Category: Liver Cirrhosis

ABSTRACT

Liver is the largest solid organ of the body. It is a self-regenerating organ. As a major organ of the digestive system, the liver must process everything that the stomach and intestines digest and absorb. It produces bile for fat digestion. A healthy liver is undeniably a key element to a healthy life. But, when liver health is altered, the results can get severe. One of such issues is liver cirrhosis. It develops first as inflammation, then fibrosis, later cirrhosis and ultimately End-stage liver disease.

INTRODUCTION

Liver cirrhosis is a serious condition which occurs due to scarring of the liver. This can be due to various reasons such as excessive alcohol consumption, drugs, hepatitis etc. Cirrhosis is a progressive condition. As the scarring continues to spread, the liver damage is inevitably permanent. But if caught in early stages, it is reversible. Every time your liver is injured, say it because of infections, alcohol, etc. It tries to repair itself as a result of which scar tissue is formed in the liver. As cirrhosis progresses, more and more scar tissue is formed and the liver is unable to perform its function. This can lead to life-threatening conditions i.e., End stage liver disease.

CAUSES

Cirrhosis is triggered by the chronic inflammation of the liver causing gradual scarring. The most common causes include:

1. Alcohol-induced hepatitis
2. Non-alcohol-related steatohepatitis: It’s related to metabolic factors like high blood lipids, high triglycerides, blood sugar and blood pressure.
3. Chronic Hepatitis C: Hepatitis C is a viral infection which is now curable.
4. Chronic Hepatitis B: Hepatitis B is also a viral infection. It’s treatable, but not curable.
5. Unmanaged diabetes and hypertension
6. Sedentary lifestyle
7. Excessive consumption of greasy, fried, oily food

Some lesser known causes are:

1. Autoimmune diseases: In certain conditions like, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis etc., where chronic liver inflammation is present this can be a cause.
2. Genetic disorders: Certain inherited conditions like cystic fibrosis and Wilson disease can cause toxic substances to build up in your liver and damage it.
3. Toxic hepatitis: Long-term exposure to certain environmental toxins or certain medications including painkillers, can cause liver damage.
4. Cardiovascular disease: congestive heart failure (causes blood to build up in your liver) or chronic ischemia (prevents blood from reaching your liver) can damage your liver.
5. Hemochromatosis: Genetic condition in which there is iron buildup in body

TYPES OF CIRRHOSIS

1. Compensated Cirrhosis: Patients with this condition do not show symptoms and life expectancy is around 9–12 years. They can remain asymptomatic for years.
2. Decompensated Cirrhosis: Patients with this condition are already experiencing symptoms and complications. Their life expectancy is reduced and can be advised for liver transplant.

STAGES OF CIRRHOSIS

1. Stage I: Steatosis: The first stage of liver disease is characterized by inflammation of liver along with accumulation of fat deposits in liver (fatty liver).
2. Stage II: Scarring (fibrosis) of the liver due to chronic inflammation.
3. Stage III: Cirrhosis.
4. Stage IV: Advanced liver disease or End stage liver disease.

SIGNS AND SYMPTOMS

Early symptoms include:

1. Nausea
2. Loss of appetite
3. Easy bleeding or bruising
4. Upper abdominal pain
5. Redness on palms of your hand (Palmar erythema)
6. Malaise/ fatigue
7. Visible blood vessels that give appearance of spider k/as spider angiomas.

Advanced symptoms which indicate decline in liver functions include:

1. Unexplained weight loss/ muscle loss
2. Jaundice (Yellow tint in skin and eyes)
3. Itchy skin
4. Swelling in face, legs, and hands. (Edema)
5. Difficulty in fat digestion
6. Dark colored urine and grey colored poop.
7. Abdominal distention due to ascites

DIAGNOSIS

Your doctor will examine you on the basis of your signs and symptoms and few follow up tests will be required for your diagnosis.

1. Blood Tests: LFT, CBC
2. Imaging: USG, Fibro scan, CT SCAN to study the echogenicity and the level of damage done to liver.
3. Liver Biopsy: if required to confirm cirrhosis

TREATMENT

In case of early stages of cirrhosis, we can minimize the damage to the liver by treating the causative factor:

1. Alcoholic Fatty Liver: complete cessation of alcohol intake is necessary to reduce the toxin build up in the liver.
2. Nonalcoholic Fatty Liver: they can get healthy again if they are able to manage their weight and fat intake.
3. Medications and Nutritional Supplements:
   • Medications for viral infections like hepatitis B & C are given.
   • Nutritional supplements to manage malnutrition in the patients.
   • Medications for high BP, in case of portal hypertension.
4. Lifestyle Modifications:
   • Low sodium diet
   • Regular exercise
   • Limiting fluid intake
   • Smaller frequent meals
   • Quitting alcohol and smoking
   • Avoid vitamin C, if iron levels are high.
5. If liver damage is extensive and permanent, then liver transplant.

AYURVEDIC OVERVIEW

Acharya Charaka has mentioned about udara roga (Abdominal distension). He has explained about 8 types of udara roga among which in yakrit udara which can be co-related to liver cirrhosis. Acharya Charaka has explained yakrit udara if left untreated and unmanaged can ultimately lead to “jalodhar” which can be co-related to ascites. After this stage, the condition becomes manageable but not curable. Therefore, timely diagnosis and initiation of treatment is essential. Acharya Charaka has explained about Agni (imbalanced digestive power) and mala vruddhi (accumulation of waste in the body causing toxin buildup) as main causes of udara roga. Patient develops karshya (emaciation), kukshi adhman (abdominal distension), pada shof (edema in feet). Patient can be given various panchkarma treatments like niruha basti, anuvasana basti, virechan, rakta mokshan (bloodletting) to balance out the vitiated doshas. (Ch. Chi. 13 /77)

षट्पलं पाययेत् सर्पिः पिप्पलीर्वा प्रयोजयेत्|

सगुडामभयां वाऽपि क्षारारिष्टगणांस्तथा||७८||

Acharya Charaka, has mentioned about gud-haritki i.e., haritki (Terminalia chebula) with jaggery is used in treatment of jalodhar (ascites), use of Shatpal ghrita, pippali rasayana, kshara, arishta. Etc. Since yakrit udara has dominance of pitta dosha therefore to balance it out ghee medicated with herbs of jivaniya varg i.e., Jeevaka (Malaxis acuminta), Rishbhaka (Microstylis muscifera), Meda (Polygonatum verticillatum), Mahameda (Polygonatum cirrhifolium), Kakoli (Roscoea procera), kshirakakoli (Lilium polphyllum) etc.

Ancient Reference – Ch. Chi. 13/87-88

AYURVEDIC HERBS HELPFUL IN LIVER DISEASE

1. Sharpunkha: The extract from the leaves of this plant is known for reducing increased bilirubin levels and it acts as a potent antioxidant due to presence of phenols.
2. Bhumi-amla: The alkanoids Phyltetralin & nirtetralin present in bhumiamla are helpful in reducing pedal edema and the extracts from the leaves have proven to restore declining liver function. It is known for its hepatoprotectant, antioxidant and antiviral properties.
3. Bhu-nimba: The andrographolides present in this provide the bitter taste to it and helps in prevention of liver fibrosis, reduces lipid accumulation, thus preventing liver damage.
4. Katuki: The compound kutkoside & iridoid glycosides which are primarily found in the rhizome & roots of this plant are known for improving liver function.
5. Kirat-tikt: The alkanoids swerchirin & sweroside are known to be a potent hepatoprotectant. The whole plant when cooked with coconut oil or sesame oil is helpful in relieving itching.
6. Daruharidra: Daruharidra is also known as Indian berberry. This herb is useful in improving liver metabolism and function. It is useful in treating liver disorders and helps maintain healthy cholesterol levels. It is helpful in removing toxins and reducing levels of liver enzymes like ALT and AST in the blood. The berberine and methanolic extract from daruharidra has hepato-protective properties.

HERBAL REMEDIES FOR LIVER CIRRHOSIS BY PLANET AYURVEDA

Planet Ayurveda provides a combination of above-mentioned ayurvedic herbs for the management of liver cirrhosis. All the Planet Ayurveda medicines are 100 % natural, vegetarian, additive free, chemical & preservative free and without any side effects. The Liver Care Pack includes Indian Echinacea Capsules, Phyllanthus Niruri, Yakrit Plihantak Churna and Liver Detox Capsules.

1. Echinacea Capsules
2. Yakrit Plihantak Churna
3. Phyllanthus Niruri
4. Liver Detox Formula

PRODUCTS DESCRIPTION

1. Echinacea Capsules

Indian Echinacea is available in capsule form which is prepared using standardized extract from Kalmegh (Andrographis paniculata). It is an ayurvedic herb rich in tikta rasa (bitter) which helps to detox the liver. As it is ushna veerya (of hot potency) it helps to balance out imbalanced kapha dosha (reduces lipid accumulation in liver). The alkaloid “andrographolides” in it is known to decrease serum transaminases.

Dosage: 2 capsules twice daily after meals with warm water.

2. Yakrit Plihantak Churna

This churna is prepared using the standardized extract of ayurvedic herbs like bhumi amalaki (Phyllanthus niruri), bhringraj (Eclipta alba), katuki (Picrorhiza kurroa), kalmegh (Andrographis paniculata) etc. which help in reversing liver damage. All these drugs have pitta balancing properties. Bhringraj (Eclipta alba) is helpful in reducing fat deposits from the liver and stimulating the regeneration of hepatocytes in the liver.

Dosage: Since it is available in powder form, to consume it you have to boil the powder 1 teaspoonful in 400 ml water, keep it boiling until it remains 50 ml. Strain it and drink the water. Leave the residue. Do it twice daily. Make it fresh every time.

3. Phyllanthus Niruri

These are prepared in capsulated form using standardized extracts from bhumi amalaki (Phyllanthus niruri). The extracts from this herb are known to stimulate repair mechanisms, normalize liver enzymes and reduce oxidative stress on the liver caused by hepatotoxic agents. Bhumi-amlaki is helpful in reducing pedal edema.

Dosage: 2 capsules twice daily after meals with warm water.

4. Liver Detox Formula

This formula is available in capsulated form which is prepared using standardized extracts from the herbs such as Katuki (Picrorhiza kurroa), punarnava (Boerhavia diffusa), Makoy (Solanum nigrum), Haritaki (Terminalia chebula), Kaasni (Cichorium intybus) and more such herbs, this potent formula helps in cleansing and strengthening of hepatocytes (liver cells), and ultimately helps in regaining liver health.

Dosage: 2 capsules twice daily after meals with warm water.

CONCLUSION

The cirrhosis is an increase in fibrous tissue caused due to chronic inflammation causing irreversible liver damage. It is a slowly progressing disease where healthy liver tissue is replaced with scar tissue. In cases where early intervention is done, the damage to the liver is reversible. Though the advanced methods of modern medicine provide an early diagnosis, the treatment itself is not promising enough. On the brighter side, the treatment followed through ayurvedic principles provides disease management in a natural way without any adverse effects.