Symptoms 

The common signs and symptoms of Acute Liver Failure include: 

• Fatigue 
• Nausea 
• Vomiting 
• Confusion 
• Drowsiness 
• Upper right abdominal pain 
• Swelling near the abdomen 
• Signs of Jaundice (yellowness of skin and eyeballs) 

Causes 

Many cases of Acute Liver Failure don't have any cause. However, the most common causes of Acute Liver Failure include: 

• Cancer 
• Acetaminophen Toxicity 
• Toxins of wild mushrooms 
• Viruses such as Hepatitis A, B, and C 
• Herbal supplements (kava, ephedra, and pennyroyal) 
• Autoimmune Hepatitis (Immune System attacks Liver cells) 
• Metabolic diseases such as Wilson’s Disease, and Acute Fatty Liver 
• Prescription drugs (antibiotics, anticonvulsants, non-steroidal anti-inflammatory drugs, etc.) 

Risk factors 

The risk factors for Acute Liver Failure include: 

• Use of illicit drugs 
• Obesity/overweight 
• Consumption of large amounts of alcohol 
• Bile Duct disorders (Primary Biliary Cirrhosis) 
• Failure to get vaccinated 
• Age and gender (women between 35-60 years, men between 30-40 years) 

Complications 

Acute Liver Failure often causes complications, such as: 

• Kidney Failure - Due to the overdosage of acetaminophen your Liver gets harmed and is followed by Kidney Failure. 
• Cerebral Edema (excessive fluid in the Brain) - Due to the excessive fluid buildup in the Brain the Brain tissue is displaced. This causes oxygen deprivation. 
• Infections - Infections related to blood, Respiratory and Urinary System is common. 
• Coma - Disorientation, mental confusion, and difficulty in concentrating progress to coma if the Liver doesn’t restore to its normal function. 
• Bleeding Disorders- In Liver Failure, your Liver doesn’t produce enough clotting factors. Therefore, there can be Bleeding Disorders, especially in the Gastrointestinal Tract 

Diagnosis 

Diagnostic tests and procedures for Acute Liver Failure include: 

• Blood tests: Prothrombin time test helps to determine how long it takes for your blood to clot. With Acute Liver Failure, blood does not clot as quickly as it does in normal conditions. 
• Imaging tests: Ultrasound testing is recommended to evaluate your Liver. This test reveals Liver damage if present and is helpful for your doctor to determine the cause. 
• Liver tissue examination: Your doctor will order a Liver Biopsy. In a Liver Biopsy, a small piece of Liver tissue is removed and examined which allows us to understand the underlying cause of Acute Liver Failure. 

 Treatment 

In many instances, your doctor would provide the treatment that focuses on symptomatic improvement while treating your Liver damage simultaneously. The treatment options for Acute Liver Failure include: 

Drug therapy to reverse poisoning: Acetaminophen and mushroom poisoning will damage the Liver cells. To counteract the toxicity, your doctor would administer certain drugs to reduce your Liver damage. 
Liver Transplant: If the drug therapy fails the only treatment strategy to correct the Acute Liver Failure would be a Liver Transplantation. A healthy Liver from the donor is replaced with your damaged Liver, and it has a success rate. 

Self-management 

You must take care of your Liver to avoid further deterioration of the Liver, follow the tips that help reduce the risk: 

• Avoid consuming a wild variety of mushrooms 
• Avoid alcohol consumption this helps reduce the strain on your Liver 
• Maintain a healthy weight; Obesity causes Fatty Liver Diseases, Cirrhosis of the Liver, and Hepatitis 
• Perform moderate exercises; this helps in stimulating the digestion and elimination of toxins from the body, which in turn relieves the strain on the Liver. 

When to call a doctor 

Call your doctor if: 

• You find blood in vomiting 
• You feel difficulty in breathing 
• You notice the yellowing of skin and eyes 
• You experience changes in the mental status 

Although a Liver Transplant may treat Acute Liver Failure, it is more often used to treat Chronic Liver Failure. Chronic Liver Failure occurs slowly over months and years. 

Chronic Liver Failure may be caused by a variety of conditions. The most common cause of Chronic Liver Failure is scarring of the Liver (Cirrhosis). When Cirrhosis occurs, scar tissue replaces typical liver tissue and the liver doesn't function properly. Cirrhosis is the most frequent reason for a liver transplant. 

Major causes of Cirrhosis leading to Liver Failure and Liver Transplant include: 

• Hepatitis B and C. 
• Alcoholic Liver Disease, which causes damage to the Liver due to excessive alcohol consumption. 
• Non-alcoholic Fatty Liver Disease, a condition in which fat builds up in the Liver, causing inflammation or Liver cell damage. 
• Genetic diseases affecting the Liver. They include hemochromatosis, which causes excessive iron buildup in the Liver, and Wilson's Disease, which causes excessive copper buildup in the Liver. 
• Diseases that affect the tubes that carry bile away from the Liver (bile ducts). They include Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis and Biliary Atresia. Biliary Atresia is the most common reason for Liver Transplants among children. 

Liver Transplant may also treat certain cancers that originate in the Liver 

Symptoms 

In the early stages, the primary Liver Cancer is asymptomatic in most of the cases. The symptoms of Liver Cancer include: 

• Upper abdominal pain 
• Loss of appetite 
• Fatigue 
• Unintentional weight loss 
• Jaundice 
• Nausea and vomiting 
• Abdominal swelling 
• General weakness 

Consult your doctor immediately when you observe the above symptoms. 

Causes 

The exact cause of Liver Cancer is not known. However, according to the research studies, it is found to be caused by conditions such as chronic infection with certain Hepatitis Viruses. In general, Cancer occurs due to mutations in the Deoxyribonucleic Acid (DNA) leading to the abnormal growth of cells resulting in the formation of a Tumour. 

Risk factors 

Men and obese individuals are more likely to develop Liver Cancer. Chronic infection with Hepatitis B or C virus, Liver Cirrhosis, Diabetes, Nonalcoholic Fatty Liver Diseases, exposure to aflatoxins (chemicals transmitted through food contamination by fungus, Aspergillus Flavus), anabolic steroid use, inherited diseases such as Wilson’s Disease, and excessive alcohol consumption increase the risk of Liver Cancer. 

Coping and support 

The symptoms and the treatment of Liver Cancer may cause some physical changes and lead to stress. You have to raise your threshold for emotions to cope with this condition. Learn about the disease and the treatment options available. You may need physical and emotional support from your caregivers, so make them understand your condition. 

Diagnosis 

The tests and procedures used for diagnosis of Liver Cancer include: 

• Blood tests: Liver Function Tests are performed to detect abnormalities of the Liver. Tumor markers such as alpha-fetoprotein (AFP) levels in the blood are also determined for treatment decisions. 
• Imaging tests: Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Ultrasound Scans are performed to determine the type and stage or extent of the damage. 
• Biopsy: A piece of your affected Liver tissue is sent for laboratory testing to confirm the diagnosis. 

Treatment 

The Liver Cancer treatment depends on the size, location, age, overall health, type and extent of the Liver damage. The treatment for Liver Cancer includes: 

Surgery

Surgery is performed to remove the affected portion of the Liver if your Liver function and overall health are good. Liver Transplantation (replacement of a diseased Liver with a healthy Liver) is also performed in cases of Early-stage Liver Cancer. 

Localized treatments 

• Radiofrequency Ablation – a special probe is used to destroy the Cancer cells with the help of heat 
• Cryoablation – Cancer cells are destroyed using extreme cold with the help of a special instrument called cryoprobe 
• Radiation Therapy – the destruction of Cancer cells or shrinking of Tumours with the help of X-rays 

Chemotherapy 

Anti-cancer drugs are given orally or intravenously to prevent the spread of Cancer. 

Targeted drug therapy  

These drugs act by interfering with specific abnormalities within the Tumour. They help to reduce progression and improve survival rates. 

Palliative care  

Palliative care is the supportive care that is given while you are undergoing curative treatment such as surgery, Radiation, or Chemotherapy. This care is provided to alleviate your pain and symptoms. 

Self-management 

Following some measures can help you to minimize the risk of Liver Cancer: 

• Taking vaccination against Hepatitis B 
• Limiting alcohol intake 
• Being aware of the ways of Hepatitis B transmission (blood transfusion, sharing contaminated needles, and having unprotected sex can cause Hepatitis B) 
• Avoiding aflatoxin exposure 
• Performing regular physical activity 

Causes 

The causes of Bile Reflux include, but are not limited to: 

Surgery Complications: Gastrectomy and Gastric Bypass Surgery are the most common causes of Bile Reflux. 

Peptic Ulcers: A Peptic Ulcer blocks the pyloric valve, not allowing the Stomach to empty up. Stagnant food in the Stomach leads to increased gastric pressure. Thereby, bile backs up into the Oesophagus. 

Cholecystectomy: Patients who had a Cholecystectomy (removal of the Gall Bladder) are more susceptible to Bile Refluxes. 

Symptoms 

You may experience certain signs and symptoms due to Bile Reflux, which includes: 

• Cough 
• Nausea 
• Vomiting 
• Hoarseness 
• Frequent Heartburn 
• Unintentional weight loss 
• Pain in the upper abdominal area 

Diagnosis 

Your doctor would order certain diagnostic tests to confirm the Bile Reflux which includes: 

Endoscopy: Endoscopic study reveals the presence of Peptic Ulcers or any inflammation in the Stomach and Oesophagus. This procedure is performed using an Endoscope (camera), a thin and flexible tube, if required tissue samples can also be collected by Endoscopic study for testing Barrett’s Oesophagus or Oesophageal Cancer. 

Esophageal Impedance: 

Oesophageal impedance is performed to identify whether the gas or liquids reflux into the Oesophagus. This procedure is performed by using a catheter and a probe that is placed into the Oesophagus. 

Ambulatory Acid Tests: Ambulatory Acid Tests are performed to identify the frequency and duration of refluxes that occur in your Oesophagus. These tests are also helpful to rule out Acid Refluxes. The tests are performed by using a catheter and a probe. 

Treatment 

Lifestyle modifications may not be effective for treating Bile Reflux. Therefore, prompt medical treatment would be recommended for treating the Bile Reflux. Your doctor will prescribe appropriate medications which include: 

Ursodeoxycholic Acid: It helps to promote bile flow. It also decreases the frequency and severity of the symptoms. 

Bile Acid Sequestrants: These disrupt the bile circulation but may pose side effects such as bloating. 

Proton Pump Inhibitors: These medications block acid production. 

If the Bile Reflux does not subside with medications, your doctor would recommend surgical options, which include: 

Anti-Reflux Surgery (fundoplication): In this procedure, the fundus is wrapped and sewn around the lower Oesophageal sphincter to strengthen the valve and reduce Acid Reflux. 

Diversion Surgery: It is a weight-loss surgery that is recommended for patients who have had previous gastric surgery with Pylorus Removal. In this procedure, a new connection is made for the drainage of bile further lower in the Small Intestine, diverting the bile juice away from the Stomach. 

Symptoms 

The elevated levels of bilirubin in blood can lead to yellowing of skin and eyes. Certain conditions like stress, dehydration, illness, cold lack of sleep, fasting, menstruation, and strenuous exercises aggravate bilirubin levels. 

Some of the Gilbert’s Syndrome symptoms are: 

• Feeling sick 
• Dizziness 
• Abdominal Pain 
• Fatigue 
• Loss of appetite 
• Irritable bowel syndrome (IBS) 
• Lack of concentration 
• Straw coloured urine 

However, these signs and symptoms may not directly indicate GS, they are also seen in other health conditions. 

Causes 

It is believed that GS is due to the reduced activity of an enzyme that is useful in the processing of bilirubin. It is an inherited condition and the cause of reduced activity of the enzyme is unknown. 

Diagnosis 

GS is diagnosed by a general physical examination followed by blood tests, urine tests, and Liver function tests. The elevated bilirubin levels can be an indication of GS. Sometimes, genetic testing may also be suggested by the doctor to confirm the diagnosis. 

Treatment 

There is no specific Gilbert’s Syndrome treatment, as the bilirubin levels in the blood fluctuate and the condition becomes normal on its own. 

Types of Pancreatic Cysts 

Pancreatic Cysts are of nearly 20 types. Some of the most important types include: 

Pseudocysts – These are mostly made of fluid, and you may be at risk of developing them if you have had a history of Pancreatitis or Pancreatic Injury. 

Serous Cystadenomas (SCAs) – These are benign cysts containing fluid with thick, fibrous walls. They may cause pain, and Jaundice, or make you feel uncomfortable as they grow. 

Intraductal Papillary Mucinous Neoplasms (IPMNs) – These are the most common type of Pancreatic Cysts which develop within the ducts connecting the Pancreas to the Intestines. The cells of the cysts produce a large amount of proteins that form mucus. 

Mucinous Cystic Neoplasms (MCNs) – These are Precancerous growths that start in the body and tail of the Pancreas and are more commonly seen in women rather than men. 

Signs and symptoms 

Pancreatic Cysts are usually asymptomatic. Some patients may have fewer symptoms that may occur days to months following a Pancreatitis attack such as: 

• Severe and persistent pain in the abdomen, sometimes at the back 
• Nausea and vomiting 
• Abdominal bloating 
• A mass of tissue can be felt in the upper abdomen 

In some cases, cysts can become infected. Call your doctor immediately if you notice fever, persistent and severe abdominal pain, weak and rapid heartbeat, decreased consciousness, and blood in vomiting. 

Causes 

The exact cause of Pancreatic Cyst is still not known. Some cysts are believed to be associated with rare illnesses such as Von Hippel-Lindau Disease which is a genetic disorder affecting the Pancreas. Pseudocysts often result from injury to the abdomen, such as an auto accident. 

Risk factors 

Heavy alcohol and Gallstones increase the risk of Pancreatitis, which in turn increases the risk of the formation of Pancreatic Cysts. 

Complications 

The growth of Pancreatic Cysts is associated with the development of a few complications which include: 

• Infection, which may also lead to Pancreatic Abscess 
• Pseudocyst rupture (breaking open or bleeding of the cyst which may be life-threatening) 
• Obstructive Jaundice may occur when a large cyst blocks the common Bile Duct, causing yellowing of the skin, mucous membrane, and eyes 
• Increase in Blood Pressure of the portal veins requiring surgery 

Diagnosis 

Pancreatic Cysts are hard to diagnose as the symptoms resemble many other disease conditions. The medical history of the patient is first assessed, and other diagnostic tests are recommended: 

• CT Scan – Provides detailed information about the size and structure of the Pancreatic Cyst 
• MRI Scan – Gives detailed information about the cyst, including whether the components of the cysts could cause Cancer 
• Endoscopic Ultrasound – Fluid is collected from the cysts to check the possible signs of Cancer 

Treatment 

Pancreatic Cysts are benign and may not require any treatment and can be left as such if it isn’t bothering you. However certain treatment options are recommended to prevent complications. 

Drainage – An Endoscope, equipped with a needle is passed through the mouth into your Stomach and Small Intestine to drain the cyst. 

Surgery – This is recommended if the cyst is larger than 3 cm in size, if the cyst has a solid component if the Pancreatic duct is widened, and if the cysts are growing and causing pain. The whole of Pancreatic Cysts are removed, either via Open Surgery or Laparoscopic Surgery. 

Prevention 

The risk of formation of Pancreatic Cysts can be reduced by minimizing or avoiding alcohol intake. Alcohol intake may be directly responsible for the condition of Pancreatitis (inflammation of the Pancreas), and indirectly for the formation of Pancreatic Cysts. 

Acute Pancreatitis Causes 

The single most common cause of acute Pancreatitis is Gall Stones, and the single most common cause of chronic Pancreatitis is alcohol. These two factors contribute up to 80% of the total Pancreatitis cases. 

Other causes of Pancreatitis include infection, Trauma, Hypothermia, smoking Tumours, inheritance, and certain medications (such as corticosteroids, diuretics, anticonvulsants, and antipsychotics). 

Risk Factors 

There are a few risk factors associated with Pancreatitis, the most important factors include: 

• Gender: Males are at a greater risk of developing Pancreatitis compared to females. 
• Age: Chronic Pancreatitis starts between the ages of 30 and 40 and is rare in children. 
• Family history: Inheritance of genes which result in conditions such as Cystic Fibrosis result in Pancreatitis. 
• Chronic alcohol and tobacco abuse: This may be the primary cause of the development of Chronic Pancreatitis. 
• Blockage of Pancreatic Duct: Auto accidents or trauma may lead to blockage of the Pancreatic duct also known as Distal Pancreatitis. 

Acute Pancreatitis Symptoms 

The most common signs and symptoms of Pancreatitis are severe pain in the upper abdomen radiating to your back, associated with nausea and vomiting. You may even notice abdominal tenderness and reduced Bowel sounds. 

Fever can be seen in a few cases of Acute Pancreatitis. Fatty stools, unintentional weight loss, and diarrhoea may be seen in a few cases of Chronic Pancreatitis. 

Complications 

Pancreatitis can cause serious complications such as infection, Pseudocyst, Diabetes, malnutrition, abscess formation, and Organ Failure. If the fluid levels drop suddenly, it results in Hypovolemic Shock which is a medical emergency. In a few cases, chronic Pancreatitis may also lead to Pancreatic Cancer. 

Acute Pancreatitis Diagnosis 

Your doctor may initially perform a physical examination and review your medical history to diagnose the condition. Your doctor may also ask you questions about your lifestyle. Your doctor may also recommend other tests and procedures for diagnosis of Pancreatitis, which include: 

Blood tests – performed to evaluate blood levels of Pancreatic enzymes (serum amylase and lipase). 

Imaging tests – Computed Tomography (CT), Magnetic Resonance Imaging (MRI), or ultrasound to detect the presence of Gallstones and inflammation of the Pancreas; abdominal ultrasound is the most reliable test to confirm the diagnosis. 

Stool test – performed to identify fat content in the faeces. 

Your doctor may confirm the condition as Pancreatitis based on the diagnosis if you meet two of the following three criteria: 

• Upper abdominal pain radiating to the back 
• Elevation of Pancreatic enzymes by more than three times the normal value 
• An imaging test showing characteristic changes 

Treatment for Acute Pancreatitis 

Management of Pancreatitis often requires hospitalization (for stabilizing) followed by treatment of the underlying cause once inflammation of the Pancreas is controlled. 

To stabilize the Pancreas, your doctor may advise you to stop eating and give painkiller medications. When the Pancreatitis is controlled, you can start taking clear liquids and bland foods. Gradually, you can go for your normal diet. Intravenous fluids are administered to provide energy. In the case of chronic Pancreatitis, Pancreatic enzymes are prescribed in a tablet form to improve digestion. These Pancreatic enzymes should be taken with each meal. 

Once the Pancreatitis is controlled, treatment is given to manage the underlying cause. If alcohol abuse is the main cause, your doctor recommends you opt for a treatment program to abstain from alcohol. If Pancreatitis is due to the presence of Gallstones, Cholecystectomy is performed to remove the Gall Bladder. Surgery to the Pancreas is performed in some cases to remove diseased tissue. 

Self-Management 

Following these measures may help you for a speedy recovery and prevent further complications: 

• Consuming a diet which is low in fats 
• Eating small meals to minimize the burden on your Digestive System 
• Stopping alcohol abuse to prevent further damage 
• Quitting smoking to fasten recovery 
• Trying yoga and relaxation techniques such as deep breathing to reduce pain