P. K. MITRAP. K. MITRAEURODRUG LABORATORIESEURODRUG LABORATORIES

KNOW THY KNOW THY LIVERLIVER

LOVE & CARE LOVE & CARE

Do you really love your liver ?Do you really love your liver ?

How can you love your liver without How can you love your liver without knowing it ?knowing it ?

After knowing it how can you do injustice After knowing it how can you do injustice to it ?to it ?

Hi... I'm Your Liver !Hi... I'm Your Liver !

Let me tell you what I do for Let me tell you what I do for you…in you…in 99 ways ways

I I store the ironstore the iron reserves reserves you you

need, as well as a lot ofneed, as well as a lot of

vitamins and other vitamins and other minerals.minerals.

Without me, you Without me, you wouldn'twouldn't

have the strength to have the strength to carrycarry

on!on!

1.

I am responsible for up to 500 separate functions, usually in combination with other systems and organs.

I make I make bilebile to help digest to help digest

your food, your food, without me,without me,

you'd waste you'd waste away to away to nothingnothing

& dump me & dump me with poisonswith poisons..

2.

The bile produced by me is collected in bile canalliculi, which merge to form bile ducts.

I I detoxify poisonousdetoxify poisonous

chemicalschemicals you give me, and you give me, and

that includes alcohol, beer,that includes alcohol, beer,

wine and drugs wine and drugs (prescribed(prescribed

and OTC)and OTC) as well as illegal as well as illegal

substances.substances.

3

Without me, your "bad“ habits would kill you.

I store I store energyenergy,,

Like a battery, byLike a battery, by

Stockpiling sugarStockpiling sugar

(carbohydrates,(carbohydrates,

glucose and fat)glucose and fat)

Until you need it.Until you need it.

4 4

Without me, the sugar level in your blood could fall dramatically and you'd go into a coma.go into a coma.

You cann’t start your day in the You cann’t start your day in the morning, if I am not on the job !morning, if I am not on the job !

I I make the bloodmake the blood that got that got

your system going evenyour system going even

before you were born,before you were born,

without me, you wouldn'twithout me, you wouldn't

be here !be here !

55

I I manufacture new proteinsmanufacture new proteins that your that your body needs to stay healthy and grow. body needs to stay healthy and grow.

Without me, you wouldn't grow Without me, you wouldn't grow properly!properly!

6

I I remove poisonsremove poisons from the from theair, exhaust smoke andair, exhaust smoke andchemicals you breathe. chemicals you breathe.

7

Without me, you'd be poisoned by pollutants!

I I make clotting factorsmake clotting factors that that

stop the bleeding when youstop the bleeding when you

accidentally prick yourself.accidentally prick yourself.

8

Without me, you'd bleed To death !

I help I help defend youdefend you against the germs going against the germs goinginto your body all the time. I take thoseinto your body all the time. I take thosecold germs, flu bugs and other germs youcold germs, flu bugs and other germs youencounter, and knock them dead - or atencounter, and knock them dead - or atleast weaken them. least weaken them.

9

Without Without me, you'd me, you'd be a be a sitting sitting duck for duck for every every infection infection known to known to man.man.

I hope now you I hope now you understand how much I understand how much I

love you……..love you……..

Let us understand the most common Let us understand the most common diseases that affect me……diseases that affect me……

FATTY LIVER DISEASEFATTY LIVER DISEASE

What is it?What is it?

• Fatty liverFatty liver is the collection of is the collection of excessive amounts of fat inside liver excessive amounts of fat inside liver cellscells, also called steatosis., also called steatosis.

• Mostly triglycerides & CholesterolsMostly triglycerides & Cholesterols

• Reversible condition. Reversible condition.

FATTY LIVER - CAUSESFATTY LIVER - CAUSES

Fatty liver is commonly caused by AlcoholAlcohol  or or MetabolicMetabolic

Syndrome (Diabetes, Hypertension, Obesity and Dysli

demia), but can also be due to any one of many causes.

1. 1. NUTRITIONAL (MALNUTRITION/WEIGHT LOSS)NUTRITIONAL (MALNUTRITION/WEIGHT LOSS)

2. 2. DRUGS & TOXINSDRUGS & TOXINS

3. 3. VIRAL HEPATITISVIRAL HEPATITIS

4. 4. AUTOIMMUNE LIVER DISEASEAUTOIMMUNE LIVER DISEASE

FATTY LIVER - CAUSESFATTY LIVER - CAUSES

• MetabolicMetabolicAbetalipoproteinemia, G, Glycogen storage diseases, , 

Weber-Christian disease, A, Acute fatty liver of pregnancy, L, Lipodystrophy

• NutritionalNutritionalMalnutrition, T, Total parenteral nutrition, Severe , Severe weight loss, R, R

efeedingsyndrome, J, Jejunoileal bypass, G, Gastric bypass, Jejunal , Jejunal diverticulosis  

with with bacterial overgrowth..

• Drugs and toxinsDrugs and toxinsAmiodarone, M, Methotrexate, D, Diltiazem, Expired , Expired tetracycline, H, H

ighly activeantiretroviral therapy, G, Glucocorticoids, T, Tamoxifen, Environmental , Environmental 

hepatotoxins  

Inflammtory bowel disease, HIV, hepatitis C and alpha 1-Inflammtory bowel disease, HIV, hepatitis C and alpha 1-antitrypsin deficiencyantitrypsin deficiency

Alcoholic FattyAlcoholic Fatty

Liver or AlcoholicLiver or Alcoholic

Steatosis causedSteatosis caused

By alcohol abuse By alcohol abuse

All body organs are All body organs are affected,affected,

with the liver and brainwith the liver and brain

suffering most suffering most seriously.seriously.   

   

Alcoholic liver disease does not usually cause any symptoms until the liver has been extensively damaged. When this happens, symptoms can include:

• NauseaNausea• Weight lossWeight loss• AnnorexiaAnnorexia• Yellowing of the eyes Yellowing of the eyes and skin (and skin (jaundicejaundice))• Swelling in the Swelling in the ankles and abdomenankles and abdomen• Confusion or drowsinessConfusion or drowsiness

Non-Alcoholic Fatty Liver DiseaseNon-Alcoholic Fatty Liver Disease

Affect people whoAffect people who

drink little or nodrink little or no

alcohol.alcohol.

Simple fatty liver Simple fatty liver (steatosis), (steatosis), usually causes no usually causes no liver damage but liver damage but may lead to NASH may lead to NASH

Exact casue Exact casue not known not known but Obesity & but Obesity & Insulin Insulin resistance learesistance lead to progress d to progress of NAFLDof NAFLDMost patients have few Most patients have few or no symptoms, may or no symptoms, may complain of complain of fatigue, malaise, and fatigue, malaise, and dull right-upper-dull right-upper-quadrant abdominal quadrant abdominal discomfort.discomfort.

NonalcoholicNonalcoholicsteatohepatitis (NASH), asteatohepatitis (NASH), amore serious type.more serious type.Caused by hepatitisCaused by hepatitisinfection, malnutrition,infection, malnutrition,obesity, diabetes obesity, diabetes

mellitus,mellitus,and and Reye's syndromeReye's syndrome . .

In some cases, In some cases, this can progress this can progress either to either to cirrhosis, which cirrhosis, which can produce can produce progressive, progressive, irreversible liver irreversible liver scarring, or to scarring, or to liver cancer.liver cancer.

Fat in the liver, with inflammation and damage, can occur in children. Weight loss & weakness may begin once the disease is advanced or cirrhosis is present.Reduce body weight, eat a balanced diet, engage in physical activity, and avoid alcohol and unnecessary medications may help in treatment as no specific treatment available till date.

Reye's Syndrome:Reye's Syndrome:A deadly disease, attack any child or adult A deadly disease, attack any child or adult

without warning. without warning. 

All body organs are All body organs are affected, with theaffected, with the

liver and brain suffering liver and brain suffering most seriously.  most seriously. 

Cause & cure remain Cause & cure remain unknown, research hasunknown, research has

established a link between established a link between Reye's SyndromeReye's Syndrome

And the use of aspirin and And the use of aspirin and other salicylateother salicylate

containing medications.  containing medications. 

Causes of NAFLD/NASH: Causes of NAFLD/NASH:

Unclear but researchers believe the contributing Unclear but researchers believe the contributing factors are:factors are:

• Obesity / Hypertension / Abnormal cholesterol Obesity / Hypertension / Abnormal cholesterol levelslevels

• Insulin Resistance / DiabetesInsulin Resistance / Diabetes

• The fat may come from other parts of the The fat may come from other parts of the body, or the liver may body, or the liver may absorbabsorb an an increasedincreased amount of fat from the intestine. amount of fat from the intestine.

• Another possible explanation is that the liver Another possible explanation is that the liver loses its ability to change fat into a form that loses its ability to change fat into a form that can be eliminated. can be eliminated.

What are the symptoms ?What are the symptoms ?

Fatty liver usually produces no Fatty liver usually produces no symptoms butsymptoms but

few patients may show the few patients may show the following symptoms:following symptoms:

• JaundiceJaundice

• Right-side abdominal painRight-side abdominal pain

• Abdominal swellingAbdominal swelling

• Fever.Fever.

• AnnorexiaAnnorexia

• FatigueFatigue

• Swollen LegsSwollen Legs

At more advanced At more advanced stage, liverstage, liver

becomes becomes cirrhotic:cirrhotic:

• Cirrhosis refers to Cirrhosis refers to scarring of the liver. It scarring of the liver. It replaces healthy replaces healthy tissue, cannot do what tissue, cannot do what healthy liver tissue healthy liver tissue does.does.

• Scar tissue also blocks Scar tissue also blocks the normal flow of the normal flow of blood through the blood through the liver, can be life-liver, can be life-threatening.threatening.

A fatty liver is enlarged and has a A fatty liver is enlarged and has a greasy, pale yellow look.greasy, pale yellow look.

NAFLD / NASH: Diagnosis ?NAFLD / NASH: Diagnosis ?

• The liver may be tender when the The liver may be tender when the abdomen is pressed. abdomen is pressed.

• Blood tests - for liver function Blood tests - for liver function (Enzymes) (Enzymes)

• Ultrasound or abdominal CT scan.Ultrasound or abdominal CT scan.

• Liver Biopsy (Grading of Steatosis)Liver Biopsy (Grading of Steatosis)

• Fibro-ScanFibro-Scan

• TSH Estimation (NASH-Marker)TSH Estimation (NASH-Marker)

NAFLD/NASH – Treatment ?NAFLD/NASH – Treatment ?• Treatment for fatty liver is aimed at Treatment for fatty liver is aimed at

eliminating or treating the cause of the eliminating or treating the cause of the condition. condition.

• In some cases, fatty liver is reversible if In some cases, fatty liver is reversible if caught early in its development. caught early in its development.

• Pregnancy-related fatty liver is treated Pregnancy-related fatty liver is treated by delivering the baby, if viable. by delivering the baby, if viable.

• In severe cases, the patient may In severe cases, the patient may eventually require a liver transplant.eventually require a liver transplant.

• Drugs like: UDCA, Pentoxifylline, Vitamin-Drugs like: UDCA, Pentoxifylline, Vitamin-E, Statins, Metformin, Pioglitazone, E, Statins, Metformin, Pioglitazone, Metadoxine may help immensely.Metadoxine may help immensely.

• Nutritional counselling, Weight reduction Nutritional counselling, Weight reduction also help also help

AbnormalityAbnormality 2005 %2005 % 2006 %2006 %

Fatty liver 17.52 24.12

Liver cyst 9.99 11.66

Renal cyst 7.04 7.77

Renal calculi 10.90 11.48

GB calculi 9.63 9.54

Prostatomegaly 4.39 6.18

ovarian cyst 4.58 4.77

uterine myoma 1.87 3.45

Total scan done 1661 1132

CholescintigraphyCholescintigraphy Statistics PGH – Statistics PGH – CT Scan CT Scan

Abnormality 2005 % 2006 %

Fatty liver 9.82 18.82

Liver cyst 1.33 2.52

Renal cyst 1.60 3.45

Renal calculi 2.21 3.39

GB calculi 3.54 5.52

Prostatomegaly

1.48 2.83

ovarian cyst 5.10 8.58

uterine myoma

2.25 3.79

Total scan done

2627 3566

CholescintigraphyCholescintigraphy Statistics Statistics PGH – USGPGH – USG

Fatty liver % detection vs no Fatty liver % detection vs no of check-up 2006of check-up 2006

Modality

2005 total

check-up

2005 %

2006- total

check-up

2006 %

Ct Scan 1661 17.52 1132 24.12

Ultrasound

2627 9.82 3566 18.82

I KNOW STILL SOME PEOPLE I KNOW STILL SOME PEOPLE DON’T LOVE ME ……DON’T LOVE ME ……

Let me tell you some easy Let me tell you some easy ways ways

to love me, ….. your liverto love me, ….. your liver

Don't drown me in beer, Don't drown me in beer, alcohol or wine ! alcohol or wine !

Even one drink is too much Even one drink is too much for some people and could for some people and could scar me for life.scar me for life.

Watch those drugs!Watch those drugs! All drugs are chemicals, and All drugs are chemicals, and when you mix them up when you mix them up without a doctor's advice without a doctor's advice you could create something you could create something poisonous that could poisonous that could damage me badly. damage me badly.

• I scar easily due to I scar easily due to repeated alcohol / drug repeated alcohol / drug abuse.. and those scars, abuse.. and those scars, called "cirrhosis" are called "cirrhosis" are permanent.permanent.

• TTaking unnecessary aking unnecessary medicine is a bad habitmedicine is a bad habit. . All those chemicals can All those chemicals can really hurt me (liver).really hurt me (liver).

• Sedentary life style or Sedentary life style or metabolic syndrome metabolic syndrome damage me most … damage me most … please take careplease take care

Be careful with Be careful with aerosol sprays aerosol sprays ! ! Remember, I have to detoxify what you Remember, I have to detoxify what you

breathe in, too. Sobreathe in, too. Sowhen you are cleaning with aerosol cleaners, when you are cleaning with aerosol cleaners,

make sure themake sure theroom is ventilated, or wear a mask. room is ventilated, or wear a mask.

That goes That goes double for double for bugbug

sprays, mildew sprays, mildew sprays,sprays,

Paint sprays Paint sprays and all thoseand all those

Other chemical Other chemical sprayssprays

you use. Be you use. Be careful whatcareful what

you breathe!you breathe!

Watch what gets on your skin! Watch what gets on your skin! Those insecticides you Those insecticides you put onput on

trees and shrubs not only kill bugs they can get to me trees and shrubs not only kill bugs they can get to me rightright

through your skin and destroy my cells, toothrough your skin and destroy my cells, too. Remember. Remember

they're all chemicalsthey're all chemicals. Cover your skin with gloves, long. Cover your skin with gloves, long

sleeves, a hat and mask every time insecticides are in sleeves, a hat and mask every time insecticides are in thethe

air or if you're handling them.air or if you're handling them.

Don't eat too much Don't eat too much fatty food fatty food ! !

I make the cholesterol I make the cholesterol youryour

body needs, body needs, and I try and I try to maketo make

the right amount. the right amount.

Give me a break. Give me a break. Eat a Eat a good,good,

well balanced well balanced nourishing diet.nourishing diet.

If you eat the right If you eat the right stuff forstuff for

me, I'll really do my me, I'll really do my stuff forstuff for

you!you!

WARNING: WARNING:

I can't and won't tell you I can't and won't tell you I'm inI'm in

trouble until I'm almost at trouble until I'm almost at thethe

end of my rope... and end of my rope... and yours.yours.

Remember: Remember: I am a non I am a non complainer.complainer.

Overloading me with drugs, Overloading me with drugs, alcoholalcohol

and other junk can destroy me and other junk can destroy me !!

This may be the only warning This may be the only warning youyou

will ever getwill ever get..

Take My Advice, Please!Take My Advice, Please!

• Check me out with your doctor regularly. Check me out with your doctor regularly. • Blood screening tests can identify some Blood screening tests can identify some

trouble. trouble.

If I'm soft and smooth, that's good. If I'm hard and bumpy, that could mean a trouble, take needful actions.

If your doctor suspects trouble, USG and CT scans can look into it.

My life, and yours, depends on how you treat me and love me.

Now you know how much I care for Now you know how much I care for you.you.

Please treat Please treat meme with tender with tender loving care.loving care.

I am your silent partner in all vital I am your silent partner in all vital

Actions of life and …. Love youActions of life and …. Love you

THANK YOU THANK YOU