As long as it is not 70 per cent
BENGALURU: Venkat was surprised when the doctor gave him the diagnosis. A teetotaler, he had not touched alcohol even in his engineering college days when some of his friends used to drink regularly and ask him to join in. He had resisted the temptation then and never had a reason to drink even later in life. So it came as a surprise when the doctor told him he was suffering from cirrhosis of the liver.
Many people are under the misconception that cirrhosis of the liver occurs only if one drinks alcohol. But alcohol is only one of the causes of cirrhosis of the liver.
The changing pace of life and diet in recent years has had a major impact with increase in lifestyle related conditions like diabetes, obesity and high amounts of fats in the blood or hyperlipidaemia. These conditions result in fat deposition in the liver tissues which results in a condition called Non-Alcoholic Fatty Liver Disease (NAFLD).
Long-term effects of NAFLD
NAFLD is commonly found in people today and in itself does not cause problems. But in a small percentage, this can develop inflammation and may lead to cirrhosis.
Cirrhosis is also called a “silent killer”. Silent because the liver function does not get affected till around 70 per cent of the liver is affected. This period is called the ‘asymptomatic window’. During this, the progress of cirrhosis is slow and the patient does not show any symptoms. Complications of cirrhosis of the liver develop slowly in the background.
Portal hypertension develops slowly with gradual increase in the blood pressure in the portal vein, which carries the blood from the bowel and spleen to the liver.
The pressure in the portal vein rises due to the resistance in the fibrosed liver tissue that occurs due to cirrhosis. This leads to a rise in pressure in the portal vein, which in turn causes blood vessels in the bottom part of the esophagus or food-pipe to open up and dilate.
If any of these dilated blood vessels burst, then the patient can present with vomiting of blood.
Another complication which can occur is the disruption in the synthesis of proteins in the liver.
This affects the fluid balance and can lead to swelling in the tissues or edema especially noticeable in the extremities.
Factors needed for the blood to clot are also produced in the liver. Cirrhosis can lead to a deficiency of clotting factors leading to symptoms like bleeding gums.
The liver is also the site for detoxification of waste products. Cirrhosis interferes with this process leading to complications such as problems with memory and in severe cases hepatic encephalopathy.
Patients need to realise that in the case of a liver with cirrhosis, regeneration of the liver cannot take place. Cirrhosis is not reversible. Cirrhosis affects the entire liver diffusely and results in the liver becoming hard and fibrosed developing nodules.
Cirrhosis can also result from other causes like viral diseases like Hepatitis B and Hepatitis C, auto immune conditions and when the body has problems with the metabolism (breaking down chemically) of iron.
Over time, NAFLD can lead to Non Alcoholic Steatohepatitis (NASH) where there is inflammation and damage in addition to the fat in the liver. This may develop into Chronic Liver Disease.
Treatment of NAFLD
The aim of treatment in NAFLD is two-fold.
First is to delay the complications and secondly to prevent further damage. It is essential to emphasize to the patient that not all fatty livers will lead to cirrhosis. The most important factor is ‘Lifestyle Modification’, mainly maintaining a healthy weight, regular exercise, healthy diet and avoiding cigarettes and alcohol.
Regular check-ups with ultra-sonography and liver function tests are important to track the condition of the liver and progress of the fatty liver and cirrhosis.
The author is and MBBS,
M D, DM (Hepatology) and a consultant of Hepatology and Liver Transplantation at Aster CMI Hospital