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Model for End-stage Liver Disease (MELD) & Ayurvedic Management

Abstract

There are many liver diseases which are caused by infections, obesity and misuse of alcohol. Due to long term liver disease it may lead to scarring and many serious complications. Liver is the body's second largest organ, which is present on the right side. The liver separates nutrients and waste and moves through the digestive system. It helps to produce bile and carries toxins out of the body and helps in digestion. Liver disease can cause cirrhosis (scarring) as it continues to replace normal liver tissue so it no longer functions properly and if left untreated causes liver cancer and liver failure. It can be caused by different types of liver disease such as Viral infections, inherited disease, consuming too much alcohol which further leads to fatty liver. Liver is a reddish brown wedge shaped organ with two lobes of unequal shape and size, it is the heaviest organ and largest organ of the body. The liver is connected with two large blood vessels: hepatic artery and portal vein. The hepatic artery carries oxygen rich blood from the aorta and the portal vein carries oxygen blood rich from GI tract and from spleen and pancreas. In the fetus a major source of blood to the liver is the umbilical vein which supplies nutrients to the fetus. It works as a dual blood supply where blood flows through the liver and empties in the central vein of lobules. The liver usually breaks down insulin and hormones. In this article we are going to discuss the end stage of the liver with its signs, symptoms and its ayurvedic management in detail.

Model for End-stage Liver Disease (MELD) & Ayurvedic Management

Introduction

Chronic liver failure is the end stage of liver disease, it is usually a result of cirrhosis where scar tissue replaces a healthy liver tissue until the liver cannot function properly. When patients have abnormal liver function and develop ascites, variceal haemorrhage, encephalopathy develops End Stage liver disease. MELD was originally developed following intrahepatic portosystemic shunt (TIPS). Cirrhosis is the late stage of scarring (fibrosis) of the liver and caused by many liver diseases and factors such as alcohol and hepatitis. When the liver get injured it repairs itself but when scar tissue forms and cirrhosis continues it becomes difficult for the liver to function (decompensated liver) and becomes life threatening. MELD is a scoring system for assessing the severity of chronic liver disease. The scar tissue blocks the flow of blood through the liver and slows down the ability of the liver to process nutrients, hormones, and natural toxins (poisons). Late stage of cirrhosis is a life threatening condition. MELD score estimates a patient's chances of surviving during the next three months, higher the range of MELD they are more likely to receive a liver from a donor whenever an organ becomes available. MELD is usually calculated on the basis of blood tests, such as internal normalized ratio, creatinine, bilirubin, serum sodium. Cirrhosis has many causes such as consumption of alcohol and hepatitis C causes liver damage.

Facts

  • Cirrhosis is a condition where liver slowly deteriorates and malfunction due to injury
  • In the United States, heavy alcohol consumption and hepatitis C are the most common causes of cirrhosis.
  • The goal of treatment is to stop progression of scar tissue and prevent complications.
  • Obesity is the main cause of cirrhosis
  • MELD score ranges from 6 to 40 relates to liver disease.
  • When liver functions are getting deteriorated it may develop many complications which are the first sign of liver disease.

Causes

  • Chronic alcohol abuse over several years causes chronic injury to the liver and cirrhosis, death caused by cirrhosis and obesity are increasing day by day.
  • Chronic Viral Hepatitis (hepatitis B, C and D) Hepatitis B D and is spread by infected person's blood and semen. Hepatitis C is spread by contact of infected blood and causes inflammation and further damage to the liver leading to cirrhosis.
  • Fat accumulation in liver (non alcoholic fatty liver disease) due to obesity, malnutrition and corticosteroid medications.
  • Poorly formed bile ducts (Biliary atresia)
  • Alpha 1 antitrypsin deficiency.
  • Inherited disorders of sugar metabolism (glycogen storage disease)
  • Autoimmune hepatitis
  • Infections such as Syphilis and brucellosis
  • Hardening and scarring of the bile ducts (primary sclerosing cholangitis)
  • Copper accumulation in the liver (Wilson's disease)

Symptoms

When a person doesn't have any symptoms is known as compensated cirrhosis, a person can survive with cirrhosis as the portal pressure in the vein is not too high. When the cause is hepatitis and it is left untreated the pressure in the portal vein increases. As the cirrhosis progresses the main symptoms are:

  • Weakness
  • Nausea
  • Weight loss
  • Vomiting
  • Spider Like blood vessels on the skin
  • Itching
  • Loss of appetite
  • Yellowish discoloration of the skin (jaundice)
  • For women there is absence of periods
  • In men there is testicular atrophy and gynecomastia)
  • Hepatic encephalopathy

Stages Of Cirrhosis

  1. Compensated cirrhosis- This is asymptomatic and imaging findings are not abnormal. Biopsy confirms the diagnosis of cirrhosis.
  2. Uncompensated cirrhosis- when compensation progresses to decompensation and gets worsen up, these complications become life threatening and can cause serious complications such as liver cancer. There is usually no sign of cancer but when the tumour becomes large and causes pain which show effects such as bleeding varices, encephalopathy, jaundice.

Complications

As the liver in cirrhosis becomes lumpy and stiff so the blood cannot flow properly and pressure gets filled up in the vein (portal vein). When this pressure is high in the vein known as portal hypertension. When a person develops cirrhosis the high blood pressure in the portal vein backs up in the other organ known as spleen which becomes enlarged and an excessive amount of platelets gets destroyed and starts to clot. As the entrance of blood gets blocked to the liver which is not enough for healthy cells to work properly, hepatocellular carcinoma also develops cirrhosis and starts to damage liver cells and develop many complications. Various complications are as follows-

  • High blood pressure in the veins that supply the liver (portal hypertension)
  • Swelling in the legs and abdomen
  • Enlargement of the spleen
  • Bleeding
  • Infections
  • Malnutrition
  • When toxins gets accumulated in the brain (hepatic encephalopathy)
  • Bone disease
  • Jaundice
  • Esophageal varices and gastropathy
  • Gallstones
  • The immune system gets dysfunction which causes lung and kidney failure.

Severity Of Cirrhosis Measured?

The model for end stage liver disease (MELD) score measures the severity of cirrhosis. It is based on three test,

  • International normalized ratio (INR) which tests the clotting tendency of blood
  • Bilirubin test- The amount of bile pigment in the blood
  • Creatinine test- kidney functions

Diagnosis

  • Laboratory tests
  • MRE (magnetic resonance elastography)
  • MRI
  • CT Scan
  • Ultrasound
  • Biopsy

Treatment

The main goal of treatment is to slow down the progression of scar tissue and prevent and treat the complication of cirrhosis.

  • Avoid alcohol
  • Patients with cirrhosis and nonalcoholic fatty disease may become healthy if they lose some weight and control their sugar level.
  • Medication to control hepatitis so it may limit the fuhrer damage to liver cells
  • Nutritional supplements must be prescribed so as to prevent cirrhosis and osteoporosis.

Treatment For The Complications Of Cirrhosis

  • Low sodium diet must be prescribed to prevent the fluid buildup in the body to prevent ascites and swelling.
  • Blood pressure medications to control the pressure in the veins which further prevent bleeding.
  • Various antibiotics to prevent infections
  • Certain medications to reduce the build up of toxins and manage the poor supply of blood.

Ayurvedic Management

Ayurveda describes three doshas vata, pitta, kapha as their life forces. When there is imbalance in any of the doshas it causes health problems. Liver disease is mainly due to imbalance in pitta dosha of the body, when there is aggravation in any doshas it leads to liver disease. When rasa and rakta dhatus are intoxicated all the dhatus get weak. Excessive bile production and blockage in flow of bile indicates high pitta doshas affects the agni and absorption which further is responsible for absorption, digestion and metabolism. If jaundice and hepatitis remains untreated then it produces dryness and roughness to the liver, malfunctioning of the organ. Yakrit means liver and vikara refers to disorder and disfigurement.

Causative Factors

  • Alcohol intake
  • Suppression of the natural urge
  • Day sleep (divaswapna)
  • Guru abhishyandi bhojana (heavy and blocking agents)
  • Night awakening

Treatment

  • Deepana
  • Pachana (digestives)
  • Laxatives
  • In panchkarma
    1. Vamana and virechana are helpful in treating liver disorders; it helps to detoxify the toxins and move out of the body.
    2. Samshamana- Various drugs are effective for the treatment of liver diseases.
    3. Kayakalpa (rejuvenation) is very beneficial in improving liver health and preventing further damage.

Pathya-Apathya

Pathya

  • Vamana, virechana
  • Purana sali, yava
  • Punarnava, ripe mango, haritaki, amalaki and gomutra
  • Buttermilk
  • Daha and agni karma

Apathya

  • Rakta mokshana
  • Dhumapana
  • Residing in hot climates and exposure to sun, anger
  • Amla rasa and guru vidhai padartha
  • Contaminated water, non hygienic diet

Herbs Useful For Liver Disease

1. Punarnava

Punarnava (Boerhavia diffusa) is an excellent anti-aging herb, helps to relieve inflammation and swelling. Punarnava has madhura (sweet), tikta (bitter) taste. Helps to balance kapha and vata doshas. It helps to reduce swelling and is helpful in liver disease. Punarnava is diuretic and helps to maintain high blood pressure. It is used in hemorrhoids and in chronic toxic conditions. They have anti-inflammatory, analgesic and rejuvenative properties.

2. Guduchi

Guduchi (Tinospora cordifolia) is a useful herb in the treatment of diabetes, jaundice, and cardiac disorders. It has rejuvenative properties, improves strength and helps to relieve excessive thirst and burning sensation in the body. It is very helpful in the treatment of liver disorders and gout arthritis. Guduchi helps to improve vision and is useful in eye disorders and has aphrodisiac properties.

3. Pippali

Pippali (Piper longum) helps to balance vata and kapha doshas. It has katu (pungent) taste and has a hot potency. Wet fresh long pepper increases the kapha dosha and balances the pitta doshas, helps to relieve cold and cough, and is useful in piles and haemorrhoids. Pippali helps to improve digestion, and is good for throat disorders used in asthapana basti.

Herbal Remedies By Planet Ayurveda For End Liver Disease

Planet Ayurveda is an ayurvedic manufacturing company that makes its products purely from plant extract, no animal products are used, It has many branches overseas. Planet ayurveda is a GMP certified, USA-FDA registered and ISO 9001:2015 certified ayurvedic company. The whole formulations are made according to ancient ayurvedic texts, The products made are free from any preservatives and additives. The ingredients are pure without any adulteration of any kind. They cause no side effects on one's life and are safe to use. Planet Ayurveda formulated LIVER CARE PACK (DOUBLE STRENGTH) for liver disease which is very useful and is an effective remedy.

Products List

Liver Care Pack (Double Strength) Inlcudes:-

  1. Yakrit Plihantak Churna
  2. Indian Echinacea Capsules
  3. Phyllanthus Niruri Capsules
  4. Liver Detox Formula
  5. Arogyavardhini Vati
  6. Yakrit Plihari Loha
  7. Livo Plan Syrup

Dosage / Usage

  1. Yakrit Plihantak Churna - You can boil the powder 1 teaspoonful in 400 ml water, keep it boiling until it remains 50 ml. Strain it and drink the water. Leave the residue. Do it twice daily. Make fresh every time.
  2. Indian Echinacea Capsules - 2 Capsules twice daily after meals with warm water.
  3. Phyllanthus Niruri Capsules - 2 Capsules twice daily after meals with warm water.
  4. Liver Detox Formula - 2 Capsules twice daily after meals with warm water.
  5. Arogyavardhini Vati - 2 Tablets twice daily after meals with warm water.
  6. Yakrit Plihari Loha - 1 Tablet twice daily after meals with warm water.
  7. Livo Plan Syrup - 2 Teaspoonful twice daily after meals.

Products Description

1. Yakrit Plihantak Churna

Yakrit Plihantak Churna is herbal powder which is formulated by Planet Ayurveda using ingredients such as Bhumiamla (Phyllanthus niruri), Kaasni (Cichorium intybus), Kalmegha (Andrographis paniculata) and many more. This churna helps to improve the functions of the liver, removing the toxins out of the body. Yakrit Plihantak Churna helps to regenerate the liver and prevents liver failure. Balances tridoshas. It helps to improve hormonal imbalances and constipation.

2. Indian Echinacea Capsules

Indian Echinacea are single herbal capsules formulated by Planet Ayurveda using single extract of Indian Echinacea (Andrographis paniculata). It is a natural blood purifier, used in liver and kidney disease. It builds up resistance to cold and infections and helps to increase the number of white blood cells and fight against cancer cells. It is highly recommended in herpes, throat infections and vaginal yeast infections.

3. Phyllanthus Niruri Capsules

Phyllanthus Niruri are single herbal capsules consisting of Bhumiamla (Phyllanthus niruri). It possesses hepatoprotective, antihypertensive properties. It is used in the treatment of urinary calculi. These capsules are an excellent remedy for jaundice, alleviates cough and relieves asthma. It is acting as a digestant, liver stimulant and useful in enlargement of liver.

4. Liver Detox Formula

Liver Detox are poly herbal capsules formulated by planet ayurveda using ingredients like Katuki (Picrorhiza kurroa), Makoy (Solanum nigrum), Kasni (Cichorium intybus), Jhavuka (Tamarix gallica) and many more. These capsules help to maintain the liver, it has katuki which is highly beneficial in treating cirrhosis and in many liver diseases. Used in the treatment of dyspepsia, strengthens the stomach and improves appetite and is helpful in treating constipation.

5. Arogyavardhini Vati

Arogyavardhini Vati are herbal tablets formulated by planet ayurveda using ingredients such as Haritaki (Terminalia chebula), Shudh Shilajit (Asphaltum), Shuddh Guggul (Commiphora mukul) and many more. These tablets are used in balancing all tridoshas, helpful in treating diseases related to liver, thyroid, acts as a digestive stimulant and further improves the function of the digestive system. It has both antibacterial and antiviral properties which help in all types of liver disease such as in hepatitis, jaundice and fatty liver.

6. Yakrit Plihari Loha

Yakrit Plihari Loha is herbal tablets formulations prepared by planet ayurveda using ingredients such as Loha bhasma (Iron), Shilajit (Asphaltum), Nirgundi (Vitex negundo), Bhringraj (Eclipta alba) and many more. It helps to balance tridoshas in the body, used in all types of fever, ascites, jaundice and in the condition of indigestion. These tablets are efficient in liver and spleen disorders.

7. Livo Plan Syrup

Livo Plan syrup is herbal syrup formulated by planet ayurveda using ingredients such as Shyonak (Oroxylum indicum), Rohitaka (Tecomella undulata), Patol (Trichosanthes dioica) Sharpunkha (Tephrosia purpurea) and many more. This syrup helps to regenerate liver cells and protect the liver from any toxins. It helps to remove the toxins out of the body and makes the liver healthy.

Conclusion

The liver is the body's second largest organ, which is present on the right side. The liver separates nutrients and waste and moves through the digestive system. Chronic liver failure is the end stage of liver disease, it is usually a result of cirrhosis where scar tissue replaces a healthy liver tissue until liver cannot function properly. MELD was originally developed following intrahepatic portosystemic shunt (TIPS). Liver disease is mainly due to imbalance in pitta dosha of the body. In this topic we discussed the Liver Care Pack (Double Strength) which provided great relief to patients without causing any side effects.

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Reviewed By:

Best Ayurvedic Doctor in Mohali - Dr. Vikram Chauhan

Dr. Vikram Chauhan

MD (AYURVEDA)

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