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Liver Health:
Prevention, Surgery, and Treatment

The liver is one of the most crucial organs related to the blood purification and digestive system of the body. It is a large organ that weighs close to 1200 to 1400 g in the adult woman and 1400 to 1500 g in the adult man. It is a delicate organ that is protected by the rib cage.

The liver and the intestines work together to digest all the food that comes into the body. It serves the function of filtering out the blood coming from the digestive tract and detoxifying it. It is responsible for metabolizing the food that enters your body. It also secretes the bile that is essential for your intestines as well as proteins that are important for blood clotting.

If you suffer from any kind of liver disease for a prolonged period of time, it may lead to liver failure. Liver failure is when the liver (or a major portion of it) is damaged beyond repair. This starts affecting the liver function and is a condition that requires urgent medical care. In this guide you’ll understand the warning signs, symptoms and risk factors of liver failure and learn how to act proactively to prevent or treat it.

Types of liver failure:

Acute Liver Failure
When your liver function is affected within a matter of a few weeks or days it is called as acute liver failure. Patients who suffer from acute liver failure may not have exhibited any signs of liver disease in the past. The failure is abrupt and not progressive.

Chronic Liver Failure
This type of liver failure builds up gradually with time and it causes the liver to stop functioning eventually. In these cases the symptoms of liver disease are apparent and go from bad to worse without timely intervention.

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1.Symptoms of Liver Disease and Liver Failure

The symptoms of liver failure are quite familiar with that of any liver disease and so it becomes difficult to diagnose liver failure in the earlier stage. Few of the symptoms are as follows:

  • Nausea
  • Loss of appetite
  • Fatigue
  • Diarrhea

And as the damage to the liver progressively increases, the symptoms become serious and they need immediate medical intervention.

  • Jaundice
  • Constant fatigue or sleepiness
  • Profuse bleeding in case of cuts or bruises
  • Swollen belly
  • Hepatic encephalopathy (mental confusion)

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2.Possible causes and risk factors that lead to liver failure

The causes of liver failure can be divided into two types in accordance with the failure type.

Acute liver failure causes

  • Large doses of acetaminophen can damage your liver rapidly and cause liver failure.
  • Hepatitis A, B, and E, Epstein-Barr virus, herpes simplex virus can cause liver damage or cirrhosis.
  • Consumption of certain poisonous mushrooms such as Amanita phalloides can damage liver cells as they contain certain toxins which eventually lead to liver failure.
  • In cases such as Autoimmune hepatitis, your body attacks your own liver and cause acute liver failure.
  • Genetic diseases like Wilson’s disease which affect the removal of copper from your body may lead to liver damage.
  • Excess fats accumulated in the liver during pregnancy may cause liver damage.
  • An overwhelming infection like septic shock damages and stops the liver from functioning.
  • Budd Chiari syndrome which causes the blood vessels in the liver to develop blockages may lead to acute liver failure.
  • Toxins like carbon tetrachloride, degreaser, cleaner have been found to cause liver damage.

Chronic Liver Failure Causes

  • The liver swells up in Hepatitis B and prevents it from functioning the way it should.
  • Long-term Hepatitis C causes liver cirrhosis.
  • Excessive alcohol consumption over a long period of time leads to cirrhosis.
  • The inherited disorder Hemochromatosis makes your body to accumulate iron in great quantity which causes liver failure.

Other conditions causing Liver Failure

Primary sclerosing cholangitis

  • The bile ducts are damaged
  • Mostly observed in young men

Oxalosis

  • Kidney is unable to remove the calcium oxalate from your body through urination, this may lead to liver damage.

Liver adenoma

  • When there are benign liver tumors
  • Mostly affects women from 20 to 44

Alcoholic Hepatitis

  • Liver inflammation from a long period of time

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3.Disease and conditions that cause liver failure

Alpha-1 antitrypsin deficiency

  • A genetic disorder causing liver or lung disease.

Liver cancer

  • People suffering from chronic Hepatitis B or C from a long period of time may develop liver cancer.

Alagille syndrome

  • Genetic disease where people suffer due to a fewer number of bile ducts than normal in the liver. This leads bile build up that causes scarring and damage.

Primary Biliary Cholangitis (PBC)

  • Destroys smaller bile ducts
  • Also known as Primary biliary cirrhosis

Galactosemia

  • Galactose digestion problem which eventually damages the liver.

Lysosomal acid lipase deficiency (LAL-D)

  • The body becomes incapable of producing enzyme-like lysosomal acid lipase which helps in breaking down cholesterol and fats.
  • The fats remain in the body causing damage to the liver.

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4.Liver disease: Understanding Stages and Progression

Liver disease stages

Inflammation (Stage 1)

This is the first stage of any liver disease. In this stage, the liver gets inflamed, tender and enlarged. The inflammation happens when the body is fighting off an injury or infection. But if the inflammation is prolonged, it may damage your liver permanently. In this, the person suffering from liver disease will not be able to feel the inflammation. And so it’s quite difficult to identify the disease at this stage. If the disease is diagnosed at this early stage, the doctor can successfully treat the person with medications and minimal lifestyle changes.

Fibrosis (Stage 2)

If the inflamed liver is left untreated, it starts scarring. This scar tissue replaces healthy liver tissue as it proliferates at a tremendous rate. The scar tissues cannot process the liver function such as blood purification or metabolization. This puts an excessive strain on the healthy tissue which tries to compensate, by working at an unhealthy rate. If the liver disease is diagnosed at this stage, there is still a chance of the liver healing itself over time with the right kind of treatment.

Cirrhosis (Stage 3)

Once a large portion of the healthy tissue in the liver is replaced by scar tissue it is called cirrhosis. If the cirrhosis is left treated, it leads to liver failure and the liver will cease to function. A number of complications arises due to cirrhosis which can cause liver cancer. In many people, liver disease only starts exhibiting symptoms at this stage.

  • Bleeding and bruising may occur easily
  • Building up of water may occur in the legs and stomach region
  • Yellow coloration of the skin, eyes is observed (Jaundice)
  • Intense itching of skin might occur
  • Blood vessels that are blocked in the liver might burst
  • You may exhibit hypersensitivity to medicines
  • You may develop type 2 diabetes
  • You may develop problems in concentrating, sleeping or performing any mental functions due to toxin build up in the brain.

End-Stage Liver Disease (ESLD or Stage 4)

This is the final stage of liver disease where other courses of treatment are impossible, at this stage only a liver transplant surgery can save the patient. At this stage the liver starts showing signs of decomposition. And this includes variceal bleeding, kidney impairment, hepatic encephalopathy, and lung issues.

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5.Understanding the Liver Transplant procedure

Before the procedure

Being placed on the waiting list:

To determine your place on the waiting list of a liver transplant, the doctors make use of the tests and another prognosis of the liver function. The prognosis is called a Model for End-Stage Liver Disease (MELD) or for children who are below 12 years old, it is known as Pediatric End-Stage Liver Disease (PELD). The score range of MELD is from 6 to 40. These scores calculate the risk of death without the transplant. The more dire your chances of liver failure, the higher your score. People with a higher MELD score receive a higher priority on the waiting list. Adults having acute liver failure are placed higher on the waiting list timely intervention is critical for survival.

Waiting for a new liver

The wait varies greatly for each liver transplant patient. Few may wait for days while some wait for months and may not receive the deceased donor liver. As the patient waits for the liver, the doctor treats the complications and tries to make the patient as comfortable as possible. Patients suffering from end-stage liver failures are frequently hospitalized. And so their MELD score is updated as the liver deteriorates further.

Staying Healthy

It is important to stay healthy whether your surgery is scheduled or you are still waiting for the donor. A transplant can only be performed if your body can sustain such a major medical procedure.

Points to note:

  • Ensure proper intake of medications as prescribed
  • Follows proper diet and exercise routine as prescribed
  • Never miss out on appointments with your doctor
  • Ensure that you stay active with your day to day routine
  • Make sure to update your doctors about any changes in your health
  • Give your correct address and your contact number so that the doctors can contact you immediately in case a donor liver is found
  • Always be prepared with a packed hospital bag and ensure transport arrangements to the transplant center are made in advance.

During the Procedure

During the Procedure

Once you are notified that the deceased donor liver is available, you must immediately make arrangements to visit the hospital. The surgeons make sure you’re healthy for the operation and you can undergo the surgery. General anesthesia is used for liver transplant surgery. A long incision is made across your stomach for the transplant surgery. The location and size may vary according to the patient as well as the surgeon's approach. The surgery may take up to 12 hours and differs from case to case based on complexity. Once the new liver is in place, the surgeon may use stitches or staples to close the incision and later the patient is transferred to the intensive care unit so that he/she may start the recovery process.

Living-donor liver transplant

In such cases, first, the donor is operated on to remove a portion of the liver for the transplant and then the surgeons remove your diseased liver and replace it with the donated liver portion. After that, they connect the blood vessels and bile ducts to the newly transplanted liver portion. The healthy liver portion transplanted in your body, as well as the donor's body, regenerate rapidly to reach the normal volume within a couple of months.

After the Procedure

  • The doctors test your liver function frequently and monitor for any symptoms of complications.
  • You may have to stay in the intensive care unit for a couple of day.
  • You may be asked to come in for frequent checkups
  • You may be prescribed medications some of which may be life-long

You may resume normal activities after six months or more after the procedure. The time for full recovery depends on the individual complications and general health before the procedure.

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6.Liver Transplant Criteria and Requirements

Choosing a liver transplant hospital

If the doctor suggests a liver transplant surgery, then it is essential that you do your research before choosing a hospital for your procedure. Since it is a major procedure, you must ask the following questions before choosing your healthcare provider.

  • Number of liver transplants they perform per year.
  • Enquire about the survival rates of liver transplant surgeries at the hospital.
  • Make note of costs involved in treatment before, during and after the transplant.
  • Also consider the additional services provided by the center for support groups, travel arrangements as it is a major operation that may require an extended stay.
  • Appraise the commitment of the center with regards to updating to the latest technology and techniques.

Patient evaluation

After choosing a hospital, the doctor will evaluate your general health to check if your are a suitable candidate for liver transplant surgery. To be eligible for the liver transplant you should be:

  • Overall health must be adequate to sustain a serious surgical procedure.
  • Must be able to cope with a long period of post-transplant medication
  • Must be clear of any medical conditions that could interfere with the success of the transplant.

Few specific tests, procedures, and consultations the patient will have to undergo:

  • Blood and urine tests to assess the liver health.
  • Ultrasound of the liver.
  • Routine general health exam to screen for liver cancer as well as to evaluate the overall health.
  • Counseling with a dietitian to recommend the nutritional intake before and after transplant.
  • Assessment of the psychological health of the patient.
  • Counseling for alcohol, drug, or tobacco addiction.
  • Financial counseling to manage the transplant cost.

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7.Finding a donor

Living Liver donors

A small percentage of liver transplants are done annually employing a portion of a liver from a living donor. At first, the living-donor liver was used for children below 12 needing a liver transplant due to the non-availability of proper sized deceased-donor organ. This has now become an important alternative explored by end-stage liver disease adults.

The determination of access to deceased-donor liver depends on the severity of liver disease (MELD score). In case of living-donor liver transplant it is done by identifying the healthy living donor who can undergo the major surgical procedure safely and the suitability of the donor organ. The close family members or friends are the most likely the living liver donors of the liver transplant candidate.

The living-donor transplants are said to have similar survival rates as those using livers from deceased donors. However, the probability of finding an appropriate donor is low as there are few restrictions such as the donor’s age, blood type, size of the liver and importantly the donor’s health condition.

Domino liver transplant

In a domino liver transplant, the patient receives the liver from a living donor having familial amyloidosis. This is a disorder in which the protein deposits accumulate and eventually damage the internal organs of the body. The patient suffering from familial amyloidosis receives the liver transplant and later this liver is transplanted to another patient because the liver functions quite well. The patient may develop the symptoms of amyloidosis eventually, but it takes at least a few decades to develop.

The candidates selected by the doctors for such transplants are those who are 60 or above so that before the end of their natural expectancy of life, so that they do not develop these symptoms.

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8.Risks associated with Liver Surgery

Risk and complications of the procedure:

Significant complications may arise in the liver transplant surgery. These risks are not only related to the procedure but also associated with the drugs used to prevent the donor liver rejection after the surgery.

Risks associated with the procedure:

  • Bleeding
  • Blood clots may develop
  • Bile ducts leakage or shrinkage
  • Failure of a donated liver
  • Infection
  • Rejection of donated liver
  • Mental seizures or confusion

Anti-rejection medication side effects:

Anti-rejection drugs are used to suppress the immune system and prevent rejection of the liver by the body. However, there are chances of an infection developing due to the lowered immunity. Doctors usually prescribe medication for fighting infections that may develop at this stage. Anti rejection medications may cause the following side effects.

  • Diarrhea
  • Headaches
  • High blood pressure
  • Bone thinning
  • Diabetes
  • High cholesterol

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9.Steps to Prevent Liver Diseases

Liver disease prevention

1. Moderate alcohol consumption:

It is better to avoid alcohol consumption altogether for liver health. However, if you must then it is advisable to limit it to one drink a day for women and two drinks a day for men.

2. Avoid risky behavior:

  • Do not abuse any kind of illicit intravenous drugs.
  • Alway use protection (Condoms) during intercourse with a sexual partner.
  • If you opt for any kind of tattoos or body piercings, ensure that hygiene and safety standards are maintained.

3. Get vaccinated:

If you’re at risk of contracting the hepatitis virus or already have been infected by the virus, consult your doctor for getting vaccinated by Hepatitis A and B vaccines.

4. Proper precautions regarding aerosol sprays:

Ventilate the room and wear the mask as well as gloves while spraying fungicides, paints, insecticides or any other toxic chemicals.

5. Maintain a healthy weight:

Make sure to follow a healthy diet and exercise regularly as obesity causes non-alcoholic fatty liver diseases.

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10.Road to Recovery and Aftercare

It is essential to ensure excellent post-surgery care to prevent organ rejection or post-transplant infection in case of liver transplant surgery. Follow these guidelines after the surgery to ensure a speedy recovery.

1.Ensure hygienic surroundings

The initial step for recovery starts from one’s home. The family members should keep in mind to provide good ventilation in the home after the person returns from the hospital. Make sure to wear a mask for at least the first 3 months after the surgery especially if you live in a crowded place. Wash your hands after meeting any strangers. Shower every day and ensure separate bed linen and toiletries for the patient.

2.Diet and Nutrition

Your diet, in general, should contain low salt, cholesterol, fat, and sugar. Avoid alcohol to prevent damage of the new liver. Make sure to avoid consuming any alcoholic beverages or even use of alcohol in cooking.

Other important recommendations after liver transplant are as follows:

  • Eat a diet rich in vegetables and fruits.
  • void fruits such as grapefruit, pomegranates or seville oranges as they may affect the immunosuppressive medications.
  • Include enough fiber in your day-to-day diet
  • Choose whole-grain foods
  • Consume low fat or fat-free dairy products as it is essential to maintain optimum calcium and phosphorus levels
  • Meats, poultry, and fish can be consumed in moderation
  • Keep your body hydrated by consuming adequate water and other fluids every day.

3.Exercise

To improve your overall physical health it is important to follow an appropriate exercise regimen and physical activities after the liver surgery. Consult a physiotherapist to get proper information regarding exercise to avoid any complications.

Do not lift any heavyweight which and do not perform any abdominal exercises until you are fully recovered from the surgery.

To enjoy a healthy and active lifestyle after surgery, you can include low intensity exercises as early as 3 months after the surgery, such as walking, bicycling, swimming, low-impact strength training in your life after surgery. Whenever you change your exercise routine, consult your doctor to make sure you aren’t delaying your recovery and healing process.

4.Regular Checkup

It is essential that the patient follow up with the hospital regularly for doctors appointments and rehabilitation.

5.Medications

Most important for the recovery process are the medicines. Make sure that you never skip the medications at any cost. It is necessary that the patient's family also be familiarized with the medicines so that they ensure that the patient has taken up the medicine or not. Sometimes, wound care is essential as the healing process is slow in liver transplant patients.

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11.Liver Disease FAQs: All your concerns addressed

1. What is liver cancer?

Cancer that proliferates in the cells of your liver is called liver cancer. There are three types of liver cancer such as hepatocellular carcinoma which happens in the hepatocyte. This is the most common type of liver cancer. The other two type’s intrahepatic cholangiocarcinoma and hepatoblastoma are very rare.

2. Is liver cancer curable?

Liver cancer is said to be difficult to cure. The first stage is rarely diagnosed and can be treated. Whereas the second stage is very difficult to heal as it has already metastasized at this stage. The complex network of blood vessels and bile duct in the liver makes the operation difficult to perform.

3. How long does it take to recover from liver surgery?

The patient may require a total of four to eight weeks to recover after the liver transplant surgery. The actual rate of recovery differs from person to person and also the condition of the patient before the surgery.

4. Can you consume alcohol after a liver transplant?

Generally, consumption of alcohol is strictly prohibited after the surgery and especially for those who had alcohol-related liver disease. You must consult with the doctor to get a detailed understanding of the contraindications and restrictions in your case.

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