Dr. Neil Julie

The liver, when not healthy is (to borrow from Winston Churchill speaking about Russia) “ …A riddle, wrapped in a mystery, inside an enigma”

This blog will demystify it for you in serial quarterly Blog posts.

Although MANY of us (worldwide) have gallstones only 1/3 or less of us will ever have any symptoms or problems from these stones. Most common symptoms are nausea or vomiting or epigastric or right sided abdominal pain especially after meals. The most dangerous complications of gallstones are pancreatitis, jaundice and acute cholecystitis and cholangitis.

A simple ultrasound is all we need to initially identify gallstone disease.

But if you are found to have some other chronic liver abnormality then you will need the expertise of a gastroenterologist to check for other potentially serious liver disorders. These can be broken down by category:

  • Infectious causes: hepatitis C, B are now being successfully treated with anti-viral therapies. Hepatitis A is often community spread, sometimes in outbreaks. Both hepatitis A and B can now be vaccinated against. There is a second set of atypical viral hepatitis caused by mononucleosis, Epstein-Barr virus, CMV and herpes.
  • Abnormalities of our own immune system leading to attack on components of the liver: autoimmune hepatitis (AIH) arises when this attack is against the liver cells, primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) arise when the attack is against the biliary system. That system is the collecting system of tubules and ducts that drain the liver
  • Toxic causes: alcohol, drug induced liver injuries, poisonous mushrooms and excessive Tylenol. Substantial liver enzyme abnormalities can occur from as low a dose as 2 g of Tylenol per day. Higher doses such as three or 4 grams per day for more than three days should be discouraged and avoided for that reason
  • Inborn abnormalities of our genes: Iron overload-hemachromatosis, copper overload-Wilsons disease, alpha-1 anti-trypsin deficiency and porphyria. As a result of certain genetic mutations each of these conditions lead to the over accumulation of toxic substances which are damaging to the liver.

To investigate your condition the gastroenterologist/hepatologist will then perform a battery of highly specific blood tests, and or scans and urine tests which will lead you to the right diagnosis and to the best available treatment.

Since many of these diseases can now be treated, it is tragic when a patient has not had a timely work up and only presents when their liver is already irreversibly scarred and cirrhotic. However chronic liver disease can be very subtle and often essentially asymptomatic except for fatigue. This does not mean that is harmless. It only means that it is often missed or easily ignored.

So remember you can’t live without your liver and don’t neglect it!