If we look at our digestive organs, it is only the liver that can regenerate itself, but that doesn’t make it invincible. Many experts warn that a neglected fatty liver can wreak havoc on your hepatic system. Just like our kidneys, if the liver is plagued by scarring or cell damage, it can lead to several life-threatening complications like liver cirrhosis (liver scarring), liver failure, kidney failure, diabetes and even liver cancer.
“Cirrhosis in the liver can dangerously elevate the blood pressure within its blood-supplying vein known as the portal vein, leading to a serious condition called portal hypertension,” warns Dr Ravindra B S, director and head of department, gastroenterology and hepatobiliary sciences, Fortis Hospital, Bannerghatta Road, Bengaluru.
Experts reckon it all begins with the fatty liver – whether it is an alcoholic fatty liver (caused due to excessive alcohol consumption) or a non-alcoholic fatty liver (occurring in people who drink little or no alcohol). “Both of these, if unattended to, eventually lead to scarring and cirrhosis which makes a person more susceptible to portal hypertension,” explains Dr Ravindra.
Portal hypertension: It is all in the veins
Like most organs, the liver too needs its supply of blood to carry out the numerous tasks it has been biologically assigned.
According to Bengaluru-based Dr Prasanna Bhat KS, consultant, hepatology and liver transplant, Manipal Hospital, Old Airport Road, “liver is where all the metabolism happens to keep our body up and running.” He further explains, “The liver is connected to hepatic artery and portal vein and both these blood vessels deliver oxygen to it. The portal vein is an important structure since it supplies about 70 percent of the liver’s blood flow. The rest (30 percent) is supplied by the hepatic artery.” The portal vein is an important pathway to the ‘blood-filtering’ liver, carrying blood from organs like the spleen, intestine and stomach.
Dr Ravindra simplifies portal hypertension and explains, “whenever there is a problem in the liver like scarring or shrinking, that’s when the portal vein feels the pressure. This leads to portal hypertension. Because of the shrinking or scarring of the liver, now the blood can’t pass through the liver. This creates resistance – like that of a blocked hose with no forward opening. Another common reason is blood clotting or thrombosis.” The pressure that the veins feel because of the blockage can cause them to rupture and bleed.
Dr Ravindra explains there are several liver-related complications which can lead to portal hypertension, but one of the most prevalent reasons is cirrhosis (which is the late stage of scarring) or liver damage. “Liver fibrosis is the initial stage of tissue scarring which (if progresses further) causes liver cirrhosis.”
He explains what can possibly cause this condition. “Among the many reasons leading to portal hypertension, some of the common causes are obesity, diabetes and infection-causing viruses like hepatitis B and hepatitis C which can lead to cirrhosis and liver damage. Another lesser common reason which eventually leads to portal hypertension is autoimmune liver disease.”
“The early symptoms of liver disease are not easily diagnosed but if you experience a swelling on the left side of your abdomen or some symptoms like blood in your stools or vomiting, you should immediately consult a doctor to rule out portal hypertension,” explains Dr Ravindra. “Feeling confused or disoriented could be another indication,” he adds.
Symptoms: Unusual suspects
Vomiting blood or black tarry stool:
This condition is known as oesophageal varices. When normal blood flow to the liver is blocked (at the portal vein because of the scar tissues at the liver), it starts flowing back into smaller blood vessels in the esophagus in order to go around the blockage. Now, these blood vessels are not equipped to handle this large volume of blood flow.
These vessels eventually start rupturing and the blood exits through the food pipe and stomach resulting in blood vomiting and black stools. It should be taken seriously before it becomes a life-threatening situation.
Swollen belly: Ascites or the fluid build-up in the abdomen makes the belly swell up and causes great discomfort to the person.
Edema: Swelling of the leg or accumulation of fluid in the legs is also a symptom of portal hypertension.
Slow cognition or hepatic encephalopathy: When the liver fails to remove toxins from the blood, it can lead to conditions like disorientation which causes confusion and forgetfulness. If not treated it can lead to brain coma in extreme cases.
Bulkiness or swelling on the left side of the abdomen: According to Dr Ravindra, sometimes bulkiness or swelling on the left side of the abdomen is caused when the blood can’t pass through the liver. Instead, it starts going through the spleen (lymphatic blood filtering organ) and the spleen becomes enlarged. This is an indication of portal hypertension and liver damage.
Low blood count: When the blood passes through the spleen, many blood cells die there and the number of white blood cells can decrease (increasing the risk of infections). This would reflect in a blood test. So, it is advisable to get a hemoglobin or white blood cell count test done.
Yellowing of the skin or jaundice: Portal hypertension can also lead to a complication like jaundice which makes the skin, eyes and nails turn pale or yellow.
Fatty liver: While alcohol consumption is one of the biggest reasons for fatty liver, non-alcoholic fatty liver disease due to the consumption of unhealthy foods laden with saturated fats is also another common factor contributing to liver disease.
Hepatitis B and C: Viruses like hepatitis B and C can cause infection, inflammation and damage the liver.
Excess iron: Similarly excess iron deposits too can cause harm to the liver. If detected early, it can be treated with medication.
Autoimmune hepatitis: This autoimmune liver disease is rare but serious considering it can lead to cirrhosis, liver failure, ascites and even liver cancer.
Wilson Disease: In this disease, the excess copper gets accumulated in the system which can be harmful. It is a genetic disorder that can be treated through medication and dietary copper restriction.
What is the way forward?
If the doctor suspects that the liver may not be in the pink of health, he will first advise a blood test. If the blood test reflects low hemoglobin, low white blood cells and low platelet count, it can further be probed with an ultrasound. “If the ultrasound reflects a shrunken liver or a large spleen, it is the first indication of the liver not functioning properly,” explains Dr Ravindra. Sometimes a CT scan or MRI is also required.
The next step for confirmation would be to go for an endoscopy and look for enlarged veins in the food pipe. “If the veins in the food pipe are enlarged, that indicates portal hypertension,” says Dr Ravindra.
To stop the bleeding of the ruptured veins, sometimes a procedure called banding is administered where rubber bands are used around the veins to stop the bleeding.
For those with ascites or a fluid-filled belly, medication is the first step to draining the water through the kidneys. If that doesn’t work, then a needle is used to drain off the fluid from the stomach.
According to Dr Ravindran some of the must-dos for liver health are:
- Consuming no more than three grams of salt every day
- Exercising daily for at least 30 minutes
- Avoiding red meat and fried foods
- Saying no to alcohol and smoking
- Vaccination for viruses like hepatitis A and hepatitis B
- People who have liver diseases running in the family should go for regular liver function and screening (through a blood test and ultrasound)
- People with hepatic encephalopathy are advised a low protein diet to reduce ammonia build-up in the blood so that the brain is not adversely affected.