Liver diseases is a worldwide problem. Conventional drugs used in the treatment of liver diseases are sometimes inadequate and can have serious adverse effects. It is, therefore, necessary to search for alternative drugs for the treatment of liver diseases to replace currently used drugs of doubtful efficacy and safety.

Below are some liver diseases caused by toxic chemical and toxicological problem.

3. NASH (Nonalcoholic Steatohepatitis)

(a.) What is nonalcoholic steatohepatitis?
(b.) What causes NASH?
(c.) What is the risk of NASH?
(d.) How is NASH diagnosed?
(e.) How is NASH treated?

4. Cirrhosis

(a.) What is cirrhosis?
(b.) What is the risk of cirrhosis?
(c.) What causes cirrhosis?
(d.) What are the signs and symptoms of cirrhosis?
(e.) How is cirrhosis treated?

Some of the common causes of liver damages. An injured liver without immediate treatment may convert to chronic or acute liver diseases, like hepatitis, cirrhosis and liver cancer.

1. Hepatitis B

(a.) What is Hepatitis B?

Hepatitis B is a serious disease caused by a virus that attacks the liver (Hepatitis B virus - HBV). Infection with the HBV may be without any symptoms, mild or severe. Over time, hepatitis B can destroy the liver (cirrhosis) and can cause hepatocellular carcinoma (liver cancer).

(b.) What is the risk of Hepatitis B?

  • It has been estimated there are approximately 350 million HBV carriers in the world, of whom 80% are Asians.
  • HBV is reported to be 100 times more infectious than HIV.
  • People who are at higher risk, including people who live with hepatitis B carrier or patient. In acute hepatitis, it may takes 1 to 6 months from the time of infection until the disease manifests itself.
  • About 1% of patients infected with hepatitis B die due to liver damage in this early stage.
  • Carriers of HBV are 200 times more likely to develop liver cancer decades after initial infection.
  • The risk of becoming chronically infected depends on the age at the time of infection. More than 90% of newborns, about 50% of children, and less than 5% of adults infected with hepatitis B develop chronic hepatitis.

(c.) What causes Hepatitis B?

HBV is spread by direct contact with blood or other body fluids of infected people.

HBV is most commonly transmitted by:

  • sharing drug needles
  • engaging in high-risk sexual behavior (especially anal sex)
  • from a mother to her baby during childbirth and in the health-care setting

(d.) What are the signs and symptoms of Hepatitis B?

Early symptoms may include nausea and vomiting, loss of appetite, fatigue, and muscle and joint aches. Jaundice, together with dark urine and light stools, follows.

  • Fatigue, malaise, joint aches, and low-grade fever
  • Nausea, vomiting, loss of appetite, and abdominal pain
  • Jaundice and dark urine due to increased bilirubin

(e.) How is Hepatitis B treated?

Acute hepatitis
- needs no treatment other than careful monitoring of liver function, by measuring serum transaminases and prothrombin time.

Liver failure
- the patient should be monitored in an intensive care unit. Because liver damage decreases the liver's ability to degrade proteins, the patient's protein intake should be restricted. Patients should be monitored until they recover or until a liver transplant appears necessary. A liver transplant is the only definitive cure in cases of liver failure.

Chronic hepatitis
- is geared towards reducing inflammation, symptoms, and infectivity. Treatment options include interferon (administered by injection) as well as lamivudine and adefovir dipivoxil (administered orally). Liver transplantation is used to treat end-stage chronic hepatitis B liver disease.

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2. Alcoholic hepatitis

(a.) What is alcoholic hepatitis?

Alcoholic hepatitis is an inflammation of the liver that lasts one to two weeks. Symptoms include loss of appetite, nausea, vomiting, abdominal pain and tenderness, fever, jaundice, and sometimes, mental confusion. It is believed to lead to alcoholic cirrhosis over a period of years. Cirrhosis involves permanent damage to the liver cells. "Fatty liver" is the earliest stage of alcoholic liver disease.

(b.) What is the risk of alcoholic hepatitis?

Long-term alcohol abuse is may cause cirrhosis and eventually liver cancer. It may be fatal, especially if the patient has had previous liver damage. Those who have had nutritional deficiencies because of heavy drinking may have other ailments. These medical complications may affect almost every system in the body. It is important to recognize and treat alcoholic cirrhosis early, so that these life-threatening consequences are prevented.

(c.) How is alcoholic hepatitis diagnosed?

Alcoholic hepatitis is not easy to diagnose. Sometimes symptoms are worse for a time after drinking has stopped than they were during the drinking episode. While the disease usually comes on after a period of fairly heavy drinking, it may also be seen in people who are moderate drinkers. Blood tests may help in diagnosis. Proof is established best by liver biopsy. This involves taking a tiny specimen of liver tissue with a needle and examining it under a microscope. The biopsy is usually done under local anesthesia.

(d.) How can alcoholic hepatitis be treated?

The best treatment is to stop drinking. Treatment may also include prescribed medication, good nutrition, and rest. The patient may be instructed to avoid various drugs and chemicals. Since the liver has considerable ability to heal and regenerate, the prognosis for a patient with alcoholic hepatitis is very hopeful - if he or she totally abstains from drinking alcohol. Patients may also take liver tonic such as Phyllanthus to improve their liver functions.

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3. NASH (Nonalcoholic Steatohepatitis)

(a.) What is nonalcoholic steatohepatitis?

Nonalcoholic steatohepatitis (NASH) is described as inflammation of the liver associated with the accumulation of fat in the liver. NASH is not connected with other causes of chronic liver disease, including hepatitis B and C viruses, autoimmune disorders, alcohol, drug toxicity, and the accumulation of copper (Wilson’s Disease) or iron (hemochromatosis).

(b.) What causes NASH?

There is no known specific cause of NASH. Men and women, overweight or not, has diabetes mellitus or not, and did or did not have excess lipids (fat) in their blood may suffer from NASH.

(c.) What is the risk of NASH?

In NASH, which resembles alcoholic steatohepatitis, the inflammation of the liver is associated with an increase of fat deposits and typically occurs in middle-aged, overweight, and often diabetic patients who do not drink alcohol. It has also been connected with rapid weight loss, or in women taking hormones (estrogen). The fatty tissue in the liver may break up liver cells (steatonecrosis) and the patient may develop cirrhosis (scarring of the liver). Recent studies indicate that NASH can result in the development of fibrous tissue in the liver (fibrosis) in up to 40% of patients or cirrhosis in 5-10% of patients. Studies report that the progression to fibrosis or cirrhosis for NASH patients is variable but can occasionally occur in less that 20 years. Some studies have shown that 20% to 40% of people who are grossly overweight will develop NASH.

(d.) How is NASH diagnosed?

Many NASH patients are unaware of their conditions because they do not exhibit any symptoms. In most cases, NASH causes a slight increase during liver enzyme tests, as do other forms of liver disease. Images of the liver are obtained by an ultrasound test, a CT scan, or an MRI scan. The diagnosis must be confirmed by liver biopsy.

(e.) How is NASH treated?

Presently, there is no specific treatment for NASH that is universally agreed upon. However, patients who are obese, diabetic, and have high lipids (fats) in their blood are advised to lose weight and control their diabetes and elevated lipids. Usually, a low fat, low calorie diet is recommended along with insulin or medications to lower blood sugar for diabetes. For many patients with NASH whow are not overweight and not diabetic, a low fat diet is recommended. Patients with NASH should avoid alcohol or other substances that could be harmful to the liver. Phyllanthus, a herb used traditionally for liver ailments may be beneficial for patients with NASH.

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4. Cirrhosis

(a.) What is cirrhosis?

Cirrhosis is a term that refers to a consequence of chronic liver diseases in which normal liver cells are damaged and replaced by scar tissue, decreasing the amount of normal liver tissue. The distortion of the normal liver structure by the scar tissue interferes with the flow of blood through the liver. It also handicaps the function of the liver, which, with the loss of normal liver tissue, leads to failure of the liver to perform some of its critically important functions.

(b.) What is the risk of cirrhosis?

Cirrhosis will lead to Hepatocellular carcinoma (liver cancer) which represents more than 5% of all cancers in the world, and the estimated number of cancer-related deaths exceeds 500,000 per year.

(c.) What causes cirrhosis?

There are a number of conditions that can lead to cirrhosis:

  • Excessive intake of alcohol (most common)
  • Chronic vial hepatitis, types B, C, and D
  • Prolonged exposure to environmental toxins
  • Some forms of heart disease (cardiac cirrhosis)
  • Other factors.

(d.) What are the signs and symptoms of cirrhosis?

The onset of cirrhosis is often “silent” with few specific symptoms to identify what is happening in the liver. As continued scarring and destruction occur, the following signs and symptoms may appear:

  • Loss of appetite
  • Nausea and vomiting
  • Weight loss
  • Enlargement of the liver
  • Jaundice - yellow discoloration of the whites of the eyes and skin occurs
  • Itching - due to the retention of bile products in the skin
  • Ascites - abdominal swelling due to an accumulation of fluid
  • Vomiting of blood - frequently occurs from swollen, ruptured varices (veins that burst) in the lower end of the
  • Increased sensitivity to drugs - due to the inability of the liver to inactivate them
  • Encephalopathy (impending coma) - subtle mental changes advancing to profound confusion and coma
  • Many patients may have no symptoms and are found to have cirrhosis by physical examination and laboratory tests, which may have been performed in the course of treatment for unrelated illnesses.

(e.) How is cirrhosis treated?

Treatment depends on the type and stage of the cirrhosis. It aims to stop the progress of the cirrhosis, reverse (to whatever extent possible) the damage that has already occurred, and treat complications that are disabling or life-threatening. Phyllanthus maybe helpful in prolong the life span and improve the patient’s condition.

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