{"id":69787,"date":"2012-08-01T11:41:37","date_gmt":"2012-08-01T15:41:37","guid":{"rendered":"http:\/\/dominicanewsonline.com\/news\/?p=69787"},"modified":"2012-08-01T12:22:04","modified_gmt":"2012-08-01T16:22:04","slug":"health-talk-let-your-liver-live-2","status":"publish","type":"post","link":"https:\/\/dominicanewsonline.com\/news\/homepage\/columns\/health-talk\/health-talk-let-your-liver-live-2\/","title":{"rendered":"HEALTH TALK: Let your liver live"},"content":{"rendered":"
\"\"
Dr. Victor Emanuel MD<\/figcaption><\/figure>\n

Today, we\u2019re going to talk about CIRRHOSIS OF THE LIVER.\u00a0 The fact is, if your liver doesn\u2019t live, and live well, neither can you.\u00a0 What do you expect, after all? It is the largest organ in the body and has a number of functions to keep your body functioning properly.<\/p>\n

WHAT ARE SOME OF THESE FUNCTIONS?<\/strong><\/p>\n

\u2022\u00a0\u00a0 \u00a0It removes or neutralizes poisons from the blood.
\n\u2022\u00a0\u00a0 \u00a0It produces immune cells to control infection.
\n\u2022\u00a0\u00a0 \u00a0It removes bacteria and other germs from the blood.
\n\u2022\u00a0\u00a0 \u00a0It makes the proteins that regulate blood clotting, so that you don\u2019t bleed to death from the slightest cut,
\n\u2022\u00a0\u00a0 \u00a0It produces bile to help absorb fats and vitamins A, D, and E, the fat \u2013 soluble vitamins.\u00a0 Vitamin K is another fat- soluble vitamin, by the way.<\/p>\n

I\u2019m giving some importance to cirrhosis of the liver because it is affecting many a person and has killed many more in our little country.\u00a0 And guess what the main reason is.\u00a0 You guessed it: ALCOHOL; that which I do not consume, not a drop on my tongue, and implore at every opportunity, others to follow me.\u00a0 You may want to think about it in\u00a0 Drug Awareness Month next month, one more time.<\/p>\n

SO WHAT IS CIRRHOSIS OF THE LIVER?<\/strong><\/p>\n

Simply put, in this condition, scar tissue replaces normal healthy tissue. When this happens, essentially the architecture of this powerhouse is disturbed.\u00a0 The consequence of this is that the flow of blood through the organ is blocked, preventing it from working as it should.\u00a0 Alcohol is not the only cause, though.\u00a0 Here are some others, below.<\/p>\n

CAUSES OF CIRRHOSIS<\/strong><\/p>\n

Just because you know how I feel about alcohol, let me mention one or two facts in its role in cirrhosis.\u00a0 It causes it to develop after more that ten years of heavy drinking.\u00a0 It takes different amounts for different people. In women, as few as two or three drinks per day might do it, and in men, as few as three to four drinks per day.\u00a0 How it does it is by blocking the normal metabolism of your proteins, fats and carbohydrates; you know, your main food groups.<\/p>\n

Other causes are:<\/p>\n

\u2022\u00a0\u00a0 \u00a0Chronic Hepatitis C.\u00a0 Hepatitis C is a virus which causes inflammation of and low- grade damage to the liver.\u00a0 But over several decades, it can lead to cirrhosis.\u00a0 So really, this would have to infect you from a fairly young age and over the years, do its damage.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Chronic Hepatitis B and D.\u00a0 As far as viruses are concerned, the Hepatitis B virus is thought to be the most common cause of cirrhosis worldwide.\u00a0 It can be carried in the feces, in blood, and is even transmitted sexually, usually by the homosexual method.\u00a0 It works like Hepatitis C in the amount of time it takes to cause damage to the liver.\u00a0 By the way, it can cause cancer of the liver, too, do not forget.\u00a0 Hepatitis D virus infects only the liver of people who already have hepatitis B; they are partners, they are tight.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Drugs, toxins, and infections. Some people react severely to prescription drugs.\u00a0 Others are exposed for a long time to environmental toxins.\u00a0 A parasite called Shistosoma which is found in Guadeloupe, where many of us frequent, causes an infection which may affect the liver.\u00a0 Repeated bouts of heart failure with the liver congestion it causes also occurs in many people in Dominica.\u00a0 All of these factors can eventually lead to cirrhosis.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Autoimmune hepatitis.\u00a0 The immune system sometimes gets out of control and attacks its own body, including the liver.\u00a0 Inflammation, damage, scarring, and cirrhosis follow.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Inherited Diseases.\u00a0 There are many of these that interfere with the way the liver produces, processes, and stores enzymes, proteins, metals and other essential substances the body needs for proper functioning.\u00a0 Wilson\u2019s disease, a disorder of copper metabolism; hemochromatosis, abnormal deposition of iron in many organs, are two I can mention for interest.\u00a0 Bet you\u2019re saying, \u201cCopper, iron, what are these metals we use in pipes and construction doing in my body?\u00a0 It\u2019s the Creator\u2019s work, is all I can say.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Blocked Bile Ducts. The right and left hepatic (liver) ducts leave the liver as a common duct, after they have joined.\u00a0 The cystic duct from the gallbladder joins this duct to form the common bile duct, which drains bile into the small intestine, right next to the main duct from the pancreas. If the ducts from the liver carrying bile are blocked, bile backs up and damages liver tissue.\u00a0 There are one or two relatively rare causes of this, but it has been known to happen after surgery on the gall bladder if the ducts are accidentally tied off or injured.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Nonalcoholic steatohepatitis (NASH).\u00a0 In this, fat builds up in the liver and later causes scar formation.\u00a0 It seems to be associated with diabetes, obesity, heart disease, protein malnutrition, and treatment with medications like prednisolone.\u00a0 In each of these categories we have enough in Dominica, so be careful, folks.\u00a0 Protect your liver.<\/p>\n

WHAT ARE THE SYMPTOMS?<\/strong><\/p>\n

In the early stages many people have none at all.\u00a0 But as more and more scar tissue replaces healthy ones, liver function begins to fail and one may experience EXHAUSTION, FATIGUE, LOSS OF APPETITE, NAUSEA, WEIGHT LOSS, WEAKNESS, ABDOMINAL (STOMACH) PAINS, SPIDER-LIKE BLOOD VESSELS (SPIGER ANGIOMAS) on the skin.<\/p>\n

COMPLICATIONS OF CIRRHOSIS<\/strong><\/p>\n

\u2022\u00a0\u00a0 \u00a0Edema and Ascites.\u00a0 Edema means swelling, and ascites means free fluid in the abdomen.\u00a0 A lot of men with big tight stomachs have ascites from cirrhosis, no joke.\u00a0 This happens when the liver loses its ability to make protein.\u00a0 Osmotic pressure in the blood vessels is low, and water is drawn out of them and accumulates in the legs and abdomen.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Bruising and bleeding.\u00a0 Remember that the liver makes clotting proteins so a person with cirrhosis may bruise or bleed easily.\u00a0 The palms of the hands may be blotchy and reddish.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Jaundice is a yellowing of the skin and eyes when the diseased liver does not absorb enough bilirubin.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Itching.\u00a0 Intense itching may result from bile products being deposited in the skin.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Gallstones.\u00a0 If cirrhosis stops bile from reaching the gallbladder, stones may develop.\u00a0 Bad news.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Toxins in the blood or\u00a0 brain.\u00a0 The damaged liver cannot remove toxins from the blood, so they accumulate in the blood and the brain.\u00a0 The results can be mental dullness, personality changes, and coma, even death.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Sensitivity to medication.\u00a0 Cirrhosis slows the liver\u2019s ability to filter medications from the blood.\u00a0 These then last longer than expected and build up in the body.\u00a0 A person will be more sensitive to medications and their side effects.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Portal hypertension.\u00a0 Now, blood from the intestines, the spleen, the pancreas, the gallbladder and its ducts go through the liver via an important vein called the portal vein.\u00a0 But cirrhosis slows the normal flow of blood through this vein- remember its architecture is all messed up- and pressure is increased within it;\u00a0 this is portal hypertension.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Varices.\u00a0 Slow blood in the portal vein backs up into blood vessels in the stomach and esophagus, and even the anus \/ rectal area.\u00a0 These vessels become enlarged because they are not designed to carry this much blood.\u00a0 These vessels, now called varices, have thin walls and carry high pressure, and naturally can burst easily.\u00a0 Serious bleeding and death can occur.\u00a0 Having mentioned the anus \/ rectal area, hemorrhoids which bleed can result too.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Liver cancer.\u00a0 Yes, whatever the cause, cancer can develop.\u00a0 Of course, this kills many.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Type 2 Diabetes and insulin resistance.\u00a0 Cirrhosis causes resistance to insulin.\u00a0 If you have insulin resistance, your muscle, fat, and liver cells do not use insulin properly.\u00a0 The pancreas tries to keep up with the demand for insulin by producing more.\u00a0 But eventually it can\u2019t, and diabetes develops as excess glucose builds up in the blood.<\/p>\n

\u2022\u00a0\u00a0 \u00a0Other problems.\u00a0 Immune system dysfunction, leading to infection. Impotence, enlarged breasts in men, and shrinking of the testicles, because the liver cannot produce enough male hormones; the female one predominate. Kidney failure and osteoporosis (brittle bones) also occur.<\/p>\n

HOW IS CIRRHOSIS DIAGNOSED?<\/strong><\/p>\n

On the basis of the information given, the physical examination in which the liver may feel harder and larger than normal, the doctor can safely make the diagnosis.\u00a0 In some advanced cases, the liver may shrink though.\u00a0 Ascites is pretty much always there.<\/p>\n

Blood tests can be done, and if the liver needs to be looked at, ultrasound, CAT Scan and MRI\u2019s may be done.\u00a0 Or the liver can be looked at directly with a laparoscope (women know a lot about this).\u00a0 Or a piece can be taken with a special needle and looked at under the microscope.<\/p>\n

HOW IS IT TREATED?<\/strong><\/p>\n

Cirrhosis cannot be reversed, but treatment can stop or delay progression and reduce complications.\u00a0 If there is a known cause, we can try to treat it, and this is possible in most of the situations mentioned under \u201ccauses.\u201d In all cases, a healthy diet and abstinence from alcohol are necessary.\u00a0 Light physical activity will help stop or delay cirrhosis also.<\/p>\n

For complications, measures can also be taken for edema and ascites; a low-sodium (low salt) diet or the use of water-pills may be recommended.\u00a0 Other measures include:<\/p>\n

–\u00a0\u00a0 \u00a0Use of antibiotics for infection.
\n–\u00a0\u00a0 \u00a0Medications for itching.
\n–\u00a0\u00a0 \u00a0Eating less protein (they cause toxins to form in the digestive system).
\n–\u00a0\u00a0 \u00a0Laxatives may help absorb and remove toxins from the intestine.
\n–\u00a0\u00a0 \u00a0Portal hypertension may be treated with what we call a beta blocker as we use for regular hypertension.
\n–\u00a0\u00a0 \u00a0Varices require special devices to control bleeding.<\/p>\n

When complications cannot be controlled, or the liver is so badly scarred that it stops functioning, a new liver, a liver transplant, is the last resort.\u00a0 Now you know I\u2019m not talking about Dominica.\u00a0 But you do know I\u2019m talking about a long waiting list, and plenty of\u00a0 cash. So people, don\u2019t allow anything to affect your liver, especially alcohol.\u00a0 It is too precious.<\/p>\n

See you next week.<\/p>\n

People of the north, Dr. Victor Emanuel will be in Portsmouth on Fridays from 8 am to\u00a0 3 pm at Bayside Medical Center across from the police station.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"Today, we\u2019re going to talk about CIRRHOSIS OF THE LIVER.\u00a0 The fact is, if your liver doesn\u2019t live, and live well, neither can you.\u00a0 What do you expect, after all? 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