Our liver plays a crucial role in the body’s functioning. This article serves as an introduction to understanding the operational importance of the liver and provides practical, workable ways to control it. The expert in the field has worked tirelessly to bring out these helpful solutions.
Outline
- Expected learning outcomes
- Introduction
- Functions of the liver
- Common diseases of the liver
- Common causes of liver diseases
- Take-home messages
- References
Expected Learning Outcomes
Members of the congregation should have sufficient information to adopt attitudes and behaviour that promote liver health, including but not limited to:
- Abstinence from excessive alcohol consumption
- Avoidance of overweight and obesity
- Avoidance of self-medication
- Periodic medical check-up
Function of the Liver
- The liver performs about 500 functions daily. Some are:
- Production of bile, which is important in the digestion of fat
- Storage of fat-soluble vitamins A, D, and K
- Synthesis of albumin
- Synthesis of anti-coagulants and pro-coagulants
- Detoxification of harmful substances
- Synthesis of cholesterol
- Metabolism (handling) of alcohol
- Storage of minerals like copper, Iron
Common Diseases of the Liver
- Hepatitis
- Liver cysts
- Liver abscess
- Fatty liver
- Liver cirrhosis
- Liver cancer
- Benign tumours of the liver
Liver Cancer
- Cancer is described as an abnormal growth in the body that is not regulated by the body’s normal control mechanisms.
- There are two forms of liver cancer.
Hepatocellular Carcinoma
- The life expectancy of people with symptomatic HCC in Nigeria is about 3-6 months.
- This means the majority of our patients would die within 6 months of presentation at the hospital.
- This is the rationale behind screening those who are at risk of HCC with abdominal ultrasound and a blood test called alpha-fetoprotein every 6 months.
- Symptoms of HCC include right quadrant upper abdominal pain, yellowness of the eyes, passage of Coca-Cola coloured urine and loss of weight, among others.
Treatment of Liver Cirrhosis/Cancer
- Liver transplantation
- Surgery
- Ablative therapy
- TACE/TARE
- Chemotherapy
Common Causes of Liver Disease in Nigeria
- Infectious causes
- Viruses
- Bacteria
- Parasites
- Excessive consumption of alcohol
- Drugs and toxins
Hepatotropic Viruses
- Though many other viruses can affect the liver, Hepatotropic viruses affect the liver most and rarely affect other organs
They are as follows:
- Hepatitis A virus
- Hepatitis B virus
- Hepatitis C virus
- Hepatitis D virus
- Hepatitis E virus
Hepatitis B Virus
- This is the most common of all the hepatotrophic viruses, having affected over 2 billion people worldwide.
- Hepatitis B infection has been designated an International Public Health challenge, with 254 million people having chronic hepatitis B infection in the world today.
- There are 1.2 new infections every year.
- It causes about 1 million deaths every year, largely from liver cirrhosis and hepatocellular carcinoma.
- At least 8 out of every 100 Nigerians have chronic hepatitis B infection
- Hepatitis B virus is the most common cause of liver disease in Nigeria
Hepatitis B Virus
- Unfortunately, the majority of people with chronic hepatitis B do not know they have the infection, even though the virus may be destroying the liver slowly.
- This is why hepatitis B is a silent killer. The rThe
- Society of Gastroenterology and Hepatology in Nigeria advises that all adults, especially those born before 2004, should be screened at least once for hepatitis B infection.
Routes of Transmission of Hepatitis B Virus (How do People Get the Virus)
- Hepatitis B virus is transmitted through blood and body fluids ( parenteral route of transmission)
- Hepatitis B virus is about 100 times more infectious than HIV and about 50 times more infectious than the hepatitis C virus
- This means that blood or body fluid can still be infectious with the hepatitis B virus for as long as a week after being out of the body.
- Mother-to-mother transmission
- Child-to-child transmission
Indiscriminate Use of Sharps
- Circumcision
- Tattooing
- Tribal marking
- Ear piercing
- Barbing
- Sharing of blades, nail cutters
- Surgery with unsterilized equipment
- Re-using needles
- Transfusion of unscreened blood
- Intravenous substance abuse
- Sexual intercourse
How Do People Know About Their Hepatitis B Test?
- Through a blood test
Clinic Features of Hepatitis B
- Chronic hepatitis B infection is usually asymptomatic
- This is why the majority of those who have it are not aware
- It is therefore a silent killer
What if One Is Positive
- It is not a death sentence
- The person must undergo evaluation to determine whether he or she will need treatment or not.
- There are effective treatments for hepatitis B that will prevent liver cirrhosis and or liver cancer largely.
Drugs for Treatment of CHB Infection
- Tenofovir disoproxil fumarate
- Tenofovir alafenamide
- Entecavir
- Lamivudine
- Pegylated interferon: This is an injection which is effective in a carefully selected few patients, and it is given for 48 weeks
- The first three are the preferred medications.
- They are available in Nigeria.a
- Patients are to take them for life, especially if the e antigen is negative before the commencement of treatment.t
Vaccination against Hepatitis B Infection
- Hepatitis B infection is vaccine-preventable
- Vaccination is very effective in the prevention of the infection
- The vaccine is widely available in Nigeria
- It has been part of the routine National Programme on Immunisation since about 2004
- Give the baby the first dose after birth.
- All children born in Nigeria should be vaccinated against hepatitis B, irrespective of the hepatitis status of the mother.
Preventive Measures against Hepatitis B
- For those who must do ear piercing, this can be done in hospitals where health care workers can use sterilised needles to do it. Some earrings do not need a hole in the ear. The use of such should be encouraged.
- Injection safety. Needles and or syringes should never be reused.
- People should not share blades, nail cutters, clippers, and other sharp objects. Every male should have his clippers for barbing.g
- People should get blood transfused in health care facilities with competent hands and adequate reagents to ensure proper screening of donors and their blood before its use.
- Fidelity should be encouraged in marriage.
Hepatitis B Infections and Their Management
- It is dangerous to say that a person with the hepatitis B virus does not need treatment just because he or she is asymptomatic. Everyone who has the virus needs to be evaluated both clinically and with investigations to determine the need for treatment.
- It is not right to commence a symptomatic patient with chronic hepatitis B infection on treatment without the proper evaluation. Not all patients will need treatment. Only about 25-40% will need treatment, and only a thorough evaluation will determine these.
- It is not right to tell patients with asymptomatic chronic hepatitis infection not to take protein in their food. Most of these patients have normal livers. Protein dietary restriction is only used in patients with a severe form of liver failure. Asymptomatic patients with chronic hepatitis B should eat a balanced diet.
- People with hepatitis B infection need to stop drinking alcohol. Alcohol can work synergistically with the virus to cause greater damage to the liver.
- It is wrong to label people with hepatitis B as being sexually promiscuous. While hepatitis B can be spread sexually, the role of sexual transmission is minimal in our environment.
- Pre-marital screening for hepatitis B should be done at least 6 months before the date of the wedding. This will allow the positive partner to be evaluated and the negative partner to be vaccinated following the conventional schedule, well before the wedding date.
- It is wrong to discriminate against people with hepatitis B infections, especially at work. Many of these people have been denied jobs wrongly in the military, banks, food industries, etc.
Hepatitis B Infection and Its Management
What happens many times is that people will go ahead to vaccinate against hepatitis B without first checking if they have the virus already. Only those who have been screened for hepatitis B virus infection and are negative should be vaccinated. The vaccination aims to prevent those who have not contracted the virus from contracting it. Vaccination does not treat the infection and is not useful for those who are already infected.
- Adults who need to be vaccinated against hepatitis B should not take the vaccine meant for children. The dose for adults is different from that of children. It is also not good to short-change our children. Hepatitis B vaccines are available and affordable for the average Nigerian adult.
- Get vaccinated if negative and avoid exposing yourself to routes of its transmission as stated earlier. Get evaluated by a doctor knowledgeable in hepatitis care if you are positive.e
- Avoid taking alcohol, and if you do take it, it should not be excessive
- Avoid smoking
- Those who are positive should be linked to a treatment centre.
Take Home Messages
- Pregnant women must attend antenatal care where there is screening for hepatitis B.
- Parents should ensure children have all the routine vaccinations as scheduled in the National Programme on Immunisation.
- A girl child should not be circumcised; a Boy child should be taken to the hospital for circumcision, where sterile equipment would be used.
- Girl children should have ear or nose piercing done (if it is the preference of the parents) in health facilities where sterilised equipment is used.
- Avoid the use of unprescribed drugs as much as possible and take those prescribed according to medical instructions.
- Regular exercise and a balanced diet are good for the liver.
- Maintain a healthy weight.
References
- National Guideline for the Prevention, Treatment and Care for viral hepatitis, November 2023
- National Strategic Framework for Viral Hepatitis Control in Nigeria 2022-2026
- World Health Organisation fact sheets on Hepatitis A, B, C, D, E and alcohol
- WHO guideline for the treatment of Hepatitis B and prevention of mother-to-child transmission.
- Society of Gastroenterology & Hepatology in Nigeria guideline for the management of Hepatitis B & C
Writer: Kolawole Oluseyi Akande
Senior Lecturer and Consultant Gastroenterologist
University of Ibadan and University College Hospital, Ibadan, Nigeria
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Editors
