Aims of liver disease treatment

Liver disease encompasses a wide range of conditions and causes. In many cases the treatment of the condition is curative i.e. it aims to cure.

However, in some therapy only aims to prevent further progression of the disease; reduce the symptoms of the disease; or reverse the damage already done.

Sometimes therapy is important to prevent fatal or life-threatening complications.

Initial treatment of liver disease

Initial therapy includes certain non-medical measures. For example in alcoholic liver disease, or that caused by drugs or medicines, it is imperative to stop the offending agent first.

A healthy diet and regular exercise is also important especially in chronic liver disease.

Therapies for specific liver diseases

Specific therapy includes (1):–

1. Infective hepatitis - In viral hepatitis there are certain anti-viral agents and drugs that can be used to treat the infection. These include Interferon, Ribavarin etc. Many new drugs also being used in Hepatitis B and C. While there is a vaccine to prevent hepatitis B, there is none to prevent hepatitis C.
2. Hepatitis A patients need maintenance of hydration and rest while the disease is tackled by the body’s immune system.
3. Patients with gallstones often require surgery to remove the gallbladder and the stones. This surgery may be performed in an open traditional manner or more commonly using laparoscopic surgical procedures.
4. Alcohol related liver disease – Stoppage of alcohol is primary therapy. Other therapy involves treating complications of the liver disease. (2)
5. Autoimmune hepatitis – Steroid agents and other immunity supressing agents may be used in these cases.
6. When there is obstruction of the bile ducts in cholestatic liver disease a medicine called ursodeoxycholic acid is given to slow damage. Surgery may also be needed in some cases of cholestatic liver disease.
7. Hemochromatosis – Since there is iron overload regular “bloodletting” by a procedure called venesection is used along with medications to remove the excess iron.
8. Wilson’s disease – Drugs that bind to the excess copper like d-penicillamine are used to render the excessive copper harmless and excrete it from the body.
9. In liver cancers specific anti-cancer drugs are used to treat the cancer. These patients may need surgery to remove the cancer followed by chemotherapy, radiation therapy and even liver transplantation in some patients.
10. Liver transplant is needed in some cases. Most commonly in cirrhosis due to alcoholic liver disease; hepatitis C induced liver disease or primary biliary cirrhosis. (3)

Treatment and management of complications of liver disease

1. Portal hypertension and bleeding (4) –
   1. Pressure in the blood vessels may be reduced by drugs like beta blockers.
   2. Some drugs such as vasopressin and octreotide may be given to cause the bleeding veins to narrow. Blood transfusions may be needed given to replace the lost blood.
   3. Surgery to bind the veins that lead to bleeding from the esophagus or rectum may be performed.
   4. Bleeding vessels, called varices, in the esophagus and rectum may also be stopped by injecting a chemical into the blood vessels. This leads the blood in them to clot and causes the formation of scars. These are called sclerosing agents.
   5. Sometimes a balloon may be used to apply pressure on the varices to prevent further bleeding
   6. Sometimes a procedure called transjugular intrahepatic portosystemic stent shunt (TIPSS) may be used to reduce the pressure in the portal vein. A bypass path is made between the portal and hepatic vein to reduce some of the pressure.
2. Ascitis and edema of the lower limbs – When fluid builds up in the abdomen it leads to pressure that may lead to swelling of the lower limbs as well. Treatment of ascites is regular removal of the fluid; restriction of salt and fluids in diet; and drugs like diuretics that lead to increased fluid excretion. Removal of the ascetic fluid may be using a needle or by placing a tube by the side of the abdomen.
3. Bleeding tendencies – liver damage leads to lack of clotting factors. This may be treated with vitamin K and replenishment of blood clotting factors by transfusion of plasma.
4. Hepatic encephalopathy – When the brain is affected there may be confusion, delirium and even loss of consciousness. Therapy is with a Lactulose syrup. It acts as a laxative and helps remove toxins like ammonia that accumulate in blood in this condition.