Prairie Doc Perspectives: Lessons from the liver
It was my first month in the hospital as a new internal medicine intern at a large university hospital. Upper-level residents that I met during orientation asked me, “What is your first rotation?” When I answered, “hepatology,” the looks I got in response told me I was in for a tough initiation.
The hepatology service included some of the sickest patients in the hospital. Each one had either end stage cirrhosis or a liver transplant, plus some acute condition requiring them to be in the hospital. They were so complicated, making clear to the newly minted Dr. Evans that a healthy liver is critical for the body to function normally.
Cirrhosis (scarring of the liver) is the undesirable result of many types of chronic liver disease. Many causes of liver disease occur at random, related to autoimmune or genetic origins. However, the most common reasons patients develop cirrhosis are alcohol related liver disease, hepatitis C, and non-alcoholic fatty liver disease, all of which might be controlled if we catch them before cirrhosis develops.
Most people know that chronic heavy alcohol use can result in cirrhosis. We don’t fully understand why some heavy drinkers develop cirrhosis and some don’t, but longstanding alcohol abuse does typically result in some degree of liver damage. Though it can be very difficult, stopping alcohol intake can, in turn, stop progression of liver damage in most patients with alcohol related liver disease.
Hepatitis C, a viral infection which in some people becomes chronic and can ultimately lead to cirrhosis, has been the most common reason for liver transplant in the United States in recent years. With major developments in treatment for this disease over the last decade, we now have highly effective and well tolerated antiviral treatments to cure hepatitis C. This virus can reside in the liver and bloodstream without causing symptoms for decades. Current recommendations advise that we screen for hepatitis C in patients who have significant risk, including all Americans born between 1945 and 1965 in addition to other high risk groups. Talk to your doctor if that includes you.
Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent and now is among the most common reasons for liver failure. NAFLD is thought to be due to metabolic factors resulting in fatty deposition in the liver. It commonly occurs along with other metabolic diseases such as obesity, diabetes, and high cholesterol. Treatment of NAFLD is focused on diet and exercise and controlling those other metabolic diseases.
That one month as a new physician on the hepatology service was enlightening. I learned so much about the importance of a healthy liver, and I continue to use those lessons regularly in primary care.
Kelly Evans-Hullinger, M.D., is part of the Prairie Doc team of physicians and currently practices internal medicine in Brookings, S.D. For free and easy access to the entire Prairie Doc library, visit www.prairiedoc.org and follow Prairie Doc on Facebook, featuring On Call with the Prairie Doc, a medical Q&A show streamed most Thursdays at 7 p.m. central.