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Liver cirrhosis may go undiagnosed over 1-2 decades
The commonest cause of long drawn (chronic) liver disease in India is Alcoholic liver disease. The disease is silent in its initial phases lasting for 1-2 decades.
The disease evolves in three patterns – to begin with fat accumulates in liver. Swelling or inflammation of liver cells follows and after many years inflammation, scar tissue forms inside the liver and when these accumulate silently, ultimately results in cirrhosis of liver.
Dr Harikumar R Nair, senior consultant hepatologist and liver transplant physician, Gleneagles Global Health City, said that alcoholic liver disease is largely silent and only an advanced stage of alcoholic cirrhosis patient develops symptoms. Cirrhosis generally occurs due to heavy alcohol consumption, but this quantification of alcohol needed to develop cirrhosis is highly variable and depends on other factors like genetic makeup of the individual and lifestyle. Those who have lifestyle disorders like diabetes, raised blood pressure, raised cholesterol levels have more risk of fatty liver and alcoholism in them may accelerate liver damage resulting in cirrhosis at a younger age.
Alcoholic liver disease occurs in three stages
Alcoholic fatty liver- first stage of alcoholic liver disease. Protracted – a decade or more, but essentially asymptomatic. Abstinence from alcohol can reverse this stage of fat accumulation. Ongoing drinking.
Alcoholic Hepatitis– The second stage where liver inflammation occurs. This can be catastrophic with high death rate. Symptomatic alcoholic hepatitis necessitating critical care occurs in heavy drinkers and may present with the symptoms like nausea, vomiting, loss of appetite, abdominal tenderness, fatigue and weight loss, bleeding tendency and brain dysfunction.
Alcoholic Liver Cirrhosis- As the phase of liver cell swelling progresses, in due course scar tissue accumulates in liver, distorts the structure and causes rise in liver pressure (portal hypertension). This eventually results in water logging- accumulation of water inside the abdomen and swelling of legs. Bleeding from veins in the food pipe and stomach, brain dysfunction (hepatic encephalopathy), loss of muscle mass. Raised liver pressure can cause changes in heart, lung and kidney. Formation of liver cancer is yet another risk.
Doctors say that once cirrhosis sets in, the most important step to improve survival is total abstinence from alcohol. Medical management in advanced stages of cirrhosis is mostly palliative, managing complications of end stage liver disease. Liver transplant is the only curative option once liver cirrhosis reaches complicated phase known as End Stage Liver Disease (ESLD).
“Due to long standing alcohol consumption, scar tissue forms in the liver. Accumulation of this scar tissue beyond a level is termed as liver cirrhosis. Anybody with liver cirrhosis runs additional risk of liver cancer. Each ml of alcohol is harmful to the liver and other organ systems. Whatever be the source/type of alcohol, whether it is beer, whiskey, brandy or wine, damage to the liver depends on the amount of Absolute alcohol (100 per cent alcohol) which reaches the liver,” added Dr Harikumar.
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