- 3 weeks ago
Dr. Latt explains why liver disease is often considered a “silent” disease, with many people experiencing few or no symptoms in the early stages.
Category
📚
LearningTranscript
00:01Hi, it's Nicole from 92.5 XTU and Marissa Magnata from the Preston and Steve show on 93.3 WMMR.
00:08And Dr. Lott is a board certified transplant hepatologist for virtual advanced transplant and organ health specializing advanced liver disease
00:18and liver transplantation.
00:20A board certified in internal medicine, gastroenterology and transplant hepatology.
00:26I mean, that is a mouthful, doctor.
00:31You are also an active researcher and published author focused on improving outcomes for patients with liver disease.
00:37And that's why you're joining us today on Virtuous Stay Well Health Chat.
00:40Welcome, Dr. Lott. How are you today?
00:43I'm good. Thank you for having me.
00:45We're so glad. I mean, we love smart people.
00:49We're always amazed. I think we've dived into almost every part of the body.
00:55And this is a new one for us.
00:56Yeah, we haven't tackled liver disease yet.
00:58So it's very, listen, the liver is extremely important to the body.
01:03So thank you for loving the liver.
01:05Thank you for loving the liver.
01:08Well, for some of us that don't quite understand how important the liver is, we just want to jump in.
01:14You know, what exactly is liver disease and why is it a growing health concern?
01:18Sure. Yeah, like you mentioned, Nicole, liver is a very vital organ in the body.
01:24It controls a lot of bodily functions.
01:27And, you know, liver disease is actually a very silent disease that in, you know, initial stages, you don't feel
01:35anything.
01:35You don't have any symptoms.
01:37You have to look for it.
01:39Your, you know, your primary care doctor may need some clues in the blood test.
01:44You know, just it's very important to keep track.
01:47So there are many diseases, many conditions which can lead to a liver problem.
01:53Usually it starts out with the inflammation of the liver.
01:57You know, umbrella word for that is the hepatitis, not hepatitis virus.
02:02Hepatitis is the umbrella word for inflammation of the liver.
02:06And a lot of things can cause that, you know, alcohol, one of them.
02:09And there is a condition we call it metabolic dysfunction associated steatohepatitis, a mouthful name, used to be called NASH,
02:18if you might have heard NASH before, non-alcohol steatohepatitis.
02:23Steatohepatitis is where fatty liver, fatty infiltration of the liver, you know, causing toxin and inflammation of the liver.
02:31But now we change the name to not just simply calling non-alcoholic, but also metabolic dysfunction because it is
02:38a metabolic disease, right?
02:40Pre-diabetes, high cholesterol, overweight, obesity.
02:45All of these can contribute to fatty liver, toxin formation, inflammation.
02:50Like we touch base, like chronic hepatitis C, hepatitis B, immune diseases, rare genetic disease.
02:56All of these things can lead to inflammation of the liver.
03:00And when you have inflammation, you know, if you have inflammation on your skin, what happens?
03:05Your skin will try to heal itself by forming scar tissue.
03:08In a liver, we call fibrosis, a term we use to describe scarring of the liver.
03:13So if you have ongoing liver injury, your liver will try to heal itself by forming scar tissue.
03:18And there are different stages of scarring, fibrosis and fibrosis stage 1, 2, 3, 4.
03:24And stage 4 is cirrhosis.
03:25You might have heard the name cirrhosis, right?
03:28That's the last stage of cirrhosis.
03:30And when you have cirrhosis, it can impact your liver function.
03:34Even though it's just a scarring, there are some patients who are compensating.
03:38Your liver is still working.
03:39So even when, you know, patients get to cirrhosis, they may not actually have any symptoms until they have decompensation
03:46of the cirrhosis,
03:48where your liver cannot keep up with the, you know, bodily function.
03:52So you become jaundice, yellowness of your eyes and skin.
03:55You could have internal bleeding, vomiting, blood.
03:58You could retain fluid.
04:01Sometimes you can have confusion in the brain because the ammonia, ammonia is a toxin that, you know, liver usually
04:08cleans it out.
04:09And that can build up in the brain and that can cause confusion.
04:11So when you get to that symptom, you're actually too late.
04:15I mean, not too late.
04:16We can still, you know, manage medically or different treatment.
04:19But I think it's important to recognize the silent disease in early stages and, you know, tackle and prevent the
04:27progression of the disease.
04:29So you kind of talked about it a little bit, but what are the most common causes of liver disease
04:33and what are the early warning signs?
04:36Because I think people associate the jaundice, the yellowness as an issue with the liver.
04:42But you're saying you're basically too far gone then, right?
04:46So what are some early warning signs that people can really know about?
04:51Sure.
04:53Introduced to answer your first question, what are the common causes?
04:57This kind of, we kind of listed, but the most common is MASH, metabolic dysfunction associated stertohepatitis.
05:06One out of three people in the United States is fatty liver.
05:10It can be early stage of MASH, but it's very common.
05:13The second most common is chronic hepatitis C.
05:16About 2.5 to 4 million people in the United States are infected with the hepatitis C.
05:22And then you have autoimmune disease, alcohol disease, and, you know, other diseases are less common.
05:29Early signs could be, you know, jaundice is one of them.
05:35And it could be just as vague as, you know, very tired, simply fatigue.
05:41The most important thing is a blood test.
05:43So if you're a primary care physician, you know, do your blood test.
05:47And if your liver enzymes are elevated, that means your liver is going through inflammation.
05:53So I think that's a very early warning sign that, you know, you have to see a specialist and try
05:59to find out what cause in it so that you can, you know, tackle the underlying cause.
06:06Yeah, we talk a lot about making sure you get your blood work, talking to your primary, getting your blood
06:10work.
06:10And I think a lot of people, and why this discussion is so important, is that they assume liver with
06:14alcoholism or extreme drinking.
06:16But there are so many other causes, and you brought up fatty liver disease, and I think it's important to
06:22talk about, and we're going to ask you right now about why organ donation is so important.
06:25And one of my best friends, her dad, was never a drinker, had fatty liver disease, and ended up getting
06:30a liver transplant.
06:32Yeah, yeah, definitely.
06:34Like we talked about, fatty liver is one of the, you know, most common cause.
06:38And, you know, people in my office, patients say, how did I get here?
06:43You know, how did I get cirrhosis?
06:44I never touched alcohol, so we've been educating about, you know, metabolic dysfunction associated with liver disease.
06:52But, yes, organ donation and, you know, organ transplantation is very important because that can save life, right?
07:00When you get to cirrhosis and decompensation, we don't have a miracle drug to reverse the fibrosis.
07:06Scientists have been working on this for two decades, and we don't have a, you know, good medication to reverse
07:12the fibrosis at this point.
07:14So organ donation saves life, definitely, especially for patients with a liver failure.
07:20Yeah.
07:21So what is the process when somebody becomes a candidate for a liver transplant?
07:26You know, what does it involve?
07:28Yeah, sure.
07:29So, you know, when you get to the point that, you know, liver is failing and you have decompensations that
07:38we talked about, jaundice, fluid, built up, vomiting, blood,
07:42then we use a different blood test score called MEL score to see how severe your liver disease is.
07:49And when your score is higher, that means your chance of having a higher mortality with the liver disease is
07:55higher.
07:56So those patients, we put them through a liver transplant evaluation, which is a very rigorous and thorough process because,
08:04you know, you want to save their lives,
08:06but also you want them to survive the surgery and also do very well after transplant.
08:11So, for instance, patients will need to see our cardiologist to make sure their heart is good.
08:17You know, if you're somebody with a weak heart, they may have complications during the surgery.
08:23Same thing for the lungs, you know, somebody with a smoking history, and then, you know, we want them to
08:29see our lung specialist to make sure their lungs are okay.
08:33And then psychosocial perspective is a very important specialty for a patient with an alcohol use disorder, right?
08:40You know, it's a disease.
08:41So we tackle as a disease, like how we treat medication to diabetic patients.
08:47Same thing, we have a robust addiction medicine clinic in virtual, and we refer our patients with alcohol use disorder
08:55to them, and they prescribe medication.
08:57They have a counseling program.
08:58They have something called IOP, intensive outpatient program, to counsel them.
09:04So transplant social worker will assess the psychosocial aspect of it.
09:09Nutritionist, pharmacist, even the finance person will kind of counsel the patients.
09:16You know, they're copay for the medications and what they should, you know, prepare for for the big surgery.
09:23So once you go through all these testing and counseling consultations, we go to a liver transplant committee meeting, and
09:31then committee will make the decision to see which patients are eligible for the transplant.
09:35And then we will place them on the U-NOS list.
09:39U-NOS, the United Network of Organ Sharing.
09:41It's under HHS, Federal Agency.
09:44And we put them on the list, transplant list.
09:48So many people involved, such an intricate podcast.
09:51And the fact that you can do organ transplantation still blows my mind, right?
09:56It's like scientists and doctors are so brilliant.
09:59And so what advances have been a proving outcome?
10:02You talked about how, you know, they're working on drugs.
10:04We talked about organ donations.
10:05What are some of the things that have you seen over the last couple years that you can touch upon
10:09a little bit?
10:10Yes, sure.
10:11So, you know, liver transplantations being, you know, being a standard of care for many decades, at least, you know,
10:20three, four decades now.
10:21And it's not an experimental process.
10:24It's a standard of care.
10:25And patients do very well in the advance of, you know, rejection medications in the 90s.
10:32But now, in the last few years, last five years or so, we have more advancement in procuring process.
10:41So in the past, when the liver is procured, it goes to the icebox and, you know, travel to the
10:47recipient hospital.
10:49And there's a...
10:49A lunchbox.
10:50Yeah.
10:52Yeah.
10:52And there's a chance that that liver can injure.
10:57So we have what we call cold ischemia time, cold time.
11:00And we don't want to prolong that cold time, you know, very long.
11:04But now, in Virtua, we partner with a, you know, group called Transmatic since last year.
11:12And what they do is they put the procured donated organ on a, you know, pump.
11:19So, so-called liver pump.
11:20And it's normal thermic.
11:21So it's not, like, cold.
11:23And it's keep perfusing.
11:25And our surgeons love it because it's really increased the patient survival, you know, decreases surgery time, increase, you know,
11:37how the recovery process and patients are getting out of the hospital in a very short period after transplant.
11:43So, wow.
11:45So, wow.
11:46Incredible.
11:46Yeah.
11:46Amazing.
11:47What inspired you to follow this field, this path of medicine?
11:52Yes.
11:53So, you know, after the intern in medicine, I went to gastroenterology.
11:57As we know, gastroenterologists, you know, we do endoscopies, colon cancer screening, treat various.
12:04But also, we treat the liver diseases as well.
12:08But I did extra training in liver transplant because transplant is very rewarding.
12:13I think it's even more rewarding than doing, you know, colonoscopy because seeing the patients going through this process and,
12:21you know, before transplant, they're in ICU, you know, they think that they're not going to make it.
12:26And then seeing them back in six months, three months down the road in clinic with their, you know, enjoying
12:33time with their loved ones, actually going back to the community, right?
12:36That's what we want for transplant patient and giving back to the community.
12:39Most of the patients go back to work.
12:41You don't become disabled.
12:42You don't, you know, become, you know, wheelchair bound, right?
12:46So, we want to give it back to the community.
12:47That's the most rewarding part of my job.
12:51That's so fascinating.
12:52Wow.
12:52I know.
12:52Well, thank you.
12:53Thank you for everything that you do, you and your entire team around you.
12:56You guys literally are saving lives every day.
12:59It's wonderful.
13:00Yeah.
13:00And we feel just so honored that we get to talk to such brilliant people.
13:02I mean, we talk for a living and you literally save lives, but it's a good combo, you know, because
13:07we're here to spread the word of why virtual is so wonderful with brilliant doctors and surgeons like yourself.
13:12So, thank you.
13:15Thank you for having me.
13:16And, you know, April is the National Donate Life Month.
13:19And we, you know, we like to promote everybody to be a donor, right?
13:24And organ donations save lives.
13:27One organ donor can save eight lives.
13:29Wow.
13:30Because one heart, two lungs, two kidneys, liver, pancreas, and intestines.
13:36It's fascinating.
13:37Well, for everybody watching out there to learn more about organ health and register yourself to be an organ donor,
13:43visit virtua.org slash transplant.
13:46Thank you so much for joining us today.
13:48We appreciate it.
13:49Thank you for having me.
Comments