Liver disease on the rise

By Sarah Namulondo

Knowing what to put in your body and what to avoid could be the difference between life and death

Doctors are sounding a warning about liver diseases, which have recorded an upward trend in Uganda and worldwide in recent years.

Liver diseases occur when there is a disturbance of the liver functions. The liver is the largest solid organ in the body and it has a number of functions like producing bile for digestion, storing glucose and converting it back into energy, producing blood clotting factors, producing amino acids, manufacturing cholesterol required for fat transport, and metabolising medicine into active ingredients in the body.

But when it fails, meaning it cannot perform its functions, it affects a lot of organs including the stomach, intestines, pancreas, kidneys and many other organs.

These effects develop into symptoms such as poor absorption of fats leading to indigestion, hemorrhoids, gall stones, intolerance to fatty foods, nausea, vomiting attacks, abdominal bloating, constipation, fatigue, weight loss, yellowish discolouration of the skin, itching of the skin and accumulation of fluids in the stomach and legs.

Other symptoms of liver disease are found in the nervous system where the disorder leads to depression, mood changes, especially anger and irritability, poor concentration and “foggy brain”, overheating of the body, especially the face and torso, and recurrent headaches and migraines.

Dr. Frederick Nakwagala, a physician consultant at Mulago Hospital, says over the years,a number of liver disease referrals to Mulago have been fluctuating and it is hard to tell the number of liver patients because there has been no statistical research done on the disease.

In 2009/2010 however, Mulago received 364 male referrals and 246 female referrals in outpatient. Out of these received patients 174 males where admitted and 125 females where admitted. Although the number of admissions in 2011/2012 shot up for the females from 125 to 138, the number of male admissions dropped from 174 to 165.

This Nakwagala attributes to the rise in alcoholism among women. “You need more alcoholic drinks to destroy a man’s liver than you need to destroy a woman’s liver,” he says. Indeed, most of the female patients were former alcoholics.

He says that although in the past the numbers of referrals were fewer, there are now more causes. Most common in Uganda are alcoholic liver, liver cancers mainly caused by high consumption of alcohol and smoking, and HIV/Aids.

This high consumption of alcohol has even seen Uganda ranked highest in Africa.

Main symptoms

He says that the most common symptoms in the drug-induced liver diseases are itchy skin, abnormal lightening of the skin, yellow eyes and change in the colouring of their stool and urine.

When the patients see that, their counselors encourage them to go for regular liver checkups and if these symptoms are found, Dr. Nakwagala says the patients are advised to change medication and go for detoxification to avoid further damage to the liver.

Another drug-induced case is where people buy off-the-counter prescription drugs like panadol, Niacin, Amoxyl, clavulanic acid, nitrofurantoin and drugs of abuse, and then take them in excess.

Dr. Adil Bahauddin, a consultant specialist physician at Norvick Hospital in Kampala, adds that these drugs too can cause the same effect as Nevarapine (ARV) and some TB drugs in intoxicating the liver and if not stopped the liver continues to get inflamed.

These drugs he says, lead to liver Cirrhosis, a disease that hardens and scars some parts of the liver.

Dr. Bahauddin says that although cirrhosis is referred to as a liver disease, it is actually an after effect of some of the diseases that affect the liver. He says that although internationally people suffer from different kinds of liver diseases, the most prominent liver diseases causing cirrhosis in Africa are Hepatitis A, B, C, and E and consumption of strong herbal remedies and abusing prescription drugs.

In Uganda, it is estimated that 15% of people living in northern Uganda and West Nile have a high chance of getting Hepatitis B and a small percentage of 4% of people in south and western Uganda also have a high level of catching the disease.

According to Dr. Bahauddin, it is because Hepatitis B is sexually transmitted and very few people go for proper treatment and regular check-ups to avert the disease. He says that the problem is that a lot of emphasis is put on HIV/Aids therefore very limited awareness is being made concerning Hepatitis, which means that often times people never ask their partners to get tested for Hepatitis.

Hepatitis B is also spread through sharing of needles and blood, which makes it easy to spread in Northern Uganda because they have diverse cultural practices that are performed on people’s bodies. For instance, the Karimojong design their skins by piercing themselves with the same razor blades or safety pins.

Although Hepatitis C is also spread the same way as Hepatitis B, Dr. Bahauddin says it is not spread through sexual intercourse.

Another infection is Hepatitis A, which Dr. Nakwagala says affects 95% of Ugandans and is caused by poor sanitation.

The disease is spread through the feacal route (where a person drinks or eats food which was contaminated by the faeces of a person infected with the disease).

This is often found in raw foods like cabbages, which have been poorly handled and drinking dirty water.

Bilharzia is also another common disease among Ugandan fishermen and beach lovers, which affects the liver. This disease, Nakwagala says, is spread through Bilharzia worms which are found in snails in the lakes. Worms enter their bodies within five to four minutes of a person entering infested waters.

That is why the disease is found in 40% or more people who live near lakes or engage in activities such as fishing, swimming, washing clothes in the lake.

Dr. Nakwagala says that Bilharzia affects the liver very slowly and it could take 20 years for it to fully show its impacts on the liver.

“I always tell my patients, although you are here now, you should have been here 20 years back,” Nakwagala says.

He adds however, that there are other non-scientific causes of liver infections. These include the consumption of molded ground nuts as one of the other causes of the fungal liver disease.

He says that usually these ground nuts are already ground using a machine and stored for a long time. This makes them form a toxin called Aflatoxin. The continuous consumption of Aflatoxin poisons the liver over time.

Healthy Liver Tips

• Get regular health check-ups, including liver function tests.
• Avoid or limit consumption of alcohol and recreational drugs.
• Avoid toxic substances such as pesticides, solvents and paint thinners.
• Eat a healthy, well-balanced diet.
• Get regular, moderate exercise.
• Drink plenty of water.
• Take no more than the recommended doses of medications.
• Be careful when using multiple drugs, herbs, or drugs and herbs together.
• Inform healthcare providers about all drugs, herbs, supplements, and alternative therapies you are using.
• Get vaccinated against Hepatitis A and B.
• Regular aerobic exercise can improve overall fitness and may help reduce fatigue, stress, and depression.
• Most people with liver disease can safely engage in moderate exercise, but strenuous exercise may lead to a flare-up of symptoms. People with advanced cirrhosis should be cautious about exercising. If you have hepatitis or HIV disease, consult your healthcare provider before starting an exercise program.
• Drinking enough fluid is also important. Doctors recommend eight glasses of water per day.
• Eat foods that cleanse the liver. These include; garlic, grape fruit, beets and carrots, green tea, leafy green vegetables, avocado, turmeric, apples, olive oil, whole grains, broccoli, cauliflower, lemons and limes, walnuts and cabbage soup.

Difficult treatment

Treating liver diseases is very difficult because the liver is a very sensitive organ. By the time many of the symptoms manifest, 80% of the liver is already destroyed, Nakwagala says.

At that stage, the liver is unable to metabolise medicine and turn it into anti-bodies to fight against diseases.

Usually, the liver cannot resuscitate the dead protein cells, which makes it hard for a patient to heal.

Dr. Nakwagala says there is also a lot of ignorance amongst Ugandan people about Bilharzia and hepatitis which are one of the number one causes of liver diseases in Uganda.

But with all those short-comings, liver ailments can be managed through scientific treatment and home management like encouraging patients to eat less salt, reduce on water intake because the liver can no longer process it and usually it ends up in the belly and the legs.

Patients are encouraged to eat less fat, proteins, fruits, stop alcohol consumption, avoid taking some medications like paracetamol, ibuprofen, anti-tuberculosis and Nevarapine to avoid excess weight gain (obesity), injecting drugs of abuse and providing routine vaccination against influenza, pneumococcal virus and hepatitis.

Regular liver function tests are important if one is taking antiretroviral regimens for HIV in order to detect liver damage that may occur as a drug side effect.

Be sure to tell your healthcare providers about all drugs, herbs, and supplements you are using so they can be on the lookout for possible drug interactions.

Because the liver processes toxins, it is important to avoid substances that may harm the liver. Avoid exposure to toxic liquids and fumes including solvents, paint thinners, and pesticides. If it is necessary to use such chemicals, work in a well-ventilated area, cover your skin, and wear gloves and a protective face mask.

Foods to avoid

• Avoid raw or undercooked foods which may contain infectious organisms or toxins
• Processed or preserved foods (which may contain chemical additives)
• Fruits and vegetables treated with pesticides
• Too much caffeine and chocolate
• High doses of vitamin A, vitamin D, iron, and niacin can be toxic to the liver
• In some cases, people with advanced cirrhosis may be advised to limit their consumption of proteins.