Liver disease that requires your attention

Four months ago I attended to a 56-year-old patient from Chamwino district in Dodoma region who had been brought to the hospital due to swelling of her abdomen.

Her problem was reported to have begun gradually but it went on progressively. I was told that at first, she used to complain that she felt something hard in the left lower part of her abdomen below the umbilicus.

On arrival at the hospital, I examined her and elicited more findings that gave me a clue that something was wrong with her liver. Her veins on the abdomen were distended and her feet were swollen (oedema).

After a battery of tests, she was then diagnosed with a liver disease known medically as liver cirrhosis. “Doctor, am I going to recover?” that was her first question when she was told about her diagnosis.

Such conditions are uncommon

To me, it was uncommon to meet a patient with liver cirrhosis in Dodoma—practically on a weekly basis. However, it was very unfortunate that most of them came to the hospital late—at a time when the liver disease was too complicated to deal with. Liver cirrhosis is a complication that normally involves loss of liver cells. Worse enough, it also involves unruly and irreversible scarring of the Liver.

Blamed on alcohol

In Tanzania the most common cause of liver diseases is alcohol. In rural areas, people are under abject poverty but they still afford buying local brews. At times, they don’t have money but they will strive and exchange maize or any possession available at home with alcohol.

In most urban areas that I have travelled to, and others where I have lived, drinking beer and other spirits in casinos and bars is the order of the day.

Hepatitis, certain chemicals may be a cause

But, in principle, the causes of liver cirrhosis include hepatitis B and C, abuse of some medicines and exposure to certain chemicals.

Currently, health care workers are being vaccinated against hepatitis since it easily spread through fluid contacts and doctors are more prone to the occupational risk.

I still remember very well one of the young doctors who died of hepatitis B in 2015 at one of the district hospitals in Tanzania. It was a sad moment.

Before that, vaccination against hepatitis B was mainly given to infants, in combination with other vaccines abbreviated altogether as “PENTAVALENT” vaccines.

Liver cirrhosis can cause general body weakness, loss of appetite, yellowish coloration of the eyes sometimes the whole body, easy bruising, sometimes itching, and swelling of the abdomen.

Occasionally, the person may experience bleeding from esophagus due to complications plus long standing liver disease symptoms, such as muscle wasting, redness of the palms, small spider like veins in the skin, breast enlargement and shrinking of testes.

Is it diagnosed properly in Tanzania?

This condition can be diagnosed by using an ultrasound, however, it is suggested that a definitive diagnosis be made through microscopic examination of tissue. This, unfortunately is not done in rural hospitals in Tanzania.

In the management of liver cirrhosis, good nutrition is vital plus alcohol abstinence, but most of the clients are not willing to abide by that. Most of them usually blame their illness to witchcraft so they don’t seek modern medical care. They simply go to traditional healers.

Due to economic challenges, most people cannot afford buying medications.

During treatment of this condition doctors do sometimes require to removal of fluid from the body in a procedure called “paracentesis.”

The procedure involves replacement of lost proteins /albumins in the body. This is because, liver cirrhosis may cause the body to have reduced amount of albumins/proteins. This requires replacement.

But the infusion of the proteins is very expensive and unavailable in most upcountry regional health facilities, including Dodoma. I have seen some in Dar es Salaam, at an exorbitant price of more than Sh50,000 for a single infusion. A patient has to undergo several infusions.

There is also the lack of endoscopic tests that are needed to diagnose the patient, especially when he/she is bleeding, however, all tertiary hospitals in Tanzania can offer this endoscopic test.

Sadly, there is no complete cure for liver cirrhosis. However, liver transplantation may help the patient.

The good news is that if detected early, it could be arrested in the early stages, if one stops taking alcohol.