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HEPATIC FIBROSIS AND CIRRHOSIS

UNDERSTANDING THE PROBLEM

The liver is a large organ that sits on the right side of the belly. The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver's main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

In the early stage of any liver disease, the liver may become inflamed. It may become tender and enlarged. Inflammation shows that the body is trying to fight an infection or heal an injury. But if the inflammation continues over time, it can start to hurt the liver permanently.

  • If left untreated, the inflamed liver will start to scar. As excess scar tissue grows, it replaces healthy liver tissue. This process is called Fibrosis of the liver or Hepatic Fibrosis. (Scar tissue is a kind of fibrous tissue.)
  • At the stage when the liver may become so seriously scarred that it can no longer heal itself is called cirrhosis. Cirrhosis can lead to a number of complications, including liver cancer.
  • Liver failure means that the liver is losing or has lost all of its function which can become life-threatening.
UNDERSTANDING WHO SUFFERS

Fibrosis occurs when excessive scar tissue builds up faster than it can be broken down and removed from the liver. Chronic infection with hepatitis C or hepatitis B virus (HCV or HBV), heavy alcohol consumption, toxins, trauma or other factors can all lead to liver fibrosis. Only in rare instances is liver fibrosis the primary problem; more often, it is secondary to some other liver disease such as cirrhosis.

The most common causes of cirrhosis in the United States are long-term viral hepatitis C infection and chronic alcohol abuse. Obesity is also a cause of cirrhosis, although it is not as prevalent as alcoholism or hepatitis C. Obesity can be a risk factor by itself, or in combination with alcoholism and hepatitis C.

Other causes of cirrhosis include:

  • Hepatitis B: Hepatitis B can cause liver inflammation and damage that can lead to cirrhosis.
  • Hepatitis D: This type of hepatitis can also cause cirrhosis. It’s often seen in people who already have hepatitis B.
  • Inflammation caused by autoimmune disease: Autoimmune hepatitis may have a genetic cause. According to the American Liver Foundation, about 70% of people with autoimmune hepatitis are women.
  • Damage to the bile ducts, which function to drain bile: One example of such a condition is primary biliary cirrhosis.
  • Disorders that affect the body’s ability to handle iron and copper: Two examples are hemochromatosis and Wilson’s disease.
  • Medications: Medications including prescription and over-the-counter drugs like acetaminophen, some antibiotics, and some antidepressants, can lead to cirrhosis.
POTENTIAL SIGNS AND SYMPTOMS

In the early stages of liver fibrosis, few people experience symptoms because the liver functions relatively well. Fibrosis is the initial stage of the formation of scar tissue in the liver. An individual may have no symptoms and live a normal, sometimes very active life, for decades, and remain unaware that he or she has liver disease.

As scar tissue builds up, due to inflammation and the continuance of liver injury, it connects with existing scar tissue, which can eventually disrupt the metabolic functions of the liver. If the disease progresses, it can lead to cirrhosis, a condition in which the liver is severely scarred, its blood flow is restricted, and its ability to function is impaired.

If poked, a healthy liver is very soft. A liver that has developed fibrosis is firmer, and if the condition progresses to cirrhosis, the liver can be almost rock-hard.

The symptoms of cirrhosis occur because the liver is unable to purify the blood, break down toxins, produce clotting proteins, and help with absorption of fats and fat-soluble vitamins.

Often there are no symptoms until the disorder has progressed.

Some of the symptoms include:

  • decreased appetite
  • nose bleeds
  • jaundice (yellow discoloration)
  • small spider-shaped arteries underneath the skin
  • weight loss
  • anorexia
  • itchy skin
  • weakness

More serious symptoms include:

  • confusion and difficulty thinking clearly
  • abdominal swelling (ascites)
  • swelling of the legs (edema)
  • impotence
  • gynecomastia (when males start to develop breast tissue)
EXAMINATIONS USUALLY REQUIRED

Several scales are used to stage fibrosis. One common classification is a scale from 0 to 4 where

  • stage 0 indicates no fibrosis
  • stage 1 indicates enlargement of the portal areas by fibrosis
  • stage 2 indicates fibrosis extending out from the portal areas with rare bridges between portal areas
  • stage 3 indicates many bridges of fibrosis that link up portal and central areas of the liver; and
  • stage 4 indicates cirrhosis
  • The degree of fibrosis can, also be assessed as none, minimal, mild, moderate or severe.

Tests used to stage fibrosis include

  • Non-invasive imaging tests (conventional ultrasonography, CT, and MRI)
  • Blood tests
  • Liver biopsy and
  • Newer tests that assess liver stiffness.

Early fibrosis can be difficult to diagnose because it is often asymptomatic. If a blood test indicates fibrosis of the liver, typically, a liver biopsy will be performed. A liver biopsy requires a needle to remove a small sample of liver tissue so that doctors can assess the extent of liver damage and stage the degree of fibrosis.

A diagnosis of cirrhosis begins with a detailed history and physical exam. Doctors take a complete medical history. The history may reveal long-term alcohol abuse, exposure to hepatitis C, family history of autoimmune diseases, or other risk factors. The physical exam will look for signs of:

  • pale skin
  • yellow eyes (jaundice)
  • reddened palms
  • hand tremors
  • an enlarged liver or spleen
  • small testicles
  • excess breast tissue (in men)
  • decreased alertness

Tests can reveal how damaged the liver has become. Some of the tests used for evaluation of cirrhosis are:

  • complete blood count (to reveal anemia)
  • coagulation blood tests (to see how quickly blood clots)
  • albumin (to test for a protein produced in the liver)
  • liver function tests
  • alpha fetoprotein (a liver cancer screening)
PROPOSING TREATMENT AND WHY AIMIS

Surgery for Liver Disorders

If your doctor recommends surgery for a disorder, you may be a candidate for a minimally invasive approach - da Vinci Surgery.

AIMIS is an expert in Robotic Surgery for Robotic Assisted Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections and other minimal invasive procedures for the Liver involving the best American and International surgeons who are experts in the field including:

  • Hepatic fibrosis and sclerosis - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Central haemorrhagic necrosis of liver - Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver
  • Infarction of liver - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Hepatic veno-occlusive disease - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Liver Cysts - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Focal nodular hyperplasia of liver - Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver

Explanation of Surgery Types:

  • Large Liver Resection – Right Lob Removed plus Segmentectomy (segment number 4)
  • Right Liver Lobectomy- Removal of one of the two lobes of liver
  • Left Liver Lobectomy - Removal of one of the two lobes of liver
  • Segmentectomy - Removal of one of the eight segments of liver
  • Multiple Segmentectomies – Two or More removal of the segments of Liver
  • Complex Segmentectomies –Complex removal of the segments of Liver
  • Small Resections – Removal of small parts of Liver ( smaller than Segments)
  • Wedge resection, non-Anatomical - Tumor removal with portion of liver
  • Left Lateral Sectionectomy- Removal of the Left Lateral Segment/section of the Liver
  • Two Step Liver Resection- Liver Regeneration

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

The process leading to cirrhosis can often be slowed and sometimes even halted. The liver has an amazing ability to regenerate itself once the underlying cause of the fibrosis is controlled or cured.

  • Abstain from drinking alcohol (drinking alcohol may cause further liver damage)
  • Treat any infections promptly (avoid people who are ill, use good hygiene by frequent hand washing, get vaccinated for hepatitis A and B, influenza and pneumonia)
  • Eating a healthy, well balanced diet including lots of fruits and vegetables/avoid raw seafood (good nutrition is important to liver health). People with liver concerns should avoid eating raw seafood due to the risk of infection.
  • Eating a low sodium/low fat diet (excess salt can cause the body to increase fluid retention in the abdomen and legs)
  • If diagnosed with hepatitis, take medications to treat it which can slow disease progression and possibly reverse fibrosis
  • Avoid inhaling toxic substances by wearing a protective mask
  • Avoid the use of recreational drugs
  • Use over the counter medications carefully avoid aspirin, ibuprofen, (Advil, Motrin, others) and naproxen (Aleve, others). When in doubt, consult a physician or pharmacist
  • Get regular exercise and rest

Treatment for cirrhosis varies based on what caused it and how far the disorder has progressed. Some treatments doctors might prescribe include:

  • beta blockers or nitrates (for portal hypertension)
  • quitting drinking (if the cirrhosis is caused by alcohol)
  • banding procedures (used to control bleeding from oesophageal varices)
  • intravenous antibiotics (to treat peritonitis that can occur with ascites)
  • haemodialysis (to purify the blood of those in kidney failure)
  • lactulose and a low protein diet (to treat encephalopathy)
  • Lobectomy: surgical removal of a lobe of an liver which is affected
  • Liver transplantation is an option of last resort, when other treatments fail.
FURTHER INFORMATION ON INCREASED RISK GROUPS

Risk factors for developing liver fibrosis are as follows:

  • Chronic infection with hepatitis B or C virus
  • Gender (fibrosis occurs more rapidly in men than in women)
  • Age (people over 50)
  • Compromised immune system (due to coinfection with HIV or use of immunosuppressive drugs after a liver transplant)
  • Heavy alcohol consumption
  • Fatty liver (steatosis)
  • Insulin resistance (the condition in which the cells of the body become resistant to the effects of insulin, that is, the normal response to a given amount of insulin is reduced. As a result, higher levels of insulin are needed in order for insulin to have its effects)
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Additional tests that can evaluate the liver include:

  • Upper endoscopy (to see if oesophageal varices (abnormal, enlarged veins) are present)
  • Ultrasound scan of the liver
  • MRI of the abdomen
  • CT scan of the abdomen
  • liver biopsy (the definitive test for cirrhosis)
  • Magnetic Resonance Elastography or Transient Elastography: These noninvasive imaging tests detect hardening or stiffening of the liver and may eliminate the need for a liver biopsy.
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections and other minimal invasive procedures for the Liver involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for the Liver and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Less scarring
  • High patient satisfaction
  • Minimal pain
  • More precise removal of cancerous tissue
  • Less risk of converting to open surgery
  • Reduced risk of blood loss
  • Shorter hospital stay

The advantage of robotic surgery is the avoidance of large incision, and also helps in removing complex or critical tumors which are otherwise, very hard to do with tradition open surgery methods. As the liver is one of the highly regenerating organ of our body, by employing robotic surgery techniques, one can easily remove complex tumors with minimal discomfort without affecting its regenerating power. Robotic technology has also been successfully used in liver transplantation, which has made liver transplantation simpler with fewer complications.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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