Chronic Liver Disease (CLD) Treatment in Delhi, India

Chronic liver disease (CLD) is a progressive condition characterised by the gradual deterioration of the liver over time. The initial stages involve inflammation, the liver's natural response to injury. However, if left untreated, this inflammation escalates into fibrosis, where healthy liver tissue is replaced by irreversible scar tissue.

As CLD advances, fibrosis intensifies, culminating in liver cirrhosis, a stage marked by widespread scarring and significantly impaired liver function. This is when symptoms like fatigue and abdominal pain become more apparent. Furthermore, advanced stages can bring several complications, including portal hypertension, fluid buildup in the abdomen (ascites), and an increased risk of hepatic encephalopathy. Ultimately, in the final stages, liver failure and an elevated risk of liver cancer may occur.

There are many potential causes associated with Chronic Liver Disease (CLD), but the most common include:

• Viral Hepatitis: Hepatitis B, C, and D are the most common causes of viral hepatitis. These viruses can be transmitted through blood or bodily fluids, and they can cause inflammation and scarring of the liver.
• Alcohol abuse: Alcohol is a toxic substance that can damage the liver cells. Over time, heavy alcohol consumption can lead to fatty liver, alcoholic hepatitis, and cirrhosis.
• Non-alcoholic fatty liver disease (NAFLD): NAFLD is a condition characterised by excess fat buildup in the liver. It is often associated with obesity, insulin resistance, and type 2 diabetes.
• Autoimmune hepatitis: Autoimmune hepatitis is a condition in which the body's immune system attacks the liver. It is more common in women than in men.
• Primary biliary cholangitis (PBC): PBC is a condition that damages the bile ducts in the liver. It is more common in women than in men.
• Primary sclerosing cholangitis (PSC): PSC is a condition that damages the bile ducts in the liver and the pancreas. It is more common in men than in women.
• Genetic disorders: Some genetic disorders can cause CLD, such as Wilson's disease and hemochromatosis.

Here are the key risk factors that can increase the likelihood of developing liver cirrhosis:

• Excessive alcohol consumption significantly increases cirrhosis risk by overloading the liver, leading to inflammation, cell damage, and scarring.
• Obesity elevates the risk of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), contributing to cirrhosis progression if untreated.
• Chronic infections with hepatitis B and C viruses directly damage liver cells, causing inflammation and fibrosis, majorly contributing to cirrhosis globally.
• Certain autoimmune diseases, such as primary biliary cholangitis and autoimmune hepatitis, increase the risk of cirrhosis by damaging the liver.
• Genetic disorders like hemochromatosis and alpha-1 antitrypsin deficiency can lead to liver iron overload, increasing the risk of cirrhosis.
• Exposure to specific toxins and medications can harm the liver, contributing to cirrhosis.
• Metabolic disorders, including diabetes, can impact liver health, elevating the risk of cirrhosis.

The symptoms of chronic liver disease (CLD) can vary depending on the stage of the disease and the underlying cause. However, some of the most common symptoms of CLD include:

• Fatigue: Extreme tiredness that does not improve with rest.
• Weakness: Loss of strength that makes it difficult to perform everyday activities.
• Loss of appetite: Reduced interest in food, leading to weight loss.
• Nausea and Vomiting: Feeling sick to your stomach and throwing up.
• Swelling in the abdomen (ascites): A buildup of fluid in the belly, causing bloating and discomfort.
• Swelling in the legs and ankles (edema): Fluid retention in the lower extremities.
• Jaundice: Yellowing of the skin and whites of the eyes due to excessive bilirubin buildup in the blood.
• Itchy Skin: Chronic itching that can interfere with sleep and quality of life.
• Confusion and difficulty thinking: Cognitive impairments like memory loss and confusion.
• Easy Bruising and Bleeding: Increased tendency to bruise and bleed due to impaired blood clotting.
• Spider Angiomas: Small, red, spider-like blood vessels on the skin, especially on the face, upper chest, and arms.
• Enlarged Spleen: Enlargement of the spleen, an organ that helps filter blood, due to increased blood flow to the liver.
• Loss of Muscle Mass: Wasting away muscle tissue, leading to weakness and frailty.

It is important to note that the presence of any of these symptoms is not a definitive indication of CLD. These symptoms can also be caused by other medical conditions. If one is experiencing any of these symptoms, it is imperative to consult a doctor for a diagnosis and to rule out other possible causes.

Chronic liver disease (CLD) can lead to many serious complications, some of which can be life-threatening. Here are some of the key complications that CLD can cause:

Portal Hypertension

This is a condition in which the blood pressure in the vein that carries blood from the intestines to the liver is increased. Portal hypertension can lead to a number of complications, including varicose veins in the oesophagus and stomach, ascites (fluid buildup in the abdomen), and hepatic encephalopathy (brain dysfunction).

Varicose Veins

These are enlarged, swollen veins that can develop in the oesophagus and stomach due to portal hypertension. Varicose veins can rupture and cause life-threatening bleeding.

Ascites

This is a buildup of fluid in the abdomen that can cause bloating, discomfort, and difficulty breathing. Ascites is a serious complication of CLD and can be life-threatening if left untreated.

Hepatic Encephalopathy

This is a condition in which the brain does not function properly due to impaired liver function. Hepatic encephalopathy can cause a variety of symptoms, including confusion, memory loss, drowsiness, and coma.

Liver Failure

This is the most serious complication of CLD wherein the liver is no longer able to function properly. Liver failure can be life-threatening and requires a liver transplant.

• Hepatocellular Carcinoma (HCC): This is a type of liver cancer that is more common in people with CLD. HCC is a serious condition that can be fatal if not diagnosed and treated early.
• Gallstones: These are hard deposits that form in the gallbladder. Gallstones can cause pain in the upper abdomen and can also block the bile ducts, which can lead to jaundice.
• Kidney Failure: CLD can damage the kidneys and lead to kidney failure. Kidney failure is a serious condition that requires dialysis or a kidney transplant.
• Malnutrition: CLD can make it difficult to absorb nutrients from food, which can lead to malnutrition. Malnutrition can further make it harder to fight off infections and can also slow down the healing process.

Chronic liver disease (CLD) is a long-term condition that damages the liver and can lead to life-threatening complications. It can be caused by a variety of factors, including viral hepatitis, alcohol abuse, and non-alcoholic fatty liver disease (NAFLD).

Diagnosing CLD can be challenging because the symptoms can be vague and nonspecific. However, there are a number of tests that can be used to diagnose and monitor CLD.

Medical history and physical exam

The first step in diagnosing CLD is to take a medical history and perform a physical exam. The doctor will ask about your risk factors for CLD, such as alcohol use, family history of liver disease, and exposure to toxins. They will also ask about your symptoms, such as fatigue, jaundice, and abdominal pain.

During the physical exam, the doctor will look for signs of CLD, such as an enlarged liver, enlarged spleen, and fluid in the abdomen.

Blood tests

There are a number of blood tests that can be used to diagnose and monitor CLD. These tests can measure the levels of enzymes and other substances that are produced by the liver. Elevated levels of these substances can indicate that the liver is damaged.

Some of the most common blood tests for CLD include:

• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)
• Alkaline phosphatase (ALP)
• Gamma-glutamyl transferase (GGT)
• Bilirubin

Imaging tests

Imaging tests can be used to visualise the liver and look for signs of damage. These tests can include:

• Ultrasound: Ultrasound uses sound waves to create an image of the liver. It can be used to detect an enlarged liver, fatty liver, and cirrhosis.
• Computed tomography (CT) scan: This test uses X-rays to create a detailed image of the liver. It can be used to detect an enlarged liver, fatty liver, cirrhosis, and other abnormalities.
• Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to create a detailed image of the liver. It is more sensitive than CT scans for detecting liver abnormalities.

Liver biopsy

In some cases, a liver biopsy may be necessary to diagnose CLD. A liver biopsy is a procedure that removes a small sample of liver tissue for examination under a microscope. This can help to determine the cause of CLD and the extent of the damage.

Other tests

There are a number of other tests that may be used to diagnose CLD, depending on the individual's symptoms and risk factors. These tests can include:

• Esophagogastroduodenoscopy (EGD): This test uses a thin, flexible tube with a camera to examine the oesophagus, stomach, and duodenum. It can be used to detect varicose veins, which are enlarged veins that can form in the oesophagus and stomach due to portal hypertension.
• Endoscopic retrograde cholangiopancreatography (ERCP): Endoscopic retrograde cholangiopancreatography (ERCP) uses a thin, flexible tube with a camera and light to examine the bile ducts and pancreatic duct. It can be used to detect blockages in the bile ducts.

If you are concerned that you may have CLD, it is important to see a doctor for diagnosis. Early diagnosis and treatment can help to prevent complications and improve your quality of life.

By performing a thorough medical history, physical examination, and a series of tests, doctors can accurately assess the extent of liver damage and assign a stage to the disease. Staging CLD is crucial for determining the appropriate treatment plan and monitoring disease progression.

Stage 1: Hepatocellular injury

In the early stages of CLD, there is damage to the liver cells (hepatocytes). This can be caused by a variety of factors, including viral hepatitis, alcohol abuse, and non-alcoholic fatty liver disease (NAFLD). The liver has the ability to regenerate, and in some cases, the damage can be repaired. However, if the damage is severe or ongoing, it can lead to scarring of the liver.

Stage 2: Fibrosis

Fibrosis is the formation of scar tissue in the liver. As the liver heals from injury, it produces scar tissue to replace damaged liver cells. However, excessive scar tissue can impair the liver's function. In stage 2 of CLD, there is moderate scarring of the liver. At this stage, there may be no symptoms, but the liver may not be able to function as well as it should.

Stage 3: Cirrhosis

Cirrhosis is the most advanced stage of CLD. It is characterised by severe scarring of the liver, which can lead to irreversible damage to the liver's ability to function. In cirrhosis, the liver is unable to filter toxins from the blood, which can lead to a variety of complications, including jaundice, fluid buildup in the abdomen (ascites), and bleeding problems.

Stage 4: End-stage liver disease

End-stage liver disease is the final stage of CLD. It is a life-threatening condition in which the liver is unable to function at all. People with end-stage liver disease may need a liver transplant to survive.

The stages of CLD are not always clear-cut, and there may be some overlap between the stages. However, the stages provide a general framework for understanding the progression of CLD and the severity of the disease.

There is no cure for CLD, but there are treatments that can help to slow the progression of the disease and manage its symptoms. The treatment depends on the underlying cause of the disease, the stage of the disease, and the individual's overall health. Here are

Lifestyle changes

Lifestyle changes are often the first step in treating CLD. These changes can help to improve liver function and prevent further damage to the liver. Lifestyle changes that may be recommended include:

• Eating a healthy diet: A healthy diet for CLD is low in fat, sodium, and sugar. It should include plenty of fruits, vegetables, and whole grains.
• Maintaining a healthy weight: Obesity is a risk factor for CLD, so it is important to maintain a healthy weight.
• Exercising Regularly: Exercise can help to improve liver function and overall health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
• Avoiding Alcohol: Alcohol is a major cause of CLD, so it is important to avoid alcohol if you have CLD.
• Saying no to smoking: Smoking can damage the liver and worsen chronic liver disease.
• Getting Regular Vaccinations: People with CLD are at risk of certain infections, so it is important to get regular vaccinations, such as the hepatitis B vaccine and the flu vaccine.

Medications

There are a number of medications that can be used to treat CLD. The specific medication that is recommended will depend on the underlying cause of the disease and the stage of the disease. Some common medications for CLD include:

• Antiviral medications: These medications are used to treat viral hepatitis.
• Corticosteroids: These medications are used to suppress the immune system and treat autoimmune hepatitis.
• Ursodeoxycholic acid (UDCA): This medication is used to treat primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).
• Diuretics: These medications are used to remove excess fluid from the body, which can help to reduce swelling in the abdomen (ascites).
• Lactulose: This medication is used to treat hepatic encephalopathy.

Other Treatments

In some cases, other treatments may be needed to manage CLD. These treatments can include:

• Endoscopic Banding: This procedure is used to treat varicose veins, which are enlarged veins that can form in the oesophagus and stomach due to portal hypertension.
• Liver Transplant: A liver Transplant is the only cure for end-stage liver disease.

What is the difference between chronic and acute liver disease?

Acute liver disease is a sudden onset of liver damage, while chronic liver disease is a long-term condition that develops over time.

What are the most common types of chronic liver disease (CLD)?

The most common types of chronic liver disease are:

• Alcoholic liver disease: This is caused by excessive alcohol consumption.
• Chronic viral hepatitis: This is caused by infection with hepatitis B, C, or D viruses.
• NAFLD (Non-alcoholic fatty liver disease): This is caused by a buildup of fat in the liver.
• Primary Biliary Cirrhosis: This is an autoimmune disease that attacks the bile ducts in the liver.

Who is at risk for chronic liver disease?

Anyone can develop chronic liver disease, but certain people are at higher risk, including:

• People who drink heavily
• People who are overweight or obese
• People with diabetes
• People with high blood pressure
• People with a family history of liver disease Symptoms and Diagnosis

What is the prognosis for people with chronic liver disease (CLD)?

The prognosis for people with chronic liver disease varies depending on the cause and severity of the condition. With early diagnosis and treatment, many people with chronic liver disease can live long and healthy lives. However, some people with chronic liver disease may develop complications, such as cirrhosis or liver failure.

How to slow the progression of CLD?

Here are some tips for slowing the progression of CLD:

• Avoid Alcohol: Alcohol is a major cause of CLD, so it is important to avoid alcohol if you have CLD.
• Eating a Healthy Diet: A healthy diet can help to support liver function. Make sure to eat plenty of fruits, vegetables, and whole grains. Limit your intake of processed foods, sugary drinks, and saturated and unhealthy fats.
• Maintain a Healthy Weight: Obesity is a risk factor for CLD, so it is important to maintain a healthy weight.
• Exercise Regularly: Exercise can help to improve liver function and overall health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
• Go for Regular Medical Checkups: It is important to see your doctor regularly for checkups and monitoring of your CLD. This will allow your doctor to detect any complications early on and make changes to your treatment plan as needed.

What kind of follow-up care will I need for chronic liver disease?

To effectively manage chronic liver disease, regular follow-up care is essential. This includes:

• Regular check-ups with your doctor or hepatologist
• Periodic blood tests to evaluate liver function
• Imaging evaluation as needed
• Nutritional guidance from a nutritionist or dietitian

By adhering to the recommended follow-up care plan, you can take an active role in managing your condition and maintaining your quality of life.

How can I cope with the emotional and social challenges of chronic liver disease?

• Join support groups: Talk to your doctor, a therapist, or a support group about the emotional and social impact of CLD. Sharing your concerns and experiences can help you feel less alone.
• Educate Yourself: Understanding CLD and its potential complications can help you make informed decisions about your care and manage your expectations.
• Maintain Social Connections: Stay connected with friends and family, even if you need to adjust your activities. Social support can strengthen your emotional resilience.
• Join a support group: Connecting with others facing similar challenges can provide a sense of community and understanding.
• Practice Self-care: Prioritise your physical and mental well-being by engaging in activities you enjoy, managing stress, and getting enough rest.

What are the potential side effects of medications used to treat chronic liver disease (CLD)?

The potential side effects of medications used to treat chronic liver disease vary depending on the specific medication. Some common side effects include:

• Nausea and vomiting
• Fatigue
• Headache
• Dizziness
• Rash
• Itching
• Joint pain
• Changes in blood sugar levels
• Increased risk of bleeding

It is important to talk to your doctor about the potential side effects of any medication you are taking for chronic liver disease. They can help you understand the risks and benefits of each medication and monitor you for any side effects.

Are there any alternative or complementary therapies that can help manage chronic liver disease (CLD)?

There are a number of alternative or complementary therapies that may help manage chronic liver disease. However, it is important to talk to your doctor before starting any of these therapies, as some may interact with medications you are taking or have other potential risks. Some of the most common alternative or complementary therapies for chronic liver disease include:

• Milk thistle: Milk thistle is an herb that has been shown to protect the liver from damage and improve liver function.
• Silymarin: Silymarin is the main active ingredient in milk thistle and is available as a supplement.
• Turmeric: Turmeric is a spice with anti-inflammatory properties that may help protect the liver from damage.
• Vitamin E: Vitamin E is an antioxidant that may help protect the liver from damage.
• Acupuncture: Acupuncture is a traditional Chinese medicine technique that may help relieve pain and fatigue associated with chronic liver disease.

How can I manage my stress levels with chronic liver disease (CLD)?

Stress can worsen the symptoms of chronic liver disease, so it is important to find ways to manage stress effectively. Some helpful stress-management techniques include:

• Exercise: Regular physical activity can help reduce stress and improve overall well-being.
• Relaxation Techniques: Relaxation techniques such as deep breathing, meditation, and yoga can help reduce stress and promote relaxation.
• Social Support: Spending time with loved ones and talking about your concerns can help reduce stress and provide emotional support.
• Counselling: Talking to a therapist can help you develop coping mechanisms for dealing with stress and anxiety.

How can I maintain a healthy weight with chronic liver disease?

Maintaining a healthy weight is important for people with chronic liver disease, as excess weight can put additional strain on the liver. Some tips for maintaining a healthy weight with chronic liver disease include:

• Eat a Healthy Diet: Choose a diet that is low in saturated and trans fats, processed foods, and added sugars. Focus on eating plenty of fruits, vegetables, and whole grains.
• Limit alcohol consumption
• Exercise regularly: Regular physical activity can help you burn calories and maintain a healthy weight.

How can I travel safely with chronic liver disease (CLD)?

If you have chronic liver disease, it is important to plan your travel carefully and take steps to protect your health. Here are some tips for travelling safely with chronic liver disease:

• Talk to your doctor: Discuss your travel plans with your doctor before you go. They can help you assess the risks and benefits of travel and provide you with any necessary vaccinations or medications.
• Get travel insurance: Travel insurance can help you cover the costs of medical care if you get sick or injured while travelling.
• Pack your medications: Make sure to pack enough of all your medications for your trip. You should also carry a copy of your prescription with you.
• Stay hydrated: Drink plenty of fluids, especially water, to avoid dehydration.
• Avoid alcohol and excessive caffeine: Alcohol and excessive caffeine can worsen the symptoms of chronic liver disease.
• Be cautious with food and water: Avoid unpasteurized milk and cheese, raw or undercooked meat or seafood, and tap water in developing countries.
• Get rest: Fatigue is a common symptom of chronic liver disease, so make sure to get enough rest while travelling.

What kind of exercise is safe for people with chronic liver disease?

Regular exercise is important for people with chronic liver disease, as it can improve overall health and well-being. However, it is important to choose exercises that are safe and appropriate for your condition. Some safe and beneficial exercises for people with chronic liver disease include:

• Walking
• Swimming
• Yoga
• Tai chi

You must talk to your doctor about which exercises are right for you. They can help you develop an exercise plan that is safe and effective.

Reviewed By Dr. Sanjiv Saigal, Principal Director & Head, Liver Transplant and Biliary Sciences, Gastroenterology, Hepatology & Endoscopy on 9-May-2024.