Dr. Pathik Parikh Hepatologist and Liver Transplant Physician

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...

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 ...

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...

Liver is the largest internal organ of the body and is the largest gland of the body. It weighs 1000 to 1500 mg and is responsible for carrying out more than 500 functions. Unlike kidney, we do not have a any artificial machine to take care of all liver functions and so when an individual develops liver failure , they are left with  liver transplant  as their only option. Myth 1 – Liver Transplant is only for elite class Liver transplant is 100 times cheaper in India than any other developed country of the world. The overall cost varies from 12 -25 lakhs for the operation. But the most important fact that people do not know is that there are a lot of social organizations and NGOs that help people financially for liver transplant. What people fail to understand that you end up spending more than the cost of transplant after cirrhosis just for repeated admissions with complications. It is advisable to get transplanted rather than getting admitted multiple times in Intensi...

There is a myth that because alcohol is banned in Gujarat, there is no  liver disease in Gujarat . Though, alcohol is one of the major reasons for liver failure, there are many other diseases which one needs to be aware of. The most common cause of  liver failure in India  is  Hepatitis B . The most common cause of liver cancer is Hepatitis B. Those who were born before 2002 need to check themselves for hepatitis B. vaccination is available and is now a part of national immunization schedule. Hepatitis B has no symptoms and the only way to diagnose is a simple blood test. If you have received blood transfusion in past, you have the risk of being exposed to  Hepatitis C . The diet in Gujarat is full of sugars and oils. With adaption of western sedentary lifestyle, obesity and diabetes is on the rise. With that fatty liver is also on the rise.  Fatty liver  can cause liver damage similar to that caused by alcohol. Fatty liver is worldwide becom...