ALCOHOLIC LIVER DISEASE - CARE TO KEEP LIVER HEALTHY

                                                                                

Alcoholic liver disease (ALD) is a term that encompasses the liver manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with liver fibrosis or cirrhosis. The liver is the largest gland in the body situated below the diaphragm, on the right side of the abdomen and has many vital functions to perform for the body. It filters the blood coming from the digestive tract before it passes to the body. Other important functions of the liver are metabolism of carbohydrates, proteins, lipids and amino acids in the body; production of bile that help in breaking down the fat and detoxification of chemicals and drugs. Its other functions include producing blood clotting factors, storage of glucose and clearance of bilirubin. Many factors can cause liver problems, but the major among them are virus infections, alcohol consumption and obesity. 

ALD is one of the major medical complications of alcohol abuse. Alcohol is the major cause of liver cirrhosis in all over world. Alcohol accounts for 80% of all liver cirrhosis cases seen in district general hospitals. Alcoholic cirrhosis is increasingly seen in countries such as Japan and India which traditionally had a low prevalence of the disease.

Causes

Alcohol abuse over the years leads to the replacement of healthy liver tissue with scar tissue. Considered as one of the biggest reasons for acute liver damage, alcohol is not only life-threatening but can also cause liver failure. Excessive consumption of alcohol can result in scarring of the liver and can cause ALD (alcohol-related diseases). Over time, scarring and cirrhosis can occur. Cirrhosis is the final phase of alcoholic liver disease.

Risk Factors

Lifetime intake of alcohol - Alcoholic liver disease does not occur in all heavy drinkers. The chances of getting liver disease go up the longer you have been drinking and more alcohol you consume. You do not have to get drunk for the disease to happen. The disease is common in people between 40 and 50 years of age. Men are more likely to have this problem. However, women may develop the disease after less exposure to alcohol than men.

Drinking pattern - The pattern of drinking was also important as ALD is increased in those who drink without accompanying food and also in those who drink multiple different alcoholic beverages. It is well known that food delays gastric emptying and intestinal absorption of alcohol and thus intake of food before drinking will decrease the rise of blood alcohol concentrations. The absorption of alcohol is lower when consuming low concentration beverages such as beer compared with high concentration spirits.

Genetic factors - Some people may have an inherited risk for the disease.

Stages of Alcoholic fatty liver disease 

ALD occurs in three stages viz. 

·         Fatty Liver (steatosis)

·         Alcoholic Hepatitis,

·        Liver Cirrhosis.

At least 80% of heavy drinkers develop steatosis, 10%–35% develop alcoholic hepatitis, and approximately 10% will develop cirrhosis

Fatty Liver – It is the first stage of ALD, and is also known as steatosis. Fatty Liver is a highly prevalent liver disease, which is characterized by an excessive accumulation of fat inside the liver cells. It makes it hard for the liver to function properly. Heavy drinkers usually get to the fatty liver stage in their early years of alcohol abuse. This reversible if alcohol use is stopped. Mild Fatty liver is usually asymptomatic. It is detected incidentally during routine tests performed. However, some persons can have symptoms which are often vague like Malaise , Fatigue - even with moderate exertion, Fullness and heaviness in the abdomen, more in the right upper corner, Occasionally the liver maybe painful on pressure.

Alcoholic Hepatitis – The second stage of ALD, Alcoholic Hepatitis is characterized by the inflammation of the liver leading to the degeneration of liver cells quickly. This stage might last for some years but will eventually progress to absolute liver damage if the patient continues to drink. In critical cases, it can lead to life-threatening complications like liver cirrhosis and absolute liver damage. Jaundice is the most common symptom in this stage along with Nausea, Vomiting, Loss of appetite, Abdominal tenderness, Fatigue and weakness, Weight loss.

Liver Cirrhosis – Liver cirrhosis is the last and final stage of Alcoholic Liver Disease where permanent scarring of healthy liver tissue occurs. It is a severe condition and an irreversible one. A patient with liver cirrhosis will witness liver failure symptoms, along with the symptoms of alcoholic hepatitis like Fluid accumulation in the abdomen, Spleen enlargement, Bleeding from veins, Confusion

Clinical presentations

Early symptoms - these are often quite vague, such as  abdominal (tummy) pain, loss of appetite, fatigue, feeling sick, diarrhoea, feeling generally unwell

Advanced symptoms -  As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as  yellowing of the skin and whites of the eyes (jaundice), swelling in the legs, ankles and feet caused by a build-up of fluid (oedema), swelling in abdomen caused by a build-up of fluid known as ascites, a high temperature (fever) and shivering attacks, very itchy skin, hair loss, unusually curved fingertips and nails (clubbed fingers), blotchy red palms, significant weight loss, weakness and muscle wasting, confusion and memory problems, trouble sleeping (insomnia) and changes in your personality caused by a build-up of toxins in the brain, passing black, tarry poo and vomiting blood as a result of internal bleeding, a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums, increased sensitivity to alcohol and drugs because the liver can't process them

Diagnosis

Alcohol liver disease (ALD) is often first suspected when tests for other medical conditions show a damaged liver.

This is because the condition causes few obvious symptoms in the early stages.

Blood tests used to assess the liver are known as liver function tests. But liver function tests can be normal at many stages of liver disease. Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver. A low level of serum albumin suggests your liver isn't functioning properly. A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage.

Other test in later or advanced stages of ALD are ultrasound scan, CT scan, MRI, Liver biopsy, endoscopy etc.,

Tips for preventing and treating alcoholic liver disease

Withdrawal

Complete abstinence from alcohol is the most important therapeutic intervention for people with Alcoholic Liver Disease. Abstinence from alcohol reduces the risk of further damage to the liver, but it also provides it with a chance to recover. Patients suffering from ALD should completely refrain from drinking, thereby improving the outcome & histological features of hepatic injury. They should give their body a chance to reduce portal pressure and decrease progression to cirrhosis. It eventually helps to improve survival at all ALD stages.

Nutritional Therapy

One of the major complications of ALD is malnutrition, especially in patients who are on the second stage of alcoholic hepatitis. In patients with ALD, protein-calorie malnutrition is highly prevalent.

Natural Treatment

Certain natural remedies may be helpful in healing fatty liver when part of a personalized and well-rounded treatment plan. Before taking natural remedies, consult with medical doctor as well as a nutritionally and botanically trained health care professional.

Vitamin E is an antioxidant, meaning it protects against free radical damage. This can be especially helpful for the liver because free radicals form during the natural detoxification process. Vitamin E also supports the immune system and can help prevent fibrosis and cirrhosis, which are common complications of long-term fatty liver.

Turmeric is popular both as a culinary spice and for its medical properties. Turmeric, also known as Curcuma longa, is used in Chinese and Ayurvedic medicine to treat liver ailments, digestive problems and skin diseases. Turmeric has a strong antioxidant and anti-inflammatory properties. It protects liver cells against damage and reduces inflammation that results from fatty liver. Turmeric may be sprinkled on food as a spice or taken as a tincture or capsule.

Milk thistle is a well-known all-natural solution for the treatment of liver disorders. The active component perfectly located at the seed will be the phytochemical silymarin. Silymarin is often a flavonoid which helps bring about regeneration regarding harmed hard working liver tissue and also improves liver organ purpose.

Omega-3 essential fatty acids are located naturally within flax plant seeds, seed natural skin oils like flaxseed along with canola oils, bass oils as well as chilly water seafood like fish. Omega-3 essential fatty acids can have outstanding hard working liver health improvements, enhance the action involving insulin, as well as aid many individuals who are suffering through junk lean meats condition. In addition, Omega-3 fat lower swelling and pain some of those who are experiencing any junk liver condition.

HOMOEOPATHIC MANAGEMENT

Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat fatty liver symptoms but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat fatty liver symptoms that can be selected on the basis of cause, sensations and modalities of the complaints.  For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of fatty liver symptoms:

Arsenic Album, Nux Vomica, Chelidonium, Cardus m, Apocynum, Lycopodium, Sepia, Phosphorous, Digitalis, Bryonia, Helleborus Niger, Ferrum Met, kali Carb, Iris V, Natrum Carb and many other medicines.

Indicated Remedies	Indications
Bryonia. [Bry]	When there are stitching pains in the right hypochondriac region, Bryonia is the first remedy to be thought of, though for these pains we have other remedies, such as Chelidonium and Kali carbonicum. Under Bryonia the liver is swollen, congested and inflamed; the pains in the hypochondriac region are worse from any motion, and better from lying on the right side, which lessens the motion of the parts when breathing. It is one of the chief remedies for jaundice brought on by a fit of anger.
Mercurius. [Merc]	This remedy has much sensitiveness and dull pain in the region of the liver; the patient cannot lie on the right side. The liver is enlarged. The skin and conjunctiva are jaundiced. The stools are either clay-colored from absence of bile, or yellowish-green bilious stools passed with a great deal of tenesmus. There is a yellowish white coated tongue which takes the imprint of the teeth and there is a foetid breath, loss of appetite and depression of spirits.
Podophyllum. [Podo]	The principal use of Podophyllum is in liver affections. Primarily, it induces a large flow of bile, and, secondarily, great torpidity, followed by jaundice. It is indicated in torpid or chronically congested liver, when diarrhea is present. The liver is swollen and sensitive, the face and eyes are yellow and there is a bad taste in the mouth. The tongue is coated white or yellow and the bile may form gall stones.
Chelidonium. [Chel]	The liver symptoms of Chelidonium are very prominent. There is soreness and stitching pains in the region of the liver, but the keynote for this drug in hepatic diseases is a pain under the angle of the right shoulder blade, which may extend to the chest, stomach, or hypochondrium; there is swelling of the liver, chilliness, fever, jaundice, yellow coated tongue, bitter taste and a craving for acids and sour things, such as pickles and vinegar.
Digitalis. [Dig]	When jaundice arises from cardiac diseases, Digitalis may be the remedy. There is no retention of bile, nor obstruction of the ducts, but the jaundice is due to the fact that the liver does not take from the blood the elements which go to form bile. There is present drowsiness, bitter taste, soreness , enlargement and bruised feeling in the region of the liver.
Myrica cerifera. [Myric]	Myrica is an important liver remedy. There is first despondency and also jaundice due to imperfect formation of bile in the liver, and not to any obstruction, comparing here with Digitalis. There is dull headache, worse in the morning, the eyes have a dingy, dirty, yellowish hue, the tongue is coated yellow.
Nux vomica. [Nux-V]	In liver affections occurring in those who have indulged to excess in alcoholic liquors, highly seasoned food, quinine, or in those who have abused themselves with purgatives, Nux is the first remedy to be thought of. The liver is swollen hard and sensitive to the touch and pressure of clothing is uncomfortable. The first remedy in cirrhosis of the liver. Colic may be present.
Lycopodium. [Lyc]	Lycopodium acts powerfully on the liver. The region of the liver is sensitive to the touch, and there is a feeling of tension in it, a feeling as if a cord were tied about the waist. Cirrhosis. The pains are dull and aching instead of sharp and lancinating, as under Chelidonium. Fulness in the stomach after eating a small quantity.
Carduus marianus. [Card-m]	This remedy is indicated in jaundice with dull headache, bitter taste, white tongue with red edges, nausea and vomiting of a greenish fluid. There is an uncomfortable fullness in the region of the liver, the stools are bilious and the urine golden yellow; there is sensitiveness in the epigastrium and right hypochondrium. Burnett regards a dark brownish patch over the lower part of the sternum as a useful hint for Carduus, and in such cases he observes that both the liver and heart are at fault. The presence of "liver spots seems to be a special indication for the remedy.
Sulphur. [Sulph]	Sulphur is suitable to chronic affections of the liver; it increases the flow of bile and there is much pain and soreness in the liver. Sulphur often completes the cure commenced by Nux. Liver complaints from abuse of mercury will oftentimes call for Sulphur. If the stools are colorless and if much jaundice or ascites be present Sulphur is contra-indicated. Lachesis, however, has jaundice, as do all snake poisons, and is useful in the enlarged livers of drunkards, with tenderness on pressure and throbbing in the right side.
Phosphorus. [Phos]	Phosphorus is homoeopathic to fatty degeneration of the liver, with well marked soreness and jaundice. The stools are grayish white. Cirrhosis and atrophy may also call for Phosphorus. The jaundice is indicative of organic diseases, and the remedy is a useful one in malignant diseases of the liver. Digitalis has also been recommended in acute yellow atrophy. Jaundice accompanying pneumonia may also call for Phosphorus.
Taraxacum [Tarax]	This is a decided liver remedy, and the indications are a mapped tongue and a bitter taste in the mouth, chilliness after eating, pain and soreness in the region of the liver and bilious diarrhoea. Kali bichromicum also has a mapped tongue. Yucca filamentosa has a pain going from the upper region of the liver to the back and a bad taste in the mouth. The stools are loose and bilious, accompanied with much flatus.