F A Q s
Answer: Anyone who works in a health-care facility, including a hospital, doctor’s office, dentist’s office, or a laboratory that handles blood specimens, and emergency medical technicians, are at risk of contracting HCV. The virus may be transmitted through a needle stick injury, a blood spill, or through pricking oneself with a contaminated sharp instrument. The larger the amount of contaminated blood that enters a person’s body, the higher the likelihood she will become infected. After a single incident of accidental exposure to HCV, the risk of contracting HCV is approximately 2 percent-although this probability has been reported to range between 0 and 16 percent. Even with the potential risk to health-care workers due to the nature of their profession, the prevalence of HCV infection among this group of professionals is actually about the same as that of the general population, which is 1 to 2 percent. Once the blood has dried the likelihood of transmission has diminished greatly, and the contaminated blood must enter a break in your skin for infection to occur.
Answer: The liver is known by its remarkable ability to regenerate itself. But this statement is somewhat misleading. The liver does not really regenerate itself the way in which a starfish re-grows a missing arm. If an individual has up to 80 percent of a healthy liver removed, the remaining portion of the liver will expand to fill the empty space until its original weight is achieved. In this scenario, the liver will be fully functioning. However, if the remaining portion of a liver is severely scarred (cirrhosis), this expansion process typically cannot occur and “regeneration” is therefore unlikely. In some cases, however, once the toxin – for example alcohol, has been removed, cases of regeneration have been reported, although not commonly.
Answer:The classification system for liver biopsies takes into account the cause (autoimmune hepatitis, for example), the grade – the amount of liver inflammation (mild grade 1, moderate grade 2, severe grade 3), and the stage (degree of scarring from none – stage 0 to cirrhosis stage 4). Therefore, grade III stage IV is an advanced stage of disease.
Answer:Signs of a failed liver include an enlarged spleen-a condition known as splenomegaly, which occurs to compensate for the decreased functional abilities of the damaged liver. Encephalopathy is an altered or impaired mental status, typically leading to coma, that can occur in people with liver failure. Encephalopathy is often associated with poor coordination, fetor hepaticus (foul-smelling breath), and asterixis (uncontrollable flapping of the hands). A person experiencing such a condition should bring it to his doctor’s immediate attention, as this may require emergency treatment.
Answer: Possibly. While alcoholism is more common among men, it has been demonstrated that women are more susceptible to the adverse consequences of alcohol on the liver. In fact, women who develop ALD and cirrhosis due to alcohol do so at a younger age than men, and they have consumed a less alcohol in total. It has been noted that women with cirrhosis due to alcohol have a shorter life expectancy than men with cirrhosis due to alcohol. So why are women so much more susceptible to the toxicity of alcohol than men? Well, the most obvious explanation is that women generally weigh less and are smaller than men. Women on average have a smaller total body area throughout which any ingested alcohol can be distributed. But neither this fact, nor the total amount of alcohol ingested, completely accounts for why women are at a much greater risk of developing ALD. Hormonal differences between men and women have been suggested as a factor. It has been demonstrated experimentally that female rats are more susceptible to alcohol – induced liver damage than male rats, at least in part because of the higher levels of estrogen- the female sex hormone, in their bodies. However, this theory has not been proven in humans.
Probably the factor that most significantly differentiates the genders is that, as compared with men, many women (not all) have less of the enzyme alcohol dehydrogenase in the lining of their stomachs. This enzyme is the same one that is found in the liver that breaks down alcohol into the byproducts that are less toxic to the liver. Thus, the reduced amount of alcohol dehydrogenase enzyme in women increases the likelihood that they will absorb nonmetabolized alcohol from their stomach linings directly into their bloodstreams. Hypothetically, if a man and a woman of equal size and weight each consumes an equivalent amount of alcohol over the same span of time, the woman will have a much higher blood-alcohol level than the man. Once in their bloodstreams, high blood-alcohol levels circulate in their bodies, placing women at increased risk for the toxic effects of alcohol on their livers and other organs.
Answer: It is important to understand that the viral load does not correlate with the severity of liver disease. Therefore, a very high viral load i.e.: > 1 million IU/mL, does not automatically indicate that a person has more liver inflammation and damage than a person with a viral load of 5000 IU/mL for example. Furthermore, the viral load typically fluctuates and does not correlate with the degree of elevation of the transaminases (AST and ALT). Finally, viral load does not appear to correlate with symptoms. HCV viral loads do correlate with response to interferon therapy, however. A person with consistently high viral loads typically have a harder time clearing the virus compared with people whose viral loads run low. Also, the tecnique by which viral loads were determined years ago is different now, so make sure that IU are not being compared to copies.
Answer: Of great concern to pregnant women infected with HCV and to women with chronic hepatitis C who are contemplating pregnancy is the likelihood of transmitting the virus to their babies. If this occurs during pregnancy, it is known as vertical transmission, and if it occurs around the time of birth, it is known as perinatal transmission. However, the risk for either of these types of transmission is very low-occurring only approximately 3 to 5 percent of the time. Transmission to the newborn has been found to occur only in HCV-infected women who had high viral loads (the amount of HCV viral particles per milliliter of blood) of at least 1 million. It has also been noted that women who are doubly infected with HIV and HCV appear to have a higher probability of transmitting HCV to their children than women who are not infected with HIV.
Breast-feeding is not considered a means of transmitting HCV. Therefore, it is believed that an HCV-infected mother may safely breast-feed her child. In fact, studies comparing the incidence of HCV in breast-fed versus bottle-fed infants whose mothers were infected with HCV showed a fairly equal incidence of HCV in each group of infants-approximately 4 percent.
Answer: Always weigh risks versus benefits. If a person needs to be protected against HBV due to possible exposure risk, then the benefits outweigh the risks. In this situation one can still get pregnant, as it is safe to be vaccinated during pregnancy. However, in general, I would not advocate vaccination during pregnancy if it can be avoided.
Answer: Unfortunately, there is no “diet for liver disease.” Such an across-the-board diet simply does not exist. Many factors account for the unfeasibility of a standardized liver diet, including variations among the different types of liver disease (for example, alcoholic liver disease versus primary biliary cirrhosis) and the stage of the liver disease (for example, stable liver disease without much damage versus unstable decompensated cirrhosis). One’s other medical disorders even if unrelated to their liver disease, such as diabetes or heart disease, must also be factored into any diet. Each person has her own individual nutritional requirements, and these requirements may change over time.
Notwithstanding the above information, an optimal diet for a person with stable liver disease (modifications to be made as per individualized needs) might contain all of the factors listed below.
- 60- to 70-percent carbohydrates-primarily complex carbohydrates, such as pasta and whole-grain breads.
- 20- to 30-percent protein-only lean animal protein and/or vegetable protein If encephalopathy ( brain fog ) is present vegetable protein is preferred.
- 10- to 20-percent polyunsaturated fat.
- 8- to 12 eight-ounce glasses of water per day.
- 1,000 to 1,500 milligrams of sodium per day If ascites is present, 500mg or less is preferable.
- Avoidance of excessive amounts of vitamins and minerals, especially vitamin A, vitamin B3, and iron.
- No alcohol.
- Avoidance of processed food.
- Liberal consumption of fresh organic fruits and vegetables.
- Vitamin D and calcium supplement.
- Vitamin C
- an antioxidant such as vitamin E or CoQ 10
- Glucosamine chondroitin
Answer: Most people with liver disease expect to feel pain over their liver. This type of pain is known as right upper quadrant pain or tenderness (RUQT). However, RUQT is rarely due to chronic liver disease. RUQT may indicate gallstones, But if your gallbladder has already been removed a stone remaining in the duct ( passageway) from the liver to the old gallbladder site should be considered. This is known as choledocholithiasis. A test to examine this area must be done, known as an MRCP or ERCP. Anyone with chronic hepatitis B must be evaluated for liver cancer – also known as hepatoma or hepatocellular carcinoma (HCC) on a regular basis. Scar tissue from prior abdominal surgery- known as adhesions, is also a cause of abdominal pain. Intestinal pain must also be considered, as the right side of the large intestine lies in close vicinity to the liver. Other causes of abdominal pain include those related to the stomach, such as peptic ulcer disease and gastritis, which are not necessarily indicative of liver disease and are readily treatable when -discovered.
Answer: PBC is most often diagnosed when abnormalities are found on blood tests. Usually, an isolated elevated alkaline phosphatase (AP) level is initially discovered. This typically leads to additional blood work testing for a specific autoantibody, the antimitochondrial antibody (AMA), that is associated with PBC. The finding of an AMA of a titer greater than 1:40 in a person almost always confirms the presence of PBC, whether or not LFTs are abnormal.
Answer:Cryptogenic liver disease was a term most frequently utilized prior to the discovery of the hepatitis C virus in 1989. Now-a-days, most cases of cryptogenic cirrhosis are due to nonalcoholic steatohepatitis (NASH). Age (approximately 65 years old or older) is known as a “relative contraindication” to liver transplantation. This means that while less than optimal for a liver transplant, but do not rule out the possibility.
Answer: No. If your wife has successfully made hepatitis B surface antibody titers > 10 IU/mL after vaccination, then she is protected. There is no risk of transmission during pregnancy or childbirth. However, your newborn will none-the-less need to be immunized as he or she will have household contact with you.