Department of Medicine, CRH

The World Hepatitis day is observed on the 28th of July every year, with the aim to raise global awareness about liver health and hepatitis virus. Would hepatitis day is a world level awareness program launched by the Global public health campaign of the World Health Organisation.
‘Hepatitis can’t wait’
This year the theme for World Hepatitis Day 2021 is Hepatitis Can’t Wait - this emphasizes the importance of efforts to eradicate hepatitis as a public health issue by 2030.
Even amid the current Covid 19 crisis, a person dies every 30 second from a hepatitis related disease, therefore we can’t wait to take action again viral hepatitis. This day, 28th July has been selected as the World Hepatitis Day because on this day was born the Noble Prize winning scientist Dr. Baruch Blumberg who discovered the hepatitis B virus and more than this, he also developed the diagnostic tests for hepatitis B and the vaccine for the virus.
Some objectives for World Hepatitis Day
1 encourage people to come forward to access hepatitis prevention, testing and treatment services.
2. Raising awareness about different forms of hepatitis and how they are transmitted
3. to make an urge for national and regional policy makers to increase political and financial commitments for hepatitis response.
4. Increase awareness about hepatitis A and B vaccine.
5. To provide an opportunity for strengthening prevention, screening and control of viral hepatitis and its related diseases.
The human Liver:- Structure and function:- The Liver weighs1.2 – 1.5 kg and has multiple functions including key roles in metabolism, control of infection, elimination of toxins and byproducts of metabolism.
The liver plays a central role in carbohydrate, lipid and amino acid metabolism and is also involved in metabolizing drugs and environmental toxins.
Thus the liver synthesizes amino acids from dietary proteins, it also synthesizes and stores glycogen from glucose. It play a central role in the control and turnover of blood lipids. The liver is also the manufacturing site of blood clotting factors.
It is a major storehouse of vitamins and minerals like A, D, B12 and minerals like iron, copper etc.
Investigations for liver and hepatobiliary disease:- investigations play an important role in the management of liver disease in 3 settings
1 identification of the presence of the liver disease
2. Establishing the cause of the liver disease
3. Understanding disease severity
4. Investigation for possible complications
There are a battery of tests available. The LFT refers to the liver related Blood tests. In addition, viral makers, coagulation tests and immunological tests are also available. Imaging studies add to the information received in blood tests. The liver biopsy remains the gold standard in diagnosing liver disease with accuracy.
Common diseases of the liver are as follows:-
1. Alcoholic liver disease
2. Non-alcoholic  fatty liver disease
3. Viral Hepatitis ( A, B, C, D, E and others)
4. Autoimmune liver disease
5. Drug induced liver disease
6. Hepatocellular carcinoma.
Presenting problems in liver disease:-
Liver injury may be acute or chronic. Acute liver injury presents with non-specific symptoms of fatigue and abnormal LFTs or with jaundice and liver failure.
Chronic liver injury is defined as inflammation and fibrosis of the liver occurring for more than 6 months with fluctuating abnormal LFTS, with more severe liver damage, the presentation may be with jaundice, swelling of abdomen and feet with retention of fluids, bleeding tendency and alteration of consciousness.
Common symptoms of liver disease
Jaundice- This is the yellowish dis-colouration of the eyes and skin which occurs in people with liver disease. It is usually associated with abdominal pain, itching all over the body, dark urine, weight loss and extreme fatigue.  
Ascitis-this is the accumulation of free fluid in the abdominal cavity. This leads to abdominal distension, fullness of the flanks, hernias and dilated veins on the abdominal wall.
Hepatic Encephalopathy- This is the  neuro psychiatric syndrome caused by liver disease. It causes alteration in the consciousness level of the patients from confusion and disorientation at one end to coma and convulsions at the other.
In addition, in liver disease, patients are prone to bleeding from mouth or in stool along with increased chances of infection at various sites, decreased urine output and fatigue.
Common diseases of the Liver and their prevention
Viral hepatitis Liver is prone to specific viral diseases. Viral hepatitis is usually caused by hepatitis A, B, C, E, D (along with hepatitis B) Hepatitis B and C combined are the most common cause of death with 1.4 million life lost annually. Viral hepatitis continues to destroy thousands of lives every day despite the Covid 19 pandemic.
Hepatitis A and E Is highly infectious and spreads by faecooral route, i.e by unhygienic food and water intake, open defaecation and pollution of water bodies by infected asymptomatic individuals who may excrete the virus in the faeces for 2-3 weeks prior to onset of symptoms and then for a further 2 weeks, when having symptoms. This infection is common in children, with overcrowding and poor sanitation
Hepatitis A is best managed by prevention of transmission by improving social conditions. Active immunization with vaccination with an inactive virus vaccine is encouraged, especially among children; for immediate protection after exposure immune serum globulin is also available.
Vaccines for hepatitis A are specially recommended for those at particular risk like close contacts of patients, elderly, pregnant women, people with other major disease etc.
Hepatitis B-  This is the most common cause of chronic liver disease and hepatocellular cancer. Approximately one third of the world’s population have serological evidence of part or current infection with hepatitis B and 350-400 million people are chronic hepatitis B carriers.
Modes of transmission of hepatitis B, C, D.
Infrequent hand working etc. hepatitis B + C and D are spread by improper blood transfusion, as in
 1 Shaving of IV needles
2. Infected unscreened blood products.
3. Tattoos, acupuncture needles.
4. Sexual activities (homosexual and heterosexual) Sexual intercourse without proper protection with an infected partner
5. Mother to Child transmission
Hepatitis B may also cause an acute viral hepatitis, which may be without any major symptom, also for this reason, screening of all individuals is necessary to pick up latent infection, if any, so that appropriate therapy and follow up may be done. Prevention of Hepatitis B is possible through behavioural change in in vulnerable population.
This virus is found in saliva, urine, semen and vaginal secretions of all infected males and females and unprotected sexual intercourse may lead to infection. This virus is 10 times more infectious than hepatitis C, which is again 10 times more infectious than HIV. The good news is that it is a vaccine preventable disease
A recombinant Hepatitis B vaccine is available which can taken by all normal individuals, especially those at risk and immunosuppressed people. This hepatitis B Vaccine is an essential member of the children’s immunization schedule and also the adult immunization schedule and is recommended for all, who are free from hepatitis B infection.
Hepatitis C- This is also a liver injury causing virus, route of transmission is as in hepatitis B. Most individuals are unware of when they get infected, and the virus is identified only when they develop chronic liver disease.
Hepatitis C screening should also be done for all individuals in a society as the positive patients can spread infection to the others; especially those with aberrant behaviours like injection drug use and multiple sex partners. Most infected individuals are asymptomatic until they develop cirrhosis of liver and hepatocellular carcinoma in the long run. There is no active or passive immunization available hepatitis C.
Alcoholic Liver Disease
Alcohol is one of the most common causes of chronic liver disease worldwide. Alcoholic liver disease is more likely to occur in continuous drinkers, consumption of alcohol of more than 5 years confers a significant risk of advanced liver disease, ranging from hepatitis to cirrhosis of liver. Women are more prone to alcoholic cirrhosis as they have higher blood ethanol levels then men after consuming the same amount of alcohol. Cessation of alcohol consumption is the single most important treatment and prognostic factor. Abstinence from alcohol reduces risk and prevents progression of liver disease.
Non-alcoholic fatly liver disease
This is a spectrum of disease encompassing fatly infiltration of the liver, inflammation and cirrhosis of liver. As the name suggests, this occurs in absence of significant alcohol consumption. NAFLD is associated with obesity, diabetes, increase in blood cholesterol levels, and is a part of the metabolic syndrome It is in part due to sedentary life styles, unhealthy dietary habits leading to weight gain along with diabetes mellitus. The management is mainly preventive with screening of the population to rule out liver aliments, viral and alcoholic hepatitis. Recommendation include life style change, healthy diet, and weight loss. Sustained weight reduction of 7- 10 % is associated with a significant improvement in the NAFLD spectrum.
Hepatocellular cancer
Epidemiological data show that modifiable lifestyle factors contribute to the pathogenesis of Hepatocellular cancer (HCC), including unhealthy diet, alcohol use, obesity, type 2DM, viral hepatitis B and C etc.
Risk factors for HCC. HCC has been increasing in incidence and prevalence for more than 30 years. Cirrhosis of liver is the underlying cause in most cases, 10% cases of HCC occurs without cirrhosis, in the setting of hepatitis B infection.

Sikkim at a Glance

  • Area: 7096 Sq Kms
  • Capital: Gangtok
  • Altitude: 5,840 ft
  • Population: 6.10 Lakhs
  • Topography: Hilly terrain elevation from 600 to over 28,509 ft above sea level
  • Climate:
  • Summer: Min- 13°C - Max 21°C
  • Winter: Min- 0.48°C - Max 13°C
  • Rainfall: 325 cms per annum
  • Language Spoken: Nepali, Bhutia, Lepcha, Tibetan, English, Hindi