Liver Disease- Don’t wait for signs, it may be too late

By Vision Reporter

HIS love for alcohol was legendary; in fact Joseph Kalii never went to bed without drinking several glasses of Uganda Waragi. This was his daily practice for over 15 years until all this turned around. “I fell sick and the doctors said I was in danger o

By Stephen Ssenkaaba

HIS love for alcohol was legendary; in fact Joseph Kalii never went to bed without drinking several glasses of Uganda Waragi. This was his daily practice for over 15 years until all this turned around. “I fell sick and the doctors said I was in danger of developing liver disease,” he says.

Even though he refrained from binge drinking, Kalii never gave up on alcohol consumption. When he went back to his doctor, it was too late. Kalii was diagnosed with liver failure and had minimal chances of survival.

Liver disease, especially alcohol-related liver failure, is a health threat in Uganda. Dr. Christopher Opio, a hepatologist (liver specialist) at Mulago Referral Hospital, says a reasonably big number of liver failure cases are abusers of alcohol.

“One out of 10 individuals seen at the Mulago Medical Emergency Unit has liver disease as a result of excessive alcohol consumption,” he says.

He explains that being among the top alcohol consumers in the world, as per World Health Organisation (WHO) findings, Uganda cannot escape the threat of liver disease.

Alcohol is just one of the many causes of liver disease. Dr. Margaret Mungherera, a consultant psychologist at Mulago Hospital who rehabilitates people with alcohol problems, says liver complication is common among many of her clients.

“When we do ultrasound scans, we find that many of our clients present with early signs of liver damage,” she says. Unfortunately, many are not aware of it.

What is liver disease?
According to Opio, liver disease is anything that affects the liver. “It could be infections, toxins, poisons, drugs, cancers or the body reacting against itself.

When this happens, patients end up with injury or damage to the liver cells (hepatitis) and or later scarring (cirrhosis) and subsequently liver failure.
Liver failure, he says, may result from excessive alcohol consumption, aggressive forms of fatty liver disease or other chronic liver disorders.

The disease can also be caused by ingestion of common medications, such as acetaminophen, contaminated herbal medicines, or toxic mushrooms.

Opio says while the exact prevalence is not known, available figures for specific diseases provide an insight into the seriousness of the disease.

“Five million Ugandans are estimated to be infected with bilharzia and probably one third will go on to develop liver and spleen bilharzia. Six out of 10 individuals seen by liver specialists are found to be using herbal remedies. In some of these, it was thought that remedies contribute to liver disease,” he says.

Opio adds that contamination with aflatoxin (poisonous by-products of molds) causes hepatitis and contributes to liver disease. Aflatoxins contaminate food, particularly cereal crops.

Groundnuts and maize are the most researched as far as aflatoxins are concerned.

According to the American Liver Foundation, chronic liver disease is the 10th leading cause of death in the US, resulting in approximately $10b (sh21 trillion) in annual health care costs.

The World Health Organisation estimates that 20 million people worldwide have cirrhosis of the liver and/or liver cancer, arising predominantly among the estimated 500 million people (nearly 10% of the world population) who are afflicted with persistent Hepatitis B or Hepatitis C viral infections.

An estimated one to two million people worldwide die each year from liver failure, with more than 50,000 deaths per year in the US.

Opio says most people with liver disease do not show symptoms or signs unless the disease is severe.

According to wikipidea free encyclopedia, liver damage from cirrhosis (a consequence of chronic liver disease characterised by replacement of liver tissue by fibrous scar tissue) cannot be reversed, but treatment could stop or delay further progression and reduce complications.

A healthy diet is encouraged, as cirrhosis may be an energy-consuming process.

Close follow-up is often necessary. Antibiotics are prescribed for infections and various medications can help with itching. Laxatives, such as lactulose, decrease risk of constipation.

Treating underlying causes
Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from alcohol, while treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis.

Otim, however, says other than wait to treat the disease, we should strive to prevent it.

“Prevention is cheaper than treatment. For example prevention of Hepatitis B with a vaccine will cost a maximum of sh150,000, while if you have chronic Hepatitis B you would be on drugs for life (a month’s dose of these drugs costs sh60,000 for inferior drugs to sh1.2m for the superior drugs), while a full treatment of injectable drugs for six months to one year costs about sh20m to sh40m.”

“This does not include the blood tests and the livers scans which have to be done at least twice a year and may cost up to sh1m per year,” he explains.

Otim says for admission during the advanced stage of liver disease, the cost may go up to sh3m or more (most of the recommended drugs are not available in public health care settings and nearly all these patients should be cared for in special units), while a liver transplant costs about $150,000 (about sh320m).

When is a transplant required?
Once a patient shows signs of a swollen belly, malnutrition and cirrhosis among other signs, this is an indication of end-stage liver failure and a need for a transplant.

Otim says while many patients come to this stage needing transplant, some never get it: “Getting a liver replacement is difficult and expensive.” Since Uganda does not have a liver transplant facility, most patients are referred to South Africa, Egypt, India, Europe or the US.

How can one guard against the disease?
Otim says knowledge and self-empowerment regarding health, advocacy for one’s rights regarding health are the best preventive measures “Get involved in your own health, seek health education, change your behaviour by, for example, eating and drinking healthy as well as going for health checks.”

Functions of the liver
The liver has several functions: It helps digest food
It clears waste from the blood
It makes proteins that help blood to clot
It stores glycogen (sugars) used for energy

It makes proteins that the body must have
It helps use and store vitamins
It makes chemicals that protect the body
It breaks down many toxins and drugs

The liver also controls the way the body uses food and the way it works with one’s immune system.

When the liver is badly damaged, it cannot grow enough new liver tissue to heal itself. Cirrhosis (severe liver damage with scarring) can lead to two problems:

Liver failure: This happens when the liver cannot do what it is supposed to do

Portal hypertension: This happens when scarring in the liver stops blood from flowing through it. It causes pressure to build up in the portal vein, the vein that feeds the liver.
When most of the liver is damaged, it starts to fail.

Once a person has signs of liver failure, it means there is not much of the liver left for the body to use during sickness and times of need.

Seventy-five to 80% of cases of cirrhosis (scarring of the liver) could be prevented by eliminating alcohol abuse.
One in every 250 people is a carrier of the hepatitis B virus.

Chronic hepatitis B infection increases a person’s chances of developing liver cancer by 100 times. A vast number of the millions of people suffering from liver disease are unaware of the extent to which it affects society.

The disease can remain undetected for years without pronounced symptoms.
The liver is the only organ that can regenerate itself and is responsible for removing toxins from our bodies.

Even though one may not be an alcoholic, a social drinker runs the risk of developing alcoholic hepatitis.
Incorporating liver wellness into one’s daily routines can help prevent liver disease and lead to longer and healthier lives.

For example, getting enough sleep and reducing stress can both be instrumental in the healthy upkeep of one’s liver, as these two factors strengthen the immune system.

Eliminating the consumption of foods that are fried or processed can also impact on liver wellness because both foods create excessive strain to the liver.

The antioxidant milk thistle has been clinically proven to dramatically affect the protection of liver cells.

Liver disease presents through the following signs:
Yellow eyes or jaundice
Weight loss
Skin changes
Abdominal swelling due to fluid or liver tumour

Muscle wasting
Hair loss
Loss of appetite
Vomiting and passing blood due to abnormal veins

Bleeding due to failure of one’s blood to clot
Kidney failure, recurrent infections and brain failure due to failure of the body to remove brain toxins.

Who is at risk?
“Everybody is at risk of catching Hepatitis B, bilharzia and diabetes,” says Opio. “And because many people take alcohol and use herbal medicine, while nearly all of us take medication in our lifetime, we are at risk of catching liver disease,” he says.

To diagnose liver disease, a physician may carry out one or more of the following tests:
Blood tests
Computed scan
Magnetic resonance imaging
Endoscopy (a physician inserts a viewing tube called an endoscope through the mouth and down into the beginning of the small intestine)

Liver biopsy (the removal and examination of tissue from the body)

According to studies, it depends on the condition and may include:
Conventional cancer treatments such as chemotherapy and radiation
Injecting cancer-killing drugs into the liver via a catheter (tube) and other interventional cancer treatments

Bile duct drainage via a catheter
Stenting (placement of a tiny mesh-metal tube to support the bile duct or a blood vessel in the liver)
Intravenous blood pressure-lowering medications
Liver transplant.

Compiled by Stephen Ssenkaaba

Liver Disease- Don’t wait for signs, it may be too late