How do I know if I have Liver disease?
There are no signs nor symptoms when a patient has liver disease. We can detect advanced liver disease by the eyes turning yellow, which is called jaundice or the abdomen filling up with fluid, which is called ascites. However, this happens in end stage liver disease. I recommend evaluating your liver with a simple blood test known as a (CMP) complete metabolic panel. This will have the markers of liver inflammation known as the AST and ALT. A normal AST and ALT for a woman is around 19 and a man is 30.
I was told I had inflammation of the liver? What does this mean?
Inflammation of the liver means a bruising of the liver. Many causes of inflammation occur as a result of things such as excessive alcohol, Hepatitis B or C, certain medications, etc.. The #1 cause of inflammation of the liver is the metabolic syndrome: obesity, diabetes, hypertension and dyslipidemia. This syndrome is known as Non-Alcoholic Fatty Liver Disease (NAFLD). It is estimated that 30 million Americans have NAFLD. The treatment for inflammation of the liver depends on the cause; minimizing excess alcohol consumption, seeking treatment for Hepatitis B or C, avoiding hepatotoxic medications and in the case of the NAFLD, weight loss. I do not recommend purchasing over the counter liver cleanses or liver detox therapy.
Who should be screened for Hepatitis C?
Hepatitis C remains a silent epidemic throughout the United States. It is estimated that 5.3 million Americans are living with viral hepatitis and don’t even know it. Viral Hepatitis can persist undetected for many years before manifesting as a chronic liver disease. The CDC recommends that anyone born between 1945-1965 be screened for Hepatitis C. Screening is a blood test that can be done in the doctor’s office.
What if I test positive for Hepatitis C? Is this a death sentence?
No! There are remarkable drugs available for the treatment of Hepatitis C. These drugs eradicate the virus and cure the patient of Hepatitis C. The treatment durations varies depending on the severity of illness and the type of Hepatitis C. There are different types of Hepatitis C known as Genotypes. These Genotypes are found in different parts of the world. Genotypes 1, 2 and 3 are common to the United States. Genotype 4 is common to Egypt, Genotype 5 to South Africa and parts of the Middle East. Genotype 6 is common to Vietnam. The duration of treatment length may vary 8, 12, or 24 weeks. Side effects are very well tolerated. I encourage anyone with Hepatitis C to seek treatment.
How do I know the severity of injury to my liver?
The Gold standard for determining the extent of liver damage was through a liver biopsy. The procedure for a liver biopsy involves inserting a needle in-between the ribs over the liver and extracting a small portion of the liver. That piece is then reviewed under a microscope and the extent of liver injury is evaluated. This is known as Fibrosis which has 4 stages. Stage 4 being cirrhosis or hardening of the liver. However, we have new technology that is able to place a probe over the liver. The stage of Fibrosis is determined without having to remove a piece of liver. This is non-invasive and causes no bodily harm to the patient. This technology is known as a Fibro-scan® and uses transient elastography to measure liver stiffness. We have this technology at California Liver Research Institute. The procedure takes about 15 minutes and the patient needs to be fasting for 3 hours.
I have been diagnosed with Cirrhosis. What should I do?
The most important message I have for a patient with cirrhosis is to remain positive. I recommend surveillance for liver cancer every 6 months. The risk of liver cancer increases 4% per year due to cirrhosis. Surveillance is done by both an ultrasound and blood test to look for markers of liver cancer known as an Alpha Feto-Protein. I collaborate with all liver transplant centers in the Los Angeles area. I refer to a Liver Transplant Center when the patient has a Model of End Stage Liver Disease (MELD) score above 15 or when the patient has liver cancer. I currently have a liver cancer clinic in the Pasadena Liver Center where we collaborate with the USC liver transplant surgeons and the Radiologist from Huntington memorial Hospital. We take a multidisciplinary approach to curing Liver Cancer and assisting our patients through a stressful and difficult period in their lives.