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Cornish doctors liver warning as national report blames alcohol drinking
Wednesday 21 November 2012
A national report today reveals that England is one of the few countries in the EU where a major cause of preventable death is on the increase. Between 2000 and 2009, deaths from chronic liver disease and cirrhosis in the under 65s increased by around 20 per cent.
England’s Chief medical Officer Professor Dame Sally Davies’ first annual report highlighted the three major, preventable causes of liver disease – obesity, undiagnosed infection and increasingly harmful drinking.
The Hepatology team at the Royal Cornwall Hospitals Trust treat Cornish patients suffering with liver conditions. The RCHT Hepatology team consists of two consultants, an advanced nurse practitioner and a nurse practitioner. The team provide the Hepatology service for the whole of Cornwall holding clinics in West Cornwall Hospital, St Michael’s Hospital, Redruth and Camborne Hospital, Truro, St Austell and Bodmin.
RCHT Consultant Hepatologist Hyder Hussaini said: “Liver disease is a growing issue. The popular idea is that people with alcohol problems or at risk of alcohol related problems are heavy drinkers or binge drinkers. It’s the stereotypical image of the person on the park bench with a bottle of strong cider stinking of alcohol and dirty. The truth is different.
“Many of the people we see in our clinics with alcohol related liver disease are not alcohol dependent, they are social drinkers who don’t have a ‘drink problem’. We are just as likely to treat the professional person who has a career, doesn’t smell of booze, who isn’t caught drink driving. They might have a couple of pints or glasses of wine on a weekday evening, a bottle of wine on a Friday/ Saturday night.
“40 per cent of men and 20 per cent of women regularly drink more than their recommended limits. There are nine units of alcohol in your average 12% bottle of wine. If you have two bottles over the course of a week and you are a woman you are over your recommended weekly consumption.
“Regularly drinking more than 21 units a week for men or 14 for women will put you at an increased risk of alcohol related liver disease over a 10 to 20 year period. If you are overweight, a woman or if you have a co-existing liver problem such as Hepatitis C your risk goes up and also the time over which damage is done goes down. Most people with pre-existing liver problems will have no symptoms.
“Anyone who drinks heavily will get fat in their liver. A third of these people will get Cirrhosis of the liver and there are complications with cirrhosis including liver failure, liver tumours, jaundice, fluid retention in the abdomen or they bleed from varicose veins in the gullet.
“The problem with liver disease is that you don’t get symptoms until it’s almost too late. You have to destroy about 90 per cent of your liver before you manifest symptoms. Thus you can go from being relatively well to having a lot of serious problems and possibly dying, sometimes in a very short time span.
“When I started in this job 20 years ago we treated people who were mainly in their 40s, ten years ago it was people in their 30s and now we are treating people in their 20s. Those who are losing their lives because of this are still mostly in their 40s, 50s and 60s. However we have had to admit young adults to the Critical Care Unit and we have had people in their 20s die from liver disease.
“When I first came to Cornwall, statistics showed a three per million under liver transplantation. Now it’s 11 per million. It’s in keeping with the national average but it’s a big jump for the county. In reality, there are around three or four liver transplants in Cornwall each year. Obviously not all liver transplants are for alcoholic liver disease. However, those transplanted with advanced alcoholic liver disease, are those people who haven’t drunk for six months and are not likely to drink again. But they will be on a cocktail of drugs to prevent rejection for the rest of their lives.”
For those patients referred to the team via their GP or the Emergency Department, there are a number of options. The Hepatology team work closely with the Alcohol Liaison Nurse Andy Brooking as well as other agencies such as the Cornwall Alcohol and Drugs Agency (CADA), Addaction and local GPs.
Hyder said: “For the social drinker, a 15-minute window of alcohol education usually works and they reduce their intake. For those with more needs, we refer to the outside agencies for longer term help in terms of rehabilitation programmes, counselling, or in-patient detox treatment.”
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