Liver – hepar, or hepato, in Greek – is the largest internal organ.
Located in the right upper abdomen, it weighs about one-and-a-half kg. It is a filter, a factory, a store-house, and a gland, all rolled into one.
Liver is the gateway for the blood draining the gastro-intestinal [gut] tract. It receives all that is absorbed in the gut, filtering and detoxifying many harmful substances. This is one reason why liver is vulnerable to many insults through food.
Liver is the “industrial unit” that produces various proteins including albumin and clotting factors. Liver also secretes bile, the juice that is needed to emulsify fats in the gut. Glycogen, vitamins and minerals are also stored in the liver.
Being an organ of such vital importance, liver has the extraordinary ability to recover from injuries and regenerate. Minor insults to the liver, therefore, may not even manifest clinically; however, by the time signs appear, the affected person usually has significant injury in the liver tissue.
Hepatitis is inflammation [swelling] of the liver. Many infectious agents, drugs, toxins and chemicals, metabolic abnormalities, auto-immune diseases etc., can cause hepatitis. The most common causes being viral infection, drugs and alcohol. Most cases of hepatitis manifest as acute illnesses and are self-limiting, with the liver healing on its own.
If the inflammatory process persists beyond six months, it is termed as chronic hepatitis. This may result in scarring of liver. This is called cirrhosis.
Viral infections are, by far, the most common causes of hepatitis [viral hepatitides], affecting any age group. It is more common in children and adolescents. More than 95 per cent of viral hepatitides are caused by the hepatitis group of viruses, named Hepatitis A, B, C, D and E [Hepatitis F and G have also been reported]. These viruses replicate within the liver cells and, in the process, cause injury and inflammation of the liver.
Hepatitis A and E are spread through contaminated food and water [faeco-oral route] and cause seasonal epidemics of hepatitis the world over, particularly in the poor and developing countries.
Hepatitis A is one of the oldest diseases known to mankind and also one of the most contagious. In areas with poor sanitation and overcrowding, it often strikes the young.
Hepatitis E was first reported from India. It is common in tropical countries.
Hepatitis A and E generally run a mild course and are self-limiting; rarely, however, Hepatitis E can cause fulminant [severe] hepatic, or liver, failure.
Hepatitis B and C are transmitted from blood to blood through transfusions, needle pricks, sexual contact, or vertically from the mother to the baby in the womb; the primary sources being unsterilised injection needles or surgical instruments and/or inadequately screened blood and blood products. It is estimated on a global scale about two billion people are infected with Hepatitis B virus [with more than 350 million having chronic infection] and 150-200 million people infected with Hepatitis C. In about 5-30 per cent of patients, Hepatitis B and C cause chronic infection and some of these develop sequelae [condition/s resulting from a prior disease, injury, or attack], like cirrhosis of liver and liver cell cancer. About one per cent of patients with Hepatitis B may develop fulminant liver failure.
Viral hepatititides manifests initially with lack of appetite, altered taste, nausea, vomiting, upper abdominal discomfort and a mild degree fever. After about a week, the patient may notice yellowish or dark-coloured urine, followed by yellowish discoloration of eyes and skin [jaundice]. By this time, fever and other symptoms usually subside. Jaundice may persist for 1-2 months in Hepatitis A and E, and for 3-4 months, or longer, in Hepatitis B and C. Many patients suffer from generalised itching during this phase.
Liver function tests [LFT] in these patients show increased levels of bilirubin and liver enzymes. Specific viral infections can be identified with serological tests [laboratory test done on blood serum].
The presence of jaundice raises concern in many. It is common to find people seeking alternative medicines for treating jaundice. It must be emphasised that jaundice is only a sign of raised blood levels of the yellow pigment bilirubin. It can have several causes and should, therefore, be evaluated. For example, in areas where malaria is rampant, a blood test for malarial parasites is a must in all cases of jaundice.
No specific treatment is needed for most cases of acute viral hepatitis. Normal diet is allowed and bed rest is unnecessary. As progression to chronic hepatitis is the rule in Hepatitis C, antiviral therapy with interferon alpha may be beneficial.
Vaccines are now available for the prevention of Hepatitis A and B. Vaccination against Hepatitis B is now a part of Universal Programme of Immunisation for the Newborn in many countries, including India. It is also recommended for people at high risk of contracting Hepatitis B, such as healthcare personnel, recipients of frequent transfusions and dialysis as well as sexual and/or close contacts with chronic carriers of Hepatitis B.
The role of sanitation and personal hygiene in the prevention of water-borne infections need not be over-emphasised. Adequate toilet facilities, use of clean drinking water and frequent washing of hands are simple, yet important measures in the prevention of epidemics of Hepatitis A and E. Universal precautions for prevention of blood-borne infections like the use of disposables and gloves as well as mandatory screening of blood and blood products for Hepatitis B and C are a must.
Drugs and toxins
Many medications/drugs and toxins can cause injury to liver cells resulting in acute hepatitis. Withdrawal of the offending agent leads to recovery. Alcohol can cause liver cell injury, acute and chronic. A binge of alcohol can lead to acute hepatitis, in some. It manifests as upper abdominal pain, nausea, vomiting, and jaundice.
Non-alcoholic steatohepatitis [NASH] is being increasingly recognised as an important cause of liver disease that may eventually lead to cirrhosis. It is characterised by the presence of fat droplets and inflammatory cells in the liver. It occurs as a part of metabolic problems seen in cases of insulin resistance, obesity, and diabetes.
A related but milder condition called fatty liver may be seen in as many as 80 per cent of patients with obesity. NASH and fatty liver are usually identified by imaging studies like ultra-sound scanning or CT scans. A liver biopsy is confirmatory. Dietary restrictions and loss of weight with subsequent improvement in the metabolic parameters can lead to resolution of these abnormalities.
The silver-lining is most causes of liver cell injury are preventable and self-limiting. Given the enormous capacity of the liver to regenerate, most cases of acute hepatitis heal on their own, without any complications. If we are a bit more careful with our food and lifestyle, we can prevent most of the problems that affect the liver, our largest internal organ.
- Ensure adequate supply of clean drinking water; use only boiled/filtered water for drinking
- Food should be prepared and served clean. It should be stored in closed containers
- Hand-washing is the most important hygienic measure in preventing water-borne diseases. Hands should be washed after using the toilets, or handling unclean materials, and before and after eating
- Provision of hygienic toilet facilities and their proper use is the most effective measure in preventing disease
- Water supply and sanitation systems should be maintained properly.