Suasth Liver Center performs the oldest deceased donor liver transplant in Maharashtra
Liver Disease

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, D and E. These five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

What are the different hepatitis viruses?

Scientists have identified five unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.

  • Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.
  • Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. A safe and effective vaccine is available to prevent HBV.
  • Hepatitis C virus (HCV) is mostly also transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.
  • Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Safe and effective hepatitis B vaccines provide protection from HDV infection.
  • Hepatitis E virus (HEV), like HAV, is transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Cirrhosis is a condition that results from permanent damage or scarring of the liver. This leads to a blockage of blood flow through the liver and prevents normal metabolic and regulatory processes.

1. What are the major causes of cirrhosis?

The major causes of cirrhosis are as follows :

  • chronic alcoholism
  • viral infections caused by chronic viral hepatitis (types B, C and D)
  • metabolic diseases such as alpha-1-antitrypsin deficiency, galactosemia and glycogen storage disorders
  • inherited diseases such as Wilson disease and hemochromatosis
  • Biliary cirrhosis resulting from diseases such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC)
  • toxic hepatitis caused by severe reactions to prescribed drugs or prolonged exposure to environmental toxins
  • repeated bouts of heart failure with liver congestion

2. How do babies develop cirrhosis?

The major causes of cirrhosis are as follows :

  • Biliary atresia, a condition caused by absent or injured bile ducts, is the most common cause of cirrhosis in babies.
  • These babies are jaundiced after their first month of life due to a build-up of bile in the liver.
  • New ducts can be surgically formed in some cases restoring normal bile secretion. Transplantation is required in other cases.

3. What are some early symptoms of cirrhosis?

People in the early stages of cirrhosis have few symptoms. Some symptoms an individual may notice include :

  • loss of appetite
  • nausea
  • weight loss
  • fatigue
  • weakness
  • exhaustion

4. What happens as liver function decreases?

People in the early stages of cirrhosis have few symptoms. Some symptoms an individual may notice include :

  • As liver function decreases, fewer proteins such as albumin are produced resulting in fluid accumulation in the legs (edema) or abdomen (ascites).
  • Individuals with cirrhosis may bleed and bruise easily due to a decrease in proteins required for blood clotting.
  • Some people may even experience intense itching due to products that are deposited in the skin.
  • Problems associated with later stages of cirrhosis? In the later stages of cirrhosis, jaundice occurs and gallstones are more common because insufficient levels of bile reach the gallbladder.
  • A cirrhotic liver no longer removes toxins effectively leading to toxin accumulation in the blood, which in turn can impair mental function and lead to personality changes and possibly coma.
  • Early signs of toxin accumulation in the brain may include neglect of personal appearance, unresponsiveness, forgetfulness, concentration problems or changes in sleeping habits.
  • Because the normal cleansing process is impaired by cirrhosis, drugs are not properly filtered resulting in an increased sensitivity to drugs and their side-effects.
  • Normally, blood from the intestines and spleen is pumped to the liver through the portal vein.
  • However, cirrhosis blocks the normal flow of blood through the liver.
  • This can lead to swelling of the liver and potentially the spleen.
  • Blood from the intestines, is then forced to find a new way around the liver through new vessels.
  • Some of these new blood vessels called "varices" which form primarily in the stomach and oesophagus become quite large.
  • These varices may rupture due to high blood pressure (portal hypertension) and thin vessel walls, causing bleeding in the upper stomach or oesophagus.

5. How is cirrhosis diagnosed?

Cirrhosis is often diagnosed by medical analysis of the following :

  • Identifiable symptoms
  • Physical examination
  • CAT scan (computerized axial tomography)
  • Ultrasound
  • Radioisotope liver/spleen scan
  • Liver biopsy
  • Immediate treatment is recommended as soon as liver disease is diagnosed

6. What treatments are used to fight liver cirrhosis?

Cirrhosis is often diagnosed by medical analysis of the following :

  • Treatments of cirrhosis are aimed at stopping or delaying the disease progress, minimizing liver cell damage and reducing complications.
  • When cirrhosis is caused by alcohol, the patient must stop drinking to halt the progression of the disease.
  • Cirrhosis caused by viral hepatitis may be treated with antiviral drugs to reduce liver cell injury.
  • Medications can be given to control the symptoms of cirrhosis. For example, drugs called "diuretics" are used to remove excess fluid and to prevent edema and ascites from recurring.
  • Combined diet and drug therapy can improve altered mental function. For instance, decreasing dietary protein results in less toxin formation in the digestive tract.
  • Laxatives, such as lactulose, may be given to help absorb toxins and speed their removal from the intestines.
  • A serious consequence of cirrhosis may be bleeding as a result of portal hypertension.
  • Medications, such as beta blockers, may be prescribed to reduce portal hypertension.
  • Even when complications develop, they can usually be treated. If the patient bleeds from the varices of the stomach or oesophagus, the doctor can inject these veins with a sclerosing (hardening) agent administered through a flexible tube (endoscope) that is inserted through the mouth and oesophagus.
  • Rubber bands can also be placed around the veins through the endoscope.
  • In critical cases, a liver transplant or a portacaval shunt, which relieves the pressure in the portal vein and varices, may be necessary.

"We provide high quality, affordable service with our experience of more than 15 years in liver cancer surgery and transplantations"
Dr. Sanjeev Kanoria
FRCS (Eng & Glasg), FRCS (Transplant), MBA (LBS), PhD (UCL))
Managing Director & Senior Consultant Surgeon
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