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Dr. Avnish Upadhyay
Clinical Research Scientist Department of Clinical Research Patanjali Yog Peeth, Divya Yog Mandir Trust, Haridwar (An Recognized R & D Institution by DSIR)
In case the liver is "not tender" the conditions which can cause enlarged liver are 1. Cirrhosis or 2. Infiltration.
In cirrhosis liver is firm; edge of the liver is thick and the surface of liver is rough or nodular in the latter i.e. in infiltration the liver is smooth and soft or rubbery and the infiltration may be due to fat, glycogen, lipoid, pigment etc. The second group is mainly of academic importance.
In cirrhosis the symptoms depend on whether
hepatic failure has started or portal hypertension has occurred both may be present for example, when the patient comes for ascitis patients with hepatic failure only come for vague symptoms of loss of appetite. Nausea Gaseous distension Dyspepsia Belching Constipation, flatus etc.
Patients of portal hypertension may come only
for haematemesis and on examination, spleen is enlarged.
In any cirrhosis of liver where the enlargement of
the liver is too much or the nodules are very big and hard, malignancy of liver should be suspected. I must stress that as compared to hepatic amoebiasis and infective hepatitis, cirrhosis of liver is a very rare disease in general practice since alcohol has now a days has become a status symbol.
Cirrhosis is usually seen in Alcoholic
patients. Before 20 yrs malignancy of the liver was more rare disease, but now as we see in our institution, Malignancy is increasing very fatly, often the patient may feel the huge liver lump and comes to a general practitioner. Regarding treatment of cirrhosis, it all depends on the mode of presentation.
Those detected during routine examination
need only by given advice regarding high protein diet and avoidance of alcohol. To those coming with symptoms of chronic hepatic failure, the same advice of high protein diet and avoidance of alcohol. To those coming with symptoms of chronic hepatic failure, the same advice of high protein diet with additional high dose of vitamin B Complex must be given. Metheonine and choline are of use in early stages only, Injections of liver extract have no place in the treatment, It is quite useless and waste of money.
A case of cirrhosis with portal hypertension
coming only for haematemesis should strongly be recommended surgery i.e. Protocaval shunt, after acute stage of haematemesis is treated by multiple blood Transfusions Cases of Ascitis need high protein but salt free diet with plenty of diuretics, The tapping of ascitis therapeutically should be discouraged because it precipitates complications.
The following are the approximate protein values of the usual food consumed.
Ozs Protein contents (Gm) Vegetable 1 0.5 Milk 1 1.0 Egg one 2 4-5 Rice Cooked 3 2 Wheat 1 Chapati 3 Dals Cooked 3 6 Meat 1 7 Fish 1 5 Dry Fruits 1 7-8 Grams and monkey nuts1 7-8 Calories 10 to 20 20 75 100 100 100 80 25 120 120
A patient of cirrhosis needs about 100 Gms of Protein per day.
Here I want to add an important fact which is more ever a reality. We all people live in an ashram where non-veg diet is strictly prohibited, It is also true, leaving some exceptions, we all are vegetarians. I only quoted above data only from medical point of view other wise I should not have mentioned them. So for all vegetarian patients, milk forms the main diet with the addition of casilan powder (Casein is the principal protein in milk, It supplies all the amino acids necessary for growth and development) which supplies 20 Gms of protein per ounce, It needs to be stressed again that high protein diet is very good and ideal for such patients and the only time when proteins are withheld is, if these patients are drowsy and are growing into hepatic coma. Even if patient takes 1ozs milk four times a day in addition to his usual diet he gets 40 Gms of protein ( 1 Gm per ounce). If one oz of Casilan is added to the above milk, he gets nearly 30 Gms extra, For the rest of 30 Gms (to complete 100 Gms) the patient can be advised to take more dals and chapatis for non-vegetarian, 2 eggs in breakfast, and meat and fish at lunch and dinner is as good advice.
In short to any patent of chronic liver disease,
the best advice that a doctor can give is to take the above high protein diet for life time. There is no drug in the market which is really effective in cirrhosis and chronic liver disease. Extra B Complex perhaps may be helpful. But most of the tonics for liver, liver extracts, bile preparations and methionine and choline preparations are nearly 100% useless and if one prescribes them it is only to pass time and fill his pocket. It is not ethically goods.
Before I finish with cirrhosis of liver. I must say that
in the early stages, an average general practitioner can easily miss the disease, as perhaps a specialist too.
Think of this disease, when a person presents with
heamtemesis and has no history of having taken Aspirin and no history of symptoms of peptic ulcer. And secondary think it in any patient of ascitis who has prominent veins on abdomen and a past history of haematemesis or an alcoholic. By the time you have tried to diagnose cirrhosis by a palpable, hard nodular liver (Which a patient has felt and has come for a lump) Chances are more that you are dealing with malignancy of liver in usual case of cirrhosis the liver is shrunken. Incidence of cancer of liver in our country is increasing, but still a rare (except in our institution) disease for a general practitioner.
Alcohol and liver
Even a layman knows that alcohol is bad for liver.
Most of alcoholics have a palpable fatty liver. This does not produce any sign or symptoms and therefore has no significance except that, if the patient stops drinking. The liver can become absolutely normal. Once this stage has progressed further, alcoholic liver cannot return to normal completely. Late stage of alcoholic liver damage is cirrhosis, which has already been discussed, where the patient one day either develops hematemesis or ascitis.
There is a third increasing disease of liver
caused by alcohol which is knows as alcoholic hepatitis, I do not want to go in its details but I would only like to warn you. That this condition can mimic all liver diseases, these patient may develop typical symptoms and signs of cirrhosis with ascitis or picture of hepatic amoebiasis or combination of all above signs. If these patients stop drinking even at this stage (There is no specific treatment). About 50% may be cured, 10 to 30% die and others develop permanent cirrhosis. The condition should be thought of only is heavy drunkards.
Dear colleagues my lesson will remain incomplete if I do not explain some terminologies mentioned above, They are
Pigment- Any organic coloring matter in the body. Lipoid- Similar to fat but not contains glycerol and fatty acids Portal hypertension- Increased pressure in portal vein as a result of obstruction of the flow of blood through the liver Portal system.- The portal vein and its branches by which blood is collected from the abdominal viscera and conveyed to the sinusoids of the liver form which it passes through the hepatic veins to the inferior venacava. Portocaval shunt- Surgical creation of a connection between the portal vein and the venacava
Liver Diseases in Ayurveda
They are not described separately, Liver diseases i.e.
Yakrodar is included in pleehodar. Though the functions of these two organs- liver and spleen are quite different, I can not say why it is so? The causative factor of the disease is to take vidahi and abhishyandi food. Treatment 1. Naidan Parivarian 2. Main herbal drugs are kutki, Bhooamalki. Punaranava, Shyonak, Bhringraj, Makoy etc. 3. Main classical and self experimental medicines Arogyavardhni, Punarnavadi Mandoor, Tapyavi loh. Navayas loh, Udramrit vati, Punarnavashtak kwath, sarvakalp kwath, Kayakalp kwath, Kumaryasava, Punarnavasava, Bhringrajasava etc.
4. Prescription for liver diseases used in Patanjali Yog Peeth, Haridwar is as follows.
Divya sarvkalp kwath 200 gm
Divya kayakalp kwath 100 gm Mix both the powders. Take one teaspoonful of mixed Powder; Boil it into 400ml of water till it is reduced 100 ml i.e. one fourth drink it on empty stomach in the morning. The same process is to be repeated in the evening.
Swaran Basant Math Pragal Panchamrit Swarna makshik bhasm Kasis bhasm
2gm 10gm 5 gm 5 to 10 gm
(as the case may be)
10 gm Mix all the contents into one and divide it into 60 equal parts each part should be taken twice daily i.e. morning-evening mixed with honey or water on empty stomach.
Punarnavadi mandoor Arogyavardhni vati
40 gm 40 gm Udramrit vati 60 gm one tablet of each is to be taken after breakfast, lunch and dinner with lukewarm water.
Traditional Medicines used (Gharelu upchar)
1. Bark of shynak 25gm Bhoomi Amla Panchnag 25gm Punarnava mool 25gm Take all these there herbal drugs in fresh form. Crush them and extract their juice take it regularly in the morning on empty stomach till cure. 2. Kutki churna 625 mg to 1.25 gm with lukewarm water.
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