welcome to global hospitals

Eminent Liver Transplantation Surgeons from across the world come together for an International Liver Conclave organized by Global Hospitals

2011-12-01T06:47:00.000-08:00

Highlights:

· First of its kind 3 day scientific session - “Master Class in Liver Diseases”

· Over 30 eminent doctors from USA & Europe & over 300 nationally renowned liver specialists congregate to demonstrate the current concepts and trends on liver transplantation from across the globe

Chennai, December 1^st 2011: Global Hospitals Group is organizing a 3 day international liver conclave, ‘Master Class in Liver Diseases’ in Chennai starting 2^nd December to 4^th December 2011. This 3 day scientific conference will be spearheaded by the world renowned Liver transplantation surgeon Prof. Mohamed Rela. Over 30 eminent doctors from USA & Europe and over 300 nationally renowned liver specialists will be present to demonstrate the current concepts and trends on liver transplantation across the globe.

MASTER CLASS IN LIVER DISEASES is the first of its kind, a 3 day scientific conference, discussing various Clinical aspects of Liver diseases & Transplantation, which will give the Indian audience a holistic and in depth understanding of liver diseases. International Faculties participating in the conclave include, Prof. Bernard C. Portmann, Dr. Alberto Quaglio, Prof. Elwyn Elias, Prof. Diedre Kelly, Prof. S. Wali, Prof. Ashley D’Cruz, Prof. Abid Suddle, Prof. Jack Lake, Prof. Julia Wendon, Prof. Nigel Heaton and Prof. Anil Dhawan amongst many other national faculties.

Global Hospitals acknowledged as the world’s most comprehensive centre for Liver, Pancreas diseases and transplantation offers the largest Liver Transplant program in the country. The Global Liver Transplant program is currently available in three centers across South India, Hyderabad, Chennai & Bangalore and is soon expected to be operational in Mumbai. With all the facilities and the technical knowhow, Global Hospitals has successfully set new standards in the management of liver diseases.

The incidence of liver diseases in India is on a rise. Cases related to hepatitis, liver cirrhosis, liver tumours are being frequently reported. A liver infection is considered to be a serious medical condition thus it should not be taken lightly.

Commenting on the occasion, Prof Mohamed Rela, Director of The Global Liver Transplant Program said, “At present India has 25 well qualified Liver transplant surgeons and would require 5 times more surgeons than the present number which is not enough. Also he said “Indian doctors need not travel abroad for training in liver transplantation as the facilities in India has improved to a larger extent and the international doctors will travel to India for training in the coming 5 years.” He also said that “Success rate of liver transplantation is 90% when the patient condition is stable, 80% if the patient is sick and 75% when the patient is on dialysis”.

Prof Mohamed Rela, Director of The Global Liver Transplant Program, is an internationally acclaimed liver transplant & Hepatopancreatobiliary surgeon who started the first successful program of living donor liver transplantation in the UK. With the arrival of Prof. Mohamed Rela, many milestones in Liver Transplantations have been achieved in last 2years at Global Hospitals & Health city, Chennai.

India’s first Split & Auxiliary Liver transplantation
India’s first Adult SWAP Liver transplantation
5 combined liver & kidney transplantations successfully performed in last 6 months
21 Paediatric liver transplantations successfully performed in last 1 year; wherein very few hospitals have the capability of performing Successful Paediatric Liver transplantation and just about 75 Paediatric liver transplantation has been performed in India so far.

About Prof. Mohamed Rela

Prof Mohamed Rela, an internationally acclaimed liver transplant & Hepatopancreatobiliary surgeon, is the Dirctor of the Global Liver Transplant Program. He had pioneered the first successful program of living donor liver transplantation in the UK and had performed the first successful living donor liver transplantation in Mumbai about 12 yrs back. He has an international reputation as one of the most innovative surgeons in the field of HPB surgery and Liver Transplantation and has pioneered some of the major technical advances such as split liver transplantation and auxiliary liver transplantation. He started the first successful program of split liver transplantation at King’s College Hospital and now has the highest experience in the world with the best results. He performed India’s First Split and Auxiliary Liver Transplant at Global Hospitals & Health city, Chennai in Sep’09. He has described techniques for safe transplantation of neonates born with liver failure and has performed a successful liver transplantation in the youngest child ever to have transplant (5 days of age) which has earned him a place in the Guinness Book of World Record 2000 Edition. He was recently awarded a Chair (Professorship) in Liver Surgery and Transplantation by the prestigious University of London, in honor of his excellent academic accomplishments.

The liver transplant program of the Global Hospitals Group is the largest in the country and has successfully completed 100 liver transplants cases most of which were refused by other healthcare establishments. Liver transplantation is now available in three centers across South India - Hyderabad, Chennai, and Bangalore and will be available in Mumbai in the near future.

ABOUT GLOBAL HOSPITALS GROUP

The Global Hospitals Group started a decade ago in Hyderabad, today has hospitals spread strategically across the country in Bangalore and Chennai and many more in advanced stages of planning and implementation. One such is the Mumbai branch, which will be operational by the end of this year. Each one of them are a tertiary care multi specialty hospital with facilities matching the best in the world and offering advanced patient care of international standards. The medical infrastructure and technology at Global Hospitals & Health city is among the best in the world. To the patient it directly translates as the highest standards in safety. Zero infection zones, certified zero infection blood and blood components are just a few examples of the enormous care that Global Hospitals take and the stringent quality control norms that are strictly followed in every aspect impacts the patient safety and comfort. Thus with all the facilities and the technical know how, Global has successfully set new standards in healthcare management. Global Hospitals group currently has hospitals located in the cities of Hyderabad, Bangalore and Chennai. Global hospital currently awaits the launch of its Mumbai facility and has announced its entry in Kolkata too.

Invitation for International Scientific Programme on Liver Diseases

2011-11-11T03:14:00.000-08:00

Dear All,

It is my great pleasure and honor to invite you for the "Clinicopathological Meet" which will be held in Chennai, South India from December 2nd to 4th 2011. This meeting in unique and first of its kind, incorporating Histopathology along with Clinical Hepatology, which will give the audience a holistic and in-depth understanding of liver diseases. The organizing Committee has made every effort to put together an attractive programme, which consists of lectures by eminent National & International speakers followed by relevant Histopathological and Clinical discussions.

I sincerely look forward to welcome you all for this meeting.

Warm Regards,

For more information, kindly visit: http://www.mcldindia.com

Invitation for TRAICA 2011 – CME on Fundamentals of Transplant Anaesthesia and Intensive Care

2011-11-10T03:21:00.000-08:00

TRAICA 2011 – CME on Fundamentals of Transplant Anaesthesia and Intensive Care
Sunday, 13^th November, 2011, 08:30 am – 04:30 pm
at the Auditorium, Global Hospitals & Health City, Chennai, Tamil Nadu, India

INVITATION

Dear Colleagues,

It is our privilege to invite you to participate in the CME on transplant Anesthesia and Intensive Care (TRAICA 2011). The first of its kind in India, being organized by the Global Hospitals and Health City and the Indian Society of Anesthesiologist, Chennai city branch to be held on the Sunday, 13^th November 2011.

The scientific program has been designed carefully keeping in view the latest developments in Anesthesia and Intensive care aspects of Liver, Heart, lung, Kidney and Pancreas transplantation that includes topics of interest and practical relevance.
This program continues our commitment to examine the most current challenges in transplant anesthesia. The faculties invited are pioneers in the field of transplantation and this CME is suitable for post graduates, anesthetists, intensivists, surgeons and physicians.

We look forward to welcoming you to the CME and hope to make this a memorable experience for you.

With Warm Regards,

Dr.K.Ilankumaran,
Organizing Secretary
Consultant in Anaesthesia and Intensive Care
Mobile: +91 9566111566
Email: dr.k.ilankumaran@gmail.com
Global Hospitals and Health City, Chennai

HIGHLIGHTS:
·         First of its kind in India
·         Brief surgeon’s perspective of transplantation
·         Eminent faculty from all over India
·         Faculties with vast experience from world’s leading transplant Centres
·         Includes Liver, Heart, Lung, Kidney and Pancreas transplantation
·         Brief coverage on organ transplantation intensive care
·         Interactive discussion with Anaesthetists, Intensivists, Surgeons and Physicians
·         Departmental tour (pre-registration required)

GUEST LECTURE:

“20 years in the field of Liver Transplantation” – Prof. Mohamed Rela, MS, FRCS, Head & Chief Surgeon – HPB & Liver Transplant Surgery, Institute of Liver, Pancreas Diseases & Transplantation, Global Hospitals Group

TOPICS:

·         Basics of organ donation and management if brain dead donor – Dr. T. Venkatachalam, MD, DA, MMC
·         Overview of Anaesthesia for Liver transplantation – Dr. Akila Rakakumar, MD, FRCA, Chennai
·         Liver transplant receipients: Intraoperative management – Dr. Vijay Vohra, MD, FRCA, Medanta, Delhi
·         Case Report: 1. Paediatric combined Liver and Kidney transplantation. 2. Transfusion free Liver transplantation – Dr. K. Ilankumaran, DA, FRCA, Chennai
·         Current Scenario of Heart and Lung Transplantation in India – Dr. N. Madhu Sankar, M.S, Ph.D, Dip. N.B, Chennai
·         Orthotopic heart transplant – Anaesthetic considerations – Dr. V. Soundararajan, MD, Chennai
·         Anaesthetic implications for donor and recipient during lung transplant – Dr. N. Kanagarajan, MD MMM, Chennai
·         Aneasthetic conditions for transplant receipients coming from non-transplant surgeries – Dr. Lakshmi Kumar, MD, Amrita
·         An update: Anaethesia for renal transplantation _ dr. Ganapathy Asokan, MD, DA, Chennai
·         Pancraeas Tranplantation – the final frontier – Dr.N.Sezhian, FRCS, ASTS, Chennai
·         ABC of anaesthesia for pancreas transplantation – Dr.V.G.Venkatesan, DA, FRCA, Chennai
·         Common post-operative problems in transplant recipients – Dr. Srinivas Rajagopalan, MD, DM, Chennai
·         Gadgets and their role in a transplant scenario
·         Transesophageal echocardiogram – Dr. Ganesh, MD, DM, Chennai
·         Thromboelastogram – Dr.Selvakumar, MD, Chennai
·         Organ transplant Anaesthesia – the future – Prof. M.V.Bhimeswar, MD, Hyderabad

ORGANIZING COMMITTEE:

Chief Patron:

Dr. Ravindranath, Chairman & Managing Director, Global Hospitals Group

Advisors:

Dr. Kirthivasan, DA, DNB, HOD, Cardiac Anaesthesia
Dr.R.Silamban (ISA)

Committee Members:

Dr. V.G.Venkatesan, DA, FRSA
Dr. Akila Rajakumar, MD, FRSA
Dr. Priti Narayanan, MD
Dr. Srinivas Rajagopalan, MD, DM
Dr. Rajasaravanan, MD
Dr. Madhan Kumar, MD

EMINENT FACULTY:

Prof. Madhan Kumar, Stanley
Prof. Shanmugan, KMCH
Prof. Mahesh Vakamudi, SRMA
Dr. M.S.Ravi, MD, DM
Dr. Thillai Valla, MD, DM
Dr. Ramesh, MD, Child Trust

Know About Osteoporosis

2011-10-19T23:01:00.000-07:00

Osteoporosis

Osteoporosis or “porous bone” - a common metabolic bone disorder affecting 200 million people worldwide –is a slow progressing and silent disease that becomes symptomatic with a fracture. Osteoporosis affects both men and women, usually as they grow older. Adequate steps taken can reduce the risk of developing osteoporosis and avoid the debilitating bone fracture, which occurs because of the disease.

About Osteoporosis

Osteoporosis is a metabolic bone disorder characterised by low bone density and deterioration of bone micro architecture that reduces bone strength and increases the risk of fracture especially of the hip, spine and wrist.

Human bone is involved in the process of continuous remodelling, comprising of bone resorption and new bone formation. Osteoporosis is the result of imbalance in bone remodelling. In osteoporosis, there is too much bone loss and too little repair or vice-a-versa, resulting in low bone mass. This causes the bones to become thinner and structurally weaker. This imbalance gets more pronounced with advancing age and hence elderly people are more susceptible to osteoporosis.

Causes/Risk Factors for Osteoporosis

The causes and risk factors for osteoporosis are many. A few of them are listed below:

Previous fracture at <50 yrs
Parent or sibling with previous fractures
Cigarette smoking
Senility
Malnutrition
Low calcium intake
Hormonal disturbance
Excessive alcohol intake
Physical inactivity
Excessive intake of certain medications like steroids

Symptoms

Osteoporosis is a disorder with many obvious symptoms. Some of these symptoms are:

Pain in the bones
Fractures with little or no trauma
Loss of height (as much as 6 inches over time)
Low back pain due to fracture of bones of the spine (lower)
Neck pain (fracture of bones of spine in the neck)
Stooped posture

Diagnosis of Osteoporosis

Diagnosis of osteoporosis is basically done with DEXA (Dual energy X-ray (absorptiometry), which is a simple test that measures the bone mineral density (BMD) in different parts of the body such as spine and hips. It is a quick and painless test similar to having an X-ray taken bit uses much less radiation. The results of the DEXA test are scored in comparison to the BMD of young healthy individuals resulting in a measurement called T score. Bone density is considered normal if the T score is between 1.0 and -1.0

The World Health Organisation (WHO) has defined bone disease based on BMD T scores:

Osteopenia (low bone mass): Tscore between -1 and -2.5
Osteoporosis: T score greater than or equal to -2.5
Established osteoporosis: T score less than -2.5 and the presence of fracture

Treatment for Osteoporosis

Treatment of osteoporosis is a two-step process, which are:

Goals of Treatment:

A part of the treatment includes setting up the goals, which include:

Maintain bone mass and integrity
Slow down the bone loss
Treat the symptomatic problems and its sequel

Maintain Bone Health:

The next part is to maintain the deteriorating bone density:

Life style adjustments
Minimise use of alcohol
Stop smoking
Reduce the intake of coffee
Avoid carbonated beverages
Supplemental calcium and vitamin D
Enough calcium in the diet (1000mg per day of calcium for adults under the age of 50 and 1200mg per day of calcium for those 50 and older)
Taking adequate vitamin D, which is important for calcium absorption and for maintaining muscle strength. The recommended dosage is 400-800IU per day for adults lesser than 50 and 800- 1000IU for those age 50 and older)
Physical exercise programmes tailored to the needs of the individual patient. This includes balance training, postural training, resistance training, stretching and weight bearing aerobic exercise. In patients with severe osteoporosis, activities that require vigorous flexing or rotation of the spine should be avoided.

Medications

Medications used in the prevention and treatment of osteoporosis are those which either reduce the bone loss (antiresorptive) or increase the bone growth (anabolic). These include:

Bisphosphonates (alendronate, risedronate, ibandronate and zolendronic acid): These have been approved for the prevention and treatment of postmenopausal osteoporosis in women and osteoporosis in men.
Calcitonin: This medication is given usually as a nasal spray or as an injection under the skin. This is helpful in controlling the pain after an osteoporotic vertebral fracture.
Estrogen or Hormone Replacement Therapy: This medication reduces the risk of osteoporosis and osteoporotic fracture. This increases the risk for breast cancer, stroke, and heart attack.
Selective Oestrogen Receptor Modulators (SERMs): This medication mimics the good effects of oestrogen in bone without the serious side effects (breast cancer).
Teripartide (forteo): This medication is a form of parathyroid hormone that helps to stimulate the bone formation.

Few Points to Remember…

In Osteoporosis, the bones are weak and break easily, resulting in severe limitation of activities and bring down the quality of life as well increase the risk of death, especially after 65 years.
Osteoporosis occurs in both sexes but is more common in women.
Osteoporosis may not be outwardly apparent until a fracture occurs. It can be detected before the first fracture, if the risk factors are identified and BMD test are done in time.
It is never too early to adopt preventive measures or too late to begin treatment to prevent further fracture.
Leading a healthy lifestyle, having a balanced & regular check up with your Physician or Rheumatologist are the key points to prevent Osteoporosis
The more you know about the prevention and treatment of osteoporosis the better are your chances of staying active and independent.

Dr. R. Kirthi
MD DM (Rheumatology)
Consultant Rheumatologist
Global Hospitals & Health City

GUIDELINES TO TRAUMA CARE

2011-10-16T23:14:00.000-07:00

With World Trauma Day being celebrated every year on October 17^th, Global Hospitals is issuing a few important points essential to trauma care. These are:

Critical Period: It is defined as the period during which all efforts are made to save a life before irreversible pathological changes can occur. This period may range from the time of injury to definitive treatment in a hospital. The first platinum 10 minutes becomes important to make Critical Period effective. If appropriate action is taken during the Critical Period to restore airway, breathing and circulation, life-saving attempt would turn out to be productive and rewarding.

Cardiopulmonary Resuscitation or CPR: It has been found to be very effective when initiated as soon as possible after the trauma (within minutes).CPR includes Chest Compressions and Mouth-to-Mouth rescue. Chest compressions are performed by applying downward pressure to the chest wall with the hands positioned in a specific way over the breast bone. These compressions cause blood to be pumped from the heart to other vital organs. Mouth-to-mouth rescue breathing is the quickest way to get oxygen into a person's lungs when a patient is not breathing. It is important to alternate chest compressions with rescue breathing while performing CPR.

Preventing Blood Loss: Severe bleeding can be life threatening. Applying direct pressure to the external bleeding can stop almost any form of bleeding. This is the most important first aid to be given. Always wash hands before and after giving first aid to avoid infections. Try to use latex gloves when treating a bleeding victim.

Broken Bones: If the injury includes fracture or broken bones, then try to keep the person still and calm. Reassure the victim and evaluate for the presence of other injuries. Call for medical help and allow the medical personnel to take over if there is an immediate response.

On the Arthritis Day: Art of Living with Arthritis

2011-10-12T03:23:00.000-07:00

Every morning your joints scream pain. You are no longer able to take those long walk you have always loved. You dread when winter sets in. Your days seem to open with pain and close with aches. Life is no longer the bed of roses it used to be, but has turned into a tryst with

pain.

Living with Arthritis can be difficult but not it is impossible. With the right medication, help and support, there is hope for every Arthritis patient.

Common belief seems to be that nothing can be done about arthritis. This is a myth. There are a variety of medications that have been introduced to the market within the last year to treat various types of arthritis. It is critical that one gets an early and accurate diagnosis to minimize the effects of arthritis.

One may not be able to prevent arthritis but those who have arthritis can take part in a treatment plan tailored to meet their individual needs. The first step is to make sure you have a proper and correct diagnosis. Your doctor can diagnose arthritis based on the overall pattern of symptoms, medical history, physical exam, x-rays and lab tests.

Arthritis can cause anxiety and weakness. To combat anxiety and weakness, relaxation exercises can be done on a regular basis. However, one must not exert and must be able to find a balance between work and activity.

There are other techniques used to manage arthritis. These include planning ahead to make work easier, maintaining proper body posture and practicing joint protection techniques with the help and support of your doctor.

You must also ensure that you take a balanced diet with emphasis on having foods that help keep bones healthy such as nuts, fish, milk, and other calcium-rich foods.

Proper medication, healthy diet and balanced physical activity can help your bones reach optimum performance.

HEALTHY HEART FOR A HEALTHY LIFE

2011-09-29T04:16:00.000-07:00

A strong heart is a result of healthy lifestyle choices.

Be active and stress-free

Fast-paced life & workplace pressures escalate stress levels, taking a toll on one's heart. The healing power of the body decreases when under stress, leading to many complications like hypertension and poor immunity. Even youngsters are prone to heart ailments. It's very important to stay healthy with a healthy heart and manage stress levels by understanding the risk factors, high cholesterol levels, stressful lifestyle, smoking, and lack of exercise. By following simple changes in lifestyle we can have a healthy heart & lead a healthy life.

Symptoms of Heart attack:

Symptom	Description
Discomfort / pain in the chest	Can feel like a tight ache, pressure, fullness or squeezing in the centre of the chest lasting for a few minutes or more. The sensation may come and go in spurts.
Pain in the upper body	Pain or discomfort may spread beyond the chest to the shoulders, arms, back, neck, teeth or jaws. Upper body pain may not always be accompanied by chest discomfort
Pain in the stomach	This heart burn-like pain may extend downward into your abdominal area
Shortness of breath	You may pant for breath or want to take deep breaths. This often occurs before the onset of chest discomfort.
Anxiety	You may feel a sense of doom or panic.
Light-headedness	You may feel giddy or like you might faint.
Sweating	You may suddenly break into a sweat with cold, sweaty skin.
Nausea and Vomiting	You may feel sick to your stomach or vomit.

How to prevent Heart Attack

Avoid smoking: Smoking reduces life expectancy by 15-25 years. If you are a smoker, you are twice more likely to have a heart attack than a non-smoker. The moment you stop smoking, the risk of heart attack begins to reduce.

Exercise: At least aim for 30 minutes of moderate exercise a day. Keeping yourself fit not only benefits the heart but also improves mental health and well-being. Monitor your BP, blood sugar and cholesterol levels: Routine medical check-ups will ring an alarm, if you need medical help.

Cut down on salt: Too much salt can cause high blood pressure, which increases the risk of developing coronary heart disease.

Watch your diet: Try to have a balanced diet. Eat fresh fruits and vegetables, starch foods such as wholegrain bread and rice.

Manage your waist: Cholesterol deposition in blood vessels begins in the first decade of life. Carrying a lot of extra weight as fat can greatly affect your health. Make small but healthy changes in your diet.

Check your family history: If a close relative had coronary heart disease at a younger age (less than 50 years), then you could be at risk too.

Manage your stress level: If you find things are getting on top of you, you may fail to eat properly, smoke and drink too much. This may increase your risk of a heart attack. Practice yoga/meditation. Take a vacation.

Monitor your alcohol: Too much alcohol can damage the heart muscle, increase blood pressure and also lead to weight gain. Avoid intake of alcohol or at least limit it to one to two pegs occasionally.

Laughter is the best therapy: Laughter anytime will work wonders for you. It is an instant way to unleash the pressure and it makes you feel light.

WHY SHOULD ONE GO FOR A PERIODIC HEART CHECK UP?

Most victims of heart attack do not know about the heart disease until the heart attack
Indians are genetically 3 times more vulnerable than their European counterparts
Every 4^th person develops a simple or complex heart problem around the age of retirement

During Emergencies Remember the Golden Hour

Emergency treatment during the first hour of any critical medical case is it a heart attack or an accident, makes the difference between life and death. It is termed as the 'golden hour', and the first 10 minutes of that hour are termed as the 'Platinum 10 minutes'.

The wisest recommended action is to seek expert medical help at the earliest by calling the Accident & Emergency number and taking the necessary precautions till it arrives.

Make an ‘Assessment of Response’ by checking whether the victim is conscious or unconscious. Please avoid shaking the victim, particularly if he is a child. Instead, use ‘talk and touch’ process using simple sentences like “Can you hear me?”, “Open your eyes.”, “What's your name?” and “Squeeze my hands.” Consider the victim conscious if any response is noticed. Otherwise take care to avoid the following actions. Firstly, don’t attempt to make him drink water as an unconscious person’s reflexes disappear and the water may cause choking. Secondly, don’t leave him on his back, as the tongue and soft tissues may block the air passage of the throat. Call the Accident & Emergency number in either case.

ALL IT TAKES IS 21 DAYS TOWARDS A HEALTHIER HEART

It is scientifically proven that all it takes for someone to let go a bad habit and develop a good one is just 21 days. So, go ahead, take the 21 day challenge and let go the “heart unfriendly” habit or develop a “heart friendly” habit. Consistently pursue the habit for at least 21 days; the chances that it will lead to a change in your lifestyle could increase.

21 days of no smoking
21 days of a healthy diet
21 days of at least 5 helpings of a fruit
21 days of 30 minutes of brisk morning walking
21 days of playing a sport
21 days of saying no to oily food
21 days of 10 minutes of meditation
21 days of stress free living

Go ahead, you can do it. Fall in love with your heart!

CONTRIBUTED BY:

Dr. Ravi Kumar Aluri, Chief Interventional Cardiologist, Global Hospitals, Hyderabad.

Dr. Ravi Kumar Aluri has been in the field of Interventional Cardiology with over a decade of experience in complex angioplasty stenting procedures and one of the pioneers in Transradial interventions.. With an immense experience in cardiac care and coronary interventions, he has to his credit over 9000 coronary procedures and over 4000 transradial procedures. Dr. Ravi Kumar is a Senior Consultant Cardiologist at Global Hospitals, Hyderabad and he can be reached on Email: ravi27369@yahoo.com; Ph: 09848024638.

Cadaver Donor Liver Transplant

2011-09-17T01:37:00.000-07:00

In the case of a cadaveric donor organ, the transplant center receives a liver offer from ORBO for a specified patient. . The patient is then notified and admitted to the hospital. While the donor team is procuring the donor liver, the recipient team begins to prepare the patient. The diseased liver is removed and the healthy liver is put in its place. The operation usually takes 6-8 hours. After the operation the patient begins taking medications to prevent the new liver from being rejected by the body. Complete recovery may take several weeks. The quality of life for transplant patients usually improves dramatically with most leading healthy, normal lives.

Such donation is possible from a brain dead person whose family wishes to donate the person's organs before discontinuing life support. This situation arises only in a hospital ICU in a person after brain injury in an accident or in someone who has suffered fatal brain hemorrhage etc. In these circumstances, the whole liver can be used for an adult, and a part of it for a child. After removal from the donor (a process called liver retrieval) the liver can safely be kept preserved outside the body in special preservation solutions for 12-15 hours. Allocation of such organs is strictly according to blood group which must match, time on waiting list and urgency of requirement.

There are different sources of donor livers. Usually the liver is obtained from a cadaveric donor (a person diagnosed as "brain dead" but whose other organs and systems are functioning properly). Due to a continuous shortage of donor livers and the high incidence of liver disease, the waiting time is increasing every year. Hundreds of people die each year while waiting for a cadaveric liver to be offered.

One of the biggest problems is the unavailability of compatible cadaveric donor livers.

A major factor in patient survival following transplantation is the degree of hepatic decomposition and associated debility at the time of transplantation. However, outcomes of liver transplantation have markedly improved due to effective immunosuppressant, improved surgical preservation techniques, and enhanced strategies to treat postoperative complications.

An important flaw with this kind of transplantation is that the impact of transplantation on pulmonary gas exchange is more pronounced in patients receiving organs from cadaveric donors. This difference may arise from longer cold ischemia times present in the cadaveric donor group.

Visit Hospitals in India for more details.

Partial Liver Transplants

2011-09-15T02:04:00.000-07:00

Partial liver transplants are having amazing results in recipients, reducing the need for medication and the risk of organ rejection. Because the operation is so rare, organ transplant networks and organizations do not track the number of partial transplants performed or have specific guidelines for it.

Doctors say children fare better with the operation because their livers have better rejuvenating abilities than adults, and that this procedure can only be used for cases of acute liver failure. Chronic liver problems, like hepatitis or cancer, would not be cured with this procedure.

While the procedure is covered by insurance companies, the cost is roughly the same as traditional transplants. The long-term health care savings however are huge: After patients get off anti-rejection drugs, they save thousands of rupees a year.

In the last two decades, liver transplantation (LTx) has become the treatment of choice for several liver diseases including hepatocellular carcinoma in selected cases. Living-donor liver transplantation and split liver transplantation are measurements to reduce the severe lack of cadaveric grafts by expanding the donor pool. Major centers around the world now routinely perform partial LTx in infants and adults with survival success equivalent to that after full-size liver transplantation.

Although wide-ranging investigations such as intraoperative ultrasound, angiography, computed tomography, and magnetic resonance imaging are used routinely to delineate the hepatic vascular and biliary anatomy, not all anomalies can be demonstrated with certainty by these investigations. Therefore, the transplant surgeons should have a profound knowledge of normal liver anatomy and should recognize the presence and implications of anatomical variations. Normally, patients with haemodynamic instability, obesity, multiple upper gastrointestinal surgeries, and severe debilitation are usually excluded from partial liver transplantation.

Vascular and biliary complications may lead to loss of valuable grafts and cause significant morbidity and mortality. It is hoped that increasing experience, center effects, coupled with refinement of technique and a sound knowledge and application of anatomy, modern diagnostic tools such as the 3-dimensional visualization of the liver will lead to an improved outcome for patients undergoing partial liver transplantation. The use of reduced-sized, split grafts, and live-donor livers has reduced the size but not eliminated the problem. Donor-to-recipient size mismatch was an additional limitation to LTx in children until the development of partial liver transplantation techniques. Although these techniques have significantly reduced waiting list mortality in children, they do not completely address the major problem of limited organ availability.

Visit Hospitals in Chennai for more details.

Auxiliary Liver Transplant

2011-09-12T22:24:00.000-07:00

In patients with acute liver failure (ALF) who fulfil criteria, liver transplantation is the only effective treatment which can substitute metabolic and excretory function of the liver. Auxiliary liver transplantation was developed because a significant minority of patients with ALF who fulfil transplant criteria can have a complete morphological and functional recovery of their liver.

In the majority of cases the auxiliary graft is a right graft which is placed orthotopically after a right hepatectomy in the recipient. After standard immune-suppression, the recovery of the native liver is assessed by biopsies, hepatobiliary scintigraphy and computed tomography. When, on the basis of histological, scintigraphical and morphological data, there is evidence of sufficient regeneration of the native liver, immune-suppression can be discontinued progressively. Complete regeneration of the native liver can be observed in >50% of patients, who can be withdrawn from immune-suppression. Therefore the advantages of auxiliary transplantation seem to balance favourably with the potential inconvenience of this technique in selected patients.

Auxiliary liver transplantation entails attaching a portion of a healthy donor's liver to a portion of a recipient's diseased liver. The donor liver remains intact until the native organ recovers, at which point the diseased liver may be removed. This procedure now accounts for a substantial proportion of liver transplants in children today.

This technique is an innovative way to treat patients with acute liver failure, in order to allow the patient's own liver to recover. While liver transplantation requires patients to take immunosuppressant medications for the remainder of their lives, auxiliary partial liver transplantation does not. The procedure entails attaching part of a donor liver to the failing liver in the recipient, where it supports the patient, clears toxins, and prevents brain injury during recovery. After the patient's native liver recovers, the donor liver withers in most patients, and the majority of patients are able to withdraw from immunosuppressant medications.

This procedure is particularly suited to children because the regenerative capacity of their livers is optimal. This technique may also be applied in young adults. This is also an advantage to patients with genetic errors of metabolism because the function of their own liver is perfectly normal except for one genetic defect. Auxiliary liver transplants are preferred because the patient is not entirely dependent upon the transplanted liver, should it be rejected.

Auxiliary liver transplant provides temporary support until the native liver recovers and immune-suppression can be withdrawn. Once you’re diagnosed with a liver disease, your physician will be able to determine whether or not you require a liver transplant. The type of transplant that you should undergo will also be decided based on the condition of your liver.

Visit Hospitals in Chennai for more details.

Split Liver Transplant

2011-09-12T01:21:00.000-07:00

The shortage of available organs was previously most acute for pediatric patients. Because of the small number of pediatric donors, the mortality rate among patients on the wait list was commonly high when only whole-organ transplantation was performed.In 1984, the introduction of reduced-liver transplant in which a portion of the adult liver was given to infants and children dramatically reduced this mortality rate. Over the past 20 years, the risk of death among patients on the pediatric weight list has substantially declined because of the ability to use these reduced-size grafts and because of the subsequent introduction of live-donor transplantation.

As most commonly performed, split-liver transplantation (SLT) involves the division of donor liver from a deceased adult between a pediatric recipient and an adult recipient to maximize the benefit of each available donor organ.

Split-liver transplantation takes advantage of the knowledge gained in reduced-liver transplantation to increase the organ supply by using the right lobe or tri-segmental graft that remains after the left lateral segment or left lobe is removed for a pediatric recipient. Split-liver transplantation has now been applied in all patient groups, including status 1 patients and patients requiring re-transplantation. In the young pediatric population, split-liver transplantation or reduced-liver transplantation has become an increasingly frequent procedure.

The goal of split-liver transplantation (SLT) is to produce 2 grafts with preserved vascular supply (i.e., portal vein, hepatic artery), venous drainage and bile duct. Anatomic variations (replaced arteries, biliary anomalies) are not considered to be a contraindication to liver splitting as long as both right and left-sided allografts have a complete set of vessels and biliary drainage. In most cases, the vena cava and the common bile duct are maintained with the right-sided allograft, and the left hepatic vein and left bile duct are divided for the left allograft.

Two approaches are available to generate split-liver allografts: ex vivo, in which the organ is removed from the donor and divided on the back table after the organ has been flushed and cooled, and in situ, in which the dissection and parenchymal division is performed in the donor while the organs are still being perfused.

Cooperation between different surgical teams is crucial, and the decision to proceed to in situ splitting should be based on the stability of the donor's condition and on the conditions of all waiting recipients. In general, acceptable outcomes can be achieved by using either approach.

Complications after split-liver transplantation (SLT) are similar to those of whole-organ liver transplantation. The rate of bile leaks may be slighted elevated because of the large cut surface, particularly in livers that are split into right and left lobes. Otherwise, the rate of delayed graft function and allograft non-function is not increased in properly selected split-liver grafts.

Visit Hospitals in Bangalore for more details.

Pediatric liver transplantation

2011-09-08T23:12:00.000-07:00

Pediatric liver transplantation has been a major success and is now an established therapeutic entity. The use of innovative surgical techniques has allowed the application of liver transplantation to even very young infants with excellent results. Selection criterion for adults is properly based on outcome measures. The major driving force for this has been the mismatch between the number of donor organs and potential recipients. While the same general principles apply to children there are notable differences. The success of liver splitting allows many children to benefit from liver transplantation with little net effect on the overall donor organ pool. Also in some circumstances a smaller probability of long-term success may be a very worthwhile outcome for some children and their families. The liver is the only solid organ that can regenerate itself. That means surgeons can transplant a small segment of a donor’s liver (small enough to fit the baby or child), and the segment will grow as the child grows. Segmental transplants can use liver tissue from living or deceased donors.

The particularly high mortality in children awaiting liver and intestinal transplantation has been recognized by allocating this group a higher priority in the allocation sequence. Patients assessed for liver transplantation usually suffer from Chronic liver disease, Acute liver failure, Liver tumors and Metabolic liver disease with life-threatening extra-hepatic complications. Common symptoms that may indicate the need for further testing and possible transplant include: jaundice, ascites (accumulation of fluid in the abdomen), bleeding episodes or poor growth pattern.

The ability of the child's family to comply with instructions and follow-up plans are relevant factors which must be considered in the transplant assessment process. However the aim of the process is to identify support required to enable successful transplantation. Children should not be disadvantaged by family factors beyond their control. Age is not itself a contraindication, but the outcome of transplantation in the neonatal period is inferior to transplantation later in childhood.

Long-term monitoring is important to assure the child’s ongoing health. Outpatient medical visits and blood testing continue at a frequency that tapers over time, according to the child’s condition and absence of complications or illnesses.

Visit Hospitals in Chennai for more details.

Living Donor Liver Transplant

2011-09-07T03:05:00.000-07:00

Living donor liver transplant offers an alternative to waiting for a deceased donor liver. Its main benefit is timeliness because it decreases the risk of complications and death while waiting for a match. For both patient survival and liver function, Global Hospitals India scores above the national average at one year post-transplant.

All liver transplant candidates undergo a similar evaluation whether they are considered for deceased donor liver or living donor liver transplantation. People who have progressive diseases and disorders can benefit from the timeliness of a living donor liver transplant, including those with: Liver tumors, Bile duct tumors, Cholestatic liver disease and Highly symptomatic patients with low priority for transplantation.

Potential donors undergo Health evaluation, Social and psychological screening, Anatomical assessment. The donor's liver size and unique anatomy, including placement of blood vessels and bile ducts, must be favorable for donation. The transplant team counsels and supports recipients, potential donors and families through every phase of the process.

The living donor's liver regenerates to full size within a few weeks of the surgery, and there is no long-term impairment of liver function. The transplanted liver portion also regenerates, increasing until it's the appropriate size for the recipient’s body.

The donor spends about a week in the hospital recovering, and should plan for two to three months off work. For the recipient, post-transplant care and follow-up is the same as for deceased donor liver transplant.

Adult-to-child living donor liver transplantation uses the left lateral portion of the adult donor's liver. The procedure has been proven safe and effective, and has helped reduce the number of children who die awaiting liver transplant. Although living donor liver transplant has been proven safe and effective for both donor and recipient, it is a major operation and not without risk. The donor is also at risk for temporary problems related to the surgical incision and the possibility of blood clots following the operation. However, the great majority of donors have recovered completely within a few months of their operations.

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Liver & Drug usage habits

2011-09-05T23:43:00.000-07:00

The liver acts like a clearing house for almost all drugs, vitamins, herbal remedies and supplements. Therefore it is prone to bearing the brunt of extended use or inadvertent overdoses and unexpected interactions. It is imperative that we take care of the health of our liver and that the medications consumed by us have only the desired result and nothing else.

The following are some tips to help safeguard your liver health and ensure that the medications and remedies you need to take achieve their desired effect:

• To avoid potentially life-threatening complications, you should talk to your doctor about all medications or supplements - pharmaceutical and herbal – that you are taking or thinking of taking.

• If your doctor prescribes a long-term medication, ask for a liver test before you start the medication and after the first few weeks of taking the drug to determine how your liver is tolerating it. Follow up with regular liver tests throughout the duration of your treatment.

• Always read and follow the dosing instructions as dictated by your doctor or the medication label. Never take more than the recommended dose and be sure to take into consideration other medications that you may be taking at the same time that may have similar ingredients.

• Never mix medication with alcohol. Alcohol increases the risk of possible liver damage. Acetaminophen can be especially toxic when combined with alcohol.

• Be careful about mixing Tylenol® with other products that contain acetaminophen. By taking more than one pain reliever or cold remedy at a time, you may accidentally take more acetaminophen than is safe. Consult your doctor

· Avoid certain herbal supplements as well as certain vitamins in high doses as they have the potential to cause damage to the liver. For example, high doses of vitamins E, K - and especially vitamins A and D - may be harmful.

· Avoid grapefruit, grapefruit juice or supplements with grapefruit bioflavonoids if you are taking medication. The chemicals in grapefruit (both rind and pulp) can interfere with the liver enzymes that break down drugs. A variety of different medications – including some anti-depressants, blood pressure medications, cholesterol-lowering drugs and tranquilizers -- have been shown to have potentially serious interactions with grapefruit products. For more information, consult your doctor or pharmacist

· Avoid the use of any form of recreational or ‘street’ drugs because they can put you at risk of contracting hepatitis B or C and can cause serious harm to your liver. Even a single ‘experiment’ could lead to a potentially life-threatening liver disease. If you do use drugs, make sure you use sterile drug-use equipment (e.g., syringes, cookers, filters, water, tourniquets, pipes, straws) and never share any of it.

If you have a chronic liver disease or other liver condition, consult your doctor before taking any form of prescription or non-prescription medication or herbal remedy. Liver disease compromises the liver’s ability to perform its normal processing functions so you may be unable to take medications to treat other health conditions.

Visit Hospitals in Hyderabad for more details.

Liver Infection & Safe Sex Practice

2011-09-04T23:22:00.000-07:00

Prior to getting involved in any kind of sexual activity, it is of utmost importance to know the risks and take steps to stay protected. Hepatitis, of which the most common forms are Hepatitis A, B & C, is a liver disease that can be transmitted sexually. Here are few safe practices and dos and don’ts you may follow to protect both, yourself and your partner.

SEXUAL TRANSMISSION OF HEPATITIS

Though Hepatitis A is not usually transmitted through sexual activity, any oral/fecal contact, including that which may occur during sexual activity, is a high risk for contracting Hepatitis A. This can include Anal sex, Anal or fecal contact to the mouth (e.g. from fingering partner’s anus or handling a used condom after anal sex then putting fingers on/in mouth).

Hepatitis B is significantly more infectious than AIDS and carries a high risk of sexual transmission. Contraction of Hepatitis B may take place as a result of exposure to blood, semen, vaginal discharge or other bodily fluids during sex. This can include unprotected vaginal, oral or anal sex, sharing of sex toys and also non-sexual activities that may carry a risk of exposure viz. tattooing, body piercing, manicures or pedicures with non-sterile equipment or inks and sharing of needles or other drug equipment.

The contribution of sexual activity to the risk of contracting Hepatitis C is very low. However, any activity that may lead to exposure of blood does carry some risk. This may include rough sex where blood is present, vaginal sex with a woman during menstruation and other non-sexual activities that may carry a risk of exposure like tattooing, body piercing, manicures or pedicures with non-sterile equipment or inks and sharing of needles or other drug equipment.

PROTECTION DURING SEXUAL ACTIVITY

Hepatitis A

Vaccination is a safe option as a measure of protection from Hepatitis A. The vaccine is given in two injections 6 to 12 months apart. Further, maintain hygiene like washing hands carefully after bowel movements, after sex, before making food and before eating, drinking or smoking. Before having sex, ensure that you have kept your genital and anal areas clean. Always use a condom during sex.

Hepatitis B

Here again, a vaccine is available as an effective protective measure. Get vaccinated. Hepatitis B vaccines are given in three doses over a period of six months. Further, practise safe sex. Always ensure to sterilize sex toys before and after use and avoid sharing personal hygiene items that may retain traces of blood, including toothbrushes, nail clippers, razors or nail files.

Hepatitis C

Since no vaccine has yet been found for Hepatitis C, the best approach is to adopt safer sex practices and take precautions to avoid any accidental contact with blood. Use condoms during vaginal, oral or anal sex and do not share personal hygiene items that may retain traces of blood, including toothbrushes, nail clippers, razors or nail files.

In any case, whenever you suspect that you or your partner may have been exposed to Hepatitis A, B or C, contact your health care provider promptly.

Visit Hospitals in Hyderabad for more details.

Liver Infection and Body Art

2011-09-01T23:45:00.001-07:00

Are you going for a body piercing, tattoo, manicure/pedicure, or permanent cosmetics? Just like HIV, even Hepatitis B & C can spread by direct contact with the blood of an infected person. Since the tools used for all these treatments can come into contact with blood and since it's not really feasible to ensure whether the person who has got treated before you was infected, it becomes imperative that the service provider takes effective measures for infection control between clients. As you may be aware, there is no vaccine for Hepatitis C as yet.

Few precautions can help avoid catching any infection when you go for body decoration:

Before you get treated, check the awareness of the staff about the risk of transmitting Hepatitis & HIV. Confirm whether the salon uses an autoclave for sterilizing tools between clients and whether the autoclave is well maintained and regularly tested. An autoclave is the only effective machine that can kill the Hepatitis virus.

During the treatment check on the cleanliness and hygiene of the premises and that its set-up and arrangement is well done for the safe conduct of the required process, Ensure that the staff follows good hygiene practices like:

· wearing clean outer clothing,

· washing hands with soap & warm water before and after each procedure or using a sanitizer

· wearing surgical gloves whenever a possibility exists of contact with blood or body fluids or tissues

· wearing aprons or such protective clothing in case of possible contact of clothing with blood

· working of surfaces that are non-porous and smooth

· cleaning all work surfaces with bleach and water

· disposing all contaminated needles and other sharp objects in an appropriate puncture-proof container

· disposing all contaminated protective equipment in proper containers marked for bio-hazardous waste

· using single-use needles and fresh inks and dyes for each customer

· using surgical steel or gold single-use needles (far better in preventing infection than silver needles)

After having undergone a treatment, in case you suspect having contracted any infection or adverse reaction, see a doctor immediately and share the true facts about the treatment you underwent.

Visit Hospitals in Bangalore for more Details.

A Healthy Liver Food Reference

2011-08-27T01:05:00.001-07:00

The liver is the most efficient battery in the world. It supports in powering our body by storing energy and releasing it when required. It converts the food we eat into chemicals that are essential for life. It is therefore imperative that we make a wise choice of the food we eat so that it keeps such a vital organ as our liver always healthy.

These diet tips may help in ensuring a well-functioning liver.

-have a well balanced diet while you ensure to have low fat foods

-eat small, regular meals

- do not skip meals nor over-eat

- drink at least 6 to 8 glasses of fluids, preferably water, daily

- avoid alcohol (if you drink, have no more than 1 to 2 drinks on any occasion. Do not drink daily)

- Few herbal supplements may be harmful to the liver and overdose of few vitamins, especially Vitamin A, too may pose danger to the liver. Consult your doctor.

- Organic food is always preferable. The liver is less loaded if we intake lesser pesticides, chemicals, hormones, antibiotics etc.

- Eat fresh, in-season, firm and clean fruits and vegetables that are washed thoroughly prior to consumption to remove pesticides.

- Have as much of fruits and vegetables with bright pigments - like red, orange, green and yellow

- Maximise the intake of raw vegetables with high-sulphur content - like cabbage, cauliflower, broccoli, garlic, onions etc

-Instead of boiling, cook vegetables by baking or steaming which helps retain nutrients.

- Prefer whole-grain products over refined/bleached grain products (e.g. prefer wheat over Maida)

VEGETABLES: Carrots, Cabbage, Tomatoes, Broccoli, Sprouts, Lettuce, Asparagus, Spinach, Green peas, Potatoes, Yams

FRUITS: Papaya, Mangoes, Berries, Citrus fruits, Canned fruit with no sugar added or packed in its own juice, Avocado, Olives, Cantaloupe, Apples, Kiwi

BAKERY: Bread, rolls, pitas, tortillas, bagels etc

Whole-grain: Rye, Rice, Multi-grain, Stone ground

PASTA & NOODLES: Whole-grain, Rice noodles (fresh or dried), Corn noodles, Potato, Buckwheat

LEGUMES: Split peas (green and yellow), Lentils (red and brown), Chick peas, Kidney beans, Navy beans, Black beans, Pinto beans

NUTS & SEEDS: Almonds, Cashews, Walnuts, Hazelnuts, Pecans, Peanuts

DAIRY & BEVERAGES: Lower or reduced fat milk (skim or <2% fat), yogurt and cheese, Non-hydrogenated margarine, Fortified Soy milk, Rice milk (un-sweetened), Water (spring, distilled or filtered), Green tea (contains antioxidants)

A note on Coffee: Caffeine may tend to rid the body of minerals such as Calcium and may be avoided if you have liver disease or if you are menopausal or post-menopausal. Several recent studies however have reported that coffee may help in case of cirrhosis and liver cancer and as reported by few studies may even reduce the risk of liver cancer as compared to non-drinkers. However, it is recommended to consult your doctor to see whether coffee should or should not be avoided.

OILS (cold pressed virgin, vegetable and seed oils): Olive, Flaxseed, Safflower, Sunflower, Sesame, Canola, Peanut, Soybean, Corn

MEAT, EGGS & SEAFOOD (preferably free-range/wild): Chicken (with skin removed), Lamb, Lean cuts or lean/extra-lean ground beef or pork, Eggs, Tuna, Salmon, Mackerel, Trout, Char, Herring, Shellfish, Sardines

RICE & GRAINS: Wheat, Couscous, Quinoa, Buckwheat , Rye, Barley, Oats, Bran, Brown rice, Wild rice, Amaranth, Brazil nuts

100% fruit and vegetable juices (fresh/bottled/canned & additive-free)

This isn’t an exhaustive list of healthy food choices nor is it meant to replace the advice of your doctor or dietician. In case you suffer from a specific health condition or are looking for counseling on nutrition, please consult with your health care provider.

Visit Hospitals in Hyderabad for more details.

Liver care while travelling

2011-08-23T01:41:00.000-07:00

Before your trip:

Talk to your doctor or an expert in travel medicine about health risks in the area you plan to visit. They can tell you how to keep yourself healthy when you travel to places where certain illnesses are a problem. They also can tell you about places that might not be safe for you to visit. Ask them if they know of doctors who treat people with liver-related infections in the region you plan to visit.

Traveler’s diarrhea is a common problem. Carry a 3- to 7-day supply of medicine (antibiotics) to treat it. A common drug for traveler’s diarrhea is ciprofloxacin. If you are pregnant, your doctor may suggest you take TMP- SMX (trimethoprim-sulfamethoxazole) instead.
Insect-borne diseases are also a major problem in many areas. Take a good supply of an insect repellent that contains 30 percent or less "Deet" with you. Plan to sleep under a mosquito net, preferably one treated with permethrin, in places where there is malaria or dengue fever. Unless you need to go there, avoid areas where yellow fever is found.
If you have medical insurance, check to see what it covers when you are away from home. Make sure your paperwork is in order, and take along proof of insurance when you travel.
Learn potential health risks and whether you need to be immunized. Hepatitis A, Hepatitis B, Hepatitis C, Malaria and Yellow Fever are some diseases you need to get vaccinated against.
Make sure all your medications are up-to-date and legal in the country you are travelling to.
Get a medical check-up at least 6 weeks before you are scheduled to leave.
Pack a first-aid kit, hand sanitizer and safe sex supplies.

During your trip:

Food and water might contain bacteria, viruses, or parasites that could make you sick.

Do not eat raw fruit and vegetables that you do not peel yourself, raw or undercooked seafood or meat, unpasteurized dairy products, or anything from a street vendor. Also, do not drink tap water, drinks made with tap water, or with ice made from tap water, or unpasteurized milk.
Food and drinks that are generally safe include steaming-hot foods, fruits that you peel yourself, bottled (especially carbonated) drinks, hot coffee or tea, beer, wine, and water that you bring to a rolling boil for1 full minute. If you can’t boil your water, you can filter and treat it with iodine or chlorine, but this will not work as well as boiling.
In many places, animals may roam more freely than they do in the area where you live. If you think animals have left droppings on beaches or other areas, always wear shoes and protective clothing and sit on a towel to avoid direct contact with the sand or soil.
Swimming can make you sick if you swallow water. You should never swim in water that might contain even very small amounts of sewage or animal waste.
Take all medications as prescribed by your doctor. If your doctor has you on a special diet, stick with it.
Keep a list of emergency numbers of hospitals and health providers.
Practice safe sex.

After your trip:

People behave differently when they travel, and this increases the risk of some medical conditions in recent travellers for reasons sometimes unrelated to the location travelled to. Causes of liver infection may be more likely in patients with travel history; cytomegalovirus - liver infection, hepatitis A, hepatitis B, hepatitis C, hepatitis E. Make sure you monitor your health for at least two weeks after your trip. Make sure you visit your doctor for a thorough check-up if you have any doubts or show symptoms of infection.

Liver care while you drink alcohol

2011-08-22T00:15:00.001-07:00

When you drink alcohol, it is absorbed into the bloodstream from the stomach and intestines. All blood from the stomach and intestines first goes through the liver before circulating around the whole body. So, the highest concentration of alcohol is in the blood flowing through the liver.

Liver cells contain enzymes (chemicals) which process (metabolise) alcohol. The enzymes break down alcohol into other chemicals which in turn are then broken down into water and carbon dioxide. These are then passed out in the urine and from the lungs. The liver cells can process only a certain amount of alcohol per hour. So, if you drink alcohol faster than your liver can deal with it, the level of alcohol in your bloodstream rises.

Your liver needs water to do its job. As alcohol acts as a diuretic (makes you pass urine), it dehydrates you and forces the liver to divert water from elsewhere. When the liver is processing alcohol it produces a substance called acetaldehyde. This has a toxic effect on the liver itself, as well as the brain and stomach lining. This is what causes your hangover. Acetaldehyde is subsequently broken down into chemical called acetate, which is broken down further into carbon dioxide and water outside the liver. Regular and heavy drinking over time can strain or disrupt this process, leading to alcoholic liver disease.

You are very unlikely to develop liver problems caused by alcohol if you drink within the recommended safe limits. That is:

Men should drink no more than 21 units of alcohol per week (and no more than four units in any one day).
Women should drink no more than 14 units of alcohol per week (and no more than three units in any one day).
Pregnant women. The exact amount that is safe is not known. Therefore, advice from experts is that pregnant women and women trying to become pregnant should not drink at all. If you do chose to drink when you are pregnant then limit it to one or two units, once or twice a week. And never binge drink or get drunk.

In general, the more you drink above the safe limits, the more harmful alcohol is likely to be. And remember, binge drinking can be harmful even though the weekly total may not seem too high. For example, if you only drink alcohol once or twice a week, but when you do you drink 4-5 pints of beer each time, or a bottle of wine each time, then this is a risk to your health.

Keep these pointers in mind;

Set limits. One way to make sure you do not drink to excess is to decide how many drinks your body can safely handle and do not exceed this limit during the course of the night. Unfortunately, it is not always easy to keep track, especially when playing drinking games. Such games may provide entertainment and a chance to feel included in a social group, but they contribute to excessive drinking. The atmosphere created by drinking games is dangerous because it causes you to drink more than you would usually through peer pressure and rapid rate of consumption. Chugging alcohol will delay awareness of how much alcohol is in your body because of the time it takes to raise your BAC.

Eat a meal before you drink. Food in the stomach will slow the entrance of alcohol into your bloodstream by preventing it from entering your small intestine which absorbs alcohol faster than the stomach. High protein foods, like cheese, are best at slowing down the effects of alcohol, and thus help prevent a hangover.

Steer clear of carbonation and shots. The carbon dioxide of carbonated drinks, like beer and soda, increases the pressure in your stomach, forcing alcohol out through the lining of your stomach into the bloodstream. The high concentration of alcohol in shots also means that your BAC will increase rapidly.

Alternate with non-alcoholic beverages. Not only will this slow your consumption of alcohol, but it will also counter the dehydrating effects of alcohol.

Don’t combine alcohol with other drugs. Alcohol’s effects are heightened by medicines that depress the central nervous system, such as sleeping pills, antihistamines, antidepressants, anti-anxiety drugs, and some painkillers. Other drugs have harmful interactions with alcohol as well, so it is best to consult a physician before drinking while on medication. The combination of illegal drugs and alcohol can also have adverse effects.

Don’t drink if you’re suffering fatigue. Exhaustion magnifies the effect of alcohol on the body. Unfortunately, alcohol is often used as a reward after periods of high stress that have overworked the body to fatigue.

Liver Cancer

2011-08-20T01:14:00.000-07:00

Cancer of the liver is known as Hepatocellular Carcinoma. When patients or physicians speak of liver cancer, however, they are often referring to cancer that has spread to the liver, having originated in other organs (such as the colon, stomach, pancreas, breast, and lung). More specifically, this type of liver cancer is called metastatic liver disease (cancer) or secondary liver cancer. This i common compared to primary liver cancer and frequently leads to confusion, because the term liver cancer actually can refer to either metastatic liver cancer or hepatocellular cancer. Liver cancer is the third most common cancer in the world, and the majority of patients with liver cancer will die within one year as a result of the cancer.

Causes, incidence, and risk factors

Hepatocellular carcinoma accounts for most liver cancers. This type of cancer occurs more often in men than women. It is usually seen in people ages 50 - 60. Hepatocellular carcinoma is not the same as metastatic liver cancer, which starts in another organ (such as the breast or colon) and spreads to the liver.

In most cases, the cause of liver cancer is usually scarring of the liver (cirrhosis). Cirrhosis may be caused due to alcohol abuse (the most common cause), certain autoimmune diseases of the liver, diseases that cause long-term inflammation of the liver, hepatitis B or C virus infection or too much iron in the body (hemochromatosis). Patients with hepatitis B or C are at risk for liver cancer, even if they do not have cirrhosis

Diabetes, obesity, anabolic steroids and tobacco use can also cause liver cancer.

Symptoms

· Abdominal pain or tenderness, especially in the upper-right part

· Easy bruising or bleeding

· Enlarged abdomen

· Weight-loss and lack of apetite

· Yellow skin or eyes (jaundice)

Signs and tests

Physical examination may show an enlarged, tender liver. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein most effectively diagnoses liver cancer. A liver biopsy can make a definitive diagnosis of liver cancer, but the procedure requires an expert liver pathologist and is not necessary for all patients.

Treatment

Aggressive surgery or a liver transplant can successfully treat small or slow-growing tumors if they are diagnosed early. However, few patients are diagnosed early. Chemotherapy and radiation treatments are not usually effective. However, they may be used to shrink large tumors so that surgery has a greater chance of success.

Ablative and local techniques such as chemoembolization, radioembolization, radiofrequency or cryoablation, and stereotactic radiosurgery can by very useful in controlling individual cancers for an extended time. Surgical resection (removal) of the tumor may be curative for a select group of individuals with liver cancer, specifically for those with small tumors and healthy liver function.

Sorafenib tosylate (Nexavar), an oral medicine that blocks tumor growth, is now approved for patients with advanced hepatocellular carcinoma. However please seek advice from a reputed doctor before taking any medication.

Prognosis

The usual outcome is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery. If the cancer cannot be completely removed, the disease is usually fatal within 3 - 6 months. However, survival can vary, and occasionally people will survive much longer than 6 months.

Complications include gastrointestinal bleeding, liver failure and spread (metastasis) of the carcinoma. Call your health care provider if you develop persistent abdominal pain, especially if you have a history of any liver disease.

Prevention

Preventing and treating viral hepatitis may help reduce your risk. Childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future. Avoid drinking excessive amounts of alcohol. Certain patients may benefit from screening for hemochromatosis.

If you have chronic hepatitis or known cirrhosis, periodic screening with liver ultrasound or measurement of blood alpha fetoprotein levels may help detect this cancer early.

Hepatitis C

2011-08-19T08:52:00.001-07:00

What is Hepatitis C?

Hepatitis C infection is an infection of the liver caused by the hepatitis C virus (HCV). It is difficult for the human immune system to eliminate HCV from the body, and infection with HCV usually becomes chronic. Over decades, chronic infection with HCV damages the liver and can cause liver failure. Although the basic structure is common to all hepatitis C viruses, there are at least six distinctly different strains of the virus which have different genetic profiles (genotypes).The genetic diversity of HCV is one reason that it has been difficult to develop an effective vaccine since the vaccine must protect against all genotypes.

What causes Hepatitis C?

The exact causes of hepatitis c, for any particular hepatitis patient, are never conclusively proven. Unsafe blood transfusions, drug usage, unprotected sex and inadequate sterilizations are some of the causes.

Who is at risk of contracting Hepatitis C?

Currently, screening for HCV is not recommended as part of a routine physical examination. Rather, testing should be done among:

Individuals at high risk for infection including current and past users of injectable drugs and persons exposed to infected blood or organs from infected persons
Children born to chronically infected mothers
People who received blood, blood products, or transplanted organs prior to 1992
Persons with abnormal levels of liver enzymes in the blood.

What are the symptoms?

About 75% of people have no symptoms when they first acquire HCV infection. The remaining 25% may complain of fatigue, loss of appetite, muscle aches or fever. Yellowing of the skin or eyes (jaundice) is rare at this early stage of infection.

As cirrhosis develops, symptoms increase and may include: weakness, loss of appetite, weight loss, breast enlargement in men, a rash on the palms, difficulty with the clotting of blood, and spider-like blood vessels on the skin.

In patients with advanced cirrhosis, the liver begins to fail. This is a life-threatening problem. Confusion and even coma (encephalopathy) may result from the inability of the liver to process certain toxic substances.

Increased pressure in the blood vessels of the liver (portal hypertension) may cause fluid to build up in the abdominal cavity (ascites) and result in engorged veins in the swallowing tube (esophageal varices) that tear easily and can bleed suddenly and massively. Portal hypertension also can cause kidney failure or an enlarged spleen resulting in a decrease of blood cells and the development of (anemia), or the development of low platelets (thrombocytopenia), which can promote bleeding. In advanced cirrhosis, liver failure causes decreased production of clotting factors.

How is it diagnosed?

Screening tests are tests that are used to diagnose a condition or disease among individuals not known to have the disease. They are particularly useful for individuals who have risk factors for the condition or disease.

Recombinant immunoblot assay (RIBA) is used to confirm the positive results of EIAs since occasionally a positive EIA is a false positive, that is, the test is positive when HCV is not present. Although the direct detection of HCV RNA (HCV PCR) also is widely used to confirm the HCV infection, RIBA is still useful to differentiate false positive results in the few individuals whose immune systems have eliminated the virus but still have antibodies left over from the resolved infection.

Several tests (assays) are available to measure the amount of HCV RNA in a person's blood. These tests are referred to as molecular tests because they examine the virus at the molecular level. A single negative test for RNA does not mean that there is no infection because the virus may appear in the blood intermittently or may exist in small amounts. Newer tests have helped by detecting smaller and smaller amounts of virus in the blood.

How is it treated?

Patients with HCV infection should discuss treatment options with a physician who is experienced in treating the disease. Treatment is recommended in patients at increased risk for cirrhosis unless there are reasons that would make treatment unsafe. the decision regarding antiviral therapy in chronic HCV infection should be tailored to the individual patient with careful consideration of the risks and benefits.

All patients with HCV should be vaccinated against hepatitis B and hepatitis A. They also should be counseled on measures to prevent the spread of HCV and eliminating alcohol use. Finally, risk behaviors for HCV overlap with those of HIV, and all patients with HCV should be tested for HIV.

Hepatitis B

2011-08-17T09:29:00.000-07:00

What is Hepatitis B?

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). When a person first gets hepatitis B, they are said to have an 'acute' infection. Most people are able to eliminate the virus and are cured of the infection. Some are not able to clear the virus and have 'chronic' infection with hepatitis B that is usually life-long.

How is Hepatitis B transmitted?

Hepatitis B is spread mainly by exposure to infected blood or body secretions. In infected individuals, the virus can be found in the blood, semen, vaginal discharge, breast milk, and saliva. Hepatitis B is not spread through food, water, or by casual contact. Hepatitis B also may be spread from infected mothers to their babies at birth (so-called 'vertical' transmission). Hepatitis B can be transmitted through transfused blood products, donated livers and other organs.

What are the symptoms?

Acute hepatitis B is the period of illness that occurs during the first one to four months after acquiring the virus. Only 30% to 50% of adults develop significant symptoms during acute infection. Early symptoms may be non-specific, including fever, a flu-like illness, and joint pains. Symptoms of acute hepatitis may include: fatigue, loss of appetite, nausea, jaundice (yellowing of the skin and eyes), and pain in the upper right abdomen (due to the inflamed liver).

Rarely, acute hepatitis damages the liver so badly it can no longer function. This life-threatening condition is called "fulminant hepatitis." Patients with fulminant hepatitis are at risk of developing bleeding problems and coma resulting from the failure of the liver. Patients with fulminant hepatitis should be evaluated for liver transplantation

Patients with chronic hepatitis B develop symptoms in proportion to the degree of abnormalities in these functions. The signs and symptoms of chronic hepatitis B vary widely depending on the severity of the liver damage. They range from few and relatively mild signs and symptoms to signs and symptoms of severe liver disease such as cirrhosis or liver failure.
Most individuals with chronic hepatitis B remain symptom free for many years or decades. During this time, the patient's blood tests usually are normal or only mildly abnormal. Some patients may deteriorate and develop inflammation or symptoms, putting them at risk for developing cirrhosis

How is it diagnosed?

Infection with hepatitis B is suspected when the medical history and the physical examination reveal risk factors for the infection or symptoms and signs that are suggestive of hepatitis B. Abnormalities in the liver tests (blood tests) also can raise suspicion; however, abnormal liver tests can result from many conditions that affect the liver. The diagnosis of hepatitis B can be made only with specific hepatitis B virus blood tests. These tests are known as hepatitis 'markers' or 'serology.'
Markers found in the blood can confirm hepatitis B infection and differentiate acute from chronic infection. These markers are substances produced by the hepatitis B virus (antigens) and antibodies produced by the immune system to fight the virus. Hepatitis B virus has three antigens for which there are commonly-used tests - the surface antigen (HBsAg), the core antigen (HBcAg) and the e antigen (HBeAg).

How is it treated?

Acute infection with hepatitis B usually does not require treatment. In rare cases, however, the infection may cause life-threatening liver failure. Patients with liver failure due to acute hepatitis B should be evaluated for liver transplantation.

If a person is chronically infected with hepatitis B and has few signs or symptoms of complications, medications usually are not used. These patients are watched carefully and given periodic blood tests. In chronic hepatitis B, the goal of treatment is to reduce the risk of complications including cirrhosis and liver failure. The medications in current use for chronic hepatitis B include the interferons and nucleoside/nucleotide analogues. There are no accepted guidelines that tell how every patient should be treated. As a result, treatment is individualized.

Know Hepatitis A

2011-08-16T03:31:00.000-07:00

What is Hepatitis A?

Hepatitis A, formerly known as infectious hepatitis is an acute infectious disease of the liver caused by the hepatitis A virus (Hep A), an RNA virus, transmitted person-to-person by ingestion of contaminated food or water or through direct contact with an infectious person.

What causes Hepatitis A?

Hepatitis A is caused by a virus (hepatitis A virus, or HAV) that multiplies in liver cells and is shed in stool.

Who gets Hepatitis A?

Anyone can get hepatitis A, but some people are at higher risk, including

people who travel to developing countries
people who live with someone who has hepatitis A
people who use illegal drugs, including noninjection drugs
men who have sex with men

You could get hepatitis A through contact with an infected person's stool.

You could get hepatitis A from:

eating food made by an infected person who didn't wash his or her hands after using the bathroom
drinking untreated water or eating food washed in untreated water
placing a finger or object in your mouth that came into contact with an infected person's stool
having close personal contact with an infected person, such as through sex or caring for someone who is ill

You cannot get hepatitis A from:

someone sneezing or coughing on you
sitting next to a person who has hepatitis A
hugging an infected person

What are the symptoms?

Children younger than age 6 often have no symptoms. Older children and adults often get mild, flulike symptoms, including

tiredness
upset stomach
fever
loss of appetite
stomach pain
diarrhea
dark yellow urine
light-colored stools
yellowish eyes and skin, called jaundice

How is it diagnosed?

Blood tests will show if you have hepatitis A.

How is it treated?

Hepatitis A usually gets better in a few weeks without treatment. Get lots of rest and avoid drinking alcohol, which bothers the liver. Your doctor may suggest medicines to help relieve your symptoms, or medicines you may want to avoid. If symptoms persist, especially if you are an older person, then you should see a doctor again.
When you recover, your body will have learned to fight off a future hepatitis A infection. However, you can still get other kinds of hepatitis.

Understanding Hepatitis A

2011-08-14T03:50:00.000-07:00

Hepatitis A is contracted from Hepatitis A Virus (HAV) which is found in the faeces of people with hepatitis A and is usually spread by close personal contact (including sex or sharing a household). It can also be spread by eating food or drinking water contaminated with HAV.

Vaccination is a must for all children at age 1 year, older children in cities and states where routine hepatitis A vaccination is recommended, household contacts of infected persons, sex partners of infected persons, persons travelling to countries where hepatitis A is common (all except Canada, Western Europe, Japan, Australia, and New Zealand), men who have sex with men, injecting and non-injecting drug users, persons with chronic liver disease and any person who wants protection from HAV infection.

The doctor will perform a physical examination and may discover that you have an enlarged and tender liver.

Blood tests may show:

· Raised IgM and IgG antibodies to hepatitis A (IgM is usually positive before IgG)

· Elevated liver enzymes (liver function tests), especially transaminase enzyme levels.

The only way to know if you have already been infected is to have your blood tested for HAV infection. If you are concerned about your risk, talk to your healthcare provider about your need for blood testing. Viral hepatitis symptoms are similar no matter which type of hepatitis you have. If symptoms occur, you might experience any or all of the following: jaundice (yellowing of the skin and whites of the eyes), fever, loss of appetite, fatigue, dark urine, joint pain, abdominal pain, diarrhea, nausea, and vomiting. Very rarely, a recently acquired case of viral hepatitis can cause liver failure and death. Sometimes in these instances, a liver transplant (if a liver is available) can save a life.

The incubation period lasts between 15 to 50 days and for an average 28 days. There is no chronic infection. Once you have had HAV infection, you cannot get it again. About 15 out of 100 people infected with HAV will have prolonged illness or relapsing symptoms over a 6–9 month period. There is no treatment for hepatitis A other than supportive care.

For a recent exposure to someone with HAV or if travel is soon (leaving in less than

4 weeks) to an area of the world where hepatitis A is common, see your healthcare provider about your need for a dose of immune globulin (IG).

Always wash your hands with soap after using the toilet, changing a diaper, and before preparing and eating food.

There is no specific treatment for hepatitis A. Rest is recommended when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver, including acetaminophen (Tylenol). Fatty foods may cause vomiting, because substances from the liver are needed to digest fats. Fatty foods are best avoided during the acute phase.

The virus does not remain in the body after the infection has gone away. Over 85% of people with hepatitis A recover within 3 months. Nearly all patients get better within 6 months. There is a low risk of death, usually among the elderly and persons with chronic liver disease.

There are usually no complications. One in a thousand cases becomes fulminant hepatitis, which can be life threatening.

Fatty Liver Disease

2011-08-12T04:49:00.000-07:00

A fatty liver is the condition wherein excess fat builds up in the liver, which happens when a person’s fat intake exceeds the capacity of her or his body to handle it. For a fatty liver, the fat content ought to be at least 5 to 10% of the liver. Once the accumulation of simple fat exceeds a certain level, it makes the liver vulnerable to further injury causing its inflammation and scarring.

Obesity is a common cause of fatty liver. Studies indicate that over 23% of obese persons run the risk of developing fatty liver with inflammation.

What causes fatty liver disease?

Certain nutritional causes of fatty liver are protein malnutrition, starvation, prolonged use of parenteral or intravenous nutrition, rapid weight loss and intestinal bypass surgery for reducing obesity. Certain causes may run concurrent with or cause fatty liver. These are diabetes mellitus, insulin resistance, hypertension and hyperlipidemia (high blood lipid levels). Fatty liver may also be caused by drugs and chemicals such as corticosteroids, alcohol, carbon tetrachloride as also due to genetic factors.

Can you define Obesity and Overweight?

A fairly universal standard of obesity and overweight is the Body Mass Index or BMI. It is calculated based on one’s height and weight. A BMI of 18-25 is termed healthy for most people, 25-30 is overweight and over 30 is obese. The healthy BMI may vary between ethnic groups. In Asians, for example, a healthy BMI is anywhere between18 to 23.

Does waist size matter?

An excessive abdominal fat is related to fatty liver disease, diabetes and other health risks. Waist size is used to identify health risks associated with abdominal fat. In men, a waist bigger than 102 cm (40in) in circumference increases health risks, while in women the threshold may be 88 cm (35in)

How does the liver accumulate fat?

If fat intake exceeds the body’s requirement, the excess fat is stored in the fatty tissue. Fat accumulation may also happen due to transfer of fat from other parts of the body or the inability of the liver to change it into a form that can be eliminated.

What exactly is NASH?

NASH stands for Non-Alcoholic Steatohepatitis and is an extreme case of non-alcoholic fatty liver disease. The harm to the liver is identical to that in alcoholic liver disease but as the name suggests, it occurs in people who may not drink at all or drink minimally. NASH is different from simple accumulation of fat in the liver, which is completely harmless. Upto 20% of adults who exhibit NASH develop cirrhosis and upto 11% may encounter lever-related fatality. In many cases NASH may lead to chronic liver failure and require liver transplantation. NASH affects about 2-6% of the population.

Do children get affected by fatty liver disease?

Fatty liver disease is getting increasingly evident in children, primarily due to increase in childhood obesity and can be seen in children as small as four years of age. Fatty liver disease affects almost 3% of children and between 22 to 53% of obese children.

What are the symptoms and what is the diagnosis of fatty liver disease?

Symptoms are generally absent, however, few complain of discomfort in the abdomen at the liver level, a general feeling of being unwell and a vague discomfort. Fatty liver disease is usually suspected in patients with an enlarged liver or with abnormal readings in the liver tests. This can be confirmed by an ultrasound or may also need a liver biopsy.

How can fatty liver disease be treated?

Treatment of a fatty liver is related to the cause. Presently there are no tests to detect any likely development of NASH. However, once simple fat starts building up in the liver the liver is prone to further injury leading to inflammation and scarring of the liver.

Obese persons are advised to undergo gradual weight reduction through proper nutrition and exercise. Patients with a high blood pressure and high blood lipid content have to curtail sugar intake and bring down lipid levels. Generally, a low fat, low calorie diet is suggested along with insulin and medications to control blood pressure in diabetic patients.

For patients suffering from NASH but not overweight and not diabetic a low fat diet is recommended. Abstinence from drinking is also suggested to avoid fatty liver disease. Patients of fatty liver disease must visit their physician regularly.

There is presently no known medication for treating fatty liver disease effectively. Fatty liver disease is more commonly seen lately and therefore evoked interest with many clinical trials attempting to seek treatment of fatty liver disease.

Can one prevent fatty liver disease?

One can certainly prevent obesity which is the most common cause of fatty liver disease. This can be done by choosing a healthy diet and lifestyle and regular exercise. One must endeavour for a gradual, not abrupt, weight loss, ensure a balanced diet high on fibre and low on saturated fats, exercise regularly at least 4 times a week and avoid alcohol. These simple habits will go a long way in helping prevent fatty liver disease.

CIRRHOSIS

2011-08-11T02:38:00.000-07:00

Cirrhosis is a condition of the liver resulting from its non-reversible damage or scarring and leads to blockage of blood flow through the liver. This prevents metabolic and regulatory processes normally carried out by the liver.

Cirrhosis is primarily caused by various reasons like chronic alcoholism, viral infections caused by chronic viral hepatitis B, C and D, diseases like Wilson’s disease and hemochromatosis which are inherited. Biliary cirrhosis is caused due to diseases such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Toxic hepatitis due to prolonged exposure to environmental toxins or severe reactions to prescribed drugs can be a cause of Cirrhosis. Even repeated bouts of heart failure with liver congestion can cause Cirrhosis.

Some early symptoms of Cirrhosis are loss of appetite, loss of weight, nausea, fatigue, weakness and exhaustion.

Does Cirrhosis affect babies? Can they be treated?

Biliary atresia is the most common cause of Cirrhosis in babies and may be caused by the lack of or injury to the bile duct. Such babies are jaundiced after they are a month old as a result of accumulation of bile in the liver. In certain cases a new bile duct may be surgically formed which restores normal secretion of bile. In few other cases, transplantation may be required.

What are the effects of reduced liver functioning?

With a decrease in liver function, fewer proteins like albumin are produced resulting in fluid accumulation in the legs or abdomen. Cirrhotic patients may bleed and bruise easily as a result of low levels of proteins that are required for blood clotting. Intense itching due to deposition of certain products under the skin may also be seen

What is the impact of later stage Cirrhosis?

In advanced stages of Cirrhosis, occurrence of jaundice and gallstones is very common as lesser bile reaches the gall bladder. Blood toxin levels go up as the liver doesn’t filter them out and this in turn has an adverse effect on mental function leading to personality changes and even coma. In early stages of toxin accumulation in the brain we may observe habits like neglect of one’s appearance, forgetfulness, lack of concentration and altered sleeping habits. As the liver is not performing its function of filtering as it normally would, drugs are not adequately filtered and the patient may exhibit increased sensitivity to drugs and their side-effects.

Blood from the intestines and the spleen is pumped into the liver via the portal vein. In case of Cirrhosis, this flow is blocked leading to a swollen liver and potentially a swollen spleen. Artificial blood veins called varices then get formed as a result of the blood forcing its way from the intestine to the liver. Varices normally form in the stomach and esophagus which may rupture due to thin vessel walls and portal hypertension or high blood pressure at the portal vein, thus causing bleeding in the upper stomach or esophagus.

How can Cirrhosis be detected?

Cirrhosis can be detected by various medical analytical methods like few identifiable symptoms, physical examination, CAT scan, ultrasound, radio isotope liver/spleen scan or liver biopsy. Immediate treatment is advised once Cirrhosis is determined

Cirrhosis is treated by stopping or slowing down its progress, minimizing lever cell damage and reducing complications. In case of alcoholic cirrhosis, it is very essential to give up drinking. Cirrhosis resulting from viral infection may be treated with anti-viral drugs to minimize lever cell injury. Symptoms of cirrhosis can be controlled by medication like diuretics, which remove excess fluid and prevent recurrence of edema and ascites. Diet and drugs therapy administered together improves altered brain function. Eg. Decreased dietary protein results in less formation of toxins in the dietary tract. Lactulose, a laxative, may help absorb the toxin and accelearate their removal from the intestines. A serious fallout of Cirrhosis is bleeding as a result of portal hypertension.

Complications in Cirrhosis can usually be well treated. In case of bleeding from varices of the esophagus or stomach, these veins are injected with a sclerosing or hardening agent. Rubber bands wrapped around the veins by means of an endoscope also help. When the case gets critical, a liver transplant shunt also called portacaval shunt may be used to reduce the pressure in the portal vein and the varices

LIVER TRANSPLANT

2011-08-10T00:05:00.001-07:00

Liver transplantation is a life-preserving surgical procedure wherein a dysfunctional or diseased liver is replaced with either a whole healthy liver or a portion of it, donated by a compatible donor. Liver transplant has become a well-accepted option for patients with liver failure. Liver transplant centres check for compatibility between donor and recipient based on blood type and liver size. Donors may either be a relative or friend of a recipient or individuals who are declared brain dead and whose next of kin have consented for organ donation.

Which diseases are most commonly treated with Liver transplants ?

Liver transplantation in adults is most commonly used in case of chronic viral hepatitis C and B, autoimmune hepatitis, primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), alcoholic liver disease, and liver cancer. In children, it is largely resorted to in case of biliary atresia (failure of the bile ducts to develop and drain bile from the liver)

Does transplantation work for Liver cancer patients?
Most cancers of the liver actually begin in other organs or tissues and spread or metastasize to the liver. Such cancers cannot be cured by a transplant. However, other tumours like Hepatocellular carcinoma which are confined to the liver may be treated with radio frequency ablation, chemo-embolization, resection or liver transplantation depending on the size, number and location of the tumours. Small, early tumours have an acceptable chance of responding favourably to liver transplant.

Does alcohol-induced liver disease respond well to liver transplant?
Fortunately, in case of cirrhosis, the liver may regenerate as a result of abstinence from alcohol. However, if even prolonged abstinence and medication does not restore normal liver condition, then transplantation may have to be considered.

In a liver disease, at what stage is transplantation considered?

Liver transplant may be considered only in case of advanced liver disease with impaired and non-reversible liver function. This begins with assessment of the patient by the specialist or family doctor who then refers the patient to the transplant team. Comprehensive medical evaluation by tests and interviews helps confirm the need for transplantation. All family members are intensely involved during the decision making process,

How long does a recipient have to wait for a transplant?
Generally the sickest patients are given priority further based on severity of the liver disease (via a MELD score- Model for End Stage Liver Disease). Assistance from a qualified health professional is essential especially in case the patient and family find it difficult to cope with the pressures.

How successful can a liver transplant be?

The success rate, as reflected by acceptance of the liver by the patient and its normal functioning, depends on various factors but can be as high as 90 per cent.

Post- liver transplant care
Patients having undergone a liver transplant are moved to the Intensive Care Unit or ICU put on a mechanical ventilator that supports breathing and closely observed for symptoms of any infection. Functioning of the transplanted liver is frequently monitored by various tests. After one to three days in the ICU they are transferred to a step-down transplant unit where intravenous medication is provided. After progressive improvement supported by physiotherapy, the patient may leave the hospital in about 10 to 14 days. For the subsequent 2 weeks or so, the patient is required to attend the outpatient clinic at the transplant centre for close monitoring of liver function, for which it is preferred that the patient stays close to the centre. Return to a good quality of life is generally seen within 3 to 6 months of surgery in case of most patients

Does anti-rejection medication have any side effects?

Anti-rejection medication is required to be administered for life by all liver transplant patients, starting with a high dose after surgery and subsequently tapering off. An appropriate anti-rejection medication available is suggested by the physician which primarily suppresses the body’s immune system thus allowing the body to accept the new organ without attacking it. A rejection episode (like increased blood pressure-due to effect of the medication on the kidneys) is generally observed in many patients but almost 90 per cent of such cases are reversed with minimum alteration in the medication and close monitoring.

What are the chances of recurrence of the original disease?
Often the original disease may return and cause similar harm to the liver. Hepatitis C, for example, cannot be eradicated by a liver transplant and may recur within a year of transplant. Hepatitis C patients are now administered anti-viral therapy after the transplant. In Hepatitis B patients, the transplant is done after having controlled the infection well with anti-viral medication. The immune-suppressants in the anti-rejection medication help slow down the progress of autoimmune diseases like PBC, PSC and autoimmune hepatitis which are known to recur after transplant. In those cases where a liver transplant has failed once, another transplant may be required.

How is lifestyle after a transplant?
A normal, healthy lifestyle with renewed energy and an enhanced quality of life is generally observed in most patients. They begin to enjoy normal activities and exercises, woman are able to conceive without any complications

Nutrition and Diet for Healthy Liver

2011-08-09T00:30:00.000-07:00

Proper nutrition and a balanced diet are critical to liver health and regeneration of liver cells. Sufficient calories, carbohydrates, fats and proteins even form a vital source of treatment of few liver disorders.

Take the case of Cirrhosis, wherein the patient needs to consume a protein-rich diet and 2Kcal to 3Kcal daily for ensuring regeneration of the liver. High protein intake, however, may cause increase in blood ammonia levels in few cirrhotic patients having protein intolerance which may need drugs like Lactulose and Neomycin to control the ammonia level. In contrast, too little protein delays the regeneration of the liver cells. In such individuals, protein intake levels will have to be carefully monitored by the doctor.

Gall bladder disorders

Prevention of obesity as well as reduced consumption of high fat and cholesterol foods helps keep gall bladder disorders in check. In the process of digestion, the gall bladder releases bile into the small intestine through the common bile duct. Majority of gall bladder problems are due to gallstones and over 90% of all gallstones are a result of excessive cholesterol which crystallizes into stones. A balanced diet with controlled cholesterol intake may help minimize incidence of gallstones.

Hepatic encephalopathy

In the case of Hepatic encephalopathy, the mental function is impaired due to altered liver function. E.g. in Cirrhosis, when entry of impure blood into the liver is obstructed due to scar tissue formation. The blood which is normally detoxified in the liver, is consequently shunted back into the central circulation and upon reaching the brain the toxins in the blood, like amino acids, ammonia etc affect the mental function in some cases.

Dietary treatment is focused on reducing such toxins, which can be achieved by restriction of protein intake to say 20 grams or less daily, which may be impractical for prolonged therapy. Generally, physicians may suggest upto 40 gms of daily protein intake coupled with lactulose and neomycin for reducing the ammonia production in intestines. Foods and dietary supplements rich in certain amino acids like Hepatic acid, which are less likely to cause Hepatic Encephalopathy, are even prescribed as a protein rich source in certain cirrhotic patients.

Ascites and Edema

The conditions Ascites and Edema refer to fluid accumulation in the abdominal cavity and in tissues, respectively. They may be caused by excessive accumulation of Sodium as a result of portal hypertension and liver disease. Sodium intake is restricted within 2-4 grams for patients with Cirrhosis and diet may exclude packaged foods like soups and vegetables, cold cut meats, dairy products and ice cream as well as ketchup and mayonnaise. Fresh foods, which are mostly low in Sodium, are preferred.

Cholestasis

Cholestatis refers to inability of the liver to excrete bile and may result in a condition called Steatorrhea. Steatorrhea is the malabsorption of fat due to insufficient bile which dissolves fat in the intestine. Symptoms may be weight loss due to calorie loss and stools which may smell foul and float. Fat supplements like medium chain triglycerides (MCT oil) and safflower oil which are absorbable with less dependence upon bile may be prescribed by the physician and can also be used as Caloric supplements. Patients suffering from Steatorrhea may have difficulty in absorbing fat soluble vitamins, but not water soluble vitamins. Supplements of fat soluble vitamins may be administered only under strict observation of a physician.

Wilson disease

Wilson disease is a condition wherein Copper metabolism is defective due to inability of the liver to excrete excess Copper. The excess Copper accumulates first in the liver followed by the brain and the cornea of the eye. A de-coppering agent, Penicillamine, is required to remove the excess Copper. Foods containing copper, like mushrooms, chocolate, nuts and shellfish have to be avoided.

Hemochromatosis

In Hemochromatosis, there is accumulation of excessive Iron due to malabsorption in the intestine. This gets accumulated in the liver, pancreas and other organs. Avoidance of Iron supplements in diet may be sufficient precaution.

Fatty Liver

Fatty Liver is not caused by eating fat but is related to intake of alcohol or some drugs, obesity, starvation and other reasons. A well balanced diet and removal of the responsible chemical substance or drug is the suggested treatment.

Fast foods and Food Supplements

Patients with liver disease should be very careful of supplements to the diet, especially fast foods or packaged nutritional supplements as these contain large amounts of salt, potassium or inappropriate blends of proteins. Even those that are deemed safe must be consumed under advice of a physician.

Immunization against Liver Diseases

2011-08-07T10:11:00.000-07:00

Preventive care for liver disease has made good progress as a result of which vaccines have been developed for immunization against liver diseases like Hepatitis A, B and D. It may be noted that Immunization against Hepatitis B protects one from Hepatitis D too, though no specific vaccine exists for the latter.

Hepatitis A

Hepatitis A is caused by a virus that attacks the liver. It is a serious liver disease wherein the virus is transmitted through contaminated food and contaminated water. The virus may be passed on to you by someone infected with it if and when she/he doesn’t wash her/his hands well after clearing bowels and touches or prepares something that is then eaten by you.

Fortunately, one can protect oneself from Hepatitis A by means of vaccination that prevents one from contracting the disease or from being a carrier.

It is imperative to get oneself vaccinated prior to travelling into countries that pose a high risk of contracting Hepatitis A as a result of improper handling or preparation of food or insufficient sewage and water purification systems. In the past, outbreak of Hepatitis A has also been reported from regions normally perceived as low risk, like North America. Those working in day-care centers, especially those who diaper infants, must also immunize themselves against Hepatitis A.

Hepatitis A vaccines are highly effective and adverse reactions are insignificant in intensity and duration, normally being pain, inflammation or soreness at the site of injection.

Hepatitis B

Hepatitis B is caused by a virus that attacks the liver and is 100 times more contagious than the AIDS virus. It is passed on through infected blood or body fluids or during sexual contact with an infected person. Hepatitis B does not spread by casual contact or by food or water. Three injections of this vaccine are required to be taken over a six month duration for effective protection. High risk groups are those exposed to blood or body fluids- like healthcare professionals, firefighters, police-, sex partners of Hepatitis B carriers and babies born to Hepatitis B carriers. Another high risk group is of those immigrating from countries where Hepatitis B is a fairly common disease, viz. Asia, sub-Saharan Africa, Southern and Eastern Europe and the Pacific Islands.

Hepatitis B vaccines are also available in formulations made specifically for adults or for pediatric use. A combined vaccine for both Hepatitis A and B is also available. These vaccines are well accepted by all age groups and cause few, mild reactions like pain and soreness at the injection site and a slight temperature.

Post-exposure Prophylaxis

In case one is exposed to infected blood or body fluids in the recent past, say within a week, immediate immunization with the Hepatitis B immune globulin may be effective in preventing onset of the disease.

Hepatitis C

No vaccine for Hepatitis C exists presently though several are under development. Nonetheless, patients with chronic liver disease including Hepatitis C should get themselves immunized against both Hepatitis A and B. A second infection by either of these viruses can cause grave complications and aggravate liver damage considerably. For patients in advanced stages of Hepatitis C it is recommended to have drug treatment closely assessed by the physician.

Liver biopsy

2011-08-06T00:13:00.000-07:00

Liver biopsy is a diagnostic procedure for acquiring a portion of liver tissue. Microscopic

examination of liver tissue is used for identification of liver disease, its cause or stage.

What are the various types of liver biopsy?

The most commonly employed method for liver biopsy involves insertion of a needle into the liver for a fraction of a second through an appropriate spot on the body. The depth and angle of needle puncture at the spot is also determined by the physician by physical examination or ultrasound. The skin and the area under it are anesthetized followed by a needle puncture, in and quickly out of the liver. While about 50% individuals experience no pain after the procedure, the rest experience a brief, localized pain which may spread to the right shoulder. Patients may be discharged within 3 to 6 hours provided there are no complications.

In another technique, the needle is guided into the liver through the abdomen or chest aided by imaging techniques like ultrasound or Computer Tomography (CT). This is helpful in case of localized tumors to determine the precise location of the tumor and then guide the needle to it. Patients are normally allowed to go home on the same day.

Laparoscopy, transvenous or transjugular liver biopsy and surgical liver biopsy are other less commonly used techniques. In Laparoscopy, a small incision is made in the abdominal wall and a narrow, lit tubular instrument is guided through it. Gas introduced into the abdomen moves the internal organs away from the abdominal wall. Liver tissue samples are obtained by instruments passed through this lit instrument or via various punctures around the liver. Patients may be discharged after several hours of the procedure.

Transvenous or transjugular liver biopsy may be performed by a radiologist in special circumstances, e.g. when the patient has a significant problem with blood clotting (coagulopathy) or accumulation of a large amount of fluid within the abdomen (ascites). For this reason, transjugular liver biopsy is recommended for patients with advanced cirrhosis. In this procedure, a small tube is inserted into the internal jugular vein in the neck and radiologically guided into the hepatic vein which drains the liver. A small biopsy needle is then inserted through the tube and directly into the liver to obtain a tissue sample.

Surgical liver biopsy is done when a patient undergoes an open abdominal surgery which makes it easier for the surgeon to conduct detailed liver inspection and obtain as many biopsy samples as required.

In what instances is liver biopsy done?

Liver biopsy is used to determine the cause of chronic liver disease inferred by liver inflammation or elevated liver tests and also for diagnosis of liver tumors detected by imaging tests. While blood tests can well indicate chronic liver disease, liver biopsy helps confirm the diagnosis and also determine the extent of liver damage. Post-liver transplant biopsy helps determine the cause of elevated liver tests and also confirm likely rejection of the transplanted liver.

What are the risks associated with liver biopsy?

During liver biopsy, the primary risk encountered, though observed in only about 1% of cases, is bleeding from the site of needle puncture into the liver. Other likely complications may be puncture of other organs such as lung, kidney or colon. Mistaken biopsy of the gall bladder instead of the liver may lead to leakage of bile into the abdominal cavity which causes peritonitis. Fortunately, the risk of fatality from liver biopsy is a miniscule 0.1% to 0.01%.

As a precaution to minimize the risk of bleeding, the patient’s coagulation status is assessed by a Prothrombin Time test. If the Prothrombin Time is high or the platelet count low, then transjugular biopsy may be recommended instead of a standard one. Alternatively, clotting abnormalities may first be rectified by using Vitamin K or fresh frozen plasma.

Does liver biopsy have any alternatives?

In case liver biopsy is not possible for any reason, a physician may make the diagnosis of a liver disease through physical examination, patient’s medical history and blood test results. While blood tests may be sufficient for diagnosis of chronic liver disease in certain cases, at other times a liver biopsy may be deemed essential.

Are liver biopsies required to be repeated?

In most instances, a single liver biopsy is sufficient to confirm a suspected diagnosis of chronic liver disease. Repeated biopsies may however be required to track changes in clinical condition or the impact of medical therapy like drug treatment. Patients having undergone liver transplant may need repeated biopsies in the first few weeks to months from surgery to eliminate possibilities of rejection of the new liver or the onset of other complications.

Tell me what is a Liver Test

2011-08-05T01:25:00.000-07:00

Liver tests are blood tests that indicate the presence of liver damage or inflammation. However, few Liver Tests also ascertain the overall condition of the liver or the biliary system and its functioning.

How helpful are Liver Tests in diagnosing liver disease?

Liver Tests supplemented by the patient’s medical history and physical examination, guide the doctor in diagnosing and treating a number of Liver diseases. A drawback of such tests is that they use the biochemical analysis of the blood as only an indirect indicator of liver condition.

Which Liver Tests are the most commonly used?

Enzymes
Bilirubin
Proteins
Specialised tests

Enzymes

Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST)

The liver cells contains enzymes which, in case of injury to the liver or hepatocellular damage, may leak out of the cells and reach the blood stream. Presence in the blood stream of such enzymes like Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) – known earlier as SGPT and SGOT – are most commonly used indicators of liver damage. ALT is a more reliable indicator of liver inflammation since AST is also present in other organs and tissues like the heart and skeletal muscle. In chronic liver disease, in spite of scarring of the liver or Cirrhosis, these enzymes may be within normal levels and hence not sufficient and reliable. However, in case of acute damage to the liver as in case of viral Hepatitis, ALT and AST may be used as an indicator of the extent of inflammation of or damage to the liver.

Alkaline phosphatase

This test is commonly used for detecting obstruction in the biliary system. Alkaline phosphatase is an enzyme found in both the liver as well as bile. It leaks into the bloodstream, like the enzymes ALT and AST, where excessive levels may be seen in disorders such as gallstone disease, alcohol abuse, drug-induced hepatitis or even primary biliary cirrhosis (PBC) and biliary tumors. However, since it is also present in other organs like bone, intestine, placenta etc it becomes necessary to eliminate the possibility of organs other than liver being the cause of its presence. Towards this purpose, one also needs to test for another enzyme which is not found in these organs – like gamma-glutamyl transpeptidase (GGT) or 5'-nucleotidase (5'-NT) to ascertain the precise origin of excessive levels of Alkaline Phosphatase.

Bilirubin

Bilirubin is the primary pigment in bile in humans, excessive levels of which leads to jaundice, the yellow discoloration of the skin. It is formed mainly from breakdown of heme, found in Red Blood Cells, then taken up from the blood, processed and finally secreted by the liver into the bile. While a healthy person would exhibit small levels of Bilirubin in the blood (< 17 µmol/L), these may increase substantially to even higher than 50 µmol/L which leads to the condition of jaundice. Such elevated levels of Bilirubin may be caused by destruction of Red Blood Cells or liver dysfunction that leads to reduction in removal of Bilirubin from the blood stream.

Bilirubin is a relatively non-specific test since the level of Bilirubin in the bloodstream may be high under a variety of liver or biliary diseases. However, by virtue of its ability to indicate the liver’s potential to process and secrete Bilirubin into the bile, it is very useful as a true Liver Function Test.

Proteins

Albumin

A reduction in the blood level of Albumin, a major protein formed by the liver, is an indicator of chronic liver disease. However it may be noted that a variety of factors may influence the level of Albumin in blood. The level normally ought to be > 35g/L and is measured as a part of most automated blood screening panels

Prothrombin time and INR

The liver generates proteins called blood clotting factors whose production is affected in case of liver damage. Tests like Prothrombin time (also commonly known as protime or PT) and INR evaluate blood clotting or coagulation which is directly indicative of liver dysfunction. PT values measured in seconds normally ought to be within +/- 2 seconds of that of a control patient

Specialised Liver tests

Certain liver diseases may need highly specialized tests for their detection. Viral Hepatitis B (HBsAg, HBV DNA) or Viral Hepatitis C (e.g. anti-HCV antibodies, HCV RNA) may be indicated by using specific antibodies, nucleic acids and proteins. Hemochromatosis may be inferred by an increase in levels of serum iron, transferrin saturation and ferritin. Patients of Wilson disease, a copper metabolism disorder, normally show a deficiency in Ceruloplasmin. Primary Biliary Cirrhosis (PBC) may be detected with the help of immunologic tests like the antimitochondrial antibody test. Antinuclear or anti-smooth muscle antibodies may point to Autoimmune hepatitis. The deficiency of alpha-1-antitrypsin may infer the presence of disease of the liver and/or lung.

DIAGNOSING LIVER DISEASE

2011-08-03T23:37:00.000-07:00

Diagnosis of Liver disease can pose several challenges, primarily in the form of vagueness of symptoms which may be misleading and be a cause of confusion with other health problems. One may come across quite a few cases where symptoms are absent but the patient may still have undergone severe damage to the liver.

An open discussion with your doctor may be necessary in case he or she suspects you to be having a liver disease. This would be required to assess various factors which you may have been exposed to like consumption of certain prescription drugs or over-the-counter drugs, blood transfusions, exposure to toxic chemicals or to blood products at work - eg. accidental pricking of needle sticks. Travel to high risk areas, alcohol consumption, sexual activity, regular or experimental use of injection drugs and a family history of liver disease are also possible factors.

Indicators of liver disease which your doctor may look for are jaundice, tenderness in the region of the liver or swelling of the abdomen.

Proper functioning of your liver and causes of liver damage, if any, can be determined by means of blood tests called Liver Tests, which indicate the presence of liver inflammation or antibodies or virus particles that point to a particular liver disease.

In some cases, you may need to undergo a liver biopsy wherein a thin needle is inserted into your liver which removes a tiny piece of tissue which is further examined microscopically.

With the advancement of medical diagnostic technology, imaging tests like Ultrasound, Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), Endoscopic Retrograde Cholangio Pancreatography (ERCP) and Magnetic Resonance Cholangio Pancreatography (MRCP), detecting specific types of liver disease has become more precise and they also help in determining the extent of scarring of the liver.

Knowing Liver Diseases

2011-08-03T00:10:00.001-07:00

Though most often liver diseases are linked to alcohol or drugs, the fact is that there are more than 100 forms of liver disease caused by many other factors that affect everyone from infants to adults.

Cirrhosis is often considered to be a form of liver disease and may be the only liver-related condition that many people have heard of. In fact, cirrhosis is a condition that results from permanent damage or scarring of the liver. Many types of liver disease still have unknown causes but the most frequent liver diseases are generally caused by one of the following factors:

Viral Hepatitis: Caused by viruses that attack the liver, viral hepatitis comes in many forms. The most common forms world-wide are hepatitis A, B and C. Although hepatitis A and B can be prevented by vaccine, there is no vaccine for hepatitis C.
Obesity: Another leading cause of liver disease fatty liver disease linked to obesity.
Alcohol: Factors such as gender, age, nationality, weight and health can affect how a person’s liver metabolizes alcohol. When the liver has too much alcohol to handle, normal liver function may be interrupted leading to a chemical imbalance.
Genetics: Several forms of liver disease are caused or thought to be caused, by defective genes. These forms of liver disease may be diagnosed in infancy or may not show up until later in life.
Autoimmune Disorders: Sometimes a body’s immune system may begin to attack the liver or bile ducts causing inflammation and scarring which leads to a progressive form of liver disease.
Drugs and Toxins: Liver disorder is a predictable consequence of overexposure or over-consumption of certain chemicals such as acetaminophen or industrial toxins like polyvinyl chloride or carbon tetrachloride.
Cancer: Although primary liver cancer is relatively uncommon, many other forms of cancer often metastasize in the liver. Because the liver filters a high volume of blood which may be carrying cancer cells, it is susceptible to developing a form of secondary cancer.

Liver – The Complex Chemical Factory

2011-08-02T00:11:00.000-07:00

The liver is a complex chemical factory that works 24 hours a day, weighing just over one kilogram. It administers everything you eat, drink, breathe in or rub on your skin and it’s some of the in it’s over 500 different functions vital to life.

Day in and day out, your liver aids in providing the body with energy, fighting off infections and toxins, helping clot the blood, regulating hormones and much, much more.

For you to understand the critical role of the liver, listed below are few of the many crucial functions of the liver:

Cleanses blood:

· Metabolizing alcohol and other drugs and chemicals,

· Neutralizing and destroying poisonous substances.

Regulates the supply of body fuel:

· Producing, storing and supplying quick energy (glucose) to keep the mind alert and the body active,

· Producing, storing and exporting fat.

Manufactures many essential body proteins involved in:

· Transporting substances in the blood,

· Clotting of blood,

· Providing resistance to infection.

Regulates the balance of many hormones:

· Sex hormones,

· Thyroid hormones,

· Cortisone and other adrenal hormones.

Regulates body cholesterol

· Produces cholesterol and converts it to other essential substances.

Produces bile:

· Eliminates toxic substances from the body and aids digestion.

Regulates the supply of essential vitamins and minerals such as iron and copper.

So don’t neglect your liver!

Understanding Liver

2011-08-01T03:13:00.000-07:00

The liver is a resilient, maintenance-free organ that' is easy to ignore - until something goes wrong. Because of its wide-ranging responsibilities, the liver’s smooth functioning is often disturbed by viruses, toxic substances (including alcohol), contaminants and disease. Even when there is a serious, fatal problem with the liver, it manages to function without much problems. Often, people with liver problems will be completely unaware because they may have very few symptoms. The liver is such a stalwart organ that it will continue working even when two thirds of it has been damaged by scarring (cirrhosis).

It is important to take steps to prevent liver disease, such as making healthy lifestyle choices and getting immunized against viruses that can cause liver disease. Today, there have been major advances in treating liver diseases and it is essential to understand liver symptoms at the very beginning and realize that there are experts available to treat all kinds of liver disorders.

Neurons – Mysteries of the Mind!

2011-04-26T11:25:00.000-07:00

Brain cells of a human body, or Neurons, are extremely complex cells that send and receive electro-chemical signals in the body. Managing diseases in these cells have been and is still a very challenging task. Neurological diseases are a multifaceted problem, hence requires a multifocal approach to deal with them.

The most common form of disorder to brain cells is when a bunch of abnormal brain cells sparkles to produce Epilepsy, which is also known as fits. In spite of advanced CT, MRI and PET scans, it is difficult to locate the abnormal areas that are responsible for fits. This limitation is now eliminated with the use of Continuous VIDEO ASSISTED EEG MONITORING- a technique in which a patient is continuously studied in a dedicated laboratory for two to three days. The abnormal electrical brain waves that are recorded in this way helps in locating the diseased area of the brain.

Another form of disorder to the neurons is Brain stroke or Brain attack, which causes paralysis of limbs and is equivalent to Heart attacks in the aspect of fatality and extent of damage to the body.

Aneurysms or abnormal dilatation of brain vessels is another fatal condition, which can be treated with coils and balloons using the same interventional techniques.

Global Hospitals & Healthcity, Chennai, has such a multifocal state of the art, comprehensive neuro care center – The Institute of Neurosciences and Spinal disorders. The center comprises of 3 highly qualified and experienced doctors – Dr. J. K. B. C. Parthiban (HOD – Neuro Surgery & Spine unit), Dr. S. Dinesh Nayak(Senior consultant – Neurologist & Epileptologist) and Dr. Selvapandian (Senior Consultant – Neuro Surgery & Interventional Neuro Radiology). These three specialists work as a team to give a new lease of life to the patients in need, suffering from illnesses that range from Severe Brain Injury to Acute Stroke, Epilepsy and Brain cancers.

Global Hospital & Health city is the only centre in south India to have the facility of Video Assisted EEG Monitoring available continuously for 72 hrs. In case of epilepsy, this form of monitoring can detect the abnormality in the brain easily and at an early stage. “Since 95% of fits can be effectively managed by medications, the remaining 5% (Refractable Epilepsy) of patients can be benefited by excising those abnormal areas using high profile delicate micro surgeries i.e., Epilepsy Surgery”, says Dr. Dinesh Nayak. At Global Hospitals, a team of Neurophyscians and Neurosurgeons execute the treatment process for epilepsy with great competency and high success rates.

In case of paralysis of the brain, Global Neurosciences centre is the only centre of its kind to have a team of Interventional Neurosurgeons and Neuroradilogists working together in the same CATH LAB. “If treated during the golden hours i.e., – within one hour after the attack, brain paralysis can be reversible. Blood Clots that obstruct the vessels can be dissolved by using Pin Hole Techniques i.e., Interventional Neurovascular procedures”, says Dr. Selvapandian.

In the recent times, a Nigerian girl’s broken neck bones were surgically removed and the crushed spinal cord was decompressed (freed), which facilitated recovery of limb functions and reduction in the stiffness. This paved way for the overall improvement in her mobility. Dr. J. K. B. C. Parthiban, the HOD of the department highlights the value of delayed decompression of the crushed spinal cord and claims that this was the most challenging spinal surgery of all. Ever since the successful spine surgery of the Nigerian girl, Global Hsopital’s Spinal Department has attracted the attention of many people from different parts of the globe suffering from Spine illness.

The Institute of Neurosciences and Spinal disorders of Global Hospitals & Healthcity provides complete and comprehensive neuro-care under one roof and is managed by very efficient doctors who are specialists in each subdivision. A one-of-its-kind Acute Stroke, Head and Spine Injury Care Unit has also been established to cater to all Neuro emergencies round the clock.

In a critical scenario, where neurological disorders invade the human body at a lightning pace, there is a need for centres of excellence to challenge its fatality and Global Hospitals & Healthcity presents just the right mix of technology and expertise to handle these cases.

All About Osteoporosis

2011-04-18T23:44:00.001-07:00

Osteoporosis

About Osteoporosis

Causes/Risk Factors for Osteoporosis

The causes and risk factors for osteoporosis are many. A few of them are listed below:

Previous fracture at <50 yrs
Parent or sibling with previous fractures
Cigarette smoking
Senility
Malnutrition
Low calcium intake
Hormonal disturbance
Excessive alcohol intake
Physical inactivity
Excessive intake of certain medications like steroids

Symptoms

Osteoporosis is a disorder with many obvious symptoms. Some of these symptoms are:

Pain in the bones
Fractures with little or no trauma
Loss of height (as much as 6 inches over time)
Low back pain due to fracture of bones of the spine (lower)
Neck pain (fracture of bones of spine in the neck)
Stooped posture

Diagnosis of Osteoporosis

The World Health Organisation (WHO) has defined bone disease based on BMD T scores:

Osteopenia (low bone mass): Tscore between -1 and -2.5
Osteoporosis: T score greater than or equal to -2.5
Established osteoporosis: T score less than -2.5 and the presence of fracture

Treatment for Osteoporosis

Treatment of osteoporosis is a two-step process, which are:

Goals of Treatment:

A part of the treatment includes setting up the goals, which include:

Maintain bone mass and integrity
Slow down the bone loss
Treat the symptomatic problems and its sequel

Maintain Bone Health:

The next part is to maintain the deteriorating bone density:

Life style adjustments
Minimise use of alcohol
Stop smoking
Reduce the intake of coffee
Avoid carbonated beverages
Supplemental calcium and vitamin D
Enough calcium in the diet (1000mg per day of calcium for adults under the age of 50 and 1200mg per day of calcium for those 50 and older)
Taking adequate vitamin D, which is important for calcium absorption and for maintaining muscle strength. The recommended dosage is 400-800IU per day for adults lesser than 50 and 800- 1000IU for those age 50 and older)
Physical exercise programmes tailored to the needs of the individual patient. This includes balance training, postural training, resistance training, stretching and weight bearing aerobic exercise. In patients with severe osteoporosis, activities that require vigorous flexing or rotation of the spine should be avoided.

Medications

Medications used in the prevention and treatment of osteoporosis are those which either reduce the bone loss (antiresorptive) or increase the bone growth (anabolic). These include:

Bisphosphonates (alendronate, risedronate, ibandronate and zolendronic acid): These have been approved for the prevention and treatment of postmenopausal osteoporosis in women and osteoporosis in men.
Calcitonin: This medication is given usually as a nasal spray or as an injection under the skin. This is helpful in controlling the pain after an osteoporotic vertebral fracture.
Estrogen or Hormone Replacement Therapy: This medication reduces the risk of osteoporosis and osteoporotic fracture. This increases the risk for breast cancer, stroke, and heart attack.
Selective Oestrogen Receptor Modulators (SERMs): This medication mimics the good effects of oestrogen in bone without the serious side effects (breast cancer).
Teripartide (forteo): This medication is a form of parathyroid hormone that helps to stimulate the bone formation.

Few Points to Remember…

In Osteoporosis, the bones are weak and break easily, resulting in severe limitation of activities and bring down the quality of life as well increase the risk of death, especially after 65 years.
Osteoporosis occurs in both sexes but is more common in women.
Osteoporosis may not be outwardly apparent until a fracture occurs. It can be detected before the first fracture, if the risk factors are identified and BMD test are done in time.
It is never too early to adopt preventive measures or too late to begin treatment to prevent further fracture.
Leading a healthy lifestyle, having a balanced & regular check up with your Physician or Rheumatologist are the key points to prevent Osteoporosis
The more you know about the prevention and treatment of osteoporosis the better are your chances of staying active and independent.

Dr. R. Kirthi
MD DM (Rheumatology)
Consultant Rheumatologist
Global Hospitals & Health City