Dr. Sandeep Kumar Jha, Consultant, Dept. of HPB Surgery and Liver Transplantation, Manipal Hospital, Delhi is a renowned Gastro-Onco & Liver Transplant Surgeon with brilliant professional qualifications including MBBS, MS, FMAS, DMAS, FICRS & DNB. In an exclusive interaction with The Interview World, he shares his expert views on various aspects of #liver diseases, advanced treatment procedures, transplantation, and secrets of keeping liver healthy.
Q: What are the key contributors to liver ailments in India?
A: In a large study done over 3 lakh population, 28% of patient presenting to the hospital have liver disease. Alcohol intake, Hepatitis B virus infection, Hepatitis C virus infection, non-alcoholic fatty liver disease are the predominant causes of liver disease. There are many other conditions that affect the liver but are relatively less common. Rising incidence of obesity and uncontrolled diabetes are leading to more cases of non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steato-hepatitis (NASH). It has been more recently recognised that the constellation of metabolic syndromes (diabetes, obesity, deranged lipid metabolism and hypothyroidism) may lead to liver disease and increasingly more cases of NAFLD/NASH are being recognised. Another common cause of liver damage in numerous health supplements, tonics, powders, supplements for liver health, traditional remedies etc that people consume very frequently and for long time. Many a times the liver function tests improve just on withholding these supplements.
Q: What are the common symptoms of liver diseases?
A: Fortunately, or unfortunately, liver is a very tolerant and robust organ. It does not complain until its very severely damaged. Hence, the symptoms of liver disease become obvious very late in the disease. Early signs or symptoms of liver disease are difficult to pick up but may include lethargy, jaundice, yellow colour of urine, poor appetite, weight loss, itching, abdominal pain, abdominal swelling amongst others. If you have any risk factors for liver disease like routine alcohol intake, Hepatitis B or Hepatitis C infection, diabetes, obesity, hyperlipidemia, then you should get evaluation of your liver done. A yearly health check-up including liver function tests and abdominal ultrasound may help us to pick up liver disease early.
Q: What are the advanced treatment procedures for liver diseases?
A: Liver transplant is the only curative treatment for cirrhosis. Cirrhosis is the end-stage of liver damage. Cirrhosis occurs after years of insult to the liver due to various causes. Cirrhosis is the stage of irreversible damage to the liver due to severe scarring and shrinkage. After this stage these changes cannot be reversed by medications and if decompensation or complications of disease arises then liver transplant is required.
Certain other conditions of liver like tumors (hepatocellular cancer and cholangio carcinoma), hydatid cyst, simple cyst, biliary cystadenomas etc can be treated by liver resection or removing the disease part of the liver. Many of these procedures are now done by laparoscopic or robotic approach.
Another common condition is the liver abscess where there is pus formation in the liver. If detected early, it might respond to antibiotics and resolve completely. However, if the liver abscess is large or impending rupture then drainage or surgery to remove the pus may be required.
Q: What are the requirements for liver transplantation & what’s its success rate in India?
A: Liver transplant can be performed via two techniques. In one technique, the donor liver is retrieved from a brain-dead donor/cadaveric/deceased donors and transplanted into the recipient (known as deceased donor liver transplant (DDLT)). Second technique, where a part of liver is taken from a living donor and transplanted into the recipient (known as living donor liver transplant (LDLT)). A blood group compatible, healthy, and fit donor who is 18-50 years of age and related to the recipient can be considered as a prospective donor. Donors undergo a series of tests to confirm their suitability for becoming a liver donor. Cost of transplant in private hospitals in Delhi varies between Rs. 18-20 lakhs. Success rate of liver transplant is close to 90%.
Q: How can we keep our liver healthy and lead a happy life?
A: Get yourself evaluated and tested for the causative factors for liver disease. If you have any of these conditions, then specific treatment of these conditions is required. You might have to be on regular follow-up to keep these causatives under check and your liver healthy. Very effective treatment is available today for both chronic hepatitis B and chronic hepatitis C which can effectively eliminate the virus form the body. Completely quit alcohol if your liver is diseased because alcohol can damage it further.
If none of these factors are present, then a healthy and fit lifestyle will help to keep your liver healthy. Keep your weight under check (BMI<25), have a balanced diet, keep your sources of food and water clean, avoid alcohol or drink only occasionally, exercise regularly, refrain from taking unnecessary health supplements or medications if not clearly indicated and keep your sugar, lipid, and thyroid status under check. Also get a yearly health check-up including blood investigations and abdominal ultrasound to catch liver disease early.
