Department of Liver Anaesthesia and Intensive Care

Department Overview

Busy schedules and bustling lives tend to push our health down in our priority list. The liver bears the brunt of such a lifestyle and the rising instances of liver-related ailments are a testament to this phenomenon. Liver health is pivotal to lead a contented life making liver care and the treatment of liver-related illnesses an important aspect of medical care. Dr Rela’s Dr. Julia Wendon Liver Intensive Care Unit is one of the top hepatology divisions in the country and is equipped with state-of-the-art medical technology to provide care on par with international standards. Named after Prof. Julia Wendon, a pioneer in the field of liver critical care and our mentor; we seek to emulate her principles. We possess a 36-bed strong liver ICU and a 24-bed liver transplant ICU specially designed to provide 24/7 adult and pediatric liver care. Our intensive care units are backed by skilled medical professionals with extensive experience and a commitment to provide patients with the care that will ensure a high quality of life.

What does the liver do?

The liver is a cone-shaped organ that is situated just below the rib cage. It is located on the right side of the abdominal cavity and has a characteristic reddish-brown colour. The liver weighs around 1.5 kilograms but its functionality massively outweighs its smaller size. The liver plays an indispensable part in metabolism and detoxification.

Its functions include:

• Haemoglobin processing: It is a processing centre for haemoglobin as the liver stores iron.
• Glucose regulation: One of the metabolic functions of the liver is the conversion of excess glucose in the blood to glycogen. Glycogen serves as energy storage and is converted back to glucose when there is a shortage.
• Bile production: Bile is a fluid made up of bile salts, bilirubin, cholesterol, water and electrolytes that are produced by the liver. It aids digestion by facilitating the breakdown and absorption of fats in the small intestine. Bile also aids in the degradation of certain proteins.
• Nutrient Store: The liver acts as a storage space for various nutrients, particularly vitamins and minerals. It functions as a reserve store of vitamins A, D, E, K, and B12 and can hold substantial quantities at a time. The liver stores iron as ferritin which is essential for the production of red blood cells. It also stores trace amounts of copper that are required by the body and releases them at appropriate conditions.
• Blood Filtration: The liver functions as a filter for the blood as it helps to remove excess amounts of hormones like estrogen from it.
• Detoxify blood: The liver also detoxifies the blood by removing external toxic components particularly those associated with drugs and alcohol.
• Aids immune response: The liver is home to a large number of Kupffer Cells that are capable of destroying foreign agents.
• Assists blood clotting: Vitamin K is essential to form the coagulants required for blood clotting. The liver facilitates clotting via bile production as it is required for vitamin K absorption.
• Albumin production: Albumin is a protein in the blood that is responsible for the transport of hormones, enzymes and proteins. It also ensures that fluid within the blood vessels does not leak out. Thus, it is a vital component of the blood serum and is produced by the liver.
• Bilirubin regulation: Bilirubin is a compound that is yellowish in colour and formed following the breakdown of haemoglobin in red blood cells. It is required for the formation of the next generation of red blood cells. The liver regulates its concentration and stores it for future use.
• Angiotensinogen synthesis: Angiotensinogen is a hormone that regulates fluid balance and blood pressure. The liver is involved in its production.

Diseases of the Liver

The liver is one of the most actively functioning organs of the human body and is integral to a host of biological activities. Therefore, liver health is vital to lead a high quality of life. There are numerous conditions that plague the liver These arise due to both genetic and environmental factors. Liver diseases can be broadly classified into 4 strata.

These include:

• Infectious diseases caused by pathogens such as viruses
• Liver Cancer
• Diseases caused by external agents like drugs, alcohol and other toxic substances
• Inherited liver diseases

Infectious diseases

Certain pathogens cause inflammation of the liver that can have potentially serious consequences. The most common liver infection is viral hepatitis and it falls under three categories:

• Hepatitis A:
  Caused by the hepatitis A virus, the pathogen responsible is often passed on by close contact with an infected individual or due to the consumption of contaminated food or drinks. Compared to the other strains, hepatitis A is mild and usually goes away without treatment. However, older patients are at risk of a sudden loss of liver function and should seek immediate treatment.
• Hepatitis B:
  Hepatitis B is more serious than Hepatitis A and recovery periods could extend well beyond 6 months. There is also the likelihood of the disease turning chronic in certain individuals. Although a preventive vaccine is available, there is no cure once infected. The complications of Hepatitis B include kidney diseases, scarring of the liver and acute liver failure.
• Hepatitis C:
  It can lead to severe liver damage and is the most potent of the three. It can turn chronic and cause serious inflammation which ultimately leads to liver failure. Using unsanitary needles, sexual intercourse with an infected person, sharing hygiene care items like toothbrush are some of the ways hepatitis C can be contracted.

Liver Cancer

The liver is susceptible to cancer and it usually spreads to the liver rather than originating from there. There are no immediate symptoms of liver cancer but there are certain warning signs.

These include:

• Unintentional weight loss
• Swelling in the abdomen
• Loss of appetite
• Prolonged periods of fatigue
• Jaundice
• Discolouration of stool

Liver cancer usually arises as a complication of diseases that affect the liver, primarily hepatitis infection and cirrhosis. Ensuring preventive care for these illnesses can drastically reduce the risk of cancer.

Drug & Alcohol Use

The liver is responsible for filtering out toxins in the blood. About 90% of consumed alcohol is processed by the liver. Naturally, increased consumption of alcohol and alcohol abuse leads to damage to the liver. This causes the formation of scars in the liver which ultimately replaces the healthier parts. The condition is termed Cirrhosis. It can also lead to fatty liver disease which involves the build-up of fat in the liver followed by inflammation. Drugs affect the liver by inciting the release of higher levels of enzymes which eventually leads to liver failure. The danger is doubled when certain drugs and alcohol are used simultaneously.

Inherited Diseases

Some people have a genetic predisposition to getting liver disease. Liver diseases that are hereditary in nature include:

• Hemochromatosis:
  It is a condition where iron from food is not broken down and builds up in the body. Since the liver stores iron, this overload can lead to complete failure of the organ.
• Alpha-1 Antitrypsin Deficiency:
  Alpha-1 Antitrypsin is a protein that safeguards the lungs against potential damage by natural enzymes. Individuals suffering from Alpha-1 Antitrypsin Deficiency have a lower than recommended amount of this protein in their bloodstream. This is because the disorder prompts the protein to accumulate in the liver. The result being damage to the lungs and cirrhosis in the liver.

Symptoms of Liver Diseases

Although the effects of liver diseases are not immediately perceivable, there are certain symptoms that can point to an underlying condition. Different types of the liver disease exhibit their own set of symptoms, but the following ones are common amongst the diseases that affect the liver:

• Jaundice:
  Jaundice is a condition that manifests as a yellowish discolouration of the mucous membranes, skin and whites of the eye. The yellow pigmentation is caused due to high levels of bilirubin which is yellowish-orange in colour. A bile pigment, bilirubin is formed when red blood cells break down.
• Abdominal pain:
  The pain varies from mild to extremely severe and can manifest as bursts or persist for prolonged periods. It occurs in the upper-right part of the abdomen and is often mistaken for kidney pain.
• Swelling in the limbs:
  Puffiness of the skin especially in the legs and ankles is a telling sign of a liver disorder. Stiffness in the legs can also be experienced alongside it.
• Dark urine:
  Since liver disease disrupts the functioning of the liver, bilirubin is not broken down at previous rates. This results in the kidneys excreting bilirubin thus giving urine a darker shade.
• Fatigue:
  Chronic fatigue accompanies all hepatic diseases although it is not exclusive to liver diseases.
• Other common symptoms include nausea, vomiting, loss of appetite and itchy skin.

Liver failure

Since the liver possesses a wide range of functionalities and is indispensable to daily function, evolution has given it the potential to regenerate. Up to a certain threshold, the liver is the only organ that can regenerate in the human body. However, once that critical point is passed, the damage is irreversible. This is known as liver failure.

Liver failure is a potentially fatal condition with falling into a coma or death being likely possibilities. Health professionals can try and stop the progression but at the end stage, the only possible recovery option is a liver transplant.

When to meet a doctor

The majority of liver diseases tend to cure by themselves and do not need professional help. However, certain conditions such as acute liver failure require immediate medical assistance as the risk of developing serious complications is quite high. The onset of diseases like acute liver failure tends to be instantaneous and fall under the category of emergency care. Therefore, meeting with a doctor instantly following the manifestation of symptoms is paramount.