Love your liver

07 January 2014

The liver is one of the most truly remarkable organs in your body, which we invariably take for granted. It is the largest organ in the body, about the size of a rugby ball, and weighs approximately 1.5kg. It performs many critical functions such as; aiding digestion, removing toxins from the blood and producing essential sugars, fats, protein, vitamins and minerals.

With January being ‘Love Your Liver’ awareness month, and approximately 2 million people in the UK being affected by over 100 different types of liver disease, Consultant Hepatologist and Gastroenterologist Professor Aftab Ala answers some common concerns about liver disease.

What causes liver disease?

There are many causes of liver disease, but over consumption of alcohol is by far the most common. Other causes include viruses such as Hepatitis B and C, diabetes, being overweight, genetic or developed autoimmune conditions and a reaction to medicine leading to liver failure. Cancer is both a cause and consequence of liver disease. Finding the cause is important as allocating the right treatment can stop the disease progressing.

What are the symptoms of liver disease?

Liver disease is sometimes referred as the ‘silent killer’ as often only vague symptoms are present until the liver damage is quite severe. Early symptoms include tiredness, poor appetite, weight loss, tender abdomen, itchiness and vomiting. Commonly, liver disease is detected during unrelated medical tests or check-ups. Symptoms of severe liver disease include; jaundice, bleeding problems, confusion, fever, swollen abdomen and legs, tarry black stools or vomiting blood.

How does drinking alcohol affect your chance of liver disease?

It varies from person to person, but as alcohol puts a burden on the liver, staying within safe guidelines and giving your liver at least two consecutive days alcohol-free each week reduces your risk of liver problems. If you are overweight, using medicines or have viral hepatitis, your liver can be more vulnerable to alcohol. If you have liver disease, regardless of the cause, alcohol can make the problem more serious and speed up the damage.

I have liver disease, what can I do to keep myself well?

1 in 10 people get fatty liver disease due to an unhealthy weight, poor diet, diabetes, high cholesterol or heart disease. When the liver cells fail to break down, transfer and store fat effectively is causes abnormal liver function and inflammation, leading to scarring known as cirrhosis.

There are many things you can do to look after yourself. No specific foods are of benefit, but a diet well balanced with protein, carbohydrate and plenty of fresh vegetables. Patients with fatty liver disease may need advice for a special diet to follow. Also, gentle exercise, without getting over-tired is beneficial. If you have diabetes or heart disease, consume only small amounts of unsaturated fat to keep cholesterol levels under control. Alcohol and smoking should be avoided as they place increased burden on your liver and accelerate some conditions. It is also essential to check that any prescription or over-the-counter medicines are safe to take with liver disease.

What treatments are there for liver disease?

Treatment is dependent on the type of liver disease, its cause and how much damage has been done. Lifestyle measures, surgery and transplants are all treatments for varying degrees of liver disease. Advanced liver disease treatments aim to reduce the impact of the symptoms including; water tablets for portal hypertension, lactulose for confusion and regular drains for fluid accumulation around the abdomen.

Why is it important to look after your liver and spot the signs early?

Your body can replace old liver cells, called hepatocytes, with new ones. This means that your liver can recover from minor stresses and strains. However, overtime damage can cause fibrous scar tissue. This changes the structure of the liver and cannot be repaired. If you catch liver disease caused by alcohol in the early stages, stopping drinking alcohol can lead you to get better, however once the liver becomes scarred giving up drinking won’t be enough to reverse the problem.

Many people with liver disease will feel quite well, and even severe symptoms may occur only in episodes that people recover from. However, the side-effects of treatment and symptoms of the illness can lead people to feel uncomfortable, in pain, depressed and anxious. It is important to spot liver problems before the damage builds up and becomes irreversible.

Should I see a specialist about my liver disease? 

Many people with liver disease benefit from a specialist organising an assessment for ongoing treatment. It is recommended you speak to your GP to request a referral to a hepatologist specialist, or a gastroenterologist if a hepatologist is not available.

The facts about Hepatitis B and C

Hepatitis B and C are blood borne viruses which can cause severe liver damage. The viruses can lead to an acute or chronic illness. An acute illness although severe will only last a short amount of time, most people recover from the illness within a few weeks with no lasting effects. A chronic illness is one that lasts a long time, often a lifetime.

The chronic hepatitis virus reproduces in the liver, damaging and destroying the liver cells and replaces them with scar tissue, known as fibrosis. Severe fibrosis causes the liver to harden which prevents it from functioning normally. In a small number of cases, severe damage to the liver leads to cancer and liver failure.  

How can you get Hepatitis B and C?

People can get hepatitis by a tiny amount of infected blood entering your bloodstream, for example through an open wound or a scratch. Some of the main routes of transmission are mother to baby (during birth), sharing needles and equipment when taking drugs, tattoos and piercings, unsafe sex and from medical treatment in a country with poor hygiene standards. To protect yourself; don’t share personal equipment, use a condom and cover all cuts and wounds.

What treatments are available for Hepatitis B and C?

There are a number of important medicines to treat both diseases, many of which are quite new. They generally need to be taken over a period of several months. For hepatitis C, they may help you clear the infection. For hepatitis B, they can stop or delay the progression of the disease. The treatments have side-effects, so wherever possible, preventing infection is the priority.

Professor Ala qualified as a Consultant in Hepatology and Gastroenterology in 1992 from Charing Cross and Westminster Medical, following medical posts and fellowships both in London and New York. He is the National Institute for Health and Research Regional Lead for Hepatology in Surrey and Sussex and has ongoing collaborative links with liver centers in the UK, Europe and USA to continually develop his clinical and research portfolio. Professor Ala is based locally at Frimley Park Hospital for his NHS Consultant post and practices privately at Spire Clare Park Hospital, Farnham.

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