Dr. Pathik Parikh Hepatologist and Liver Transplant Physician

  Complications of Liver Cirrhosis Liver Cirrhosis means permanent irreversible damage to most of the liver. The complications develop when more than 80% of functioning parenchyma is lost. As liver has more than 500 functions, the complications are not limited to one or two systems but has systemic effects. Complications of Liver Cirrhosis should be managed in a tertiary care setup where multiple specialists are available round the clock. We describe complications of liver cirrhosis for all patients to comprehend in simple language.   best liver cancer doctors in ahmedabad 1. Ascites – Fluid accumulation in the tummy This is a common feature of cirrhosis.It is an accumulation of excessive fluid within the peritoneal cavity due to the increased plasma volume ‘spilling over’ into the abdominal cavity. This isusually accompanied by swelling of the feet (Edema). Whenever you develop fluid in your tummy for the first time, you need a needle aspiration and testing. You also need to ...

  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 ...

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...

What do you mean by cirrhosis of liver? In medical terms cirrhosis is diffuse irreversible damage to liver parenchyma. In the current era, it is irreversible. That means that the damage to the liver has crossed the point of no return. Although, you can remain stable with cirrhosis, you cannot cure or reverse cirrhosis of liver.  Under normal circumstances, liver is smooth and soft to touch. In cirrhosis your liver becomes hard and irregular and rough. In simple terms, it means, your liver is damaged. How does cirrhosis affect your body? Liver performs more than 500 functions. So when you develop cirrhosis, these functions start decreasing. Some of these functions include cleaning of toxic byproducts of your body, metabolizing all the food that you eat, storing important vitamins and even forming proteins necessary for life. Besides, all the blood from your tummy (including from your intestines), drain through the liver into the heart. In cirrhosis this draina...

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 ...

With the prolonged monsoon season that we had this year, the  Dengue Fever  cases have been on a rise. Dengue fever is a viral disease transmitted by a vector known as Aedes mosquito.  The weather in Ahmedabad being warm and with humidity provided by the prolonged monsoon has resulted in Aedes getting multiple breeding sites.It is a self-limiting condition for which no specific treatment is available and the trials on vaccination to prevent are just coming out.  It is the most rapidly spreading mosquito borne disease in the world. Most of the cases of dengue fever behave like a routine viral illness where the patient develops fever with flu like symptoms – body ache, headache, joint pains, malaise, nausea, vomiting, and loss of appetite.  With supportive care, these symptoms subside in a period of few days and the disease leaves without any long term sequel. Affection Liver by the virus is an important aspect of the disease. Most of the time, it causes a...

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 ...