 1. Liver disease
What are the usual symptoms of liver disease?
2. Hepatitis
What are the types of viral hepatitis and how
do they spread?
What is the cause of viral hepatitis?
What are the late complications of chronic
hepatitis?
3. Liver cirrhosis
What are the complications of cirrhosis?
What is the treatment of cirrhosis?
What are the signs of worsening (decompensation)
in a cirrhotic patient?
What is the treatment of decompensated cirrhosis?
4. Hepatocellular
carcinoma
What are the types of liver cancer?
What are the symptoms of liver cancer?
5. Liver transplant
What is liver transplantation?
6. Donor
How do I qualify to be a living donor?
Does the donor need to be related to the recipient?
What happens during the donor surgery?
How long does the donor remain hospitalized?
How long does it take for the donor's liver to fully recover?
How often are the follow-up assessments for the donor?
How long does a pre-transplant evaluation take?
What
are the usual symptoms of liver disease?
Usual symptoms of liver disease are jaundice (yellow discoloration
of the eyes), dark coloured urine, itching, vomiting of
blood, ascites (accumulation of fluid in the abdomen), easy
bruisability or tendency to bleed, and mental confusion.
Many people with liver disease have non-specific symptoms
only (loss of desire to eat, nausea, weight loss, lethargy,
and general feeling of not being well). TOP
What
are the types of viral hepatitis and how do they spread?
Types of viral hepatitis are Hepatitis A, B, C, D &
E. Of these, Hepatitis D can occur only in conjunction with
Hepatitis B.
Hepatitis A and E spread through the feco-oral route i.e
by contaminated water and uncooked fruits & vegetables.
Hepatitis B and C spread through contact with body fluids
i.e by blood transfusion, unprotected sexual contact, use
of shared/contaminated needles/razors etc, and transmission
from an infected mother to her baby (during pregnancy/childbirth/breast-feeding). TOP
What
is the cause of viral hepatitis?
Hepatitis A and E are generally self-limiting. After the
resolution of an acute infection, they rarely go on to chronic
hepatitis or carrier state. Occasionally, however, they
may lead to fulminant hepatitis.
After the resolution of acute hepatitis B or C, some of
the patients may become carriers or may have chronic hepatitis.
It is this group of patients who may develop complications,
e.g. liver cirrhosis or liver cancer. TOP
What
are the late complications of chronic hepatitis?
Chronic hepatitis leads to an ongoing damage to the liver
cells and as a response; there is regeneration and scarring
of the damaged tissue. This may result in cirrhosis with
its attendant problems of liver failure, and/or liver cancer. TOP
What
are the complications of cirrhosis?
Cirrhosis of liver may lead to portal hypertension (increased
pressure of the blood in portal circulation). This may result
in vomiting of blood, black coloured stools, accumulation
of fluid in the abdomen (ascites). There may be an alteration
in levels of consciousness with tremors, forgetfulness (hepatic
encephalopathy) because of the toxins which are not being
cleared by the liver. As the liver is unable to synthesize
proteins necessary for clotting, there may be increased
bleeding tendency. In addition, liver cancer can develop
on the background of cirrhosis. TOP
What
is the treatment of cirrhosis?
Treatment of cirrhosis generally depends on the clinical
manifestation and underlying liver function. The patient
may require endoscopic banding/sclerotherapy of the esophageal
varices if he has had vomiting of blood or black stools.
He/she may need diuretics (medicines to increase urine output)
for fluid collection in abdomen and swelling of feet. If
the patient also has active viral hepatitis, he/she may
require specific treatment (antiviral medication for hepatitis
B, interferons for hepatitis C). Other than these, for a
patient with well compensated cirrhosis, the treatment is
supportive. Unfortunately, there is no effective medicine
to reverse the process of cirrhosis. TOP
What are the signs
of worsening (decompensation) in a cirrhotic patient?
The common signs of worsening or decompensation in a cirrhotic
patient are increasing fluid accumulation in the abdomen
(ascites) which is unresponsive to treatment, and signs
of hepatic encephalopathy (altered consciousness, tremors,
forgetfulness, etc). Blood tests may reveal low levels of
albumin, high levels of bilirubin & ammonia and elevated
prothrombin time (reflecting decreased coagulability of
blood). An episode of upper GI bleed can precipitate decompensation. TOP
What is the treatment
of decompensated cirrhosis?
The ideal treatment of decompensated cirrhosis is liver
transplantation. Other forms of treatment like liver dialysis
may serve as temporary supportive measures and as a bridge
to transplantation. TOP
What are the types
of liver cancer?
Liver cancer can be either primary or secondary (spread
from cancer elsewhere in the body, eg. colonic cancer).
Secondary liver tumors are generally diagnosed concurrently
or on follow-up after treatment of the previous cancer elsewhere.
Primary liver tumors can be related to hepatitis B or C,
can develop on the background of cirrhosis from other causes,
or can be idiopathic (unknown cause). TOP
What are the symptoms
of liver cancer?
Patients with liver cancer may present with pain or a lump
in right upper abdomen. They may have non-specific complaints
like weakness, inability to eat, loss of weight etc. In
addition, they may have symptoms attributable to the pre-existing
hepatitis or cirrhosis. TOP
What
is the treatment for liver cancer?
The most effective treatment of liver cancer is surgical
resection. However, there would be a large group of patients
who have cancer which cannot be resected because of either
tumor spread or poor underlying liver function. The alternative
forms of treatment for such cancers are TACE (trans-arterial
chemoembolization), local ablation techniques like RFA (radio-frequency
ablation) and PEI (percutaneous ethanol injection), and
systemic chemotherapy. The patients in whom resection is
not possible due to poor liver function can be candidates
for liver transplantation but careful assessment is required. TOP
What is liver transplantation?
Liver transplantation is a surgery in which the diseased
liver is completely removed and replaced with a normal liver
or a part of liver from the donor. The donor liver can be
from a deceased person (cadaveric donor) or from a living
person. TOP
How
do I qualify to be a living donor?
You should be between 21-50 years of age and free from any
significant medical or psychiatric problems. You cannot
be pregnant or overweight. Preferably a body mass index
of 30 or less is required. If you smoke, you are advised
to stop prior to surgery. If you have any major medical
problems, you will be ineligible to be donor. In addition,
your blood type needs to be compatible with the recipient's
blood group. You must be either the same blood type as your
recipient or blood type 'O'. You must be competent and freely
willing to donate. TOP
Does
the donor need to be related to the recipient?
The donor should be either related or emotionally-related
to the recipient. TOP
What
happens during donor surgery?
The donor undergoes removal of a part of his / her liver;
right lobe if the recipient is an adult and a part of left
lobe if the recipient in an infant or child. This part of
liver is removed along with its attached blood vessels and
bile duct. The donor is operated under general anaesthesia.
A drain placed in the abdomen at the end of the surgery
and will be removed once drainage is minimal post operatively.
The remaining liver of the donor is sufficient for his functions
and it regenerates within 2 to 4 weeks to almost the normal
size. All effort is made to make the donor surgery as safe
as possible. The blood loss in this procedure is usually
minimal and the donor generally does not require any blood
transfusion. TOP
How
long does a donor remain hospitalized?
Generally, the donor stays in the hospital for a total of
7 days. After surgery, the donor spends the first two nights
in the ICU to be closely monitored and normally transferred
to the general ward the following day. Donors are encouraged
to get out of bed and sit up in the chair on the following
day after surgery and walk short distances as soon as they
are able. TOP
How long does it take for the donor's
liver to fully recover?
Recovery time varies from each individual. Typically, donors
spend 2-4
weeks to recuperate after surgery. Most of the time, the
donor is able to
return to work 4-6 weeks post-surgery. They are however,
advised not to
lift heavy objects or do strenuous exercise for at least
6 months. TOP
How
often are the follow-up assessments for the donor?
After discharge, the donor is advised to be monitored weekly
for 2 weeks,
then once in 3 months, 6 months and a year, depending on
the
individual's condition. TOP
How
long does a Pre-Transplant Donor Evaluation take?
It takes typically 5-6 working days. TOP |
