We yu yon bɔdi atak yu liva? Lɛ wi tɔk bɔt ɔtoimyun ɛpatitis.

Yu dɔn ɛva tink se yu yon bɔdi in difɛns sistɛm, we na di imyun sistɛm, go bigin fɔ atak yu yon liva? I de sɔprayz, nɔto so? Bɔt, ɔtoimyun ɛpatitis na ɛksaktɔli da kayn kɔndishɔn de. Pan ɔl we dis kin tan lɛk se i kɔmplikt smɔl, lɛ wi tɔk bɔt am simpul wan, di we we yu go ɔndastand.

Wetin na ɔtoimyun ɛpatitis?

Fɔ tɔk am simpul wan, ɔtoimyun ɛpatitis na sik we kin de fɔ lɔng tɛm ɛn we kin afɛkt yu liva. I kin bigin wit smɔl mistek na yu bɔdi in difɛns sistɛm, di imyun sistɛm . Tink bɔt am dis we: wi imyun sistɛm tan lɛk ami we de protɛkt wi kɔntri. I wok na fɔ fɛt fɔrina dɛn we de kam insay am lɛk jem ɛn vayrɔs. Bɔt, insay ɔtoimyun ɛpatitis, dis ami, di imyun sistɛm, kin mistek tink se in yon wɛlbɔdi liva sɛl dɛn na di ɛnimi ɛn bigin fɔ atak dɛn.

We di imyun sistɛm atak di liva tisu dis kayn we, i kin mek di liva inflamɛns , ɔ epataytis. As dis atak de kɔntinyu, dis inflamɛns kin bi krɛse. As tɛm de go, dis inflamɛns we nɔ de dɔn kin mek di liva pwɛl bad bad wan. sכm spεshal wan, di liva tisu kin skata εn di liva kin fεl sכmtεm. Dɛn kɔl dis sik we dɛn kɔl sirosis .

Di gud nyus na dat, mɛrɛsin kin mek di liva nɔ swel ɛn mek i nɔ gɛt prɔblɛm wit di sik. Bɔt sɔmtɛm yu nɔ kin gɛt ɛni sayn we dis sik bigin.

Wetin na di men kayn ɔtoimyun ɛpatitis?

Tu men kayn ɔtoimyun ɛpatitis (AIH) de. Dɛn kin difrɛns pan dɛn tin ya bay we difrɛn ɔtoantibodi dɛn de, we wi sayɛnsman dɛn kin no wit antibodi tɛst . dis difrεn antibodi dεm de atak difrεn kayn sεl dεm na di liva.

Tayp 1

Dis na di "klasik" tayp, ɛn na di kayn we we kɔmɔn pas ɔl bak. Na lɛk 80% pan di wan dɛn we dɛn dɔn no se gɛt dis kayn sik. I kin divɛlɔp pan ɛni ej. insay tayp 1 כtoimyun epataytis, antibodi dεm we dεn kכ l ASMA (anti-smooth muscle antibodies) de atak di smol mכsul sεl dεm na di liva. dis tayp 1 kכndyushכn sכmtεm dεn kin kכl am "lupoid hepatitis" biכs in simptom dεm lεk di wan dεm fכ Systemic Lupus Erythematosus . Bɔt di ASMA blɔd tɛst kin ɛp fɔ no difrɛns bitwin di tu sik dɛn.

Tayp 2 we de na di wɔl

Tayp 2 ɔtoimyun ɛpatitis na wan kayn epataytis we nɔ kin bɔku ɛn we kin rili bad. Bɔku tɛm, i kin apin bifo tɛm, we i smɔl. i kin go bifo kwik kwik wan bak pas tayp 1. Dis tכp de kכz fכ anti-LKM-1 (anti-liva-kidni maykrosכm tayp 1 antibodi dεm) כdi antibodi dεm we involv dεn kכl dεm anti-LC1 (anti-liver cytosol type 1 antibodies) . di anti-LKM-1 antibodi dεm de tכk to wan protin we dεn k כl saytokrכm P450-2D6 (CYP2D6) insay di liva sεl dεm. Anti-LC1 na liva antibodi we spεsifi k fכ tayp 2 AIH.

Aw i nɔ kin izi fɔ gɛt ɔtoimyun ɛpatitis?

Awtoimyun epataytis nɔto sik we kin rili bɔku. I nɔ klia yet ɔmɔs pipul dɛn gɛt am. Akɔdin to Yuropian stɔdi dɛm, dis sik kin afɛkt bitwin 0.010% ɛn 0.025% pan di pipul dɛm na Yurop. Pan ɔl we i kin afɛkt ɛni rays ɔ etnik grup, i kin kɔmɔn smɔl pan di pipul dɛn we kɔmɔt na Alaska (lɛk 0.043% pan da pipul dɛn de). I kin bɔku bak pan uman dɛn pas man dɛn, we na 4:1.

Wetin na di sayn dɛm we de sho se yu gɛt dis sik?

Nɔto ɔlman we gɛt ɔtoimyun ɛpatitis go gɛt di sayn dɛm. Sɔmtɛm di sayn dɛm kin kam leta, afta di sik dɔn bigin fɔ afɛkt di liva in wok. Dis kin mek difrɛn sayd ɛfɛkt dɛn na di bɔdi.

Sɔm kɔmɔn tin dɛn we kin apin kwik kwik wan na:

• Bɛlɛ de pen ɔ nɔ de fil fayn.
• Abdominal swelling bikɔs ɔf di liva we dɔn big.
• Taya .
• Pen na di jɔyn dɛn.
• Skin rash min fɔ irita.
• Akni we gɛt akni.

We yu liva bigin fɔ wok fayn, di bayl kin gɛda na yu blɔd. Dis kin mek yu gɛt sɔm kayn sik lɛk:

• Jaundice ( di skin ɛn di yay dɛn we de yɔlɔ).
• urine we gɛt dak kɔlɔ ɔ stɔl we gɛt layt kɔlɔ.
• I de it (Pruritus) .
• Nɔs ɔ nɔ want fɔ it.

Ɔda sayd ɛfɛkt dɛn we kin delay kin bi:

• Spayda angiomas (rɛd spat dɛn na di skin we tan lɛk spayda wɛb) .
• di vein dεm we de na di anכs de big (varices) .
• I izi fɔ brus ɛn blɔd.
• Di we aw uman dɛn kin lɔs di mɔnt we dɛn kin gɛt mɔnt.
• Fluid we de bɔku na di bɛlɛ (ascites) ɔ di limb dɛn (edema) .
• Kɔnfyushɔn, slip, ɔ slip (hepatic encephalopathy) .

Wetin na di tin dɛm wae kin mek pɔrsin gɛt ɔtoimyun ɛpatitis?

Ɔtoimyun sik kin apin we yu imyun sistɛm mistek sɔm pan yu yon sɛl dɛm as trɛtin. we di imyun sistεm no dis "threat," i de atak dεn sεl dεm de. Dis kin mek wan patikyula pat na di bɔdi inflamɛns we nɔ de dɔn. insay כtoimyun epataytis, di imyun sistεm de sεnd spεshal antibodi dεm fכ atak spεshal tכp sεl dεm na di liva. Dis na rili wan tin we rili kɔmpleks.

Wetin na di avrej ej wae dis sik kin bigin?

Nɔto ɔltɛm i pɔsibul fɔ no ustɛm ɔtoimyun ɛpatitis fɔs bigin. Dis na bikɔs bɔrku tɛm nɔr kin gɛt ɛni sayn fɔ de na di fɔs stej. Dɛn kin no di tayp 1 AIH mɔs pan di fɔs to midul ej, bitwin 15 ɛn 40. Bɔt i kin apin pan ɛni ej. Tayp 2 AIH kin apin ivin bifo, we i smɔl, bitwin 4 ɛn 14 ia.Ivin da tɛm de, bad bad sayn dɛm fɔ gɛt liva sik kin de.

Aw ɔtoimyun ɛpatitis kin kam?

Wetin mek pipul dɛn kin gɛt ɔtoimyun sik na rili kɔmpleks kwɛstyɔn. I tan lɛk se nɔto wan kɔz de, bɔt na wan kɔmbayn tin dɛn.

• Jɛnɛtik inflɔwɛns: Sɔntɛnde, yu jin kin mek yu gɛt sɔm sik dɛn we yu kin gɛt we yu de fɛt yu bɔdi. Bɔt nɔto ɔlman we gɛt dɛn jin dɛn de go gɛt dis sik, ɛn nɔto ɔlman we gɛt dis sik go gɛt dɛn jin dɛn de.
• di tin dεm we de apin na di envayroment: כda tin dεm we nכ de fכ jεnεtiks, we dεn kכl bak "envayroment fכs tin dεm," kin kכntribyut to dis. Dɛn tin ya kin bi pɔyzin ɔ tin dɛn we kin mek yu gɛt prɔblɛm wit yu imyun sistɛm. pan sɔm pipul dɛm wae kin gɛt dis sik, dɛn tin ya kin mek di imyun sistɛm de riak pasmak, ɛn dis kin mek dɛn gɛt wan sik we de mek dɛn nɔr gɛt dis sik.

Dɛn dɔn no sɔm mɛrɛsin ɛn vayral infɛkshɔn as tin dɛn we kin mek pɔsin gɛt ɔtoimyun ɛpatitis. Dɔn bak, if yu dɔn ɔlrɛdi gɛt ɔda sik we de mek yu nɔ ebul fɔ fɛt, yu go gɛt ɔtoimyun ɛpatitis.

Us vayrɔs kin mek pɔsin gɛt ɔtoimyun ɛpatitis?

Yu kin gɛt ɔtoimyun ɛpatitis if yu gɛt histri fɔ dɛn vayral infɛkshɔn ya:

• Vayral ɛpatitis (A, B, C, D ɔ E).
• Mononucleosis (Mononucleosis - Ɛpstayn-Bar vayrɔs) .
• Mizɛl .
• Ɛpis we pɔsin kin gɛt .

Us drɔgs kin mek pɔsin gɛt ɔtoimyun ɛpatitis?

Dɛn dɔn sho se ɔtoimyun ɛpatitis we dɛn kin gɛt wit drɔgs gɛt fɔ du wit dɛn drɔgs ya:

• Nitrofurantoin ( fɔ infɛkshɔn na di urinary tract).
• Minocycline ( fɔ akni).
• Atorvastatin ( fɔ ay kɔlɔstrel).
• Isoniazid ( wan antibayɔtik).

Us ɔda sik dɛn we pɔsin kin gɛt we i de fɛt insɛf we gɛt fɔ du wit ɔtoimyun ɛpatitis?

Sɔm pipul dɛn kin gɛt ɔtoimyun ɛpatitis wit ɔda ɔtoimyun sik we kin afɛkt dɛn bayl dakt. Fɔ ɛgzampul:

• Praymari biliary cholangitis (PBC) we gɛt di sik .
• Praymari sklɛrosin kɔlɛnjayt (PSC) .

Dɛn kin tek dis as "variant type" fɔ ɔtoimyun ɛpatitis.

Bɔt in jɔnal, if yu dɔn ɔlrɛdi gɛt wan sik we de mek yu nɔ ebul fɔ fɛt, yu go gɛt ɔda wan. I tan lɛk se if pɔsin gɛt inflamɛns we nɔ de dɔn na wan eria, i kin mek i gɛt inflamɛns na ɔda say. di chans fכ divεlכp sεkכn כtoimyun sik na bכt 25%-50%. If ɔtoimyun ɛpatitis na yu fɔs ɔtoimyun sik, yu gɛt di sem chans fɔ gɛt sɛkɔn wan.

Ɔda kɔndishɔn dɛm wae dɛn kin si wit AIH na:

• Di sik we Grev bin gɛt .
• Siliak sik we dɛn kɔl .
• Inflammatory bowel disease we pɔsin kin gɛt .
• Rimatɔyd at at sik.
• Tayp 1 dayabitis.
• Vitiligo ( wayt spat na di skin).

Yu tink se ɔtoimyun ɛpatitis kin pas?

Nɔ, vayral ɛpatitis (lɛk epataytis A, B, ɛn C) kin kɔmɔt frɔm vayrɔs dɛn we gɛt infɛkshɔn. Dɛn infɛkshɔn ya kin pas to ɔda pipul dɛn. Bɔt, ɔtoimyun ɛpatitis nɔto infɛkshɔn, so i nɔ kin pas ɔda pipul dɛn.

Aw dɛn kin no se pɔsin gɛt ɔtoimyun ɛpatitis?

Yu kin gɛt ɔ nɔr kin gɛt klia simptom dɛm fɔ AIH. Dɔktɔ go fɔs chɛk yu bɔdi ɛn du sɔm bɛsik tɛst dɛn lɛk fɔ tek pikchɔ ɛn fɔ tɛst yu blɔd. Wan blɔd tɛst we dɛn kɔl kɔmprɛhɛnsif mɛtabolik panɛl kin luk fɔ pruf fɔ se pɔsin gɛt liva sik. dis panεl inklud sεvεra liva fכnshכn tεst dεm we de mכsu tin dεm lεk di liva εnzym lεvεl εn inflameshn.

Bɔt dɛn indikɛtɔ ya nɔto spɛshal fɔ ɔtoimyun ɛpatitis. Yu dɔktɔ go du ɔda blɔd tɛst fɔ luk fɔ sɔm patikyula vayrɔs ɛn ɔda tin dɛn we kin mek pɔsin gɛt epataytis. Dɛn go luk bak fɔ ɔtoantibodi dɛn . Wae dɛn dɔn pul ɔda kɔz ɛn no di antibodi dɛm wae gɛt fɔ du wit ɔtoimyun ɛpatitis, dɛn go rɛdi fɔ kɔnfɔm di diagnosis. Di bɛst we fɔ kɔnfɔm dis na fɔ du liva bayɔpsi . Dis min se dɛn kin tek wan smɔl pat pan di liva ɛn chɛk am ɔnda maykroskɔp.

Wetin na di tritmɛnt fɔ ɔtoimyun ɛpatitis?

di standad tritmεnt na fכ stat wit hכy doz dεm fכ kכtikostεroyd f כ kכntrכl inflameshn εn di כtoimyun rεspכns, dεn sכmtεm ridyus di doz. Prɛdnison na di mɛrɛsin we dɛn kin gi ɛn we dɛn kin stɔdi di bɛst fɔ ɔtoimyun ɛpatitis. I kin wok fayn fɔ bɔku pipul dɛn, bɔt i kin mek dɛn gɛt sayd ɛfɛkt. I tan lɛk se ɔda mɛrɛsin dɛn lɛk budesonide nɔ kin gɛt bɛtɛ sayd ɛfɛkt.

Yu dɔktɔ kin gi yu wan mɛrɛsin we dɛn kɔl azathioprine wit stɛroyd.Dɛn kin gi yu di mɛrɛsin. Ɔ dɛn kin gi yu am afta yu dɔn fɔ gi yu stɛroyd tritmɛnt. Bikɔs azathioprine nɔ gɛt bɛtɛ sayd ɛfɛkt pas stɛroyd, i kin wok fayn as tritmɛnt fɔ lɔng tɛm mentenɛns, we min se i kin mek yu imyun sistɛm nɔ de wok pasmak igen. Yu go nid fɔ tek am wan wan tɛm insay yu layf.

Wetin na di bad tin dɛn we di mɛrɛsin kin du?

Dɛn tritmɛnt ya kin gɛt sɔm sayd ɛfɛkt dɛn bak. Na dat mek di dɔktɔ go de wach yu ɔltɛm.

Di sayd ɛfɛkt dɛn we pɔsin kin gɛt we i yuz stɛroyd fɔ lɔng tɛm (Corticosteroids):

• I kin mek pɔsin want fɔ it mɔ ɛn mɔ ɛn i kin gɛt mɔ wet.
• Disɔda wae de mɛk pɔrsin fil lɛk wae pɔrsin de wɔri ɛn pwɛl hat.
• Glaukoma ( we pɔsin nɔ de si fayn).
• Osteopenia ɔ osteoporosis (we di bon dɛn wik).
• Shuga .
• Di ay blɔd prɛshɔn .

Di sayd ɛfɛkt dɛn we pɔsin kin gɛt we i tek di mɛrɛsin dɛn we de mek pɔsin nɔ ebul fɔ fɛt di sik:

• Infεkshכn dεm we kin de fכs fכs (bikoz fכ di imyun sistεm we dεn dכn dכn).
• Nɔs ɛn vɔmit.
• Skin rash (it we yu de it).
• I izi fɔ brus ɛn blɔd.
• Di kidni nɔ de wok fayn.
• Pankriaytis we dɛn kɔl .

We yu de tek dɛn mɛrɛsin ya, yu dɔktɔ go de wach yu fɔ si if yu gɛt sayd ɛfɛkt. If di sayd ɛfɛkt dɛm fɔ yu mɛrɛsin tu bad, ɔ if i nɔr de ɛp yu inof, dɛn go gi yu ɔda we fɔ du am. Nɔr frayd, tɔk to yu dɔktɔ bɔt ɔl dis.

Aw lɔng i kin tek fɔ mek di tritmɛnt wok?

Di gol fɔ di mɛrɛsin na fɔ put di sik na rɛmishɔn . Yu kin nid fɔ tek di mɛrɛsin fɔ sɔm mɔnt to sɔm ia fɔ mek yu ebul fɔ du dis. Insay dis tɛm, yu dɔktɔ go de chɛk yu liva ɔltɛm fɔ mek shɔ se di tritmɛnt de wok. di tεst dεm fכ di liva fכnshכn go sho se yu liva εnzym lεvεl dεm de kam bak sכmtεm sכmtεm to nכmal. Rimishɔn min se ɔl di sayn ɛn simptom dɛm fɔ di sik dɔn dɔn.

Di American Association for the Study of Liver Diseases (AASLD) se yu fɔ tek stɛroyd fɔ at le tri ia bifo yu stɔp di mɛrɛsin. Afta yu dɔn de na remission fɔ at le tu ia, dɛn go tink bɔt fɔ stɔp di immunosuppressants. Afta dɛn dɔn stɔp di mɛrɛsin, lɛk 50% pan pipul dɛn kin gɛt di sik bak insay tri mɔnt. Fɔ ɔda pipul dɛn, i kin tek sɔm ia, ɔ dɛn nɔ kin ɛva gɛt di sik bak atɔl.

Sɔm pipul dɛn kin gɛt sɔm impɔtant tin wit tritmɛnt, bɔt nɔr kin du fɔ go na rɛmishɔn. If na so i bi, yu dɔktɔ go tray ɔda mɛrɛsin dɛn. Sɔm pipul dɛn nɔ kin ansa di tritmɛnt atɔl. If na so i bi, di kɔs fɔ di sik kin kɔntinyu fɔ wɔs. Dɛn pipul ya kin gɛt prɔblɛm dɛn we kin nid ɔda tritmɛnt. Dɛn kin dɔnI kin nid bak fɔ transplant di liva.

Yu tink se dɛn kin mɛn ɔtoimyun ɛpatitis ɔltogɛda?

Nɔ, i nɔ go ebul fɔ mɛn am kpatakpata. Bɔt dɛn kin put di sik na rɛmishɔn. dis min se di inflammatory prכsεs de go fכ sכm tεm, sכmtεm fכ lכng tεm. Bɔt afta yu dɔn stɔp fɔ trit yu, i kin kam bak. Dɛn kɔl dis wan sik we de kam bak . Bɔrku pipul wae kin stɔp fɔ tek di mɛrɛsin (lɛk 80%) kin gɛt di sik kam bak ɛn gɛt fɔ bigin fɔ tek di mɛrɛsin bak. Bɔku tɛm, mɛrɛsin kin kɔntrol di sik fayn fayn wan, bɔt yu kin gɛt fɔ tek am wan wan tɛm insay yu layf.

Wetin na di avrej layf we pɔsin kin liv wit ɔtoimyun ɛpatitis?

If yu nɔ gɛt tritmɛnt, di fayv ia sɔvayv rɛt na 50%. Bɔt wit tritmɛnt, di 10 ia sɔvayv rɛt na 90% ɛn di 20 ia sɔvayv rɛt na 70%. Ivin wit tritmɛnt, lɛk 15% pan pipul dɛn kin dɔn gɛt sirosis, bɔku tɛm afta 10 to 20 ia. Dis kin apin if di tritmɛnt nɔ wok, if di tritmɛnt nɔ kɔmplit, ɔ if di sik kam bak bɔku tɛm. We di sik kam bak, i kin kam bak kwik kwik wan.

Aw a fɔ kia fɔ misɛf we a de liv wit ɔtoimyun ɛpatitis?

Dis na tin we rili impɔtant. Sɔm tin de wae yu kin du pan yu pat fɔ kɔntrol de sik ɛn liv wɛl bɔdi layf.

• Nɔ mis yu dɔktɔ in apɔntinmɛnt dɛn. Yu dɔktɔ go nid fɔ wach yu liva fɔ di res ɔf yu layf. Ivin if yu dɔn de na remission fɔ sɔm tɛm, de sik kin kam bak witout wɔnin ɔr klia sayn dɛm. Yu dɔktɔ kin wach di kayn fibrosis (we dɔn damej bifo yu gɛt skata) na yu liva bay we i yuz we dɛn we nɔ de ambɔg yu lɛk ɛlastografi . If yu bigin fɔ gɛt di sik bak, kɔl yu dɔktɔ wantɛm wantɛm.
• Tek kia ɔf di tin dɛn we yu de it. Fɔ it fayn fayn it impɔtant fɔ ɛnibɔdi we gɛt liva sik. Ɛspɛshali wit AIH, stɔdi dɔn sho se lɛk 30% pan pipul dɛm gɛt sayn dɛm fɔ gɛt nɔr-alcoholic fatty liver disease . Dis min se yu bɔdi kin lɛk fɔ kip ɛkstra fat na di liva, we na ɔda tin we kin mek yu gɛt inflamɛns. Yu kin kɔba dis bay we yu gɛt wɛlbɔdi wet ɛn ridyus di shuga ɛn sɛtyuret fat we yu de it. Dis kin ɛp bak fɔ mek yu tritmɛnt go bifo.
• Protɛkt yu imyun sistɛm. Ɔl tu di liva sik ɛn di mɛrɛsin dɛn we de mek yu nɔ ebul fɔ fɛt di sik kin mek yu imyun sistɛm wik. Dat min se yu nid fɔ kia fɔ yusɛf gud gud wan fɔ mek yu nɔ sik. Yu dɔktɔ kin tɛl yu fɔ tek sɔm vaytamɛn ɛn vaysin dɛn fɔ protɛkt yu frɔm infekshɔn. Nɔ tek ɛni supamakit we yu dɔktɔ nɔ gri fɔ.
• Nɔ drink rɔm. If yu drink rɔm, dat kin mek yu imyun sistɛm wik ɛn i kin pwɛl yu liva.

Autoimyun epataytis na siriɔs sik, bɔt bɔku pipul dɛn kin du wɛl we dɛn gɛt tritmɛnt. Di sik kin go insay rɛmishɔn, i kin lɛf smɔl fɔ lɛ i dɔn fɔ lɔng tɛm. If i kam bak, dɛn kin yuz di sem tritmɛnt bak. Di tritmɛnt kin gɛt sayd ɛfɛkt, bɔt if yu tek kia ɔf yu it ɛn di imyun sistɛm, yu kin liv nɔmal layf. If di tritmɛnt nɔ wok, fɔ transplant liva na opshɔn.

Tin dɛn fɔ mɛmba frɔm dis atikul (Take-Home Message)

Okay, so, frɔm wetin wi dɔn tɔk bɔt, dɛn tin ya na di impɔtant tin dɛn we yu nid fɔ mɛmba:

• Awtoimyun ɛpatitis na wan sik we nɔ de mɛn we yu yon imyun sistɛm de atak yu liva.
• Dis nɔto sik we pɔsin kin pas.
• Nɔr sayn nɔr kin de na di fɔs stej, bɔt sɔm sayn dɛm lɛk wae yu taya, yu bɛlɛ nɔr kin fayn, ɛn yu kin gɛt jaundice.
• I kin nid fɔ du blɔd tɛst ɛn liva bayɔpsi fɔ mek dɛn no di sik kɔrɛkt wan.
• Tritmɛnt (stɛroyd, immunosuppressants) kin put di sik insay rɛmishɔn. Bɔt, no kɔmplit mɛrɛsin nɔ de, ɛn i pɔsibul fɔ mek i gɛt di sik bak.
• Di tritmɛnt kin gɛt sayd ɛfɛkt, so i impɔtant fɔ mek dɔktɔ de wach am.
• Fɔ liv fayn layf (gud it, nɔ fɔ drink rɔm, fɔ fala dɔktɔ advays) rili impɔtant fɔ kɔntrol di sik.
• Nɔ fred. Yu kin liv gud layf ivin wit dis kɔndishɔn. Tɔk bɔt ɔltin wit yu dɔktɔ ɛn fala in advays.

If yu gɛt ɛni ɔda kwɛstyɔn bɔt dis, mek shɔ se yu aks yu dɔktɔ. Wi de wish yu fɔ wɛl kwik kwik wan!

` Liva sik, ɔtoimyun ɛpatitis, imyun sistɛm, liva inflamɛns, sirosis, ɔtoimyun sik, liva tritmɛnt