What is liver disease? What is pancreatic cancer? What are liver tumors

How do I get treatment?

For further information and appointments please see the below contact numbers:

For Mr Rob Hutchins:

020 7234 2940

For the following Consultants:

020 7234 2730

Professor Nigel Heaton
Mr Parthi Srinivasan
Mr Andreas A. Prachalias
Dr Phil M. Harrison
Dr Michael Heneghan

Treatment for Liver Disease, London

What is Hepatitus C?

If a person suffers from Hepatitus C over time their healthy liver cells will be replaced by increasing amounts of scar tissue and the liver becomes cirrhotic, loses shape and fails to do it’s normal job. About 16 – 20% of people with chronic HCV develop cirrhosis over a period of 20 years or more.

When cirrhosis is severe, the damage causes your liver to gradually stop working. This is known as liver failure and the only treatment for this is a liver transplant.

Why is it important to attend a specialist hepatitis clinic?

Chronic HCV is a progressive disease and however well you feel it is important to attend a specialist clinic, so that your disease can be checked and to asses you for treatment.

It is important to measure any progression of cirrhosis, which describes severe scarring of your liver. Instead of the liver being pink and smooth, it will look lumpy and have an uneven outline and it may not work as well as a healthy liver

Some people have what is known as well-compensated cirrhosis which you can have for 10 – 40 years without having any problems and have the same life expectancy as someone who is healthy and who does not have the condition.

If you have what is known as decompensated cirrhosis, again your liver will not be working as well as it should.

This causes complications which require medical help including:

  • A build up of fluid that causes your ankles and abdomen to swell up (ascites)

  • Encephalopathy and confusion which is made worse if you are constipated or dehydrated, or if you also have a bacterial or fungal infection

  • Jaundice, which causes yellowing, particularly the whites of your eyes as well as the skin

  • Oesophageal varices – varicose veins in your gullet (which is the tube which takes food from your mouth to your stomach) which may bleed. If you vomit blood, this is a medical emergency and you should go immediately to your nearest Emergency Department

How is liver scarring measured ?

By fibroscan. A completely painless outpatient procedure similar to an ultrasound. The greater the liver tissue stiffness score, then this indicates the greater the degree of liver scarring.

By liver biopsy which is a procedure when a very small sample of your liver cells are examined at under a microscope to determine the amount of inflammation and scar tissue present.

Following the results, your doctor will advise follow up at least every six months with an ultrasound scan to check for any progression of disease.

It may also be recommended that you have an endoscopy- this procedure allows a surgeon to carry out a visual inspection of the interior of the stomach without making an incision. Requiring only mild sedation, an endoscope (a small, highly flexible tube with a minute video camera at the end) is passed through the mouth and into the stomach to check for any oesophageal varices which may develop as a complication of cirrhosis. These tests allow early detection and treatment of any potential complications.

Routine blood tests performed:

Blood clotting studies

Your liver helps to make substances that cause blood to clot (clotting factors). When you have liver damage, clotting may be affected. This test shows how well the liver is carrying out this function.

Blood chemistry

How well both the cells in our body are supplied with electrolytes such as potassium, sodium, calcium, phosphate and glucose as well as how well your kidneys are working. Electrolytes are substances in your blood that are essential to your cells to produce energy. If liver damage becomes worse the kidneys may also be adversely affected.

Full blood count

This shows us the haemoglobin levels and the number and quality of red and white blood cells in your body. The amount of haemoglobin in your blood tells us how well your blood cells are able to carry oxygen to your tissues. A low level may make you feel tired and lack in energy. Too many white cells may indicate an infection, while too few red cells with a low haemoglobin level may suggest that you are bleeding internally. The number of platelets in your blood gives us another indication of how well your liver is working.

Hepatitis B surface antigen (ABsAg)

This shows if a hepatitis B infection is present. This is important, as a positive test showing that you have two viruses may indicate that fibrosis of your liver may happen at a faster rate.

Liver function tests

This measures several separate markers that can tell us how well your liver is working in addition to how inflamed or damaged it is.

Viral load, HCV RNA

Shows the number of viral RNA particles in the blood, which indicate how active the infection is. This test is invaluable for monitoring the response to treatment

Viral Genotype

Determines which type of HCV virus you have. There are six types of hepatitis C virus – these are known as genotypes. Each genotype has subtypes labelled a, b and c., they are usually specific to a geographical area:

Genotype 1 Europe/North Africa
Genotype 2 or 3 Europe/North America, Far East and Australia
Genotype 4 Middle East
Genotype 5 Australia
Genotype 6 Rare

The type of viral genotype you have can affect your response to treatment and how long treatment is needed for.

Antiviral treatment for HCV

Effective antiviral therapy is available for hepatitis C. This consists of weekly injections of Pegylated Interferon and Ribavirin tablets. The two medications taken together are known as combination therapy and these will be prescribed according to your genotype and the stage at which your disease is at.

The treatment may need to be taken for some considerable time and it can cause side effects such as:

  • Being more likely to catch other infections
  • Blood sugar problems
  • Difficulty sleeping, low mood, depression
  • Fatigue
  • Fever
  • Headaches
  • Muscle aches and joint pains
  • Skin problems
  • Thyroid gland problems

Ribavirin can cause anaemia and is toxic to unborn children, and it is for this reason that a patient on starting this therapy is advised not to either become pregnant or to father a child during treatment and for at least six months after finishing treatment.

It is also essential that the patient is regularly monitored whilst on antiviral therapy with blood tests and regular clinic visits.

How can HCV be given to others?

There is no vaccine available to prevent hepatitis C from being passed to another person. However, the following precautions will help:

  • Clean all blood spills yourself with undiluted bleach or carpet disinfectant. Hepatitis C can live outside the body for up to a month
  • Dispose of dressings in two bags – one inside the other – to make sure that no-one can accidentally come into contact with them
  • Do not share toothbrush, razors, hair clippers, nail clippers or scissors, sponges or towels.
  • Keep cuts covered and clean
  • Use a condom during sexual activities