“I was terrified to notice that my urine was brown in colour,” says Anya Shroff, 17, a home science student from Mumbai who had been experiencing mild abdominal pain but preferred not telling her parents assuming it wasn’t severe. “But the odd-coloured urine prompted me to speak up,” she says. Her family physician suggested a blood test along with an ultrasound and the test results revealed that she had an inflamed liver. The culprit was a herbal drink she had been consuming for two months for her pimples, said her doctor.
How does the liver get inflamed?
Dr Naveen Ganjoo, senior consultant of hepatology and transplant at Sparsh Hospital, Bengaluru, says one of the many functions of the liver is detoxification. That is, filtering and breaking down the toxins such as medicines, alcohol and chemicals that are ingested and flushing them out of the body through the urine. But this process comes with a price. Excessive exposure of the liver to toxins can damage the cells (hepatocytes) and cause inflammation of the liver. The condition is called hepatitis.
Dr Gaurav Gupta, senior consultant and chief surgeon, liver transplant and HPB surgery, Fortis Hospital, Mumbai, adds that liver inflammation is not related to age or gender but only to the type and amount of toxin and the condition of the liver.
What are the symptoms of toxic liver disease?
According to Dr Ganjoo, liver inflammation initially presents itself through non-specific symptoms like nausea, vomiting, lethargy, fatigue, abdominal pain on the upper right-side pain and lack of appetite. At a later stage, symptoms like itching, jaundice, water retention in the abdomen, swelling of legs and excessive bruising develop.
Dr Gupta says the onset of symptoms depends on the type and amount of toxin consumed and the health of the organ. An excessive amount of paracetamol can cause liver failure within a few hours while the symptoms of anti-tuberculosis medicines can take up to two to four weeks to manifest. He further adds that people with a healthy liver can fight the toxin and their liver regenerates faster.
The guilty toxins
Hepatitis is mostly due to the indiscriminate use of drugs or chemicals, says Dr Ganjoo. An overdose of paracetamol, (more than 4 g), antibiotics and oral contraceptives, in some people, can all be the culprits. Chemical-induced hepatitis is mostly an occupational hazard for people who work in industries and is due to exposure to heavy metals in large quantities.
“Apart from drugs and chemicals, viral infections like Hepatitis (A, E, B & C) dengue and protein supplements in large quantities also cause inflammation of the liver,” he adds.
“That is the reason why whenever a person is prescribed medicines that are known to affect the organ, they are asked to do regular liver function tests,” explains says Dr Gupta who doesn’t exonerate chemotherapy as a cause for liver injury.
Dr Gupta points out that many counterfeiters sell strong medicines in the name of homeopathy, ayurveda or unani. These could contain toxins such as lead and mercury which can damage the liver.
He recalls treating a 42-year-old male from Mauritius who was advised a transplant due to hepatitis. After a detailed investigation, it was discovered that the man was consuming a drink to fight Covid infection. The drink was discontinued and he was started on liver-protective oral medication. Within six to eight weeks the man’s liver started functioning normally and no transplant was required.
How is hepatitis diagnosed?
Blood count, liver function test and coagulation tests are done for determining the degree of liver damage based on the levels of bilirubin and enzymes says, Dr Gupta. Occasionally imaging is recommended through an ultrasound or a CT scan for comparing and corroborating results and a liver biopsy to estimate the degree of liver damage, he adds.
Management of toxic liver disease
Doctors say the most effective ways to manage the condition are to stop taking the drug which is causing the reaction, stop exposure to the chemical by removing it from the environment and consult a doctor in case of any symptoms.
Dr Gupta says a stomach wash is used to remove medicines within six hours of ingestion while chemicals can be removed through blood dialysis. “People with severe symptoms must be admitted to the ICU and started on liver protection medicines. Sometimes the organ recovers but at times it becomes an acute condition and a liver transplant is recommended,” he adds.
Within three weeks of stopping the drink, Anya’s urine turned yellow and her abdominal pain reduced significantly.
Takeaways
- Constant exposure to toxins like drugs, chemicals and herbal products can inflame the liver and cause toxic hepatitis.
- Inflammation of the organ initially presents itself with non-specific symptoms like nausea, vomiting, tiredness, stomach pain, occasional lack of appetite, yellowing eyes, darkening urine and jaundice.
- Doctors say the most effective way to manage the condition is to stop taking the drug which causes the reaction and stop exposure to the chemical by removing it from the environment.
- If exposure is continued it may lead to a liver transplant.
