Liver disease is one of the leading causes of death worldwide. Liver disease accounts for two million deaths annually and is responsible for 4% of all deaths (1 out of every 25 deaths worldwide); approximately two-thirds of all liver-related deaths occur in men. As per WHO data (Year 2020), liver disease death accounts for 3.17 % of total deaths in India, which is rising at an alarming rate as in the year 2016, same was 2.1 % of total deaths in India. (66 % rise in deaths in 4 years)
The Importance of the Liver:
The liver performs several vital functions in our body which supports metabolism, immunity, digestion, detoxification, vitamin storage among other functions.
Metabolism: The liver breaks down fats to produce energy and produces proteins that are important for blood clotting such as such as albumin, osmolyte, soluble plasma fibronectin, and C-reactive protein.
Detoxification: The liver converts toxins into waste products, cleanses the blood, and metabolizes nutrients, alcohol, and medications.
Digestion: The liver makes and secretes bile and processes and purifies the blood, which contains newly absorbed nutrients. The liver breaks down proteins into amino acids, which are then converted to glucose, fats, and proteins.
Immunity: The liver breaks down old or damaged blood cells.
Vitamin storage: The liver stores vitamins
Producing cholesterol: The liver synthesizes cholesterol and regulates cholesterol levels.
Control Metabolic processes: liver is a metabolic powerhouse that can perform thousands of chemical reactions and has about 500 metabolic functions.
Risk Factors for Liver Disease:
The most common causes of cirrhosis worldwide are related to viral hepatitis, alcohol, and non-alcoholic fatty liver disease (NAFLD). Most people believe that Liver damage comes only from drinking too much alcohol but the reality is liver disease can also be caused by
- Eating too many sweetened, sugary and processed foods and drinks,
- Consuming too many omega-6 vegetable oils and fast foods
- Using painkillers too often, like acetaminophen or Ibuprofen
- Viral Infections (Hepatitis A, B, C, D & E)
- Having too much elemental iron in the body and
- Toxins from the environment like pesticides, plastics, petroleum and the list goes on and on
- Other risk factors include obesity, type 2 diabetes, tattoos or body piercings, drug abuse, exposure to blood and body fluids, unprotected sex, and a family history of liver disease
12 Signs and Symptoms of Liver Disease:
Liver injury or failure can present with various signs and symptoms. However, many people are unaware of what causes liver failure and how to recognize these symptoms. Here are some common signs to watch out for:
1. Pale Stool (Acholia): The Liver releases bile acids to help digest fats from food, which gives its normal brown colour of stool. In case of fatty liver disease or liver damage, this bile stops flowing properly, causing stool to become lighter, paler or clay coloured, and it may float on the top of the toilet water because of the indigested fat.
2. Poor Night Vision (Nyctalopia): This may indicate a retinol (vitamin A) deficiency. The bile from the liver helps to absorb Vitamin A, to help the rod cells in the eyes adapt to different levels of light. Having liver disease, causes a lack of bile, so absorption of Vitamin A is hampered, triggering “night blindness”.
3. Swollen Right Foot (Edema): One of the most common signs of liver damage. When the blood isn’t flowing normally through the liver, it can become swollen and enlarged which puts pressure on the portal vein. This causes fluid and water to accumulate in the legs or feet, If the finger is pressed into the swollen area, it may leave an indentation (pitting oedema).
4. White Eyelid Growths (Xanthelasmas): In case of liver damage, there is the appearance of white/yellowish growths around the eyelids (xanthelasmas). These are small pockets of cholesterol deposits
5. Right Side Pressure (Biliary Cholic): Another sign of liver disease is a feeling of pressure or pain on the right side of your ribcage, especially after meals. Bile from the liver turns into a sludge because of liver damage, which clogs up the bile duct, causing a sensation of pain and discomfort.
6. Purple/Red Spots (Purpura): When the liver is congested, inflamed, or damaged, it produces fewer proteins that are needed for normal blood clotting which leads to bruising more easily,
7. Cracked Heels (Pellagra): Your body uses Vitamin B3 (niacin) to keep skin cells strong, smooth and moisturised to prevent it from becoming damaged. In the case of liver disease the body uses up its Vitamin B3 stores to help repair the damage, causing the skin on the soles of the feet and heels to start cracking.
8. Itchy Hands & Feet (Cholestasis): Another symptom of liver disease is having a constant urge to scratch or itch the palms of the hands or soles of your feet. This condition is caused by a build up of bile acids under the skin because the liver is not filtering them out properly. This causes histamines to build-up in the blood causing the itchy reaction.
9. White/Clubbed Nails (Terry’s Nails): If the liver is damaged, it prevents oxygen from reaching the nail matrix and fingernails begin to turn all-white, losing their pink colour. The nail also becomes rounded clubbed or bulbous.
10. Dark Urine (Bilirubinuria): One of the most common signs of liver disease is dark urine. The Major function of Liver is the breaking down of the old red blood cells, which contain a yellowish pigment called bilirubin. If the liver or the gallbladder becomes damaged, this pigment can build up inside the body and be flushed through the urine, causing your pee to have a strong, dark, orange, amber, brown or cola colour because your liver isn’t breaking this pigment down normally. However, this can also be caused by certain medications like antibiotics, sleeping pills, or birth control pills.
11. Yellowed Skin (Jaundice): When the liver isn’t working properly and filtering bilirubin from the blood, the level of bilirubin increases leading to yellow skin and white part of the eyes (sclera)
12. Spider Veins (Angioma): Spider veins are small red dots, with spider-like extensions of blood vessels that appear on the skin. These are blood vessels that have become damaged because your liver isn’t doing its job in filtering out excess estrogen.
Treatment Options:
If you have one or more of these symptoms, it is highly recommended to consult the doctor and request for an ultrasound test. The treatment for liver disease depends on the underlying cause. Medical professionals may advise various tests, such as blood tests, ultrasonography, and liver biopsy, to determine the cause of liver dysfunction. Treatment options may include medication, dietary changes, and, in severe cases liver transplant.
Liver Disease and Insurance Claims (India)
Liver disease, like jaundice or Hepatitis, Liver abscess, etc. if detected during the policy period, is covered under health insurance. However, some policies exclude Liver cirrhosis for 2 years from the date of Purchase. But Alcoholic liver disease / Liver disease due to any substance abuse or drug abuse is permanently excluded from the scope of health insurance coverage.
References
The Global Burden of Liver Disease – Journal of Clinical Gastroenterology and Hepatology (VOLUME 21, ISSUE 8, P1978-1991, JULY 2023)
Global epidemiology of cirrhosis — aetiology, trends and predictions – Nature Reviews Gastroenterology & Hepatology (Published: 28 March 2023) Daniel Q. Huang, Norah A. Terrault, Frank Tacke, Lise Lotte Gluud, Marco Arrese, Elisabetta Bugianesi & Rohit Loomba
Epidemiology of Liver Diseases in India – Clinical Liver Disease, VOL 19, NO 3, MARCH 2022- Dipankar Mondal,* Kausik Das,† and Abhijit Chowdhury
A Study on the Temporal Trends in the Etiology of Cirrhosis of Liver in Coastal Eastern Odisha (National Library of Medicine)
Etiological Spectrum of Cirrhosis in India: A Systematic Review and Meta-analysis –(Journal of Clinical and Experimental Hepatology- Volume 14, Issue 2, March–April 2024, 101291) Shekhar Swaroop ∗, Manas Vaishnav ∗, Umang Arora ∗, Sagnik Biswas ∗, Arnav Aggarwal ∗, Soumya Sarkar †, Puneet Khanna ‡, Anshuman Elhence ∗, Ramesh Kumar §, Amit Goel II, Shalimar
https://www.worldlifeexpectancy.com/india-liver-disease
The Digestive Process: The Liver and its Many Functions- John Hopkings Medicine.
Jaundice in Adults: American Academy of family Physician Am Fam Physician. 2017;95(3): online