Fatty Liver

Fatty liver, or hepatic steatosis or simple steatosis, is a reversible condition wherein large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis (i.e., abnormal retention of lipids within a cell). Despite having multiple causes, fatty liver can be considered a single disease that occurs worldwide in those with excessive alcohol intake and the obese (with or without effects of insulin resistance). The condition is also associated with other diseases that influence fat metabolism. When this process of fat metabolism is disrupted, the fat can accumulate in the liver in excessive amounts, thus resulting in a fatty liver. It is difficult to distinguish alcoholic FLD, which is part of alcoholic liver disease, from nonalcoholic FLD (NAFLD), and both show microvesicular and macrovesicular fatty changes at different stages.

The accumulation of fat in alcoholic or non-alcoholic steatosis may also be accompanied by a progressive inflammation of the liver (hepatitis), called steatohepatitis. This more severe condition may be termed either alcoholic steatohepatitis or non-alcoholic steatohepatitis (NASH).

Symptoms

Fatty liver can develop into a fibrosis or a liver cancer. For people affected by NAFLD, the 10-year survival rate was about 80%. The rate of progression of fibrosis in NASH is estimated to one per 7 years and 14 years for NAFLD, with an increasing speed. There is a strong relationship between these pathologies and metabolic illnesses (diabetes type II, metabolic syndrome). These pathologies can also affect non-obese people, who are then at a higher risk

Causes

Metabolic

abetalipoproteinemia, glycogen storage diseases, Weber–Christian disease, acute fatty liver of pregnancy, lipodystrophy

Nutrition

alobesity, malnutrition, total parenteral nutrition, severe weight loss, refeeding syndrome, jejunoileal bypass, gastric bypass, jejunal diverticulosis with bacterial overgrowth

Drugs and toxins

amiodarone, methotrexate, diltiazem, expired tetracycline, highly active antiretroviral therapy, glucocorticoids, tamoxifen, environmental hepatotoxins (e.g., phosphorus, mushroom poisoning)

Alcohol

Alcoholism is one of the causes of fatty liver due to production of toxic metabolites like aldehydes during metabolism of alcohol in the liver. This phenomenon most commonly occurs with chronic alcoholism.

Other

celiac disease, inflammatory bowel disease, HIV, hepatitis C (especially genotype 3), and alpha 1-antitrypsin deficiency

Treatment

Diagnosis:

The diagnosis of cirrhosis is usually based on the presence of a risk factor for cirrhosis, such as alcohol use or obesity, and is confirmed by physical examination, blood tests, and imaging. The steps in making the diagnosis of cirrhosis will include medical analysis of the following:

During a physical examination the health care provider may find:

• An enlarged liver or spleen
• Excess breast tissue
• Expanded (distended) abdomen, as a result of too much fluid
• Reddened palms
• Red spider-like blood vessels on the skin
• Small testicles
• Widened (dilated) veins in the abdomen wall
• Yellow eyes or skin (jaundice)

The following Blood Tests can reveal liver problems:

• Aminotransferases – AST and ALT are moderately elevated, with AST > ALT. However, normal aminotransferases do not preclude cirrhosis.
• Alkaline phosphatase – usually slightly elevated.
• Gamma-glutamyl transferase – correlates with AP levels. Typically much higher in chronic liver disease from alcohol.
• Bilirubin – may elevate as cirrhosis progresses.
• Albumin – levels fall as the synthetic function of the liver declines with worsening cirrhosis since albumin is exclusively synthesized in the liver
• Prothrombin time – increases since the liver synthesizes clotting factors.
• Globulins – increased due to shunting of bacterial antigens away from the liver to lymphoid tissue.
• Serum sodium – hyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.
• Thrombocytopenia – due to both congestive splenomegaly as well as decreased thrombopoietin from the liver. However, this rarely results in platelet count < 50,000/mL.
• Leukopenia and neutropenia – due to splenomegaly with splenic margination.
• Coagulation defects – the liver produces most of the coagulation factors and thus coagulopathy correlates with worsening liver disease.

The following tests may be used to evaluate the liver:

• Ultrasound of the abdomen
• CT scan or MRI (MRCP) scan
• Laparoscope
• Endoscopy to check for abnormal veins in the oesophagus or stomach
• Radioisotope liver/spleen scan
• A liver biopsy confirms cirrhosis. Some patients will be screened for liver cancer.

Ayurveda Management

The liver is called Yakrit in Ayurveda. Pitta is the predominant humour of the liver. Most liver disorders are aggravated by conditions of Pitta. Excessive bile production or a blockage in the flow of bile usually indicates high pitta, which in turn affects the Agni or enzyme activities responsible for absorption, digestion and metabolism.

Kumbha Kamala is the classical description if cirrhosis of the liver in Ayurveda.

“|| Kaalantarath khareebhutah kruchrasyaat khumba Kamala ||”

It is a neglected or untreated stage of jaundice or hepatitis, when becomes chronic, produces dry or roughness to the Liver (kharathva or rookshatva). It can become incurable if not attended immediately.

At Bhagwati Ayurveda, we are providing highly effective treatment for Liver Cirrhosis. Our treatment involves Shodana chikitsa (detoxification through Panchakarma procedures), Shamana chikitsa (Palliative researched Ayurvedic medicines) and Kayakalpa (rejuvenation). Our treatment is useful in improving the liver heath and preventing further damage.

Diet restrictions, lifestyle modifications and de-addiction are also the essential factors practised for the best possible results.

Prevention

The main goal of treatment is to eliminate the cause.

1. Stop alcohol
2. Lose weight
3. Routine regular exercise- a brisk walk of 30mins- 45mins, at least 4 days a week can help. Start with 15mins a day, then gradually increasing up to 45minutes.
4. Good control of diabetes
5. Take measures to lower triglyceride levels

Apart from these lifestyle changes, you can also protect your liver with the herbal liver support supplements available. Livomyn is one such herbal supplement designed by Charak Pharma. Some of the herbs in Livomyn are- Kalmegh, Bhumyamalaki, Kasni, Punarnava, Daruhaldi, Guduchi, Sunthi etc. Livomyn by virtue of its antiviral, anti-inflammatory and anti-oxidant properties is an ideal hepatoprotective. These liver support supplements and dos and dont’s will definitely improve liver health.