Best Hepatology Hospital In India

Signs and symptoms

The onset of symptoms depends on the extent of the Liver Damage. If there is a mild Liver Damage, then you may not have any symptoms. However, you may experience the following symptoms if the Liver Damage is severe.

• Jaundice
• Nausea and vomiting
• Fever
• Confusion
• Loss of appetite
• Tiredness
• Abdominal pain and swelling
• Weight loss
• Excessive thirst and dry mouth

Causes

When the alcohol is metabolized in the Liver, it releases the toxic substances. These toxic chemicals result in Liver Damage which ultimately leads to inflammation and Alcoholic Hepatitis. Consuming alcohol isn’t only the cause of Alcoholic Hepatitis; there are other factors affecting Liver function. These include the following:

• Malnutrition
• Genetic factors that affect the alcohol metabolism
• Medical history of other Liver Diseases such as Hepatitis C

Risk factors

The risk factors for Alcoholic Hepatitis are listed below:

• Alcohol consumption: The primary risk factor for Alcoholic Hepatitis is the amount of alcohol intake. A study shows that 60 to 80 grams of alcohol intake per day increases the risk of Cirrhosis in men and 20 grams of alcohol intake per day increases the risk for women.
• Gender: Women are at higher risk of developing Alcoholic Hepatitis when compared to men. This is because of the difference in the processing of alcohol in men and women.
• Other risk factors include obesity, binge drinking, and also African-American or Hispanic ethnicity.

Complications

Alcoholic Hepatitis may cause various complications including the following:

• Increased blood pressure in the portal vein
• Enlarged Veins
• Severe Jaundice
• Fluid retention
• Hepatic Encephalopathy
• Cirrhosis
• Kidney Failure
• Ascites

Diagnosis

Your doctor begins the diagnosis with a physical examination and a review of medical history including questions about alcohol consumption. Certain tests are recommended to confirm the diagnosis:

• Blood tests include Liver function tests, blood cell counts, bleeding time, and electrolyte tests. The Liver function tests determine the levels of Liver Enzymes that can be abnormal if there is Alcoholic Hepatitis.
• Ultrasound of the abdomen is recommended to view the internal structures and identify the abnormality.
• Computed tomography (CT) scan and magnetic resonance imaging (MRI) provide detailed imaging of internal Organs of the body.
• Liver Biopsy: A small sample of Liver tissue is removed to test under the microscope, and the purpose is to determine the type of Liver Disease.

Treatment

The main aim of the Alcoholic Liver Disease treatment is to restore the normal functioning of the Liver and relieve the symptoms. The Alcoholic Hepatitis treatment involves the following:

• Stop alcohol consumption: If you are diagnosed with Alcoholic Hepatitis, you must withdraw alcohol consumption completely. Your doctor may suggest an alcohol rehabilitation program or counselling and other supportive treatment to help prevent withdrawal symptoms.
• Treatment for malnutrition: Your doctor may recommend vitamin and nutrient supplements to rectify nutritional problems that contribute to Liver Disease.
• Drugs to reduce inflammation of the Liver: Your doctor may prescribe drugs if you are diagnosed with severe Alcoholic Hepatitis. These include corticosteroids and pentoxifylline.
• Liver Transplantation: If you have severe Alcoholic Hepatitis that cannot be reversed, your doctor may suggest Liver Transplantation.

Prevention

The following strategies may help to prevent and reduce the risk of Alcoholic Hepatitis:

• Consume alcohol moderately or avoid it completely.
• Maintain a proper diet that includes adequate vitamin and mineral supplements.
• Protect yourself against Hepatitis C.

Causes

The main cause of Autoimmune Hepatitis is an attack of the Immune System on normal Liver cells. But the reason for self-attack on the Liver by the own body is unknown. Researchers assume it is an interaction between genes.

Type 1 Autoimmune Hepatitis

Type 2 Autoimmune Hepatitis

It is the most common type of the disease. About half of the people with Autoimmune Hepatitis are with other Autoimmune Disorders such as rheumatoid arthritis, celiac disease, or ulcerative colitis.

This type of Hepatitis usually develops in adults but is most commonly developed in children and young people. Other types of Autoimmune Diseases can also accompany this type of disorder.

Risk factors

Factors that may increase the risk of Autoimmune Hepatitis are:

• Gender: Autoimmune Hepatitis is more common in females than in males.
• Infections: Certain infections like measles, herpes simplex or Epstein-Barr Virus make you more susceptible to Autoimmune Hepatitis.
• Heredity: If you have a familial history of Autoimmune Hepatitis, then you are at an increased risk of developing Autoimmune Hepatitis.

Symptoms of Hepatitis B

The symptoms of Autoimmune Hepatitis, are related to that of the symptoms of Hepatitis B and C.
The symptoms can range from mild to severe. The most common symptoms include:

• Fatigue
• Nausea
• Jaundice
• Joint pain
• Loss of appetite
• Light-coloured stools
• Discomfort in the Liver
• Yellow colouration of urine

Symptoms of Hepatitis C

The most common symptoms of Hepatitis C include:

• Tiredness
• Abdominal pain
• Loss of appetite
• High temperature of 38C

Diagnosis

Your healthcare provider would diagnose the case of Autoimmune Hepatitis by understanding your symptoms and performing physical examination, blood tests, and Liver Biopsy.

• Blood tests: performed to differentiate other Liver Disease which has the same symptoms as that of Autoimmune Hepatitis, such as viral Hepatitis.
• Liver Biopsy: Liver Biopsy determines the extent and type of the Liver Damage. For this test, a small amount of Liver tissue is removed, using a needle that is passed to the Liver through the skin.

Other complications

You may have complications that include permanent scarring of Liver tissue. Other complications may include:

• Liver Failure
• Liver Cancer
• Fluid in the abdomen
• Enlargement of the veins of the Oesophagus

Treatment of Hepatitis B and Hepatitis C

The main goal of Autoimmune Hepatitis treatment is to suppress the overactive Immune System. The disease can be controlled in most cases by following the standard treatment options. Medications are the first choice of treatment.

• Medications: If your symptoms are mild, or there are no symptoms, your doctor may not give you any medications. Corticosteroids are used to reduce swelling and reduce the activity of the Immune System; the main task is to find the lowest dose sufficient to treat the disease.
• Immunity suppressors: These drugs reduce inflammation and block the immune cell’s activity.
• Liver Transplant: In most severe cases such as Cirrhosis or End-stage Liver Failure, a Transplant is required. Your Liver would then be replaced by a healthy Donor’s Liver.

Effects of diet and alcohol

You can have a normal healthy diet which is balanced with all the nutrients. You must totally avoid alcohol as it further deteriorates the damaged Liver. If you consume alcohol, you may develop a more complicated disease such as Cirrhosis.

Causes

Enlarged Liver occurs as a result of the following conditions:

• Alcoholic Liver Disease
• Non-alcoholic Fatty Liver Disease
• Viral Hepatitis (Hepatitis A, B, C, D or E)
• Liver Cancer

The less common causes of Liver Enlargement include:

• Cancers such as leukaemia, multiple myeloma, and lymphoma
• Genetic diseases such as Wilson’s disease, hemochromatosis, Gaucher’s disease, and glycogen storage disease
• Cardiovascular Abnormalities
• Infections such as amebiasis, schistosomiasis, and fascioliasis
• Damage due to toxins such as carbon tetrachloride and chloroform
• Complex Liver and systemic disorders such as amyloidosis, Autoimmune Hepatitis, and primary biliary Cirrhosis.

Some types of abnormal growths such as cysts and Tumours that begin in the Liver or spread to the Liver may also lead to Hepatomegaly.

Risk factors

The following are the factors that increase your risk of Hepatomegaly:

• Excessive consumption of alcohol
• Intake of high doses of drugs such as acetaminophen or vitamin supplements
• Intake of medicinal herbs such as comfrey, mahuang, and mistletoe

Symptoms

The signs and symptoms of Liver Enlargement include the following:

• Severe pain in the right upper abdomen
• Fatigue
• Muscle pain
• Nausea and vomiting
• Poor appetite and weight loss
• Yellowish discolouration of skin and eyes
• Swelling of the feet and legs
• Easy bruising
• Black tarry stools
• Shortness of breath

Diagnosis

Your doctor may initiate the diagnosis with a thorough physical examination and by taking a medical history. If your doctor suspects Hepatomegaly, the following tests are ordered:

Blood tests: The blood test includes a complete blood count and evaluation of the levels of Liver enzymes.

Imaging tests: An abdominal X-ray is ordered to evaluate the abdominal Organs. Computed Tomography scans of the abdomen and magnetic resonance imaging provide a detailed view of your abdominal Organs.

Ultrasound of the abdomen: The ultrasound is used to evaluate the Liver and other Organs.

Liver Biopsy: In the Liver Biopsy, a small piece of your Liver tissue is removed to examine under the microscope for any abnormalities.

Complications

An increase in the size of the Liver may occur due to several underlying conditions. If it is left untreated, permanent Liver Damage or a serious complication may occur. Treating the underlying condition may reduce complications such as hepatic encephalopathy, hepatocellular carcinoma, portal hypertension, the spread of Cancer, and the spread of infection.

Treatment

Your doctor determines your Liver Enlargement treatment based on the underlying condition or cause.

If the underlying condition is Alcoholic Hepatitis or Non-alcoholic Fatty Liver Disease, then abstinence from alcohol consumption and adopting a healthy lifestyle would benefit you.

When the cause of an Enlarged Liver is Cancer, then the treatment involves Chemotherapy, surgery, or Liver Transplant.

Self-management and Prevention

The risk of having Liver Damage can be reduced by following a healthy lifestyle. Certain measures to reduce the complications are listed below.

• Complete abstinence from alcohol consumption or a moderate intake would reduce the risk of Liver Damage.
• Avoid taking excess doses of vitamin supplements and limit yourself to the prescribed doses.
• Confirm the safety of your doctor while taking herbal medications such as black cohosh, chaparral, comfrey, germander, valerian, mahuang, skullcap, kava, mistletoe, and pennyroyal.
• Maintain a healthy weight by avoiding the consumption of fat-containing foods.
• Smoking cessation may also reduce the risk of Liver Damage.
• Increase the intake of fruits and vegetables to keep your Liver healthy.

Causes

The causes of Hepatitis are:

• Autoimmune Disorder
• Liver Injury
• Alcohol abuse
• Lack of blood supply to the Liver
• Poison
• Certain drugs
• Viral infections like Cytomegalovirus and Mononucleosis

Symptoms

When the Liver is inflamed due to Hepatitis, it will be unable to perform its basic function of getting rid of waste products like Bilirubin in the blood.

The common symptoms of Hepatitis are:

• Jaundice
• Itching of the skin
• Body pains
• Nausea
• Fever
• Fatigue
• Loss of appetite
• Abdominal pain
• Weakness
• Passing dark-coloured urine
• Stools that are light in colour
• Skin and eyes turn yellowish due to Jaundice

Spread of Hepatitis A

A virus called Hepatitis A virus (HAV) causes Hepatitis A. This spreads through the oral faecal route, meaning contact of faeces through the mouth. This can happen due to consuming infected water and food. It is commonly seen in countries where sanitation is poor.

The virus also spreads through the Oral anal sex route. It is known to spread in children in daycare centres where the children in diapers may not be able to wash their own hands often.

In some cases, the HAV virus is also known to spread through blood transfusion of infected blood or sharing needles with a HAV-infected person.

Once you are infected with HAV and symptoms appear, you are very contagious. If you are a healthy adult, then you remain contagious for 2 weeks.

If your Immune System is weak then you remain contagious for 6 months. A child with a weak Immune System also remains contagious for 6 months.

Once you are infected with HAV, you develop immunity to the virus and rarely ever get it again.

Treating Hepatitis A

There is no specific treatment for Hepatitis A.

• Taking plenty of rest and consuming a balanced diet is recommended.
• Medication like acetaminophen and alcohol should be avoided as they can cause more Liver Damage.

If you have any problems like severe pain in the abdomen or dehydration, consult your doctor. If you are taking any over-the-counter medications, you should inform your doctor.

Preventing Hepatitis A

You can prevent Hepatitis A by maintaining good personal hygiene habits. A few of them are mentioned below:

• Wash your hands properly after you use the bathroom or after you change the diapers of your kid.
• Wash all the fruits and vegetables thoroughly before cooking.
• Avoid raw meats.
• Vaccinations are available for people at high risk of getting Hepatitis A.

The vaccination is advised for people living in communities with;

• High incidence of HAV infection
• children who are 1 year of age
• people who travel to countries having high incidence of HAV infection
• Men who have sex with other men
• People who inject drugs with needles
• People with chronic Liver infections and people who are given clotting factor concentrates

A vaccination called Twinrix is given to people who are 18 years and above for protection against the Hepatitis A virus and Hepatitis B virus. To prevent illness, a single dose of injection Immunoglobulin G (IG), is given within 14 days of HAV infection to prevent illness. This injection is also given if you feel you are going to get exposed to HAV infection.

If you are infected with HAV, you must talk to your sexual partner about it. It is advised that you abstain from sexual intercourse till you are completely cured.

Use of latex condoms and dental dams can prevent infection in oral anal sex.

Protecting your Liver from insult

Your Liver is an important Organ of the body. If it stops working, all the toxins would start accumulating in the body. Protect this precious Organ by adopting hygiene habits, and getting vaccinated against the viral infection. It’s never too late to get yourself vaccinated.

Silent but Lethal

Hepatitis B is a disease of the Liver caused by the Hepatitis B virus that can be transmitted from one person to another person through infected blood or body fluids. Ironical but true, that it is not the virus per se that causes Liver injury.

The immune response it triggers in your body by its presence causes inflammation and injury to the Liver while trying to eliminate the virus.

When you are first exposed to the virus your body may be able to eliminate the infection, and you can be cured of it. Successful persistence of the virus in your body for over 6 months can lead to Chronic Liver Disease. It may be a minimum of 4 months after exposure, before you experience any symptoms or until it is very severe.

There are also chances of you carrying the virus in your body without any symptoms for the rest of your life. Nevertheless, the risk of others getting infected from you remains the same.

Once infected, protective antibodies in your blood will guard the body against any further infection with the Hepatitis B virus.

Risk of Infection

You are at risk of getting the infection if you come in contact with an infected person’s blood, semen, or other body fluids. This happens when you have sex with an infected partner, get tattooed or pierced with unsterilized tools, get accidentally injured with infected needles, share drug needles with an infected person, or share razors/toothbrushes with a person having Hepatitis B.

You are also at high risk if you are medical/ paramedical personnel, need blood or blood-related product transfusions due to illness, or if any of your family members have Hepatitis B. Your unborn child is at risk if you are pregnant and carry the infection.

Symptoms

Many people affected with Hepatitis B do not know they are suffering from the infection. They may feel they have been suffering from the flu. A few symptoms of Hepatitis B are:

• Fatigue
• Mild fever
• Headache
• Belly pain
• Poor intake of food
• Dark-coloured urine
• Nausea
• Vomiting
• Yellowish eyes and skin

Time to Seek Medical Care

You may need to see your physician if you develop symptoms of jaundice such as yellowish eyes and skin, tiredness, upset stomach, fever, loss of appetite, Diarrhoea, light-coloured stools, dark-coloured urine, swollen stomach and ankles, and easy bruising.

While you may never experience the above symptoms despite the infection, you must get evaluated by your physician, if you are at risk or have a history of exposure.

If left untreated the Hepatitis B virus can lead to Cirrhosis of your Liver (normal Liver cells die and are replaced by scar tissue). The normal function of the Liver is affected as the damaged areas stop working. Eventually, it can lead to Liver Failure, Liver Cancer and death. It also increases your risk of infection with the Hepatitis D virus which can worsen your Liver Disease.

Diagnosis at the Clinic

Your doctor evaluates Hepatitis B infection by doing certain blood tests to assess your Liver function and levels of antibodies in your body present against the virus.

An ultrasound imaging of the abdomen to evaluate the health and function of your Liver may be done.

He may recommend a Liver Biopsy (removal of a tiny piece of Liver to be examined under the microscope) if there is suspicion of persistence of the infection in your body for over 6 months.

Cure for the condition

During the period of your acute symptoms of vomiting and Diarrhoea, you may require hospitalization for fluid replacement and to ensure adequate nutritional balance. Your physician will also recommend regular blood tests and physical checkups for the treatment of Hepatitis B and to monitor the progression of the disease after the acute episode.

Once you have the disease, there is no cure for the elimination of the virus from the body. A few lifestyle measures that can help prevent deterioration of the condition are abstinence from alcohol, and smoking, and intake of a well-balanced diet that is low in fat and includes lots of vegetables. Your physician may prescribe drugs that are either shots or oral medications to slow or stop the virus from damaging the Liver if you develop Chronic Hepatitis.

If chronic Hepatitis B causes Liver Failure then Liver Transplant (replacing failed Liver with a healthy one from a donor) may be the only option available. You may however need to take medicines after the surgery to prevent the infection from coming back.

If infection with Hepatitis B causes Liver Cancer then surgery and Chemotherapy may help in prolonging life; but the outcome is always fatal in all cases.

Protect yourself and others

You can avoid infection with Hepatitis B by getting immunized with the Hepatitis B vaccine. While the vaccine is safe for use in adults and children, you may also take it if you are pregnant. However, ensure that you take all the 3 shots for complete protection. The vaccine is also given as a routine immunization in all infants to prevent Hepatitis B.

Apart from this, paying attention to certain other measures can go a long way in preventing infection with Hepatitis B. Ensure that you use a condom during sex, do not share drug needles, do not borrow razors/ toothbrushes belonging to an infected person, use sterile tools to make tattoos or piercings, and wear gloves when you touch another person’s blood.

You may need to see your doctor immediately if you suspect that you have been exposed to the infection. Your doctor will administer a medicine called Hepatitis B immunoglobulin along with the first shot of the Hepatitis B vaccine that would help prevent you from falling sick.

Inform your sexual partner if you have been diagnosed with the condition. Your partner needs to get immunized with the Hepatitis B vaccine to protect against the disease.

The other precautions to be taken are to keep all your cuts covered, avoid sharing any sharp instruments and toothbrushes, and do not donate blood or blood products. If you are a carrier of the infection during pregnancy then your baby needs to be immunized within 12 hours of being born.

You can prevent HBV!!

Hepatitis B is a more infectious virus as compared to even the AIDS virus. Infection with the virus causes Liver Damage and has the potential to even lead to Liver Failure and Cancer later in life. A few points to prevent HBV are:

• Unsafe sex with multiple partners
• Intravenous drug abuse
• Using unsterilized needles for tattoos

Remember that it’s a silent disease and once infected the result is always fatal. While there is no cure for the disease the only positive thing about the condition is that it is highly preventable. Make the most of it and get yourself and your family immunized with the Hepatitis B vaccine. Timely diagnosis and early medical intervention can at least aid in slowing the progression of Liver Damage if not cure it completely.

Transmission

The HCV virus is transmitted through blood. The common modes of transmission for both sexes are:

• Sharing of needles
• Blood transfusions are unscreened
• Inadequate sterilization of medical equipment

In women, the exposure of blood may occur by manicurists, facialists, housekeeping, or nursing. Women infected with HCV may spread the infection to the sexual partner during the menstrual cycle.

You must know that Hepatitis C is not spread through milk, food, water or by causal physical contact.

Causes

Hepatitis C Virus is the cause of Hepatitis C infection. It is transmitted through blood-to-blood contact. The virus is RNA type. The virus stays in a dormant state until it enters the host cells, and is then replicated into billion viruses and circulates in the bloodstream.

Symptoms

The Hepatitis C symptoms in men and women slightly differ. The most commonly reported symptoms of the Hepatitis C Virus are:

• Fever
• Nausea
• Fatigue
• Jaundice
• Colored stools
• Abdominal pain
• Loss of appetite

The symptoms of HCV in women appear in the later stage. Though they occur in earlier stages, the symptoms are considered to be because of other conditions such as Anaemia, depression, or menopause. The Hepatitis C symptoms in women include abdominal pain, loss of appetite, fatigue, and joint pain.

Complications

As Hepatitis C is asymptomatic, signs can be observed when Liver Damage occurs. Liver Cirrhosis is a complication of Hepatitis C. Replacement of healthy Liver tissue with hard scar tissue is seen in the case of Liver Cirrhosis. If it is left untreated, you may develop Liver Failure. Chronic Liver Failure may cause end-stage renal disease that requires Liver Transplantation. In a few cases, Liver Cirrhosis may also develop into Liver Cancer.

Diagnosis

Generally, HCV infection is diagnosed in two steps:

Serological testing: Screening for anti-HCV antibodies helps your doctor to identify the infection.

Nucleic acid test: If the test is positive for anti-HCV antibodies, then your doctor orders a nucleic acid test to confirm chronic infection.

If you are diagnosed with a chronic Hepatitis C infection, then your doctor would assess to confirm the stage of Liver Damage. This needs a Liver Biopsy or some non-invasive tests. Also, your doctor would order the laboratory test to identify the genotype of the Hepatitis C strain to provide accurate treatment.

Early testing

Early screening of HCV can prevent the infection and transmission as well. World Health Organization (WHO) recommends screening for high-risk population groups that include:

• People who inject drugs
• People who administer intranasal drugs
• People who have sex with HCV affected partner
• Children who are born to the HCV-infected mothers
• People with immune suppressive diseases such as HIV or AIDS

Treatment

The main goal of the treatment is to cure the infection and avoid damage to the Liver. The cure rates depend on the strain that causes the infection and the treatment regimen.

Earlier Hepatitis C was treated with interferons and ribavirin which was injected weekly for up to 48 weeks. Though the success rate of the treatment was good, there were life-threatening adverse reactions seen with the treatment.

Recently, new advances in medicine have developed antiviral drugs that are more effective, safer and well-tolerated. The drugs are economical, and the duration of the treatment is up to 12 weeks.

Prevention

No vaccine can prevent Hepatitis C infection. So, the prevention of HCV infection focuses on reducing the risk of exposure to the virus. The following are the interventions that help reduce the risk of Hepatitis C infection:

• Promotion of correct use of condoms
• Regular screening for Hepatitis infections
• Maintaining hand hygiene, by regular washing
• Testing the donor’s blood before transfusion
• Training of the health personnel in treating HCV-infected patient
• Regular monitoring for early diagnosis of Liver-related complications
• Immunizing with Hepatitis A and B viruses to avoid coinfection and Liver Damage

There are several types of Liver Diseases which are discussed below.

• Cirrhosis – Fibrosis of the Liver cells or scarring of the Liver due to viruses, alcohol overconsumption, or Liver Toxicity; this condition can lead to Chronic Liver Failure.
• Hepatitis – inflammation of the Liver due to viruses or other toxins.
• Alcoholic Liver Disease – occurs due to excessive consumption of alcohol.
• Fatty Liver Disease – occurs due to the accumulation of fat in the Liver cells.
• Primary Liver Cancer – malignancies of the Liver such as hepatocellular carcinoma and cholangiocarcinoma.
• Hereditary diseases – for example, hemochromatosis and Wilson’s disease.

If the Liver Disease is left untreated, it leads to chronic Liver Failure or End-stage Liver Disease which is life-threatening.

Symptoms

Symptoms of Liver Disease include:

• Jaundice (yellowish eyes and skin)
• Swelling of the legs
• Abdominal pain and swelling
• Fatigue
• Nausea and vomiting
• Dark urine and tarry stools
• Loss of appetite

Causes and risk factors

Liver Diseases can occur due to various causes:

Infections: Infections due to parasites or viruses. Common viruses that cause Liver Disease are Hepatitis A, Hepatitis B, and Hepatitis C.

Alcohol: Excessive alcohol consumption leads to Liver Damage leading to diseases such as Fatty Liver Disease, Alcoholic Hepatitis, and Cirrhosis. If the Liver Disease occurs due to other causes, alcohol can enhance the progression of the disease.

Other causes of Liver Diseases are genetics, immunity, and Cancers. Exposure to chemicals and toxins, body piercings, obesity, malnutrition, sharing needles, and Diabetes are the risk factors for Liver Disease.

Diagnosis

Your doctor performs a thorough review of your medical history and physical examination. Your doctor may also recommend tests such as:

Blood tests: Liver function tests are performed to diagnose Liver Disease. Other blood tests are also recommended specific to the type of Liver Disease.

Imaging tests: Computer tomography (CT) scan, magnetic resonance imaging (MRI) scan or ultrasound abdomen is performed to identify the type of Liver Disease.

Biopsy: A Liver tissue sample is removed for microscopical examination to confirm the diagnosis.

Treatment

Treatment of Liver Disease is based on the type of Liver Damage or the underlying cause.

The most important management of Liver Disease includes abstinence from alcohol. Your doctor may also recommend you undergo an alcohol rehabilitation program or counselling depending on the severity of your alcohol addiction.

Antibiotics are given if the Liver Damage occurs due to infections.

If there is an extensive Liver Damage or end-stage Liver Disease, your doctor may also recommend Liver Transplantation. This process involves the replacement of the Diseased Liver with a healthy Liver. In most of the cases, Liver Transplantation was successful.

Self-management

Following some measures helps to prevent Liver Diseases:

• Limiting alcohol intake
• Getting vaccinated
• Not sharing syringes or needles
• Avoiding unprotected sex
• Avoiding contact with other’s blood and body fluids
• Maintaining a healthy weight
• Performing regular physical activity

Causes

The cause of Liver Hemangioma is still unclear. The Liver Hemangioma may occur as a single abnormal collection of the blood vessels, or it can be multiple. Researchers believe that Hemangiomas are congenital. The Liver Hemangioma usually measures less than four centimeters in diameter and in some cases, it can be even larger. Larger Tumours may cause certain symptoms such as abdominal discomfort and nausea. In most cases, Liver Hemangioma does not grow and does not cause any symptoms.

Symptoms

Rarely, a Liver Hemangioma may cause signs and symptoms that include:

• Pain in the upper right quadrant of the abdomen
• Lack of appetite
• Nausea
• Vomiting

Risk factors

The risk of Liver Hemangioma may be increased if you:

• Have a family history of Liver Hemangioma
• Are aged between 30 and 50
• Are women

In women, the formation of Hemangioma is associated with estrogen levels. The women who are undergoing hormone replacement therapy are at high risk of developing Liver Hemangioma.

Complications

Liver Hemangiomas cause complications very rarely. If trauma or an injury triggers the growth of the Hemangioma it may lead to the following complications.

• Liver Damage
• Bleeding
• Severe pain

Sometimes, the risk of complications may be high in pregnant women diagnosed with Liver Hemangioma. The estrogen hormone that is released during pregnancy may aggravate the Hemangioma.

Diagnosis

Because Liver Hemangioma doesn’t cause any symptoms, it may go unnoticed. The Liver Hemangioma may be diagnosed incidentally while performing the tests for another medical condition. It can be identified with imaging tests such as ultrasound, computed tomography scan, or magnetic resonance imaging. These imaging tests provide a detailed view of your inner Organs and help to identify the abnormalities.

Treatment

In most of the cases, Liver Hemangiomas may not require any treatment. But, it requires continuous monitoring. However, if the Hemangioma is causing symptoms such as pain and vomiting, then you may require medical care. The treatment of Liver Hemangioma depends on the number, size, and location of the Tumour. Your doctor might recommend any of the following treatments.

• Surgical removal: Your doctor suggests surgery if the Hemangioma can be removed easily from the Liver. If the Hemangioma covers a large portion of your Liver, then a portion of your Liver is surgically removed.
• Stopping the blood flow to the Hemangioma: Your doctor might suggest certain medical procedures that involve obstructing the blood flow to the Hemangioma. The procedures involve tying the main artery that supplies blood to the Liver or injecting a medication that obstructs the artery.
• Liver Transplantation: If the Hemangiomas can’t be treated with other surgical procedures, your doctor might suggest Liver Transplantation.
• Radiation Therapy: In rare cases, your doctor recommends radiation therapy which uses high-energy beams to destroy the Hemangioma.

Causes

NAFLD results when the Liver is unable to break down fats and results in accumulation of the fat. What causes this is still unknown. Though NAFLD and NASH are very common among Americans, the underlying cause is still unclear. It is observed that NASH and NAFLD are more common in people who are obese.

Many patients with NASH and NAFLD are found to have an elevated level of cholesterol and triglycerides; and high blood glucose. This doesn’t mean that every obese person with or without Diabetes will have NASH or NAFLD or neither it mean that every person having NAFLD should be obese or diabetic.

The most probable causes of NAFLD are mentioned below:

• Insulin resistance (the body does not respond to insulin hormone and therefore results in increased glucose level)
• Release of cytokines (toxic inflammatory proteins) by fat cells
• Oxidative stress (imbalance between the pro-oxidant and anti-oxidant that results in deterioration of the Liver cell) inside the Liver
• In some it is hereditary
• Death of Liver cells
• A number of drugs prescribed for other medical conditions result in Fatty Liver
• Very rarely pregnancy results in acute Fatty Liver Disease (AFLD)

Symptoms

Many patients with NAFLD do not show any symptoms until the fat deposition is sufficient to damage the Liver. Here are a few Non-alcoholic Fatty Liver Disease symptoms:

• Tiredness or fatigue
• Pain on the right side due to Liver Enlargement
• Yellowing of eye and skin (Jaundice)
• Lower abdomen may be swollen due to accumulation of fluids
• Weight loss may be noted in some patients
• Bloody vomit
• Blood in stool causes it to become dark black or tarry
• Tend to bruise easily

In the case of Liver Cirrhosis, a person may experience fluid retention, muscle wasting (decrease in size of skeletal muscle), intestinal bleeding, and finally Liver Failure.

Diagnosis

Some tests and procedures may be performed to diagnose NAFLD.

A blood sample is taken to perform a Liver function test, to check the Liver enzymes present in blood.

Along with this, blood glucose levels and blood cholesterol and triglyceride levels are also checked.

Imaging tests like ultrasound, magnetic resonance imaging, and computer tomography are used to check the structure and function of the Liver. These imaging tests can diagnose NAFLD but do not give any clue about the severity of the disease.

A Liver Biopsy may be required for confirmation of diagnosis.

A small sample of Liver tissue is removed and checked for signs of scarring and inflammation. This test is done only if severe Liver Damage is suspected.

Treatment

Presently, there is no specific treatment for patients with NAFLD. But doctors may advise the patients to reduce weight, if obese; eat a healthy balanced diet; and avoid alcohol and unnecessary medications.

Gradual weight loss usually improves Liver tests and reverses the disease to some extent and sudden weight loss usually worsens the condition.

People with NASH often have associated complications like Diabetes and high blood cholesterol levels; therefore medications to treat these underlying conditions are prescribed mostly.

If medicines are the cause for NAFLD then the physician might change the medicine and prescribe different medications. In case of severe Liver Cirrhosis or Liver Failure, the patient might require Liver Transplantation. These were a few Nonalcoholic Fatty Liver Disease treatments.

Prevention

Although NAFLD cannot be prevented completely, it is possible to reduce the risk by:

• Exercising regularly
• Eating a healthy diet
• Keeping weight under control
• Maintaining blood glucose level and blood cholesterol level

Another very important thing is to avoid taking unnecessary drugs, which might also result in fat deposition in the Liver. If diagnosed with non-serious NAFLD, then avoiding alcohol will prevent further serious complications.

Symptoms

Usually, mild Hepatitis does not produce any symptoms, but when present they include:

• Jaundice (yellowing of skin and eyes)
• Either brown or white-coloured stools
• Dark or tea-coloured urine
• Nausea and vomiting
• Loss of appetite
• Pain in the upper right quadrant of the abdomen
• Itching

Causes

The most important function of the Liver is to break down the nutrients, chemicals, and other foreign substances present in the blood. However, it becomes difficult for the Liver to process certain chemicals which can, in turn, become toxic and damage the Liver. This leads to the inflammation of the Liver.

Substances, that are associated with Toxic Hepatitis, are:

• Alcohol – consumption of alcohol on a regular basis for several years
• Herbs and supplements – cascara, comfrey, kava, chaparral, and ephedra
• OTC pain relievers – frequent administration of over-the-counter drugs such as acetaminophen, aspirin, ibuprofen, etc.
• Prescription drugs – certain antibiotics such as statins, anti-epileptic drugs, etc. when taken regularly

These medications damage the Liver when taken in higher than the recommended doses.

• Industrial chemicals – excessive exposure to carbon tetrachloride, vinyl chloride, paraquat (a herbicide) and polychlorinated biphenyls

Risk factors

The below factors can make you more prone to Toxic Hepatitis:

• Ageing - Elder people are at higher risk when exposed to a toxic substance
• Being female
• Having Hepatitis and other Liver Diseases
• Inheriting certain genetic mutations
• Working with certain industrial chemicals
• History of street drug or alcohol abuse

Complications

Hepatitis can lead to scarring and Liver Damage which can eventually lead to Cirrhosis. Thus, the Liver cannot function normally, and slowly Liver Failure can happen.

Diagnosis

Diagnosis mainly involves taking a thorough medical, medication, and occupational history. You will be asked related questions while collecting the information. A physical exam helps the doctor to know if the size of the Liver has enlarged or if there is any associated tenderness.

• Blood tests may be conducted to assess Liver functioning. They include measuring the AST, ALT, and serum bilirubin levels. Ethanol levels are checked in the case of an alcoholic abuser.
• Imaging studies are conducted to look at the state of the Liver.
• A Liver Biopsy helps to assess the Liver tissue directly under a microscope.

Treatment and Self-management

Usually, the inflammation resolves with the elimination of the toxic substance. But prolonged exposure to the toxin can lead to Liver Damage or even Liver Failure in some cases.

Toxic Hepatitis treatment involves:

• Eliminating exposure to toxic substances either by changing your job or taking necessary precautions is the first measure of treatment.
• Supportive conservative care includes a proper diet and measures to avoid and treat dehydration, bed rest, and prevention of malnourishment.
• If acetaminophen has caused the damage, then acetylcysteine is administered immediately as an antidote to prevent further damage to the Liver.
• A Liver Transplant may be indicated when all the other treatments have failed or if acute or chronic Liver Failure has occurred. It involves the replacement of the damaged Liver with a healthy Liver.

Prevention

It may not be possible always to prevent Toxic Hepatitis because it is difficult to predict how our body reacts to certain chemicals, medications, etc. But taking certain measures may help to cut down the risk factors

• Take the medications only as directed by the physician and if you are taking OTC make sure you don’t overuse it.
• You should take extreme care while taking herbs or supplements and make sure you discuss the use of such supplements with your doctor.
• Never mix alcohol and drugs as they may be highly dangerous
• Be alert and take special care if you are working in some chemical industry.