Evolution of Medical Treatments of End-Stage Liver Diseases
Evolution of Medical Treatments of End-Stage Liver Diseases
The liver problems become increasingly alarming because of the kinds of pollution we introduce into our body. Like for example are the food we eat, what we drink, and other form of body pollutants which we never imagined to have negative effects. Alcohol consumption, aflatoxins, anabolic steroids, diabetes, oral contraceptives, and cigarette are the major causes of liver damage. There are different kinds of liver disease. Named here are just few: the liver cancer or hepatocellular carcinoma; chronic viral hepatitis, hepatitis B and C and chronic liver disease.
When the liver is severely damaged and it is almost impossible to repair it, the case is called end-stage liver disease. Liver cancer is an example of end-stage liver disease and is one of the most harmful liver diseases one could acquire. Age is also considered among the factors, which is attributed to gene damage accumulation that happen upon committing the abovementioned reasons of damaging the liver (Palmer, 2004). For the HBV or hepatitis B virus, Saharan Africa is a special case where it is endemic to them, and the expectancy of having HBV is at a very young age of 20. Chinese people also suffer in HBV at this very young age.
Because of this alarming situation, doctors and medical practitioners looked for solutions, may it be a mild case or in their so-called end-stage case (Yi Jiang et al, 2007). First is their way of diagnosing the case. Blood test is one of the earliest techniques that they developed, and is actually the cheapest way. It is not a cure of course, but a way to prevent the disease or to avoid its continuous growth in the body. Abnormalities in the secretion of liver enzymes are attributed to hepatitis, whereas when a patient has undergone a decrease in platelet count, it is due to liver cirrhosis.
These two are underlying diseases that may lead to HCC. Because this technique is non-specific, we are not that confident that we are getting through the correct disease and this gives unreliable results. Sometimes, like in the case of the liver tumor, we cannot rely solely on this because sometimes the tumor does not cause significant abnormalities on liver enzymes and platelet count and for other symptoms as well. One modification due to the unreliability of the technique of the blood test is the alpha-fetoprotein (AFP) blood test.
Alpha-fetoprotein is indicative of the disease, but is actually not a way to actually claim it as the proper diagnosis. If the amount of AFP in the blood is greater than four hundred (400) ng/mL then we are confident to conclude of the presence of the disease. Amounts lower than this are confusing and is subject to other supporting tests since the substance level can be contributed by other liver diseases such as acute and chronic hepatitis, pancreatic cancer and gastric cancer. Pregnancy is also a factor contributing to the increase in the substance concentrations.
Even if AFP concentration does not reach 400, but there is an abrupt increase, lets say from 60 to 230 units, it could already be an indication of HCC. This technique, however, has limitations considering the sensitivity of the test due to some factors. Its combination with des-gamma-carboxyprothrombin (DCP) tests is another modification. This substance level is independent of AFP normal patients. In the same way that AFP test has limitations, this technique shows positive results when the size of the HCC is about 3 cm.
This technique however is still subjected to review for the significant difference in results when combined with AFP and AFP alone. When the tandem of these techniques is proven 100% effective, this will definitely help the medical practitioners. Callaghan, on her feature story-article The Comprehensive Liver Center at the University of Maryland Medical Center, it was emphasized that the University of Maryland Medical center applies these techniques, and of course newer methods for patients looking for more advanced and effective treatments.
Since liver cancer is the most common cancer in the world, accounting for 6% of all the cancer cases, the university is competitive in their equipment and discipline regarding liver disease medications, quoted from Dr. Regine of the same institution. Furthermore, stated in the article was an interview with the chief of the Division of Transplantation. As stated above, liver transplantation is one of the techniques available for terminal cases, or again termed as end-stage liver diseases.
On the negative side, available organs are somewhat low in number, and actually the demand has already exceeded the available supply. Although this is the case, still many patients come to them to have a second chance to live. Patients with cirrhosis are their major clients who undergo their program. The liver of a human is composed of two lobes, the left and the right, wherein one could perfectly function and sustain the body without the other. For live donors, they actually should not have any fear of dying when they donate their livers. The right lobe is bigger than the other and is the one being donated.
Forty percent of the liver is left with the donor who could actually grow to meet the body’s physiological needs, and the 60 percent is given because it is a lot bigger and can function right away for the weakened body of the patient. This procedure is complicated, but complications may arise due to the negative response of the body to the incoming organ, but mostly the operations have been successful. The problem with this technique is obviously its being expensive. Costly is the hunting of liver donors, and as mentioned, there is more demand than the supply.
When a patient has a family donor then it would largely lower the price though any organ transplant operation is really expensive. There are cases in which complete removal of the liver is not needed, and actually it should be the first option to consider. For example is when the patient does not have cirrhosis but a tumor has already developed in the lung. Through the process of surgical resection, wherein only 80% of the lungs is removed, and the 20% remaining is allowed to grow, the patient no longer needs to undergo transplantation.
This technique if considered first is far cheaper than the removal and replacement of the organ. This technique could also help avoiding cirrhosis, but should meet the criteria to make him eligible to undergo surgical resection. This surgical technique could extend a person’s life in 5 years time. The only problem is that there is still a possibility that the tumor might reoccur because as mentioned, some part of the liver is retained for it to grow. An advantage is that it is cheaper, but the effect is not that long in terms of life prolongation.
But then a patient who does not have the money needed at that moment for transplantation may resort to this first, then decide to subject himself to the transplantation within the 5-year life extension, which may be subject to how the person lived his life after the surgical resection. SIR-Spheres, on the other hand is done for those liver cancer cases considered inoperable. This is an internal radiation treatment, usually done in two sessions, wherein microspheres of about 1/3 the diameter of a hair are radiated directly to the tumor.
The tumor is killed by the radioactive isotope of Yttrium, Yttrium-90, for about 2 weeks of stay in the liver. This technique lasts about 1 hour and the patients are confined for 6 hours or less. Compared to other radiation techniques, its radiation is 40 times stronger. They use here the Model for Endstage Liver Disease (MELD) to prioritize the patients, for them to know who is to undergo the radiation technique first. MELD predicts the patients dying in three months time.
A news 2007 involved the Bishop of Athens wherein he was placed in the number 1 slot for undergoing a liver operation though the computation of the MELD. The case is not to undergo SIS-Spheres medication, but the MELD is useful in prioritizing the patients in need of immediate medical attention (Gilson, 2007). Other liver modern medications are percutaneous alcohol injection (PEI), tumor embolization and chemoembolization, the recent Nevaxar (a drug that interferes in the formation of blood vessels that feed the cancer cells.
Subject: Liver Diseases,
University/College: University of Arkansas System
Type of paper: Thesis/Dissertation Chapter
Date: 21 September 2016
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