Dr. Pathik Parikh Hepatologist and Liver Transplant Physician

  Interesting Case – Drug Induced Liver Failure Successful Management of Anti Tuberculosis Therapy induced liver failure by Liver Team 50 year old female during routine follow up was diagnosed to have mild pericardial effusion. She was started empirically on 4 drugs anti tuberculosis therapy (ATT). She tolerated the therapy well and on completion of intensive phase her pericardial effusion disappeared. She was maintained on isoniazid, rifampicin and ethambutol therapy. 4 months after starting ATT, she noticed jaundice and consulted her physician who stopped ATT and started her on Ursodeoxycholic acid. However, her jaundice worsened and that is when she presented to Zydus Hospitals. At the first visit she had full blown liver failure. Her reports showed a bilirubin of 14 mg/dl, AST 157 IU/ml, ALT 90 IU/ml, Albumin 2.9 mg/dl and a International Normalized Ratio (PT-INR) of 7.1. Her ultrasound showed mild ascites and hypo echoic liver. She had over encephalopathy with flaps on examina...

  Liver is the largest internal organ of our body and has more than 500 functions. Considering the significance of liver, we expect it to cause symptoms even with minimal injury. However, liver is quite resilient with tremendous regenerating capacity and hence, symptoms do not appear till very late. Even with ongoing liver damage, liver tries to cope up by not only enhancing the function of remaining liver but also be growth of the liver tissue. Based on the acuity of liver damage we can get symptoms. When the liver suffers from acute insult, there are symptoms seen frequently (as we see with routine viral hepatitis). However, if it is chronic or gradual long standing damage, there would be no symptoms. Symptoms only develop in such situation when liver failure begins. We divide symptoms and signs of liver damage in three subgroups   A)  Acute Hepatitis – The symptoms are known to every one of us. The most common cause is viral hepatitis A or E. Patients initially have lo...

Successful Management of Anti Tuberculosis Therapy induced liver failure by Liver Team 50 year old female during routine follow up was diagnosed to have mild pericardial effusion. She was started empirically on 4 drugs anti tuberculosis therapy (ATT). She tolerated the therapy well and on completion of intensive phase her pericardial effusion disappeared. She was maintained on isoniazid, rifampicin and ethambutol therapy. 4 months after starting ATT, she noticed jaundice and consulted her physician who stopped ATT and started her on Ursodeoxycholic acid. However, her jaundice worsened and that is when she presented to Zydus Hospitals. At the first visit she had full blown liver failure. Her reports showed a bilirubin of 14 mg/dl, AST 157 IU/ml, ALT 90 IU/ml, Albumin 2.9 mg/dl and a International Normalized Ratio (PT-INR) of 7.1. Her ultrasound showed mild ascites and hypo echoic liver. She had over encephalopathy with flaps on examination. She was counseled about the need for l...

All patients who are  suffering from liver disease  and need a transplant are currently in dilemma on when and how the transplant would proceed. Even doctors are in dilemma on whether they should divert the healthcare staff and infrastructure to transplant when we have a great pandemic going on. To answer these queries, the American, European, Asian and Indian societies have drawn out guidelines for doctors to help in decision making. Should we as healthcare providers decide on who is more in need of limited resources, i.e., COVID-19 patients versus patients in  urgent need of liver transplantation?  It is impossible to weigh the value of the life of a patient with COVID-19 against that of a patient in need of life-saving liver transplantation. We should not compound the pandemic by risking the lives of patients in need of liver transplantation and our goal should be to ensure that an ICU bed is available for every patient who requires one. All centers offeri...

Covid-19 is a disease caused by a novel type of coronavirus now termed as SARS-CoV-2. The virus originated from Wuhan, #China and has now spread throughout the world now responsible for more than 50,000 deaths worldwide. The disease is primarily responsible for causing lung injury and acute respiratory distress syndrome or ARDS. In the 1.4 million cases noted so far # liver  involvement is also seen. The cells of the bile duct contain the same receptors as the ones present in lung by which the virus causes lung damage. Theoretically, it was expected to cause damage by the same mechanism – ACE2 receptors. However, practically we have not noted significant liver injury. No case of #LiverFailure caused by the virus per se is noted. There is rise in transaminases and non-specific abnormalities are noted in # LiverFunctionTests   or # LiverProfile . Most studies have found elevation of AST and total bilirubin similar to injury caused by other non hepatotrophic viruses. Initia...

Millions of people buy new cars regularly in the United States. With so many companies regularly launching new models that continue to amaze humans, the sale of cars goes on incessantly. And buying car insurance is mandatory which in turn leads to a high sale of car insurance, nationwide. And given the demand for car insurance, you would expect the sellers and agents to have a good time by getting ample leads and converting them to sales. But nothing in this world comes easy. Does it? The agents and brokers often suffer from the lack of   genuine car insurance lead   in spite of all the demand in the market. This again has various reasons and the agents or brokers can’t be blamed. There are too many sellers in the market with multinational corporations as well with a lot of resources at their disposal. They are able to get most of the leads and convert them leaving behind very few leads for the other agents and brokers. Another reason why these agents and brokers...

Not all causes of  jaundice  are same! Jaundice means yellow discoloration of eyes/sclera and urine. It is caused by a substance known as bilirubin. It is common misconception that all causes of jaundice behave similarly and can be treated by rest and restriction of diet. Today, we would understand what jaundice is and will break the above myth. Jaundice is visible whenever the blood level of a substance called bilirubin increases. It is not visible to us till the blood level rises above 3 mg/dl. Whenever, the red blood cells get destroyed, they release this bilirubin, which is taken up by liver and after detoxification released in bile. So any disease which can cause increased damage of red blood cells, damage liver or obstruct the outflow of bile will lead to jaundice. The jaundice caused by these three types of diseases are different in the aspects of their liver tests and ultrasound reports with the help of which your doctor identifies the exact cause of jaundice. ...

Patients who are suffering from Cirrhosis are often suffering from Malnutrition. They not only have reduced intake and decreased absorption, there is increased loss as well. Greater than 70% of the individuals suffering from cirrhosis suffer from malnutrition. They tend to lose their muscle mass and build up distended tummy because of fluid. It is now beyond doubt that those who fail to maintain nutrition are at more chances of dying from complications of liver disease. Patients with cirrhosis fail to store micro-nutrients and are deficient in multiple micro-nutrients namely zinc, selenium, Vitamin B, Vitamin C, Folic acid, etc. They also tend to have weakened bones and low calcium. There is a general belief amongst patients suffering from  Liver Disease  to cut down on diet as a whole and restrict proteins and other nutritious substances. It is a myth that more protein will lead to more complications. Instead, lack of these foods lead to more complications D...

Liver is an organ of your body that carries out nearly 500 functions. It is impossible for us to test for each of these functions. The freely available tests at all laboratories are usually called  liver tests  or  liver function tests  which are ideally a screening test and helps the doctor decide a direction for the direction of next investigation. Liver disease per se develops symptoms very late. When they develop symptoms, the liver damage is often quite severe. The only ways to detect abnormalities of liver before the development of symptoms are the above battery of tests.  They not only tell us the reason for liver abnormalities, they also help to decide the severity. The tests include bilirubin, ALT, AST, ALP, GGT, Proteins, Albumin and Prothrombin Time. These tests are bundled together in different combinations are known as liver function tests. It is based on these tests doctors can gauze what is wrong with your liver. The term jaundice is derived...

What is hepatitis? Inflammation of liver is usually referred as hepatitis. Infection or non-infectious causes – Infectious is mainly by virus. What is viral hepatitis? Hepatitis is caused by the hepatotrophic viruses A, B, C, D and E. D is not a concern in India How are these viruses different? A and E are spread from unhygienic food practices A is seen usually before 25 years of age and is most common cause of liver failure in children E is mainly seen in adults. E in pregnancy is dangerous causing 20-25% mortality A & E virus infections are self-limiting and immunity is life long B & C are spread by unsafe sexual practices and by contact with infected blood Tattoo, razors, toothbrushes, dental extractions are also risk factors They cause chronicity and can cause permanent liver damage What are the symptoms? A, E and rarely B present acutely with jaundice, fever, malaise, bodyache, anorexia, nausea C and most of the time B is chronic ...