Monday 27 May 2019

Ask the Doctor: My husband drinks and he's ignoring his enlarged liver

Once fibrosis and scarring occurs it is irreversible and potentially fatal
Once fibrosis and scarring occurs it is irreversible and potentially fatal

Nina Byrnes

Question: During a routine medical exam, my husband was told that he has an enlarged liver. He is refusing to take this piece of information seriously, even to the point where he won't discuss it with his GP. He's overweight and likes his pints. Is this a serious problem and what does he need to do to help himself?

Answer: healthy liver contains little or no fat. Alcohol excess and obesity result in damage to the liver. In the first stage fat levels increase above 5pc. Early on there is no visible liver damage and this is referred to as simply fatty liver. This is one of the most common forms of liver disease. It has been estimated that over a quarter of adults in the UK may have this condition. It is likely numbers are similar here. Fatty liver slowly builds up when a person's intake of fat exceeds that expended. Simply fatty liver may not cause any damage, but once a liver has a build up of fat it becomes more susceptible to further injury, which could lead to inflammation and scarring. About 75pc of those who are obese are at risk of simple fatty liver.

In up to 23pc of people who are obese, the fat build-up may lead to inflammation and swelling of the liver, a condition called Non-Alcoholic Steatohepatitis (NASH). Liver function tests may be abnormal and there may be symptoms, such as abdominal pain, fatigue and malaise. Those who have type 2 diabetes, high cholesterol, high blood pressure, are over age 50 and those who smoke are at an increased risk of developing the more serious NASH. Alcohol also causes similar damage over time so obesity and excess alcohol combined is a particularly risky combination. The third step in this disease is shrinking and scarring of the liver causing fibrosis then cirrhosis.

Lifestyle is key in all health prevention and it's never too soon to start. Eating a healthy diet, maintaining a healthy weight, avoiding smoking and keeping alcohol to less than 17 standard drinks a week will go a long way. Leading a healthy lifestyle can reverse simple fatty liver and help control NASH. Gradual weight loss of about 1kg a week is beneficial. Rapid weight loss diets are not recommended as these can in fact lead to a build up of fat in the liver making matters worse. Weight loss of 5pc to 10pc of body weight is advised. Those who have diabetes or high cholesterol should make sure these are well controlled.

Men die on average five years younger than women; they have higher death rates than women for all of the leading causes of death. Why is this exactly? Men mainly attend doctors when prompted to by their partners or when symptoms have a significant impact on their quality of life. As a result disease when diagnosed is more likely to be at an advanced or untreatable stage, thus leading to the poor statistics above. Your husband really needs to take his recent diagnosis seriously, as once fibrosis and scarring occurs this is irreversible and potentially fatal. We only have one liver.


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