Liver Disease Off The Grid: Hepatitis

 

There are various diseases that may confront the caregiver in off-grid settings. Some affect the entire body, but others affect a particular organ in the body. Today, we’ll talk about the human liver and the most common disease associated with it: hepatitis.

Although the body’s largest organ is the skin, the largest internal organ is the liver. The reddish-brown liver is located in the upper right-hand portion of the abdominal cavity under the diaphragm at the bottom of the rib cage, and over the GI tract and right kidney. It’s somewhat cone-shaped and weighs about three pounds.

The liver is so important for survival that impairment in its function can be life-threatening. The liver has many duties, including:

• Production of bile, a fluid needed for digestion and absorption of fats in the small intestine.
• Filtration of certain toxins from the blood (for example, alcohol).
• Storage of certain vitamins and minerals like vitamins A, B12, D, E, K, iron, and copper.
• Regulation of amino acids needed to make proteins.
• Maintenance of normal levels of glucose (sugar) in the blood by storing and releasing it as needed.
• Production of cholesterol (yes, you need cholesterol).
• Production of urea from toxic substances like ammonia, which is then excreted by the kidney.
• Processing of old red blood cells.
• Production of certain hormones.

PERFORMING A LIVER EXAM 

 

If the liver is diseased, it can become enlarged and tender. This compromises its ability to perform functions like helping your body eliminate toxins, digest food, store energy, and more. The off-grid medic should know how to evaluate the liver on exam.

-The simplest way of evaluating the liver involves standing on the right side of the patient as they lie flat on their back. Use one (or two, if obese) hands starting at the right side of the belly button.

-Slowly and gently press downward as the patient takes a deep breath to see if you can feel the solid edge of the liver.

-Move upwards, each time during the patient’s deep breath, until you are just under the lowest rib.

-In a normal-sized liver, you likely won’t feel it at all or, perhaps, barely feel it under the rib during the deep breath. If you can feel it without difficulty during this process, it is likely enlarged.

LIVER INFLAMMATION

Hepatitis is the term used for inflammation of the liver. Mostly caused by viruses, this condition disrupts the body’s ability to process toxins and can be life-threatening.

Besides viral infections, alcohol abuse and certain drugs (even acetaminophen/Tylenol) can also lead to hepatitis, especially if used excessively over time. Chronic liver diseases and autoimmune conditions like autoimmune hepatitis can also cause liver inflammation.

SYMPTOMS OF HEPATITIS

jaundice

Symptoms can range from none at all to life-threatening. The hallmark of hepatitis is jaundice, a yellowing of skin and eyes that occurs due to an excess of a yellowish substance called “bilirubin” in your system. Bilirubin is formed by the breakdown of old red blood cells in the liver. A healthy liver eliminates bilirubin as part of this process.

Other symptoms may include:

• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Fever
• Dark-colored urine and
• Pale greyish bowel movements
• Stomach pain
• Itching
• Muscle and joint aches
• Fatigue
• General ill feeling (also called “malaise”)

TYPES OF HEPATITIS

There are various types of hepatitis, listed as A, B, C, D, and E. Each has its own characteristics, but many symptoms are similar. Some types are related to poor hygiene, others from poorly prepared food or contaminated water; some are even transmitted sexually. All are contagious and have the potential to cause liver dysfunction and, perhaps, long-term scarring.

HEPATITIS A

Hepatitis A virus is caused by oral-fecal contamination; it can be gotten, for example, by drinking water that has particles from the bowel movements of infected individuals. It begins as a flu-like syndrome, then quickly manifests many of the symptoms mentioned above two to six weeks after exposure. It can also be transmitted sexually.

In survival, failing to properly purify water can cause an epidemic of Hepatitis A. In normal times, a restaurant employee who doesn’t wash his hands after using the bathroom can pass the disease along to customers.

Hepatitis A usually gets better without treatment after a few weeks. Interestingly, children rarely get symptoms, while 80% of adults do. In areas at risk, a vaccine is available.

HEPATITIS B

Hepatitis B can be spread by exposure to infected blood products, semen, and vaginal fluids. Symptoms are usually indistinguishable from Hepatitis A.

Hepatitis B, however, may cause scarring in the liver that leads to a chronic condition known as “cirrhosis.”  In cirrhosis, the functioning cells of the liver are replaced by non-functioning nodules. Cirrhosis may also be caused by long-term alcohol or drug abuse. Besides jaundice, the condition can lead to “ascites”, an accumulation of fluid that causes swelling of the abdomen, swollen legs, and other symptoms.

HEPATITIS C

Hepatitis C can cause acute or chronic infection, and is seen most often in older individuals. It may be contracted by intravenous drug use, transfusion, and unsafe sexual practices. A percentage of these patients will progress to cirrhosis over time and, sometimes, complete liver failure. A vaccine is now actively promoted by the government that may protect infected individuals from future damage.

HEPATITIS D

The hepatitis D virus is unusual because it seems to only occur in those with an active Hepatitis B infection. In tandem, the two viruses cause a significant “superinfection.”

HEPATITIS E

Hepatitis E is typically an acute infection that is sometimes associated with eating poorly cooked pork or wild game. It is self-limited, which means that it gets better without treatment after several weeks. Some types of hepatitis E virus are spread by oral-fecal contamination similar to Hepatitis A.

NATURAL SUPPORT FOR THE LIVER

There are a few detoxifying and anti-inflammatory herbal remedies that may help support a liver afflicted with hepatitis. Some of these supplements include:

• Milk Thistle
• Artichoke
• Dandelion
• Turmeric
• Licorice
• Red Clover
• Green Tea

These aren’t cures, but may assist your other efforts by having a restorative effect. Nutritional strategies that may have a beneficial effect:

• Avoid fatty foods and alcohol
• Increase zinc intake
• Decrease protein intake
• Improve hydration status, especially with herbal teas, vegetable broths and diluted vegetable juices.

PREVENTION AND TREATMENT OF HEPATITIS

Off the grid, the family medic won’t have modern medical technology, but they can still help the patient recover. It’s important to make them comfortable by encouraging rest, assuring hydration, and giving antihistamines like diphenhydramine as needed for itching.

The vigilant medic can, however, practice good preventive medicine by encouraging the following policies:

• Wash hands after using the bathroom and before preparing food.
• Wash dishes with soap in hot water.
• Avoid eating or drinking anything that may not be properly cooked or filtered.
• Make sure children don’t put objects in their mouths.
• Use condoms to avoid sexual transmission.
• Don’t share personal items, if at all possible, like toothbrushes or razors with infected persons.

Although viral diseases are difficult to treat off the grid, many can be prevented with a plan action. Focus on prevention and you’ll help ensure your people will keep it together, even if everything else falls apart.

Joe Alton MD

Dr. Joe Alton