You have one liver, take care of it
Common symptoms of the disease include fatigue, fever, poor appetite, nausea and vomiting, stomach pain and diarrhoea.
What you need to know:
Aga Khan University Hospital introduces new liver monitoring machine
The Aga Khan University Hospital has introduced a simple non-invasive ultrasound-based technique for the diagnosis and monitoring of liver disease (i.e. scarring). The technique, known as liver elastography, is a simple, safe and efficient way to estimate liver scarring.
Dr Sudhir Vinayak, Chair, Department of Radiology at the hospital and also chair of the Kenya Society for Ultrasound in Medicine and Biology (KESUMB), said that this assessment of liver scarring provides prognostic information and assists in establishing treatment priorities for patients.
What is liver elastography?
Liver elastography is technique of assessing the hardness (or stiffness) of the liver. Liver hardness is evaluated by measuring the velocity of a vibration wave generated on the skin and estimating the time it takes to travel through a particular depth of the liver.
Because fibrous tissue is harder than normal liver, the degree of liver fibrosis can be inferred from the liver’s hardness.
How is the test performed?
With the patient lying on their back, an ultrasound probe is placed on the skin over the liver area and 10 measurements of the liver stiffness acquired. The test takes around 10 minutes and causes no discomfort. No preparation is required for this examination.
Who can benefit from liver elastography?
People who have had any form of liver infection. Hepatitis B and C are the two main causes of chronic liver disease that may result in increased liver stiffness. Patients with chronic alcohol abuse and fatty liver would also benefit from this examination.
Why is it important?
The more fibrosis and scarring occur, the higher the liver stiffness reading will be. This reading may be used to: Estimate the existing degree of liver damage; monitor disease progression or regression via serial measurements; and inform prognosis and further management,
When Faith Juma was diagnosed with Hepatitis B at the age of 24, she was thoroughly shaken.
“I felt my life was over. I could remember the patients who came to come to the hospital and were told to take glucose and sugar,” says the nurse.
“Those days, when the doctor told you he or she could not give you any specific treatment, you knew your days were numbered.”
Hepatitis B is a liver disease caused by the Hepatitis B virus, which enlarges the liver and hampers its functioning.
Common symptoms of the disease include fatigue, fever, poor appetite, nausea and vomiting, stomach pain and diarrhoea.
Some people also have dark yellow urine, light-coloured stools and yellow eyes and skin.
UNSTERILISED MACHINES
However, not everyone shows symptoms. Three out of 10 people who get Hepatitis B develop chronic hepatitis and suffer liver failure, cirrhosis, or even cancer. The other seven will heal completely.
Hepatitis B is highly infectious, and is transmitted through sex, sharing needles, toothbrushes, razors or nail cutters, or through unsterilised machines in salons and barbershops. An infected woman can also pass on the disease to her baby during delivery.
“I was a nurse but didn’t know much about hepatitis, so you can imagine how little the public knew; and the situation hasn’t changed. People have no clue about hepatitis B,” says Faith, addin that she got the disease from a patient.
She eventually returned to work, but suffered relapses and was admitted to hospital due to fatigue and abdominal pain. Her supervisor arranged for her to go for treatment abroad but she could not, since there was no one to take care of her daughter.
WOULD IMPROVE
At around that time, doctors began noticing that a number of HIV patients also had Hepatitis B.Even more remarkable was that during HIV treatment, the patients’ symptoms of Hepatitis B would improve.
That marked a breakthrough in the treatment of chronic hepatitis B, and between the late’80s and the ’90s, more hepatitis B patients were given HIV drugs. However, this breakthrough was short-lived as most of the patients developed resistance to the drugs, rendering them ineffective.
Faith had heard of this breakthrough in Kenya and wanted to try it out, but she was held back by her mentality”.
“I believed I could get better treatment abroad than at home. I felt they were more advanced. Today, I feel Kenya has advanced enough to take care of me and other hepatitis patients,” she says.
According to the Gastroenterology Society of Kenya, at least 10 per cent of Kenyans have Hepatitis B and three per cent have liver disease. Statistics indicate two age peaks: Children between the ages of seven and 12, and youth between 18 and 25 years.
ALCOHOL IN MODERATION
In the former, it is contracted most likely through contact with sharp objects while playing and exchange of blood, while in the latter is attributed to sexual activity.
About 90 per cent of people with Hepatitis B do not even know they have the disease, since the symptoms are not significant enough to warrant medical attention.
“Ideally, all patients should be screened for hepatitis B, and this is what we, as doctors, are pushing for,” said Prof Godfrey Lule, a Nairobi-based gastroenterologist during the launch of the Kenya Guidelines on the Management of Chronic Hepatitis B and C in February.
The guidelines provide information on the progress made in the management of Hepatitis B and Hepatitis C.
“The only way to reduce the risk of getting hepatitis B is to change your lifestyle. Mother’s should ask doctors to vaccinate their children against Hepatitis B.
“Never have unprotected sex or engage is risky sexual behaviour. Take alcohol in moderation since excessive alcohol can speed the progression of Hepatitis B,” he added.
MORE THAN SH100,000
His fellow gastroenterologist, Dr Betty Musau, suggested that those without the disease be vaccinated. Over the years, the treatment of Hepatitis B has been mostly supportive, and the outlook has not always been good.
But the guidelines give hope that having Hepatitis B is not a death sentence. They indicate two courses of treatment: interferon injections and oral drugs.
While interferons build the body’s immunity, oral drugs attack the virus. The aim of these treatments is to prevent or delay the onset of liver cancer.
A quick market survey indicates that the monthly injections cost more than Sh100,000, which translates to more than Sh1,000,000 for the 11 months of treatment. Although more effective, the injections should not be given to the elderly.
Meanwhile, the oral drugs cost Sh5,000 per dose. But the challenge is that they must be taken for life.
Hepatitis infection is the major cause of liver cancer — the fifth common cancer in Kenya —contrary to the belief that alcohol is to blame. “You only have one liver, take care of it,” advised Dr Musau, adding that it is extremely difficult to get a new liver.
DREAMS INTACT
Besides, there are no proper liver transplant programmes in Kenya or East Africa. The procedure is mainly carried out in India, the UK and US and the cost can be anywhere between Sh5 million and Sh50 million, depending on where it is done.
The high costs are attributed to the complexity of the procedure and post-surgery management.
But advancements in treatment continue. Recently, the US Food and Drug Administration agency approved new types of antiviral tablets that eradicate the virus after three months in about 70 per cent to 90 per cent of patients.
The treatment is estimated to cost between Sh7 million and Sh18 million. The big question is, when will it reach Africa?
It might be coming late for Faith but she is glad just to be alive. “I am a survivor. Some of the doctors who told me I had a few months to live have died. I am happy with where I am.
There are days when I think, ‘why do I have to go through this’ but most of the time I try not to dwell on it. These are the cards I’ve been dealt and I have to play my best with them. Hepatitis doesn’t have to mean your life is over. You can still have your hopes and dreams intact,” she says.
