Our liver has the ability to repair and regenerate itself. However, as it gradually builds scar tissue, it is less able to function correctly. As the number of scarring increases, the liver’s circulatory flow decreases. Further, the essential functions of the liver are compromised. In some cases, this may lead to liver failure and even death. Globally, over one million people die every year from Cirrhosis.

Dr. Gaurav Gupta, Head of Liver Transplant and HPB Surgery at Fortis Hospitals, Mumbai has over decades of experience in handling complex liver surgeries and treatment of Liver Cirrhosis too. Due to his vast expertise and experience, he is known to provide the best liver transplant in Mumbai.

Now, let’s know about Cirrhosis, its diagnosis, and treatment.

 

Prolonged liver damage leads to a condition known as Cirrhosis of the liver. In this condition, the liver becomes hard and nodular. Liver tissue is replaced by fibrosis. Once cirrhosis sets in, liver damage becomes irreversible. The cirrhotic liver becomes incapable of regenerating.

Classification of Cirrhosis

1. Compensated Cirrhosis

It is merely a damaged liver that is still relatively functional.

2. Decompensated Cirrhosis

It represents the advanced stage of cirrhosis where signs and symptoms of liver dysfunction start.

Why can Cirrhosis be Dangerous?

Cirrhosis leads to various complication like

• Ascites (fluid in the abdomen)
• Edema (fluid in limbs)
• Variceal bleeding (bloody vomiting)
• Confusion (encephalopathy)
• Kidney dysfunction (hepatorenal Syndrome)
• Lung complication (Hepatic hydrothorax, Hepatopulmonary syndrome)
• Liver cancer

The risk of death with intractable ascites and variceal bleed can be quite high. Patients with ascites that are not controlled with medications (intractable ascites) have a mortality risk of almost 70% within one year.

A single episode of infection in patients with ascites (SBP) carries a 50% one-year mortality risk.

If complications are not controlled when the liver ceases to function, your Liver Transplant Surgeon in Mumbai may recommend liver transplantation.

Approximately 5% of people with cirrhosis develop hepatocellular carcinoma (HCC). It’s the most common form of liver cancer.

Symptoms of Cirrhosis 

Progression of liver damage from early-stage fibrosis to cirrhosis usually takes years to manifest symptomatically. There are often few, if any, symptoms in the early years.

When symptoms occur, they are sometimes misdiagnosed, ignored, or attributed to other possible causes. However, as the ailment progresses, the symptoms may get more apparent. These symptoms include:

• Fatigue
• Confusion
• Weakness
• Itching
• Loss of appetite
• Weight loss
• Nausea
• Easy bruising
• Jaundice
• Swelling of ankles, feet, and legs
• Abdominal bloating from the ascites

Causes of Cirrhosis

The most common causes of cirrhosis are:

1.  Alcohol-related liver disease: It is typically associated with heavy alcohol intake over several years.
2.  Hepatitis B: It is a prevalent cause of cirrhosis.
3. Hepatitis C: It is one of the frequent causes of cirrhosis and the leading indicator for liver transplants.
4. Non-alcoholic fatty liver disease: People with diabetes, high blood pressure, obesity, and high cholesterol are more prone to cirrhosis. This is becoming one of the most common causes of Liver cirrhosis with the increasing incidence of lifestyle diseases in our population.

 

Some of the rare causes of cirrhosis include:

• Primary Sclerosing Cholangitis
• Hereditary diseases like Wilson’s disease
• Autoimmune hepatitis
• Hemochromatosis
• Celiac disease
• Medication

 

Diagnosis of Cirrhosis

1. Liver biopsy:

It is the most accurate method for the diagnosis of cirrhosis and its stage. With advancements in Radiological tools, Liver Biopsy is rarely done these days to diagnose cirrhosis.

2. An ultrasound or Magnetic Resonance Elastography:

These are non-invasive ways to detect cirrhosis.

3. Blood tests and imaging tools (CT scan and MRI):

These can be used to monitor disease progression.

Treatment of Liver Cirrhosis

• Many cases of cirrhosis have been manageable before they progress and require a liver transplant in Mumbai.
• The management of cirrhosis depends primarily on the cause and severity of the disease.
• But the treatment should begin immediately after its diagnosis.
• Cirrhosis is generally not curable except through liver transplantation.

You should take the below steps to decrease the progression of liver scarring, including:

• Avoid taking alcohol and medicines that can cause injury to the liver.
• Avoid over-the-counter herbal agents and supplements, as some have been associated with liver injury.
• Cirrhosis elevates the risk of prescription-drug liver injury. So, all prescriptions should be carefully reviewed for effects on the liver.
• Avoid raw shellfish that may contain bacteria. It could potentially cause severe infection in people with advanced liver disease.
• Screening and vaccination for hepatitis A and  hepatitis B
• Antiviral therapy for hepatitis B and hepatitis C.
• Screening and treatment of secondary causes of cirrhosis such as ursodiol for bile duct blockages.
• Nutrition plays an important role in managing Cirrhosis patients.

The management of cirrhosis should begin as soon as you’re diagnosed with the condition. After the diagnosis, you should always consult a qualified and experienced Liver Specialist in Mumbai to seek the best treatment.

‘Is the life worth living? It depends on the liver.’ This saying is so apt when talking about the liver. It is a vital organ in humans.

It is so vital that people would perish if it stopped working even for a single day. Regrettably, it is also one of the organs that receive the least attention.

That’s why, when liver damage becomes irreversible due to acute or chronic liver disease, a liver transplant becomes the only option for treatment. Luckily, most patients can get the best treatment for a liver transplant in India due to improved infrastructure and advance technology.

Let’s take some time to learn more about the liver and give it the attention it deserves, considering its significance. 

Interesting facts about the Liver

• The liver is the largest glandular organ in the human body and the second largest organ in the body after the skin.
• The liver is multifunctional, performing over 800 essential functions for the body at the same time. Providing glucose to the brain, fighting infections, and storing nutrients are only a few of these vital functions.
• Around 5-10% of the liver is made up of fats. Higher fat content in the Liver leads to a condition called “fatty liver.” This condition is more prone in people with obesity, type 2 diabetes, hypertension, High Cholesterol, and heavy alcohol drinking.
• The human liver produces and stores iron and essential vitamins and nutrients from the diet and keeps them in storage until the body needs them.
• It also acts as a detoxifier. The toxic substances consumed by people, such as alcohol and drugs, are detoxified by the liver. The body cannot process these substances without the liver.
• The liver produces important proteins of blood clotting, which circulates in the body. That’s the reason patients with liver failure are more prone to bleeding.
• The liver has the incredible capacity to regenerate, which makes Living donor liver transplantation possible. When people donate half of their liver, the liver regenerates the portion that the doctor removed. Within three months, the liver grows back to 90% of its original size.

So, the liver is an essential organ that performs a variety of functions. It works in coordination with other organs of the body to keep us fit and healthy. This is the reason with Liver failure other organs also start to get affected like kidney, heart, lungs, and many more.

What are the causes of Liver Disease?

The following factors can cause Liver disease:

• Viruses and parasites
• Autoimmune disorders
• Cancer 
• Abnormal gene
• Alcohol abuse for a long time
• The fat build-up in the liver

Which are the most common Liver diseases? 

1. Hepatitis is caused by viruses, obesity, allergic reactions, drugs, or heavy drinking.
2. Cirrhosis scars the liver as a result of long-term damage.
3. The most common form of liver cancer develops after the presence of cirrhosis.

What are the signs and symptoms of Liver diseases?

One or more of the following symptoms can occur, with more severe symptoms often associated with more advanced disease:

• Skin and eyes turn yellowish (jaundice)
• Easy bruising or bleeding
• Tiredness
• Swelling in legs and knees
• Itchy skin
• Urine with a dark hue
• Stools that are pale, bloody, or tar-colored
• Vomiting or nausea
• Diarrhea
• Appetite loss
• Swelling in the abdomen
• Mental confusion

What is the treatment for liver disease?

Treatment options depend on the nature and severity of the damage as well as the underlying cause. Some liver treatment includes losing weight or avoiding alcohol while the doctor monitors the patient’s liver functions.

In certain cases, the doctor may opt for medicine or surgery. The patient may need a liver transplant in the most severe cases.

For critical procedures like these, patients are recommended to undergo Liver Treatment in Mumbai as the city is equipped with expert surgeons and world-class infrastructure.

Hepatitis is an inflammation of the liver. Our liver, located in the abdomen’s right upper area, performs many critical functions that affect our metabolism.

You should consult an expert like Dr. Gaurav Gupta for issues related to the liver. Dr. Gupta is among the top-rated Liver Specialist in Mumbai. He is renowned for his expertise in Liver Transplant in Mumbai. He has more than 15 years of surgical experience, out of which 10+ years in the field of Liver Transplantation.

Moreover, Dr. Gaurav Gupta is among the best liver transplant surgeons in Mumbai and has conducted more than 500 liver transplants. Presently, he is associated with Fortis Hospitals as a Consultant and HOD of the Liver Transplant & HPB Surgery.

Overview of Hepatitis, its types, symptoms, diagnosis, and hepatitis treatment.

What is Hepatitis?

It is an inflammatory disease of the liver usually caused by a viral infection. However, other possible causative factors of hepatitis include autoimmune hepatitis. Hepatitis also occurs as a secondary result of drugs, toxins, and alcohol which are also major causes of other diseases like Liver Cirrhosis.

Symptoms of Hepatitis

You may not have signs at first if you have chronic infectious forms of hepatitis, such as hepatitis B and C. Symptoms may not occur until the damage has a detrimental effect on liver function.

Acute hepatitis symptoms and signs appear rapidly. They are as follows:

• fatigue
• abdominal pain
• flu-like symptoms
• loss of appetite
• dark urine
• pale stool
• yellow skin and eyes
• unexplained weight loss

Types of Hepatitis

Hepatitis is of different types, viz. infectious and non-infectious. However, the most common type is viral hepatitis.

Viral hepatitis can be broadly divided into two types:

1. Acute Viral Hepatitis

a. Hepatitis A

An infection causes it with the hepatitis A virus. It usually transmits by consuming food or water contaminated by faeces from a patient infected with hepatitis A.

b. Hepatitis E

It is a waterborne disease caused by the hepatitis E virus. It is mainly found in areas with poor sanitation. It typically results from ingesting fecal matter that contaminates the water supply.

 

2. Chronic Viral Hepatitis:

a. Hepatitis B

It spreads through contact with infectious body fluids, such as blood, genital secretions, containing the hepatitis B virus. Using shared injections or razors of an infected person or having sex with an infected partner increases the risk of acquiring hepatitis B.

b. Hepatitis C

It results from the hepatitis C virus. It is one of the bloodborne viral infections. It circulates through direct contact with infected body fluids, usually through injections and sexual contact.

c. Hepatitis D

It is a severe liver disease caused by the hepatitis D virus. It is also known as delta hepatitis and its spreads through close contact with infected blood. It is a rare form of hepatitis and only occurs in conjunction with hepatitis B.

 

How Is Hepatitis Diagnosed?

a. History and Physical exam

At first, your doctor will record your medical history to determine any risk factors you may have for infectious or non-infectious hepatitis. Your doctor may gently press your abdomen to see if there’s pain or tenderness and check whether your skin or eyes are yellow.

b. Liver Function Tests

It involves taking blood samples to check the efficacy of your liver. High levels of liver enzymes could mean that your liver is inflamed, or not working correctly.

c. Other Blood Tests

If your liver function tests come back abnormal, your doctor can order additional blood tests to determine what’s wrong. These tests will detect the hepatitis-causing viruses. It also detects the presence of antibodies that are common in conditions such as autoimmune hepatitis.

d. Ultrasound

It involves using ultrasound waves to create an image of the abdominal organs. It assists your doctor in checking any abnormalities in your liver and nearby organs.

e. Liver biopsy

It is an invasive process that involves taking a tissue sample from your liver. It can be done with a needle through the skin and does not require surgery. These days role of Liver biopsy is very limited in diagnosing liver ailments. Typically, an ultrasound guides your doctor when taking the biopsy sample.

How Is Hepatitis Treated?

Mainly acute viral hepatitis needs symptomatic treatments and good nutrition to support the liver. Almost 90-95% of patients get cured without hospitalization. However, rarely, 1-2% of cases result in acute liver failure. It is a critical condition in which the bilirubin level increases, the liver stops making protein, and the liver starts to fail. Patients can develop Encephalopathy. It is a severe condition that needs to be treated only at a dedicated liver care unit.

1. Hepatitis A

Hepatitis A often doesn’t need treatment as it’s a short-term illness. Follow your doctor’s hydration and diet guidelines if you have vomiting or diarrhea. Hepatitis A vaccine is available for both children and adults to prevent the infection.

2. Hepatitis B

Acute hepatitis B doesn’t require specific treatment. Antiviral medications are beneficial in treating chronic hepatitis B. Hepatitis B can be prevented with vaccination.

3. Hepatitis C

Very good antiviral treatment is available these days to cure Hepatitis C. Hepatitis C patients who develop cirrhosis or liver disease may need a liver transplant. Hepatitis C vaccine is currently unavailable.

4. Hepatitis D

To date, no antiviral medications exist for the treatment of hepatitis D. According to research, a drug called alpha interferon can be used to treat hepatitis D. Still, it only shows improvement in about 25 to 30 % of patients. Hepatitis B vaccination can help prevent it, as infection with hepatitis B is needed to develop hepatitis D.

5. Hepatitis E

Hepatitis E is currently treated with no particular medical therapies. Since the infection is often acute, it usually resolves on its own. The doctor frequently advises people with this condition to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol.

6. Autoimmune hepatitis

Corticosteroids, like prednisone or budesonide, are beneficial in the early treatment of autoimmune hepatitis. They’re effective in about 80% of patients with this condition.

Prevention of Hepatitis

1. Hygiene

• Practicing good hygiene and avoiding outside food is one fundamental way to avoid contracting hepatitis A and E.
• Hepatitis B, C, and D are transmitted through contaminated blood. It can be prevented by not using shared drug needles, razors, toothbrushes, etc.
• Sexual contact and intercourse can also lead to the transmission of hepatitis B and C. Practicing safe sex by using condoms can help decrease infection risk.

2. Vaccination

Vaccination is a vital factor in avoiding the spread of hepatitis. So, you should discuss with your doctor about hepatitis vaccination and get it done.

The complete diagnosis and Hepatitis treatment in Mumbai are available at Fortis Hospital, Mulund with the best infrastructure and state-of-art technology. Patients all over India are recommended Mumbai for their Hepatitis Treatment.

Make an appointment with Dr. Gaurav Gupta to avail the best Liver treatment in Mumbai.

Wilson’s disease is a rare genetic condition in which copper builds up in the liver, brain, and other essential organs. Wilson’s disease most often occurs between the ages of 5 and 35. However, it can also affect younger and older adults. 

There are people in Mumbai who suffer from the disease mainly due to their genetic issues. A patient with Wilson’s disease can lead a quality life by availing of proper treatment from a liver transplant surgeon in Mumbai.

 

Copper is essential for developing healthy nerves, muscles, collagen, and the skin’s pigment melanin. Generally, our body absorbs copper from the food we eat and exerts the excess through bile secretion.

On the other hand, the excess copper accumulates in the body of people with Wilson’s disease. This high level of copper accumulation is very harmful to your health. Wilson’s disease is treatable if identified early, and even individuals with this condition lead normal lives.

What are the symptoms of Wilson’s disease?

Wilson’s disease occurs by birth, but symptoms do not occur until copper levels in the brain, liver, or other organs have increased. The signs and symptoms of the disease differ based on the affected body parts. They may contain the following:

• Fatigue, a loss of appetite, or stomach pains
• Jaundice
• Discoloration of the eyes (Kayser-Fleischer rings)
• In the legs or lungs, there is a build-up of body fluid.
• Issues while talking, chewing, or physical coordinating
• Muscle tightness or uncontrollable motions

If a person experiences any of the mentioned symptoms, he or she should avail liver transplant after having a consultation.

How does Wilson’s disease happen?

Wilson’s disease is hereditary. It is an autosomal recessive disorder, which means the patient must inherit one problematic gene from each parent. The person won’t get sick if you get one rare gene, but you will be a vector and pass the gene on to your offspring.

The cases of Wilson’s disease in India are increasing and many liver surgeons observe patients complaining about this condition. More and more awareness needs to be made so that early diagnosis is possible for Wilson’s patients.

How does a liver transplant doctor diagnose Wilson’s disease?

Wilson’s disease is challenging to diagnose, and its signs and symptoms are also difficult to distinguish from those of other liver disorders, like hepatitis. The diagnoses are based on the symptoms and tests. These include:

• Tests of the blood and urine: Blood tests are essential to evaluate your liver function. It helps to check the level of ceruloplasmin, a protein that binds copper in the blood and copper in the blood. The doctor will also want to monitor the amount of copper excreted in your urine over a day.
• Eye examination: An ophthalmologist tests Kayser-Fleischer circles’ eyes. Excess copper causes complications in the eyes. Wilson’s disease is also related to a cataract form known as a sunflower cataract, which can come out during an eye test.
• Biopsy: A thin needle is inserted through your skin into your liver, where we take a small tissue sample. Then the tissue goes for examination in a laboratory to check the excess copper.
• Genetic testing: If Wilson’s disease occurs due to genetic abnormalities, genetic testing will detect that from the patient’s blood sample. Knowing the family’s mutations helps doctors to test siblings and start treating them before signs occur.

Now let us see the treatment for Wilson’s disease

The doctor may prescribe proper medications to bind copper and then release them into the bloodstream. Finally, they will be released through your urine. After that, the treatment stops the copper formation. The doctor may also suggest a liver transplant if there is serious damage to the liver.

Prescription drugs

If a patient has Wilson’s disease, they will have to take drugs for the rest of your life. The medications include the following:

Note: Below drugs can be taken only on the prescription of a qualified doctor. Self-diagnosis can land a patient in trouble.

• Penicillamine: It is a chelating agent that may have severe side effects, including skin and renal disorders, bone marrow suppression, and deteriorating neurological symptoms. If a person is allergic to penicillin, he or she will require proper supporting remedies for allergy. You will need to take vitamin B6 supplements in limited doses.
• Triennial: Trientine is similar to penicillamine, but it has fewer side effects. However, it can escalate few neurological problems also.
• Galzin: Galzin drug prevents the body from consuming copper from food. It may bring stomach disturbance.

Surgical techniques

A patient may require a liver transplant if the liver damage is severe. The liver transplant removes the diseased liver and replaces it with a healthy liver from a donor during a liver transplant.

Are there any home treatments/remedies available for Wilson’s disease?

If a person has Wilson’s disease, the doctor would typically encourage limiting the copper intake from a regular diet. Even the person should avoid copper-containing multivitamins.

Avoid food items like mushrooms, chocolate, shellfish, liver, or any other copper-rich food. Further diet control can be prescribed only after proper diagnosis of the patient

Frequently Asked Questions :

1. How long can you live with Wilson disease?

Life expectancy without treatment is expected to be 40 years, although patients who receive quick and effective treatment may live a normal lifespan.

2. Is Wilson’s disease reversible?

Wilson disease has no known treatment. Copper-chelating drugs, which help your body’s organs and tissues get rid of excess copper, are one type of treatment that may be required for the rest of your life.

3. Who is most likely to get Wilson’s disease?

Wilson disease is more common in people under the age of 40. By the age of four, children begin to display symptoms. The organs that are impacted, stop functioning normally. Eastern Europeans, Sicilians and southern Italians are the most affected, but it can affect anyone.