Showing posts with label hepatology (liver). Show all posts
Showing posts with label hepatology (liver). Show all posts

Friday, August 12, 2011

Gallstones and Gallbladder Flush

There are generally 2 types of gallstone: cholesterol or pigment stones. It is believed that >80% of gallstones are caused by excessive cholesterol in the bile.

Gallstones can be easily diagnosed using an ultrasound scan. Most gallstones are diagnosed incidentally while doing ultrasound scan for screening or other purposes, as most gallstones do not produce any symptoms. When they do, the most common symptoms they produce is pain at the right upper region of the abdomen which may radiate to the right shoulder, especially after a fatty meal.

The stones can irritate the gallbladder and cause inflammation of the gallbladder referred to as "cholecystitis". Sometimes the stone can pass through the bile duct and get trapped half way. It will result in severe pain and jaundice (yellow eyes & skin). If left untreated, serious complication such as pancreatitis can occur. Both these two conditions are common gallbladder disorders and need emergency surgery to remove the gallbladder (cholecystectomy).

     Gallbladder at your right upper abdomen

If you find out that you have gallstones and you still have not experience any symptoms, then usually nothing need to be done. Some doctors may recommend surgery to remove the gallbladder straight away as when problems arise, surgery will have higher risk. Other doctors may recommend medication such as ursodeoxycholic acid to dissolve the cholesterol stones. However, this drug is not commonly given nowadays as it takes many years to dissolve the stones and the stone may reform after that.

If you have gallstones with no symptoms or only mild infrequent discomfort, you may want to try an alternative treatment called gallbladder flush. This method is not 100% effective and it depends on how well you follow the plan.

There are many version of gallbladder flush available, but their principle are almost the same. Here is an example.

2-4 weeks before:
Eat healthy diet rich in fruits & vegetables, with no meat and no refined food. Make sure there is no constipation.

Day 1-5:
Continue with the healthy diet. Drink at least 2 glasses of apple juice a day. 

Day 5:
Do not eat anything after lunch. Take 1 teaspoon of epsom salts at 4pm and then another teaspoon at 6pm.
From 8pm, take 15ml of olive oil mixed with 15ml of lemon juice every 15 minutes for 8 times (total 120ml of olive oil & 150ml of lemon juice taken in 2 hours time).
Then go to bed lying on your right side with right knee bend.

Day 6-7:
You may pass out greenish/yellowish stones if successful. To confirm it, just see your doctor to do an ultrasound scan.

    Gallstones

Plenty of fruits and vegetables help to cleanse the bowel in preparation for the stones to pass out. Apples are rich in malic acid which can help to soften or break the cholesterol gallstones. Epsom salt or magnesium sulfate helps to relax smooth muscle within the bile ducts so that the stones can pass through easily. Olive oil will make the gallbladder contract forcefully to flush out the stones, while lemon juice just make the olive oil better to drink.

There is a possibility that the stones may trapped halfway and causes pain which may need intervention by doctors. Other than this, gallbladder flush is a safe practice for healthy adults. Even if it is not successful, your body will still benefit from a few weeks of healthy diet.

Friday, April 15, 2011

Fatty Liver: please check ALT


Fatty liver is just accumulation of excess fat in the liver. It can be primary or secondary.

Primary (cause unknown)
  • NAFLD (Non-Alcoholic Fatty Liver Disease)

Secondary (cause known)
  • Alcohol
  • Hepatitis B
  • Hepatitis C
  • Drugs-induced
  • Wilson's disease
  • Autoimmune hepatitis

    Fat cells (white) in the liver

NAFLD is a spectrum of diseases ranging from
  • Simple fatty liver (steatosis)
  • Fatty Liver with inflammation & fibrosis (NASH – Non-Alcoholic Steato-Hepatitis)
  • Severe liver scarring/fibrosis (cirrhosis)

    Note the changes in liver size

The cause of NAFLD is not clearly known. However it is believed to be associated with insulin resistant, a condition that causes metabolic syndrome and type 2 diabetes mellitus. So, you probably have NAFLD if you have the following:

  • Obesity/overweight
  • Diabetes mellitus (type 2)
  • High LDL-cholesterol
  • Low HDL-cholesterol
  • High triglycerides

Fatty liver has no specific symptoms in early stages. It is usually first suspected when people do blood test for whatever reason and find that their ALT (alanine transaminase) is raised. There are a few causes of raised ALT, which represent liver inflammation/injury. Doctors will rule out those causes such as drug-induced (esp cholesterol medicine) and viral hepatitis etc. If nothing can be found, ultrasound of the liver should be done to look for fatty liver. Ultrasound is a cheap, simple and accurate (though not 100%) method to diagnose fatty liver.

    Fatty liver on ultrasound, "more white" compare to the kidney

When fatty liver is confirmed via ultrasound, the next step is to find the cause of fatty liver. As mentioned earlier, the secondary causes such as alcohol, viral hepatitis etc need to be ruled out. If a cause of fatty liver is identified, we can treat that condition accordingly. But if no cause can be found, then we can call it NAFLD.

  • NAFLD with normal ALT = simple fatty liver = harmless
  • NAFLD with raised ALT = NASH = slight risk of progression to liver cirrhosis & subsequently liver cancer

The risk of liver cirrhosis in NASH is not well established, should be around 10%. However, it takes many years (>20 years) to progress from NASH to cirrhosis. Compared to NASH, cirrhosis usually occurs earlier in fatty liver caused by alcohol and hepatitis.

If your fatty liver is due to alcohol, you have to reduce or stop drinking. If it is due to viral hepatitis, you may need anti-viral treatment. Though there is no specific treatment for NAFLD, one can benefit from losing weight, lowering blood cholesterol/triglycerides/sugar through diet, exercise and sometimes medication. Control it before it is too late, as the liver damage will become irreversible (incurable) if it reaches cirrhosis stage.