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liver disease presentation and it's overall effects
- 1. Management of Non-Alcoholic Fatty liver Disease with Unani Medicine Dr Syed Asaduddin Ahmed, Unani Medicine Practitioner, Al Hijama Alternative Medical Center, Sharjah, U.A.E
- 2. NAFLD • Prevalence high in developed countries • One of the main contributor to chronic LD and cryptogenic cirrhosis. • Greater risk of developing NAFLD in those with obesity, insulin resistance , Diabetes Melitus, Hyperlipidemia and Hypertension • Key pathological processes such as insulin resistance, abnormal lipid metabolism, oxidative stress , inflammation, apopstosis and fibrosis are linked in developing NAFLD.
- 3. Unani Concept about NAFLD • It comes under warm e kabid Balgami. • Synthesis of humours (Akhlat) is regarded as center of all metabolic process in the body. • Liver is considered as the kitchen (Matbakh) of the body. Hence unani scholars always tend to keep liver functions normal to treat any disorders • Lot of methods have been advised in unani literature to keep liver healthy. • Unani scholars always consider liver disorder in case of flatulence , Dyspepsia and indigestion.
- 4. Unani Line of Treatment •Ilaj Bil Ghiza (specific food advise) • Ilaj Bil Tadbeer (procedures like Hijama etc) • Ilaj Bil Dawa (Herbal treatment)
- 5. Ilaj Bil Tadbeer – Regimental therapy • Jalinoos was of the opinion that su Mijaz Barid Kabid should be managed by simple steps like • Exercise – Riyazat He favoured Brisk walking or running as it reduces body mass. • Massage – Dalak Massage in Rt Hypochondrium with Roghan Afsanteen, Sibr ( Alovera), Zimad Jalinoos and Zimad Sunbul uttib • Cupping – Hijama Hijama both to reduce imbalance Aqlat (Balgam/ Saham) and inflammation.
- 6. Ilaj Bil Ghiza - Dietotherapy • Scholars advise on eating on time. • Irregular eating habits cause sue mijaz barid ( Gives coolant effect to the organ which helps in excessive storage of fat. • Avoidance of fried , oily,fatty and poorly digested food • Encourage small bird soup, chicken soup, pulses, sagodana, kheer, dalia ( Wheat Gruel/ Harisa) , kisneez (coriander Sativam), Pudina ( Mentha Piperta and other light and easily digested foods should be recommended for liver sufferers.
- 7. Ilaj Bil Dawa – Pharmacotherapy • Unani Physicians are of the opinion that the line of treatment should be on the basis of inflammatory surface of the Liver. • If the inflammation is on Concave surface (inferior Surface) then Purgation with mild Muhallilat (anti inflammatories) should be administered. • If inflammation is on the Convex surface (Superior surface) then it should be treated by diuretics.
- 8. Commonly used medicines Muffarad • Anisoon (Pimpenellaanisum) • Badiyan (Fennel Seeds) • Tukum Karafs (Apium graveolens L.) • Beeq Kasni (Root of Cichorium intibus) • Beeq Izkhar (Root of Andropogenshoenanthus) • Sumbul ut Tib (Nardostachys jatamansi) • Mastagi (Pistacia Lentiscus) • Zafran Murrakab • Majun Dabid ul ward • Dawa Ul Kurkum • Shikanjabeen • Arq Kasni • Arq Brinjasif • Aab e Murwaqain • Sharbat Deenar • Sharbat Bazouri • Jawarish Jalinoos
- 9. Kasni – Cichorium Intybus L • Chicory is a perinnial herb of the dandelion family • Bright Blue Flowers, rarely white or pink • Different parts are used for medicinal purposes like leaves, seeds and root • Hepatoprotective and Neuroprotective properties • As a hepatoprotective Kasni extract (Arq) reduces the level of liver enzymes such as Alanine amino transferase , Aspartate amino transferase and Alkaline phosphatase • Action – The main action attributed to chicory are deobstruent, diuretic, blood purifier anti inflammatory. • Useful in treatment of Jaundice, Gastritis, Ascitis, Arthritis, Asthma
- 10. CASE 1 • NAME – Mohamed El Mhaoufor • AGE – 31 years, male • NATIONALITY- Moroccan • OCCUPATION – Fitness Trainer / Body Builder • HABITS – Consumption of protein supplements, oily and fatty food stuff • CHIEF COMPLAINT- Nausea and occasional vomiting, loss of appetite, Abdominal pain, since 15 days • INVESTIGATIONS- T.Cho 256, TG – 420, LDL 210, ALT- 87, AST-55. • USG- Fatty liver Grade 2 • Treatment – Along with Diet restriction and Hijama the following Unani medicine course was given for a period of 3 Months. • D.Ward, Arq Kasni, Cinnamon Tea, I. Kishneezi
- 11. CASE 2 • NAME – Victoria Monterio Schmidt • Age – 32 years • Sex - Female • Nationality- German • Occupation – Real Estate Agent • Habits – Irregular dietary habits, smoker, occasional Alcoholic • CHIEF COMPLAINT - Breathlessness on walking upstairs, Lost 15 kgs in 2 months, generalized weakness, UTI • Investigation- T.Chol 215, LDL 145, TG NAD,Alt 68, AST 40,Epithelial cells, Mucus (Urine) • Treatment – Diet advise, Arq Kasni + Arq Mako , Saffron and Turmeric milk for 15 days followed by D.ward, Kasni, mako, Ardkurma for 15 days
- 12. CASE 3 • NAME – Salim Ali • AGE – 56 Years • NATIONALITY- UAE • OCCUPATION – Police Officer • HABITS- consumption of excess meat, smoke midwaq, • CHIEF COMPLAINT – Pain in stomach and joints since 2 months, Yellow urine and sclera • Investigations- T. Chol 225, TG 219,LDL 160, ALT- 78, AST -60,urine bile salts +, • Treatment – Regular exercise, Fat free diet, reduce proteins • D.Ward, I.Muqil, J.Noos, Sharbat Bazouri, Arq Kasni, Cinnamon Tea
Editor's Notes
- Slide 1: Introduction Good health is a delicate balance orchestrated by our body's intricate systems, and at the heart of this symphony is the liver. Often underestimated, the liver plays a pivotal role in maintaining our overall health. Acting as the body's metabolic powerhouse, the liver is involved in a myriad of essential functions that contribute to our well-being. Metabolism: The liver processes nutrients from the food we consume, converting them into energy for our body's various activities. It regulates glucose levels, ensuring a steady and balanced energy supply. Detoxification: Serving as the body's detox center, the liver filters and neutralizes toxins, drugs, and other harmful substances. Protein Synthesis: The liver produces proteins crucial for blood clotting, immune system function, and maintaining fluid balance. Storage: Essential nutrients, such as vitamins and minerals, are stored in the liver for release when needed, ensuring a constant supply for bodily functions. In essence, the liver is an unsung hero, tirelessly working behind the scenes to maintain the delicate equilibrium necessary for our overall health and well-being. Understanding the significance of the liver is the first step in appreciating the gravity of liver enzyme diseases and their potential impact on our health.
- Enzymes are the molecular catalysts that drive biochemical reactions, and within the liver, they play a pivotal role in maintaining the body's intricate balance. The liver houses a spectrum of enzymes, each with specific functions crucial for various biochemical processes. Metabolism: Enzymes in the liver facilitate the breakdown of nutrients like carbohydrates, fats, and proteins, converting them into energy. For instance, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are enzymes involved in amino acid metabolism. Detoxification: Cytochrome P450 enzymes, found in the liver, are instrumental in detoxifying drugs, chemicals, and other harmful substances. These enzymes transform toxic compounds into water-soluble forms, making them easier for the body to eliminate. Synthesis of Proteins: The liver produces numerous proteins critical for blood clotting (e.g., fibrinogen), immune system function (e.g., complement proteins), and maintaining fluid balance (e.g., albumin). Storage and Release: Enzymes regulate the storage and release of glucose through processes like glycogenesis and glycogenolysis, ensuring a stable blood sugar level. Lipase enzymes aid in the breakdown of stored fats into fatty acids, releasing energy when needed. Immune System Support: Enzymes in the liver contribute to the body's defense mechanisms by producing proteins that play a role in the immune response. Understanding the significance of these enzymes is vital as any imbalance or dysfunction can disrupt these processes, leading to health issues. Monitoring liver enzyme levels through blood tests is a key diagnostic tool in identifying potential liver problems and maintaining overall health. The liver's enzymatic orchestra is a testament to the intricate nature of our biological systems, where balance is key to optimal functioning.
- Viral Hepatitis: Hepatitis B and C: These viruses can cause inflammation of the liver, leading to elevated liver enzymes. Chronic infections may result in long-term liver damage. Alcohol Abuse: Excessive and chronic alcohol consumption can lead to alcoholic liver disease, causing inflammation, fatty liver, and ultimately cirrhosis. Elevated liver enzymes are common in this scenario. Non-Alcoholic Fatty Liver Disease (NAFLD): Linked to obesity and metabolic syndrome, NAFLD involves the accumulation of fat in the liver. Inflammation associated with NAFLD can elevate liver enzyme levels. Medications and Toxins: Certain medications, including some antibiotics, antifungals, and pain relievers, can affect liver function and elevate enzyme levels. Exposure to toxins, such as industrial chemicals, can have similar effects. Genetic Factors: Inherited conditions like hemochromatosis, Wilson's disease, and alpha-1 antitrypsin deficiency can predispose individuals to liver diseases by affecting enzyme function or causing abnormal liver metabolism. Autoimmune Diseases: Conditions like autoimmune hepatitis and primary biliary cirrhosis involve the immune system mistakenly attacking liver cells, leading to inflammation and elevated liver enzymes. Metabolic Disorders: Disorders like Wilson's disease and glycogen storage diseases can disrupt normal metabolic processes in the liver, impacting enzyme function and leading to liver dysfunction. Obesity and Insulin Resistance: Obesity and insulin resistance are associated with the development of NAFLD, which can progress to more severe liver conditions with elevated enzyme levels. Hemodynamic Disorders: Conditions affecting blood flow to the liver, such as Budd-Chiari syndrome, can contribute to liver enzyme abnormalities. Unknown Causes: In some cases, liver enzyme diseases may occur without a clear identifiable cause.
- Hepatitis: Hepatitis A, B, C, D, and E: Viral infections causing inflammation of the liver. Chronic hepatitis can lead to elevated liver enzymes, cirrhosis, and liver failure. Alcoholic Liver Disease: Resulting from chronic alcohol abuse, it includes fatty liver, alcoholic hepatitis, and cirrhosis. Elevated liver enzymes are common indicators. Non-Alcoholic Fatty Liver Disease (NAFLD): Characterized by the accumulation of fat in the liver. Inflammation associated with NAFLD can elevate liver enzyme levels. In advanced stages, it can progress to non-alcoholic steatohepatitis (NASH). Cirrhosis: A late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions. Cirrhosis leads to compromised liver function and elevated enzyme levels. Autoimmune Hepatitis: An autoimmune disorder where the body's immune system attacks liver cells, leading to inflammation and elevated liver enzymes. Primary Biliary Cirrhosis (PBC): An autoimmune disease where the small bile ducts within the liver are gradually destroyed, leading to liver damage and elevated enzyme levels. Wilson's Disease: A genetic disorder causing copper to accumulate in the liver, brain, and other organs. It can lead to liver damage and elevated liver enzymes. Gilbert's Syndrome: A benign genetic condition where the liver has difficulty processing bilirubin, resulting in occasional elevated levels of this pigment in the blood. Hemochromatosis: A genetic disorder causing excessive iron absorption and deposition in various organs, including the liver. This can lead to liver damage and elevated enzymes. Alpha-1 Antitrypsin Deficiency: A genetic disorder causing a deficiency of the alpha-1 antitrypsin protein, which can lead to liver and lung disease.
- Fatigue: Persistent tiredness and lack of energy, often unrelated to exertion, can be an early indicator of liver enzyme diseases. Jaundice: Yellowing of the skin and eyes due to the accumulation of bilirubin. It is a common symptom of liver dysfunction. Abdominal Pain: Discomfort or pain in the upper right side of the abdomen may be indicative of liver issues, especially if associated with swelling or tenderness. Unexplained Weight Loss: Significant and unintentional weight loss without changes in diet or physical activity may signal underlying liver problems. Changes in Urine and Stool Color: Dark urine and pale-colored stools can be linked to disruptions in the liver's ability to process bilirubin. Swelling: Edema or swelling in the abdomen and legs may occur due to fluid retention resulting from liver dysfunction. Nausea and Vomiting: Persistent nausea and vomiting, often accompanied by a loss of appetite, can be associated with liver enzyme diseases. Itchy Skin: Pruritus or itching, especially on the palms and soles, can be a symptom of liver diseases, as the liver plays a role in processing bile. Easy Bruising and Bleeding: Reduced production of clotting factors by the liver may lead to easy bruising and prolonged bleeding. Confusion and Cognitive Issues: Hepatic encephalopathy, a condition associated with severe liver dysfunction, can cause confusion, memory problems, and altered consciousness. Spider Angiomas: Formation of spider-like blood vessels on the skin's surface, particularly on the upper body, may be a visible sign of liver disease.
- Lifestyle Modifications: Alcohol Cessation: For alcoholic liver diseases, discontinuing alcohol consumption is paramount to prevent further liver damage. Weight Management: In cases of NAFLD, adopting a healthy diet and exercise regimen is crucial to manage weight and reduce liver fat. Medications: Antiviral Medications: In cases of viral hepatitis (e.g., Hepatitis B, C), antiviral drugs may be prescribed to control viral replication and reduce liver inflammation. Immunosuppressants: Autoimmune liver diseases may be treated with medications that suppress the immune system to alleviate inflammation. Nutritional Support: Dietary adjustments, including a low-sodium diet for fluid retention and a balanced diet rich in nutrients, are often recommended. Liver Transplantation: In advanced cases of liver disease or cirrhosis, liver transplantation may be considered as a life-saving option. Antioxidant Therapy: Antioxidants like vitamin E may be recommended for certain liver conditions to mitigate oxidative stress and inflammation. Management of Complications: Treatment focuses on addressing complications such as ascites (fluid buildup in the abdomen), hepatic encephalopathy, and variceal bleeding. Phlebotomy: For conditions like hemochromatosis, regular removal of blood (phlebotomy) is employed to reduce excess iron levels. Supportive Care: Symptomatic relief and supportive care play a crucial role in managing the symptoms associated with liver enzyme diseases. Monitoring and Follow-Up: Regular monitoring of liver enzyme levels, imaging studies, and clinical assessments is essential to track disease progression and treatment effectiveness. Clinical Trials: Participation in clinical trials may be an option, especially for individuals with advanced liver diseases, to explore new and innovative treatment approaches.