＜要旨＞　肝臓は、感染症と戦ったり、毒物やアルコールを分解したり、血液を浄化したり、コレステロールをコントロールしたりする重要な仕事をしています。 肝臓病は致命的であるうえ、手遅れになるまで兆候や症状を示すことはめったにありません。The liver carries out essential work fighting infection, destroying poisons and alcohol, cleaning the blood and controlling cholesterol. Liver disease can be fatal and rarely shows any signs or symptoms until it is too late.

By Maria Gertrudes P. Axibal, MD MMHA, COO-President, Angelus Medical Clinic

A seafarer in his mid-thirties, examined for the fourth time at Angelus Medical Clinic under the UK P&I Crew Health Programme, was rated 'pending' for elevated liver enzymes. He was given a temporary unfitness status after an additional ultrasound showed Diffuse Parenchymal Liver Disease.

Alcohol drinking, commonly expressed as an "occasional social drinker" on a PEME record, provides a continuing trial for the examining physician.

Following inspection by the attending Gastro Intestinal Specialist, the seafarer mentioned above was diagnosed as a heavy alcohol drinker for at least eight years, contrary to his disclosure at the time of his pre-employment medical exam (PEME). He received an official diagnosis of Alcoholic Hepatitis, and was prescribed medication twice daily for at least six months, including total alcohol abstinence.

Many similar cases are missed when there are no signs or symptoms (e.g. fever, jaundice, nausea, vomiting, right side abdominal pain below the ribs, and tenderness).The challenge for examining physicians is to continue the awareness campaign to minimise the alcohol drinking habit. Failure to control alcohol intake and modify lifestyle can result in End-Stage Liver Disease.

Signs of liver disease

Appearance of signs and symptoms vary depending on the stage of liver disease. Acute Hepatitis A manifests with flu-like symptoms, nausea, vomiting, loss of appetite, yellow eyes (jaundice), dark brown urine and pale to clay-coloured stools and fever. Known Hepatitis B carriers, including newly diagnosed cases at the PEME, are usually symptom-free. Likewise, incidental Fatty Liver cases remain asymptomatic.With advanced  or End-Stage Liver Disease (Cirrhosis), liver cells turn to scar tissues and presents as bleeding gums, confusion, enlarged breasts in men, and fluid accumulation in the abdomen and legs.

Treatment

Hepatitis A is a self-limiting disease, and as soon as you recover, you gain permanent immunity. Hepatitis B and C patients, when diagnosed at the PEME, are referred to medical specialists for management. Known Hepatitis B carriers showing evidence of viral activity are treated with anti- viral medication. Hepatitis C is treated by prescription medication, which can last for around six months. Drug- induced Hepatitis and Fatty Liver are addressed effectively by lifestyle modification. No specific treatment is recommended for mild Alcoholic Hepatitis. Seafarers are simply advised to stop drinking alcohol.

Protecting your liver

• Why suffer treatment when you can be vaccinated against Hepatitis A or B?
• Observe proper hygiene. Drink safe bottled water on your travels.
• Have your own personal grooming items, like nail clippers and razors.
• Observe a low fat, low carbohydrate diet, and monitor your weight.
• Eat food that is good for the liver: cruciferous vegetables like broccoli, cabbage, kale and rocket.
• Avoid medicines that are harmful to the liver, like statins and cholesterol- lowering drugs.
• Abstain from alcohol. Heavy drinking can lead to irreversible liver damage or Alcoholic Liver Disease.