The Hindu
20 April 2010
By Ramya Kannan

This Monday, observed across the world as ‘Liver Day,’ experts called for spending a little time talking about the organ that helps the body detox on a daily basis. The day was also an occasion to learn about how to avoid the liver plague– the fatty liver.

The liver is a ‘wonder’ organ, says K. Ravindranath, chairman, Global Hospitals Group. “It has a self–renewing ability, a lot of resistance and falters only when more than 80 per cent of it is damaged.” The liver, then, is a vital power house that plays a vital part in the functioning of the body.

“Basically the liver is a most metabolically active organ in the body. It is said that at any given moment, 36,000 functions are being carried out in the liver, which is the biggest organ in the body,” adds R. Surendran, Head, Institute of Surgical Gastroenterology and Liver Transplant.

It has a tremendous capacity to regenerate – taking only between 15 and 20 days to regrow in a normal individual, even if 80 per cent has been removed.

As such, the liver is also most resilient, as if built to withstand a lot of assaults, he explains. The problems relating to the liver can be brought under three major categories – enzyme defects that are hereditary, acute liver failure and chronic liver failure. Viral infections, drug–induced failure and alcohol consumption (since they are metabolised in the liver) mostly lead to acute liver failure, necessitating a transplant.

Chronic liver failure can be caused by lifestyle–related disorders such as diabetes or hypertension, autoimmune disorders and hepatitis B/C and D. Current lifestyles, trendy and exciting as they may be, are, however, causing a great deal of damage to the liver, Dr. Ravindranath says. “Stress, alcohol, fast food, and polluted air and water are all leading to catastrophic effects on one of the most vital organs of the body.” Fatty liver is one direct result.

S. M. Chandramohan, head, Department of Surgical Gastroenterology, Government General Hospital, says that fatty liver is the commonest finding when you ask for an ultra sound of the abdomen in anyone above 40 years. People who are obese, diabetic, hypertensive, or have had a history of jaundice are more prone to a fatty liver. While alcohol consumption can compromise the liver, it is also common to find non–alcoholic fatty livers, he says.

While an ultra sound is ordered for people complaining of abdominal discomfort, there are others, who show no symptoms at all, and discover they have a fatty liver from the annual master health check–up, Dr. Chandramohan adds.

Anand Khakhar, Senior Consultant Liver Transplant & Hepatobiliary Surgery and Program Director for the Liver Transplant Program at Apollo Hospitals, Chennai, says that when he joined about two years ago, he was surprised by the number of fatty liver cases reporting after a master health check–up. Over the years, the numbers have constantly been increasing, he says. They have even noticed otherwise normal people (with no other chronic conditions and not overweight) reporting with fatty liver.

“Of late, what we see in most of our livers, especially in Asia, are fatty livers – a definition given to the organ when it accumulates fat. It could lead to unnatural levels in the enzymes, presenting with the same condition that alcoholics report with.

“The medical term for this condition is Non Alcoholic Steato Hepatitis and if you do not take care, it will lead to cirhossis of the liver, and ultimately failure,” Dr. Surendan adds. In fact, in the rather vibrant cadaver transplant programme of the State, about 20 per cent of the cadaveric livers are non–usable since they are fatty, he states.

Food habits and lifestyle – excessive indulgence with fatty foods, lack of exercise, untimely meals and high stress levels – are the culprits.

“We test patients who come with fatty liver for other metabolic disorders including diabetes and start treating them for those conditions. A dietician and physiotherapist will then evaluate each patient and suggest changes in diet and lifestyles. They suggest measures to get to the normal Body Mass Index; urge them to have timely meals and sleep, eat healthy food and exercise well. The best part about the fatty liver is that it is reversible. In most of the patients who follow the diet and exercise chart, the fat deposits actually disappear in the re–evaluation done after three months,” Dr. Khakhar explains.