Know Your Liver

Common liver disease

  • Know your liver
  • Liver function test what you should know
  • Nutrition in liver disease
  • Prevention of liver disease
  • Fatty liver
  • Hepatitis (ABC E and others)
  • Cirrhosis
  • Cirrhosis and complications
  • Liver tumor/cancer

Alcohol and liver disease

  • Is alcohol good for liver
  • When to stop alcohol
  • Alcohol intake: -the recommendation by experts

Liver Transplant

  • What is it?
  • When Liver transplant needed?
  • How to get prepared for liver transplant
  • Post liver transplant care
  • Post liver transplant quality of life

Organ donation

  • What is organ donation
  • Who can donate organ
  • When to donate organ
  • Pledge for organ donation today
  • Create awareness on organ donation

The liver is the vital organ of body in fact it is the largest organ of body. It is located in the upper right part of the abdomen and weighs about 1200 – 1500 grams in an average individual. The liver helps in digestion, production of protein and many nutrients ready for use by other organs body and removal of toxic materials from body.

[Here with we addressed the most commonly asked for questions as well as few health tips to guide you. Professional opinion from your doctor is needed. The things explained here are for general information, not to be followed in absence of professional guidance]

Liver function test what you should know

Nutrition in liver disease

Nutrition for liver includes both supplementation and cut down, depending upon the stage of liver disease, associated complication and other illness. Malnutrition is a common complication of advanced liver disease. Stemming from poor oral intake, faulty absorption and an altered pattern of fuel consumption, it carries important prognostic implications for a hepatic patient and is associated with higher rate of complication and, overall, an increased mortality rate if left untreated. It is, therefore, critical to assess the nutritional status of all patients with chronic liver disease and to optimize their nutritional support. The focus should be on maintaining adequate protein and caloric intake and correcting nutrient deficiencies.

[Here with we addressed the most commonly asked for questions as well as few health tips to guide you. Professional opinion from your doctor is needed. The things explained here are for general information, not to be followed in absence of professional guidance]

1. Fatty Liver And Obesity:

  • Limit foods that are high in calories
  • Eat more fiber rich food
  • Avoid Calorie rich food like sweets, ice cream, cold drinks, sugary juices, sherbet,
  • Fried stuffs like samosa, vada, paratha, poori, chips, farsan, nimki, pakoda, burger, pizza, roll, chowmin, excess oil in curries, ghee, butter, margarine etc.
  • Eat more vegetables, saag, salad, fruits, sprouts, oats, seeds etc.
  • Avoid alcohol.
  • Increase your physical activity.
  • Take your food in proper time; take small portion at frequent interval.

2. Alcoholic Liver Disease:

  • Stop Alcohol
  • Small frequent feed, need to increase your food intake at least 1.5 to 2 times that you used to take before
  • Avoid high fat foods like samosa, vada, paratha, poori, chips, farsan, nimki, pakoda, burger, pizza, roll, chowmin excess oil in curries, ghee, butter, margarine etc
  • Maintain your weight as per height A balanced high protein diet will help.
  • Vitamin & mineral supplementation as per doctor’s advice will help to fight micronutrient deficiencies.
  • Take your food in proper time; take small portion at frequent interval.

3. Nutritional advise in early liver cirrhosis:

  • Limit salt and foods that contain a lot of salt, like: Papad, Pickle, Chips, Bhujia, Mixture, Salted Nuts. Tomato Sauce, Soya Sauce, Road Side Fast Foods, Ready To Eat Packaged Food.
  • Fluid restriction as per doctor’s advice
  • Plant based  protein like All variety of Dal& Pulses are good for you, like(Arhar, Mung, Masoor, Chana, Rajmah, Chole, Chawli, Soybean),
  • Restrict animal protein like mutton, beef, Fatty chicken, prawn, crab etc. Fish, egg white, lean chicken can be taken as per Dietitian/doctor advice.

4. Nutritional advise in advanced liver cirrhosis:

  • The essential guidelines for designing nutritional therapy for patients with advanced liver disease are the following:
  • Calorie intake: Patients with cirrhosis should receive at least four to five small meals during the day, as well as a late evening snack. A uniform distribution of calories round the clock with as brief an interlude of fasting as possible during nighttime reduces the likelihood of lipolysis and nitrogen catabolism.
  • Protein intake: Cirrhosis is a catabolic disease with increased protein breakdown and inadequate re-synthesis; Protein should be given even to patient even with episodic hepatic encephalopathy. The estimates of protein requirements vary with the state of disease and the nutritional status of the patient. In uncomplicated cirrhosis, protein intake should be in the range of 0.8-1.2 g/kg body weight/day.
  • Water Intake
    • Fluid requirement for normal person/3-4ml/existing body weight/hourly
    • But in liver disease many times it is restriction due to Ascites and Edema.
  • Salt Restriction (Sodium restricted diets in liver cirrhosis)
  • Min requirement of sodium=1500mg/day (<1tea spoon salt)
  • Moderate Ascites:  ½ tea spoon salt = 1200mg of Na
  • Severe tense Ascites:  ¼ tea spoon salt = < 500 mg of Na
  • Pedal edema: ½ – ¾ tea spoon salt = 1200-1800 mg of Na
  • Additional Nutritional advice for micronutrients: Over time, most patients with cirrhosis develop micronutrient deficits. Almost all patients with advanced liver disease, and particularly those with a cholestatic liver disease, develop a deficiency of patients with alcoholic liver disease show deficiency of thiamine, folate, Vitamin B12, niacin, zinc, and magnesium.

Vitamin A: Decreased vitamin A levels result secondarily to fat malabsorption, as well as a defective mobilization of vitamin A from the liver.Supplementation of vitamin A for four to 12 weeks can correct this deficit.

Vitamin D and calcium: Deficits of vitamin D and calcium can result from several factors, including poor absorption from the intestinal mucosa, a decreased exposure to UV light and inadequate dietary intake, and impaired hepatic 25-hydroxylation of vitamin D. A prolonged deficiency state eventually produces bone weakness, bone pain and risk of fracture. Supplementation with calcium (1.000 mg/day) and vitamin D3 (800 IU/day) is necessary.

Zinc:  Zinc deficiency is common in patients with cirrhosis, and may have a possible role in the pathogenesis of hepatic encephalopathy.Supplementation with 600 mg zinc per day for three months has been shown to improve the mental functioning in patients of hepatic encephalopathy.

5.Nutrition in various complication of advanced liver disease:

Ascites

  • Salt intake: A low-sodium diet (2 g salt per day) is useful, since it helps limit further fluid accumulation in the body.
  • Electrolytes: Since the patient is on a regular diuretic therapy (drug for increased urination), a close watch is necessary on the serum electrolytes.
  • Protein intake: To compensate the protein loss, patients requiring frequent removal of fluid from belly should receive increased amounts of protein.

Hepatic encephalopathy

Protein intake: A normal protein diet, per day should be prescribed. This will barely maintain the nitrogen balance in the body, and yet, not burden the patient with too much protein degradation products. Several studies have documented the benefits of a vegetable protein diet in comparison to the animal protein diet in comparison to the animal protein diet in patients of hepatic encephalopathy. This benefit mostly relates to a reduced urea production in vegetable diets. A higher dietary fiber content in a vegetable diet also increases the incorporation and elimination of nitrogen through the faecal bacteria.

Vegetable proteins also carry a lower concentration of tryptophan and sulphur-containing amino acids. The intake of these amino acids is associated with worsening of the hepatic encephalopathy.

Sample menu (For a early cirrhosis patient, 54 year male, diabetic with 70kg body weight)

6.30-7AM:Toned milk Tea with Biscuits (3nos)   NO SUGAR
8.30-9AM:Chapati (2nos) with vegetable Curry (1 bowl)   1 CHAPATI= 25gm ATTA Or:  Iddly(3nos) with Samber and Chutney      NO COCONUT   AND GROUNDNUT Or:  Uttapam(3nos) with Mater curry Or:  Vegetable Daliya Or Oats Upma (1 bowl)
10.30-11AM  Buttermilk (200ml) or  1nos Cucumber or Fruits 150gm( Apple/Guava/Orange)
1-1.30PMSalad Full plate( Cucumber+Carrot+Tomato+Onion etc.) Rice(1cup) or Roti (2nos)   ½ cup RICE= 1 nos ROTI  With Dal (1 katori), Vegetable curry, Leafy vegetable,Curd (weakly 3 times Non-veg/150gm like Egg white/ Less than 1kg fish/Lean chicken) *Non-veg cook in form of stem, stew, rosted,…….
4-4.30PM:Toned milk Tea with Biscuits (3nos)   NO SUGAR
5.30-6PMBoiled sprouts salad( 1 bowl) or    vegetale and soyabeen  stuff Sandwich(3nos Brownbead)
8-8.30PM:Roti(2nos) With  vegetable curry/ soyabeen curry/ Rajma etc… With Salad
10PMToned milk (1 cup)

Avoid:  sugar, honey, jaggery , potato, yam etc.(avoid simple carbohydrate,  Fried foodand no fasting

Moderate intake:

  • Oil 15ml/day.
  • Fruits 150gm/day.
  • Milk and Milk product (350ml-400ml)/day.
  • Non-veg like: egg white, lean chicken, small fish(3times weakly)

Tips:

  • Small and frequent meal, Regular exercise (minimum 1hour)
  • Improved fluid intake if not restricted (3-4 lit/day)
  • Take 7gm Fenugreek /day for controlling sugar level.
  • Prevention of liver disease
  • Fatty liver

The burden of obesity has been steadily increasing with an estimated 1 billion people reported as overweight, and over 300 million people as obese (WHO 2005 report). Globally, the prevalence of fatty liver related disease ranges from 6% to 35%, and in India it has been reported to be 5-28% i.e. about 30 million obese people in India.  And the problem is expected to get worse as obesity is increasing due to urbanization, economical improvement and the sedentary life style due to entrance of modern technology and Internet. Being obese more and more people reel under excess body weight, even at a relatively younger age leading to the joint disorders and knee pain, fatty liver, cirrhosis, blood pressure, diabetes, and heart disease. Obesity has also emerged as a major public health challenge. Further, obesity among children and adolescents too is rising rapidly making the younger generation at risk from early age and a long life to survive with poor quality.

  • Hepatitis (A,B, C, E and others)
  • Hepatitis A and E related liver disease
  • Hepatitis B related liver disease

It is a virus infecting liver and is the major cause for chronic liver disease, cirrhosis and liver cancer, particularly in india, Asia and other developing countries.  Currently it affects 3% of population of India. India has more than 37 million HBV carriers and contributes to 10–15% of the entire pool of HBV carriers of the world.  About 15–25% of HBsAg carriers are likely to suffer from cirrhosis and liver cancer and may die prematurely. Infections occurring during infancy and childhood have the greatest risk of becoming chronic. Of the 2.6 Crore (26 million) infants born every year in India, approximately 10 Lakhs (1 million) run the life-time risk of developing chronic HBV infection. It’s commonly from mother to baby without any fault and is preventable by simple screening of mother as well as vaccination to newborn.  Blood transfusion, surgery, tattoo, multiple sex partners and injectable drug abuse further adds the burden. There is a need for awareness, detection and public health measures to prevent disease transmission and decrease the burden of the disease.

  • Hepatitis C related liver disease

It is a virus infection of liver and mostly blood borne i.e. by contaminated blood transfusion, surgery, needle prick, unsafe syringe and injecting drug abusers. It is most infectious virus i.e. 100 times more chance infection than the HIV. Once infected in 85% cases it becomes chronic liver disease may progress to cirrhosis and liver cancer in a period of 15-20 years. But often remain asymptomatic and early diagnosis and the recently available drugs make the treatment easy and effective. India is estimated at between 0.5% to 1.5% of population i.e. about 1 Crore Indians . The small steps by us like safe needle use, precautions during surgery and blood transfusion and screening test may prevent this. This is has been planned globally to be eliminated by 2030, lets join hand in global platform to make it a success.

  • Cirrhosis
  • Cirrhosis and complications
  • Liver tumor/cancer
  • The liver cancer has been steadily rising at an alarming rate, liver cancer was recognized as the 4th most common cancer in males and accounted for 37% of all infection-related cancers in females in a recent study from India. Almost 85% of primary liver cancers occur in the developing world like our country. Hepatitis B and C were the measure cause, however with improved quality of life, the fatty liver related cirrhosis is also becoming a major concern.  In contrast to western countries in India/Asia the liver cancer is detected late where treatment options are very limited leading to a high rate of cancer related death. This is all due to lack of annual health check up, awareness and poor sensitization among the health care providers to monitor. Lets join hand, target high-risk group, encourage regular health check up and offer treatment at early stage.

Alcohol and liver disease

Closely related as it affects the younger generation, in the age group of 25-50 years and were from middle or lower income groups. The treatment is costly and the severe liver disease is usually fatal despite treatment. Once liver problem started subsequent any small dose of alcohol is like a poison. If early detected and treated the disease can be totally prevented, you can take a normal life, enjoy your family life and excel in your professional or business life. Alcohol intake and road traffic accident is a common cause of death, also crimes under influence of alcohol is embracing to you and your family or social position too. According to the WHO, alcohol consumption accounts for 3.8% of the worldwide death. Today, even in Asian countries like India, alcohol is emerging as the commonest cause of chronic liver disease. According to the report, around 30% of the total population of India consumed alcohol in the year 2010. It was also revealed that over 11% of the population in India indulged in heavy or binge drinking compared to the global figure at 16%. This implies that the alcohol consuming population of our country loses most years of their life because of drinking and its consequences and with increasing income, urbanization as well as access to alcohol the problem is going to be a more serious one in near future. We need a strong motivation, good family support and strict laws to curb this problem.

  • Is alcohol good for liver
  • When to stop alcohol
  • Alcohol intake: -the recommendation by experts

Liver Transplant

[Here with we addressed the most commonly asked for questions as well as few health tips to guide you. Professional opinion from your doctor is needed. The things explained here are for general information, not to be followed in absence of professional guidance]

  • What is it?
  • When Liver transplant needed?
  • How to get prepared for liver transplant
  • What is Living Donation in Liver Transplant?
  • It is the process of organ donation by person while alive to his near one suffering from liver disease. The decision to donate should be completely voluntary and free of pressure or guilt. Living donors should be in good overall physical and mental health and older than 18 years of age and upper limit 50 to 60 years Centre wise. Some medical conditions could prevent an individual from being a living donor. The donor surgery is highly demanding technical procedure and also not without risk. The major complications may be one in 200 and the minor complications may be in 5-10% cases. In absence of complications the outcome as far as normal activities, married life and pregnancy is not an issue. You can enjoy as before. The scar of surgery in right part of upper abdomen is a cosmetic issue.
  • Living donors must be made aware of the physical and psychological risks involved before they consent to donate an organ. Please discuss all feelings, questions and concerns with a transplant professional and/or social worker.
  • Post liver transplant care
  • Post operation diet:  After the operation, doctors will advise you to resume a regular diet as soon as possible to obtain adequate nutrition. When you first resume diet, you will experience loss of appetite, nausea or even vomiting. This is probably because the residual effects of anesthesia and slow bowel movement after the surgery. You will recover in a few days and your appetite will gradually improve. We recommend you to reduce the regular meal size and eat between regular meals. Do not get too full and avoid taking a lot of liquid before and after meals.
  • Post operation care and exercise:  Apart from obtaining sufficient nutrition and taking medications at specific times, mild exercise is essential for recovery. In the first few days after surgery, you should get out of bed and sit on chair for at least 1-2 hours every day. Please do more deep breathing exercise because it helps your lungs to expand and enables you to cough up sputum easily or use your self-financed breathing exerciser {respirometry}. Besides, that physiotherapist will teach you to exercise your legs by cycling,  so that your leg muscles can be strengthened, blood circulation is increased, and the risk of complications such as venous thrombosis of the legs is reduced. The level of exercise, e.g. walking, can be increased progressively.
  • Personal hygiene:  Personal hygiene is essential before and after operation. A daily shower or bath keeps your skin clean and prevents growth of bacteria. If you worry that the wound will get wet in bath or shower, we recommend you to clean your body with a wet towel and change clothes that are in close contact with the body every day during hospitalization with the help of your family or hospital healthcare assistants. When the wound heals and the staples are removed, you will be able to bathe or shower as usual. Remember to dry the gaps in an incision and keep the incision dry and clean. If there is oozing from the wound or you suspect an infection, please contact the doctors immediately. If you find your skin dry, you may use a mild bathing lotion and apply moisturizing lotion after bath or shower. Also, it is important to keep your home clean. Clean your home regularly (e.g. once a week), to eliminate pest and prevent infection.
  • Quit smoking and drinking:  Please do not smoke and drink. Smoking damages your lung and predisposes you to chest infection. Alcohol harms the liver further. Please quit drinking.
  • Avoid crowded public places:  In the first 3 months after liver transplantation, you should avoid visiting crowded public places like cinemas, restaurants and department stores, etc. If it cannot be avoided, please wear mask and perform hand hygiene in public places. We suggest your friends and relatives to wear masks if they want to visit you in the first 3 months after liver transplantation. Avoid contact with animals and birds to prevent infection.
  • Exercise and social activity: During your recuperation period or the first few weeks after hospital discharge, you will feel tired easily. Please do more deep breathing exercise and take more rest. Sometimes you will find weakness in the muscles all over your body, and leg muscles in particular. This is a result of a lack of exercise after surgery and a side effect of steroid. To strengthen the leg muscles, you are recommended to progressively increase the level of exercise. Walking, cycling and working out on exercise bikes are good choices. If your feel any discomfort during exercise, like shortness of breathe, dizziness, chest pain, tachycardia or palpitations, please stop your exercise immediately and have rest. If the situation does not improve, you can seek advice from your doctor. Exercise can improve your muscle strength, reduce side effects of some drugs and prevent constipation. However, in the first three months after liver transplantation, you should avoid heavy lifting work and vigorous exercise. Basically, you can do whatever you want to do gradually, including sit-ups, abdominal exercises and swimming, which help to tighten abdominal muscles, and flatten your tummy. We encourage you to return to school or work as soon as possible, but in the first 3 months of recuperation, please seek advice from the doctors and consider your health condition before making a decision. If you plan on a trip to a foreign country, please seek advice from Transplant Team doctors first.
  • Dental care: After liver transplantation, you should beware of oral hygiene and keep your teeth healthy. Always brush your teeth and rinse your mouth after eating. If you receive dental care or dental treatment, please let the dentist know that you are a liver transplant patient and that you are on immunosuppressant.
  • Pregnancy: For female patients, menstruation may temporarily stop after surgery, but there is still a chance to get pregnant. Contraceptive methods should be practiced. You are advised to wait at least one year following transplantation before trying to conceive. Immunosuppressant can interfere with the effects of certain kinds of oral contraceptive pills. If you would like to take oral contraceptive pills, please discuss with your doctor. If you decide to have children, please discuss your plan with the Transplant Team doctors. Although a number of women are able to have children after liver transplantation with minimal risk to the mother and baby, pregnant transplant recipients will need to be closely followed.
  • Avoid contacting patients with infectious diseases: If your friends or relatives suffer from infectious diseases such as influenza and pneumonia, or in particular communicable diseases such as chicken pox and hepatitis, please avoid physical contact with them. If they are members of the household, they should take general precautions, for example, use separate tableware and utensils, and cover their mouth when coughing, etc. Also, it is important for you to wear mask and perform hand hygiene frequently too. However, it is still possible for you to be infected.  If you are infected, you should inform the Transplant Team doctors, who will give you advice and arrange necessary treatment.
  • Guide to follow up visits after liver transplantation: After discharge from the hospital, you are responsible for continuing appropriate treatments and cares according to the advice given by the Liver Transplant Team. After discharge, you will go to the Liver Transplant Hospital for routine follow-ups as scheduled. If you notice obvious abnormality in your body, please report to the Liver Transplant Team for further management. If you feel discomfort, such as fever, vomiting and diarrhea, please seek medical help as soon as possible.
  • Return for follow-ups as scheduled:  In general, follow-up visits will be more frequent at the early period after discharge. You are necessary to return for follow-up, so that the doctor is able to give you safe and appropriate medical instructions. Without the doctors’ instruction or a phone call indicating a change of medications, never stop taking or change your medications.
  • Post liver transplant quality of life

Organ donation

[Here with we addressed the most commonly asked for questions as well as few health tips to guide you. Professional opinion from your doctor is needed. The things explained here are for general information, not to be followed in absence of professional guidance]

  • After the disease beyond control, liver transplant is the only treatment to improve survival.  In India 200,000 people need a new kidney every year and 100,000 need a new liver, only 2% to 3% of the demand for new organs is met. The organ donation is very dismal in country i.e less than 5 per thousand death in comparison to >15 to 20 in developed countries. Finding a donor match is difficult and often people with advanced liver disease die to lack of a donor for this life saving liver transplant. In india every year about 5 lakh people die due to this but at the same time road traffic accidents death or brain stoke (those are eligible for organ donation) is much higher. But as per our belief, lack of awareness, poor support system for how, when to whom donate- nothing happened.  Life can go after death. Death is not the end for you, because with organ donation you can save someone’s life. The main problem is awareness. The first challenge is that it is often difficult for family members to accept their loved one is brain dead. Even if the family is ready to donate organs, religious superstitions become impediments. So let join hand to spread the organ donation awareness, enforce the agencies to come with a strong support system to  save people at distress at no cost but with a noble understanding i.e. Donate organ and Save life.
  • What is organ donation
  • Organ donation is gifting the organ to another person when removed legally, either by consent while the donor is alive or after death with the assent of the next of kin. Donation of a healthy transplantable organ or tissue to another person who is needy of the same as a treatment for that disease.
  • Who can donate organ
  • People of all ages can be considered for donation. At the time of death, age and medical condition will determine the organs and tissues that can be donated and the treating doctor can explain it upon your queries.
  • Organ donation is only possible when a person is on a ventilator (breathing machine) in an intensive care unit, usually with non-survivable brain damage. Organs will need to be removed by the surgical teams within a few hours. This is a respectful process, carried out with care, using normal operating procedures.
  • When and How the organ donation happen ?
  • Following a family’s agreement to donation, the donor co-ordinator for Organ. The donor coordinator obtains the medical information about the patient who is donating, liaises with the transplant teams and organizes the organ retrieval operation. The family may spend time with their loved one, if they wish, following the donation. Organ and tissue donation will not interfere with the funeral arrangements, including an open coffin, or having their loved one at home.

The length of time donated organs and tissues can be kept outside the body, before transplantation is to occur, vary:

  • Heart: 4-6 hours
  • Liver: 12-24 hours
  • Kidney: 48-72 hours
  • Heart-Lung: 4-6 hours
  • Lung: 4-6 hour

Common transplantations include: kidneys, heart, liver, pancreas, intestines, lungs, bones, bone marrow, skin, and corneas.

Organ/TissuesAge (years)
Eyes10-85
HeartUpto 65
LungsUpto 70
KidneyAll Ages
PancreasUpto 45
SkinAll Ages
LiverAll Ages
  • Pledge for organ donation today
  • Let’s take a pledge from right now to donate organ.  and live life after death in 8 peoples, so that we can spread smile after death in 8 different families. We will see life, feel emotions of others and also fall in love after death, eat delicious food and much more, your mother can listen your heart beat after your death, you can see your family after death. So why are you waiting for…… come and join hands with us.. for the awakening of masses & be first country in a world where no one die due to non-availability  of organs.
  • Create awareness on organ donation
  • Organ donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient). Transplantation is necessary because the recipient’s organ has failed or has been damaged by disease or injury.
  • Organ transplants save lives. Also, donor families tell us that the act of donation helps them in their grieving process. It does not take away the pain of their loss; however, it does help them to know that someone else is alive because of their loved one’s donation.
  • Organ and tissue donation is important. One organ and tissue donor can save the lives of up to 10 people and significantly improve the lives of many more. Smoking has a disastrous effect on health and although it is most commonly associated with lung cancer, smoking harms nearly every organ in the body. … Most will gladly accept any organ that they are offered.so it is better to quit smoking and come ahead for organ donation.