Hello everyone and welcome to this week's blog post. This article is the second in a series about the liver. In last week's article, I explained some of the key functions of the liver and how the liver can become diseased. In this week's article, I will explore some of the treatments of liver disease and some of the ways liver disease can be prevented.
As I mentioned in last week's article, the liver has many different functions in the body. As a result, when someone has a liver that is diseased, they are not able to carry out many functions. This complicates the treatment of liver diseases, as this treatment needs to compensate for these functions not occuring.
The treatment of viral hepatitis
The treatment of viral hepatitis diseases depends on the type of virus and whether the infection is acute or chronic. For example, hepatitis A does not have a a specific cure. Instead, treatment focuses on relieving the symptoms of the disease while waiting for the body to fight the infection itself. These treatments include painkillers, eating small meals to reduce vomiting, and getting lots of rest. Additionally, sufferers are also advised to avoid alcohol, as this would put even more strain on the liver.
Meanwhile, hepatitis B can also not necessarily be cured. The treatment of hepatitis B depends on whether the infection is acute or chronic. Acute hepatitis B is when the infection only lasts for a short period of time - in these cases, treatment of the virus is similar to hepatitis A. As there is no cure for acute hepatitis B infection, treatment also focuses on relieving the symptoms of the disease.
Chronic hepatitis B can also occur. This is when the genetic material of the virus can remain inside the liver cells for a long period of time. Consequently, medications are sometimes needed to control the hepatitis B virus and prevent the damage continuing to occur. These medications, which sometimes must be taken for life, include antiviral medications and immune system modulators (substances that encourage the immune system to attack the virus).
The most common type of viral hepatitis in the UK is hepatitis C. Fortunately, effective cures for hepatitis C do exists - according to the NHS, roughly 90% of hepatitis C cases can be cured. The type of treatment the patient receives will depend on the strain of the virus - in most cases, direct acting antiviral tablets (e.g. simeprevir and ribavarin) are used. In addition, stopping smoking, reducing alcohol consumption and doing regular exercise can also help reduce the strain placed on the liver.
Treating other liver diseases
Unfortunately, there are very few cures for other common types of liver disease, including alcohol-related liver disease and non-alcoholic fatty liver disease. For these diseases, patients are encouraged to reduce the stress placed on their liver by doing regular exercise, stopping smoking and reducing alcohol consumption. In addition, medications can also be prescribed to treat some of the symptoms of the disease (such as high blood pressure and high cholesterol).
In the early stages of disease, the liver can regenerate itself if stress on the liver is reduced (e.g. by reducing alcohol intake or destroying the hepatitis virus). The liver is unique in this way, as it is the only internal organ in the body that can do this.
The liver is able to regenerate by increasing the number of hepatocytes. This process occurs in three stages. The first stage (the 'initiaion phase') occurs once damage has been detected by the liver. In this phase, signals are sent throughout the liver the prepare the cells to divide. In the next stage (the 'proliferation phase'), DNA replication occurs and the cells divide. Once the liver reaches its normal size, the 'termination phase' occurs, which is where the liver cells stop dividing.
Consequently, as long as the cirrhosis of the liver is not too great, the liver is able to recover from the damage. This is one reason why it is so important to reduce alcohol consumption after being diagnosed with alcohol-related liver disease, as it allows the liver to start recovering from the damage.
Liver transplants
In some cases, there is so much scar tissue in the liver that the liver fails and has to be replaced by a liver from a donor. According to the NHS, this treatment option is usually very successful, and patients who receive a donated liver can return to a normal lifestyle within a few years. In the UK, there are strict criteria for receiving a donor liver. As part of this, a surgical assessment is carried out to check whether a transplant would be possible.
In addition, an assessment is also carried out to check whether the patient is likely to adhere to post-operation guidelines. For example, if alcohol was the cause of liver disease, then the assessment team must be convinced that the patient will not drink alcohol after the transplant, as this would cause damage to the transplanted liver.
According to the British Liver Trust, recovery from a liver transplant can take a long time. Additionally, after the operation the patient will also need to take immunosuppressants to prevent their immune system from attacking and rejecting the donor organ. These medications can have numerous side effects, including making the patient more susceptible to other infections.
Fortunately, live organ donation is also possible with the liver. This is because the liver can regenerate itself. As such, a small section (or 'lobe') or the liver can be removed from the donor and transplanted into the recipient. This lobe will then regenerate into a normal-sized liver in the recipient. The donor's liver will also regenerate to its normal size. This is very useful, as it increases the availability of the organ, thus reducing the time patients have to spend on waiting lists for this procedure.
Preventing liver disease
Since the methods for treating liver disease are limited, it is much better to prevent the disease occurring in the first place. There are a few different ways to achieve this. One of the main causes of liver damage are hepatitis viruses. These viruses are transmitted through a number of different routes, including the oral-faecal route and through bodily fluids.
Consequently, there are two main ways to reduce the spread of viral hepatitis. Firstly, there are vaccines available for the hepatitis A and hepatitis B viruses, which provide immunity to those who receive them. As such, individuals who are at a higher risk of contracting these viruses should be offered the vaccine to reduce the likelihood of them contracting the disease.
Furthermore, those exposed to the hepatitis B virus can also be given antibodies that act against the virus in addition to the vaccine - whilst these antibodies do not provide long-term immunity against the virus, they do offer short-term immunity to protect the body.
In addition, it is important to diagnose hepatitis infections as quickly as possible. If these infections are diagnosed in their early stages, then sufferers can be advised on how to change their behaviour to limit the spread of the virus, thus limiting the spread of the disease.
According to the NHS, obesity is also one of the main causes of liver disease (especially non-alcoholic fatty liver disease). Therefore, programmes to help reduce obesity (such as encouraging healthy eating and regular exercise) could also result in a reduction in liver disease. Additionally, reducing obesity also reduces the risks of getting many other diseases, such as coronary heart disease and stroke.
Indeed, the government has launched many schemes to attempt to reduce obesity, such as the £2 billion scheme launched in May 2020. This scheme aims to reduce obesity by a few different ways, including issuing vouchers for cycle repairs and increasing the number of bike lanes.
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