Q: 2) What are the common liver diseases?

Hepatitis : Inflammation of the liver is known as hepatitis. Hepatitis is usually caused by viruses like hepatitis A, B, and C. Hepatitis can also be due to other causes which are non-infectious like heavy drinking, drugs, uncontrolled consumption of over the counter medications, allergic reactions, or obesity. Liver Cirrhosis : Severe damage to the liver from any untreated cause may lead to permanent scarring, called cirrhosis. Cirrhosis is a serious degenerative disease that occurs as a result of alcohol abuse or chronic hepatitis. As liver cells develops tough scar tissues, liver loses its ability to function well. Hepatocellular Carcinom a Hepatocellular Carcinoma is the cancer of liver cells caused by severe liver cirrhosis. Cancer of liver is a serious condition, which interferes with all other metabolic functions of body. H emochromatosis Hemochromatosis is a disease of liver due to which there is iron deposition in the liver causing damage to the liver. Liver Failure Liver failure is a life threatening condition that occurs when the liver become damaged beyond repair and is no longer able to function. Liver failure is of two type depending upon duration of damage. Chronic liver failure is one where liver damage takes place gradually over months to years. Acute Liver Failure is a condition characterise by sudden liver failure.

Q: 3) What are the causes of liver failure ?

T he common causes of C hronic liver failure include: -Long-term alcohol consumption -Cirrhosis -Hepatitis -Hemochromatosis -Malnutrition The causes of A cute liver failure are different from that of chronic liver failure, the are: -Acetaminophen (Tylenol) overdose -Viruses including hepatitis A, B, and C -Reactions to certain prescription and herbal medications -Ingestion of poisonous mushrooms

Question 1

1) What are the physiological functions of the liver?

Accepted Answer

The major function of liver is filtering the blood of the digestive tract, before passing it to the rest of the body. The liver also functions as an organ of detoxification, helping in for detoxification of chemicals and metabolizes drugs.

Question 2

2) What are the common liver diseases?

Accepted Answer

Hepatitis: Inflammation of the liver is known as hepatitis. Hepatitis is usually caused by viruses like hepatitis A, B, and C. Hepatitis can also be due to other causes which are non-infectious like heavy drinking, drugs, uncontrolled consumption of over the counter medications, allergic reactions, or obesity.
Liver Cirrhosis: Severe damage to the liver from any untreated cause may lead to permanent scarring, called cirrhosis.

Cirrhosis is a serious degenerative disease that occurs as a result of alcohol abuse or chronic hepatitis. As liver cells develops tough scar tissues, liver loses its ability to function well.

Hepatocellular Carcinoma

Hepatocellular Carcinoma is the cancer of liver cells caused by severe liver cirrhosis. Cancer of liver is a serious condition, which interferes with all other metabolic functions of body.

Hemochromatosis

Hemochromatosis is a disease of liver due to which there is iron deposition in the liver causing damage to the liver.

Liver Failure

Liver failure is a life threatening condition that occurs when the liver become damaged beyond repair and is no longer able to function. Liver failure is of two type depending upon duration of damage.

Chronic liver failure is one where liver damage takes place gradually over months to years.
Acute Liver Failure is a condition characterise by sudden liver failure.

Question 3

3) What are the causes of liver failure ?

Accepted Answer

The common causes of Chronic liver failure include:

-Long-term alcohol consumption

-Cirrhosis

-Hepatitis

-Hemochromatosis

-Malnutrition

The causes of Acute liver failure are different from that of chronic liver failure, the are:

-Acetaminophen (Tylenol) overdose

-Viruses including hepatitis A, B, and C

-Reactions to certain prescription and herbal medications

-Ingestion of poisonous mushrooms

Question 4

4) How are the diagnostic tests before Liver Transplant?

Accepted Answer

There are two types of medical tests namely blood and imaging tests.

Blood tests:

The blood tests includes administration of marker substances. They are

ALT (Alanine Aminotransferase)
AST (Aspartate Aminotransferase)

Elevated ALT and AST indicates liver function is inadequate.

Alkaline phosphatase: Indicator of bile dysfunction.
Bilirubin
Albumin
Ammonia
Hepatitis A tests: detect the hepatitis A virus.
Hepatitis B tests: determine if you have been infected with the hepatitis B virus.
Hepatitis C tests: determination of hepatitis C virus.
Prothrombin Time (PT): checks for blood clotting problems.
Partial Thromboplastin Time (PTT) to check for blood clotting problems.

Imaging Tests:

Ultrasound: An abdominal ultrasound can test for liver diseases, including cancer, cirrhosis, and gall stones.

CT scan : A CT scan of the abdomen gives detailed pictures of the liver.

Liver biopsy

Question 5

5) What is the treatment for liver failure ?

Accepted Answer

The treatment for liver failure is Liver Transplant. A Liver Transplant is considered when the liver no longer functions adequately.

Question 6

6) Who needs Liver Transplant?

Accepted Answer

Anyone with a long-standing (chronic) or sudden onset (acute) severe liver disease leading to liver failure needs to be considered for a liver transplant

Question 7

7) What is the procedure of liver allocation  ?

Accepted Answer

There is a scoring system followed by most hospitals to determine how sick a patient is. This system is known as MELD (Model for End-stage Liver Disease), identified as highly predictive of the risk of death.

The MELD score is determined by the results of three tests:

1.) Total bilirubin, a measure of jaundice

2.) Prothrombin time, a measure of clotting ability

3.) Creatinine, a measure of kidney function

Further, a MELD calculator is used to calculate the MELD score by putting in the values of these tests.

Question 8

8) How can donate liver?

Accepted Answer

Any organ donor can be classified into following two types.

1) CADAVERIC DONOR which includes brain dead organ donors and cardiac dead organ donors.

2) LIVING DONOR are living individuals donating a part of their liver.

Question 9

9) Who can be a living donor?

Accepted Answer

The donor must be a close relative aged between 18-55 years, have a matching blood group, and weigh between 50-90kg (but not obese)

Question 10

10) How can a living person donate his/her liver ?

Accepted Answer

Although each person has only one liver and would die without it, it is possible to donate a portion of the liver for transplantation into another individual.

The liver has a segmental anatomy. This segmental anatomy allows the experienced surgeons to create grafts of varying size by the process of grafting, depending upon the recipient's requirement for liver tissue.

The partial liver in both the donor and the recipient will grow to provide normal liver function for both the donor and the recipient.

Question 11

11) Is every patient eligible to receive a new liver ?

Accepted Answer

A patient cannot receive a new liver in following conditions:

carcinoma in any other part of your body
serious heart, lungs or diseases of the nervous system
active alcoholics etc.

Question 12

12) How is matching of liver done ?

Accepted Answer

The donor and recipient liver needs to be of the same size, and compatible blood type. Other than that no other matching is required.

Question 13

13) How safe is liver donation ?

Accepted Answer

Liver donation is a very safe procedure because of liver's innate capacity to regenerate quickly. Liver also has a great reserve and it grows to its normal size in a short span of time. Donor can also continue any strenuous physical activity in approximately 2 to 3 months of surgery.

Question 14

14) Are there any major risks involved post surgery ?

Accepted Answer

After surgery, the complications such as bleeding, poor functioning of the grafted liver, and infections could be some major risks. The patient is also carefully monitored for several weeks for signs of any complications.

Question 15

15) What are the chances of survival after Liver Transplant?

Accepted Answer

The chances of survival after Liver Transplant are good. 80 to 90 per cent recipients respond well to the treatment.

Question 16

16) How long will the Liver Transplant Surgery take  ?

Accepted Answer

Liver Transplant surgery takes around 4 to 14 hours.

Question 17

17) What happens during Liver Transplant surgery ?

Accepted Answer

During the surgery, doctors will remove the diseased liver and will replace it with the donor liver.

The surgeon will disconnect the recipient’s liver from bile ducts and other blood vessels before removing it. The surgeon will then put the healthy liver in place and reconnect it with bile ducts and blood vessels. The blood flow will then take place into the new liver.

As Liver Transplant is a major procedure, several tubes are connected to the body during operation and will remain for a short time afterwards. These tubes are helpful to body in carrying various functions.

Following tubes are connected:

A tube will be placed through your mouth into your trachea (windpipe) to help you breathe during the operation and for the first day or two after.
A nasogastric tube will be inserted through your nose into your stomach to drain secretions from your stomach. It will remain in place for a few days until your bowel function returns to normal.
A tube called a catheter will be placed in the bladder to drain urine. This will be removed a few days after the operation.
Tubes will be placed in your abdomen to drain blood and fluid from around the liver. These will remain in place for about a week.

Question 18

18) Do recipients of new liver have to take medications for the rest of their lives ?

Accepted Answer

Usually, yes. However, as the body adjusts to the new liver, the amount of medication required to control rejection can be decreased gradually. Usually the medications given are immuno-suppressive agents which help in preventing rejection.

Question 19

19) What are the precautions one has to take after Liver Transplant Surgery ?

Accepted Answer

Walking requires some assistance at first. Coughing and deep breathing are very important to help the lungs stay healthy. Diet may at first consist of clear liquid and finally solids. It is important for the patient to abstain from alcohol and taking over the counter medications is also not advised.

Question 20

20) When can I return to work after  Liver Transplant Surgery ?

Accepted Answer

It normally takes about 3-6 months and a person may return to work if he feels ready and is approved by the primary doctor.

Question 21

21) What is the cost of Liver Transplant Surgery in India?

Accepted Answer

The cost of Liver Transplant Surgery varies across different cities and hospitals across India.

Cost of Liver Transplant Surgery in India
CITY	COST
Cost of Liver Transplant Surgery in Mumbai	INR 1900000- INR2500000
Cost of Liver Transplant Surgery in Bangalore	INR 1800000- INR2400000
Cost of Liver Transplant Surgery in Delhi	INR 1800000- INR2400000
Cost of Liver Transplant Surgery in Chennai	INR 1600000- INR2200000

Liver Transplant

Symptoms

The signs and symptoms that indicate the necessity of a Liver Transplant are-

Diagnosis

Treatment

There are several types of treatments for this on the basis of the donor available such as:

Risks

After Procedure

Liver Transplant from one of the best multi-speciality hospital: Manipal Hospital Yeshwantpur Earlier Columbia Asia Hospital Yeshwanthpur, Malleshwaram, Mumbai Region

Dr. Raghavendra Babu

Dr. Aravind Seshadri