Dr. Pathik Parikh Hepatologist and Liver Transplant Physician

  Kidneys in liver cirrhosis – Hepatorenal Syndrome What are different complications of cirrhosis? Liver Cirrhosis progresses to develop many complications.  It is prudent to be aware of the complications of liver cirrhosis, so that it can be picked up early and treated timely. Some of these are often ignored for long time before they become life threatening. The table shows different complications of liver cirrhosis. Blood Vomitus Swelling of feet Poor memory Black Stools Fluid in chest Altered behaviour (Brain Involvement) Blood in stools Ascites – Fluid in abdomen Hypoxia (Lung Involvement) Nasal Bleeding Jaundice Low BP (Heart Involvement) Increased bleeding tendency Loss of muscle mass Low Urine (kidney Involvement) Darkening of skin Bone weakness (Osteoporosis) Loss of sexual hair (Gonad involvement)   Usually, the initial complications are fluid collection and bleeding. Renal involvement is a sign of very advanced disease. Kidney involvement presents as hepatorenal...

  Liver as you all know it, is not only the second largest organ of the body after skin, but also a major organ for metabolizing. Whatever we eat goes to liver before reaching anywhere else in the body. The liver stores the excess energy as fat and condensed glucose known as glycogen. So whenever we eat excessively, the energy is stored in liver as fat. If we continue to do so for months and years together, the liver starts accumulating fat and enlarges in size. A point comes when liver no longer can take it and starts undergoing destruction. What is Fatty Liver? Whenever the fat accumulation in liver crosses 5% of liver weight it is known as fatty liver. Though in last century alcohol was believed to be the major cause of fatty liver, the diet and lifestyle is rapidly becoming the major cause of fatty liver now. The disease is known as non alcoholic fatty liver disease or NAFLD. Once it starts destroying liver it is called as steatohepatitis or NASH. Who is likely to have it? All ...

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...

Water gets accumulated in your tummy (abdomen) as a part of a disease. It is known medically as Ascites. Most common reason for ascites is Liver Disease. Although, local disease of tummy (Peritoneum), Kidney, Heart can cause water accumulation in your tummy, by far the most important reason is Liver. If there is water in your tummy there is 85% chance that you have Liver Disease. What causes Ascites? There are many causes, but the most common are mentioned here Liver Disease, Cirrhosis, Liver Cancer, Liver Failure Cancer Malignancy Kidney Disease Heart Disease Infections Tuberculosis What are the symptoms of Ascites? As the fluid gets collected very gradually, you may realize it only after weeks that you are having symptoms of Ascites Heaviness of stomach Distension of stomach Bloating Appetite getting lower (Tummy feel full all the time) Breathlessness Swelling of feet may accompany How can we diagnose Ascites? Ultrasound – Even before you realize it, a ...

Liver biopsy is a procedure where a small piece of your liver tissue is obtained and sent for examination. Not all patients with liver disease warrant Liver Biopsy. Your Liver Specialist or Hepatologist will look at your disease course – history and clinical examination, blood reports including  Liver Function Tests  and reports for  HepatitisB ,  HepatitisC ,  Wilson’s Disease ,  Autoimmune Hepatitis  and then take a decision on need for  liver biopsy . Why does Hepatologist advice Liver Biopsy? Reason for abnormal liver tests (Diagnose) Determine the stage of your liver disease (Stage) Determine the severity of your liver disease (Grade) Decide on need and success of the treatment (Treatment) If there is any suspected tumour in the liver (HCC Hepatocellular Carcinoma Liver Tumour) Unknown reason of fever Is there different ways to carry out liver biopsy? Most common is via Ultrasound (Sonography) guided biopsy through the skin ...

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 ...

Over the last 50 years, transplantation has advanced dramatically and with each passing day the number of individual waiting for a transplant keep on rising exponentially. The gap between the available organs and the numbers needed has been widening. Though this gap is present for all available organs in each of the transplant centers of the world, there is a significant difference between the patterns of donation between different countries. A rough estimate of the need for Liver Transplant in India is 15000-20000 per year and the current number fulfills only 10% of the requirement. Against a requirement of 1 to 2 Lakh kidneys, only about 7000 transplantations are being done annually. Types of deceased organ donations There are three forms of established organ donations which form the source of organs for transplantation; donation after brain death (DBD), donation after cardiac death (DCD) and live related donation. Brain death is defined as the irreversible loss of all fun...

Intrahepatic cholestasis of pregnancy is a disorder characterized by itching,  with onset in the third trimester of pregnancy, without any primary skin lesions with relief of signs and symptoms within two to three weeks after delivery. It affects 0.7% of pregnancies in multiethnic populations and 1.2–1.5% of women of Indians. Prevalence is influenced by genetic and environmental factors and varies among populations worldwide. In Chile, 2.4% of all pregnancies are affected, with a 5% prevalence in women of Araucanian – Indian origin. Pruritus in pregnancy is common, affecting 23% of pregnancies, of which a small proportion will have obstetric cholestasis. A higher incidence is seen in twin pregnancies, following IVF, women of age more than 35 years, with a history of itching in previous pregnancies and in women with a history of the biliary disease. Patients with IVF may present in the second trimester with ICP. The itching/pruritus of obstetric cholestasis is typically worse...

Hepatitis B  is a global public health problem, with the highest number of hepatitis B virus (HBV) positive cases in  China  and  India . Since the majority are asymptomatic, the disease burden is under appreciated. It is a unique challenge to manage HBV infection in pregnant women, as can have consequences to both mother and newborn. About 12 studies in the Indian subcontinent have looked specifically at the prevalence of hepatitis B surface antigen (HBsAg) positivity in the pregnant women. The prevalence rate of HBsAg positivity in pregnant women varies from 1-9% in different parts of the country. All pregnant women should be tested for hepatitis B surface antigen (HBsAg) early in pregnancy. Pregnancy does not have a major effect on the liver disease in mothers with chronic hepatitis B, except in the context of cirrhosis but cirrhosis is relatively uncommon in young childbearing women with HBV infection. All hepatitis B positive women should be monitored clos...