Articles on hepatology

Jaundice: Why It Happens in Newborn Babies?

Dr. Rahul Varma, Pediatrician
Over the years, we all have seen lots of newborn baby diagnosed with jaundice on 3rd or 4thday of life, which turn out to be of great concern for most parents. First thing that comes to mind (esp. of grand parents ) that in old days jaundice was not so high, why is it now? Are doctors over diagnosing it ? Is our baby kept unnecessarily in nursery?I will try to answer these question in this article and will not go into too much technical details.Facts: Jaundice is universal phenomenon i.e. it occurs in every baby who is born.Normal trend is that Jaundice starts from day 2 or 3 and rises till 7th day and decreases gradually by 14th day of life. If its goes beyond a certain level then we need to treat , otherwise it will decrease on its own with time.Sunlight can not decrease jaundice. Enough scientific data is there, as it requires particular wavelength of light to be given from close range in order to decrease it. Still some of the doctors might suggest sunlight exposure, which is incorrect. However, giving sunlight exposure to your baby has various other advantage most important being Vitamin D3, hence it is advisable to give sunlight but not for jaundice.Important points for parents:Do not panic , it is very normal for babies to have jaundice  and it is easily treatable by giving Photo therapy in most cases.But if there is significant delay in starting photo therapy and bilirubin level is very high it can cause brain damage which cannot be reversed.It cannot be predicted at birth how high jaundice will go i.e.most likely  you will be told about jaundice by your child doctor on day 3 or 4 of life (that unfortunately, usually coincide with the timing of your discharge from hospital) .There is no way that it can be prevented as it is a normal (or physiological) phenomenon.As the treatment is so simple and risk if not treated is so high, its always better to be cautious and over treat rather then under treat.Sunlight do not have any effect on jaundice as the distance is too far away and particular wavelength of light is required to decrease it.Have faith in your doctor, not everyone is there to make money, most of the child specialist are honest and have soft corner for children. Further details  regarding Jaundice (if you wish to know in details,  otherwise you can skip it):We as a doctor  has various cut off values for bilirubin level . (Bilirubin levels is tested in blood which helps in assessing the severity of jaundice). These cut off  level guides us to decide whether your child need treatment or the level of bilirubin is with in normal limits and baby can be sent home. These cut off values varies as per, how old is your baby, what was birth weight, how mature your baby was i.e. born as per date or before that, blood group of baby and mother etc.In most of the babies who are born on time and are good size babies and whose blood group matches their mother, jaundice is less likely to go above danger level (however photo therapy may be needed).As the baby grows older, his liver starts functioning better and he can tolerate higher  level of jaundice. For eg, a bilirubin level of 12 at 36 hours of life is more alarming than level of 15 at 60 hours of life.Best thing which you as mother can do for your baby is breast feed, as feeding gets better child is able to metabolize and tolerated  bilirubin levels better.This jaundice is newborn babies (indirect bilirubin is high) technically different from what usually occurs in adults (direct bilirubin is high). And it is not very dangerous unless until levels become too high.  A very high level of indirect bilirubin can cause brain damage, and once that damage occurs, its difficult to treat and child`s brain functions are hampered for life.As medical science has evolved, we are able to diagnose more cases and start photo therapy early and actually prevent lots of cases of brain damage, which were there is past. (Enough scientific data is there to suggest decrease in incidence of bilirubin induced brain damage).Besides today most of us wants to have one baby or at the max 2, and do not want to take risk and want our children in best health.Treatment of Jaundice is Photo therapy and in rare cases of very bilirubin Exchange transfusion.Photo therapy:Special wavelength lights are given to babies from a particular distance. If level is high , we might give light from both side i.e.  one above the child hanging and one below the child. We give it continuously, interrupted only for feeding. We keep monitoring bilirubin levels and do repeat blood tests 12 to 24 hours usually but in some cases more frequently. It usually take around 48 hours to get jaundice in lower range but time taken to control jaundice is very variable. Exchange transfusion: In this we change the whole blood of baby gradually over few hours and replace it with blood from blood bank after cross matching. Its relatively serious process and is our last option when bilirubin levels are very high and neurological damage is suspected.Its virtually impossible to write everything here, so for any queries , feel free to contact us or your pediatrician. Its your right to discussion , the plan of care of your baby with treating pediatrician or Newborn specialist.Stay healthy!

Non-Alcoholic Fatty Liver Disease (NAFLD)

Dr. Naman Ajudiya, Ayurveda
Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. It's usually seen in people who are overweight or obese. A healthy liver should contain little or no fat. It's estimated that up to one in every three people in the UK has early stages of NAFLD where there are small amounts of fat in their liver. Early-stage NAFLD doesn't usually cause any harm, but it can lead to serious liver damage, including cirrhosis, if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of problems such as diabetes, heart attacks and strokes.If detected and managed at an early stage, it's possible to stop NAFLD getting worse and reduce the amount of fat in your liver.  NAFLD develops in four main stages. Most people will only ever develop the first stage, usually without realising it. In small number of cases it can progress and eventually lead to liver damage if not detected and managed. The main stages of NAFLD are Simple fatty liver (steatosis) – a largely harmless build-up of fat in the liver cells that may only be diagnosed during tests carried out for another reason non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD, where the liver has become inflamed this is estimated to affect up to 5% of the UK population   fibrosis – where persistent inflammation causes scar tissue around the liver and nearby blood vessels, but the liver is still able to function normally    cirrhosis – the most severe stage, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and can lead to liver failure (where your liver stops working properly) and liver cancer It can take years for fibrosis or cirrhosis to develop. It's important to make lifestyle changes to prevent the disease from getting worse.Am I at risk of NAFLD?You're at an increased risk of NAFLD if you are obese or overweight particularly if you have a lot of fat around your waist (an "apple-like" body shape)    have type 2 diabetes    have high blood pressure    have high cholesterol   over the age of 50    smoke However, NAFLD has been diagnosed in people without any of these risk factors, including young children. Although it's very similar to alcohol-related liver disease (ARLD), NAFLD isn't caused by drinking too much alcohol. Symptoms of NAFLD There aren't usually any symptoms of NAFLD in the early stages. You probably won't know you have it unless it's diagnosed during tests carried out for another reason. Occasionally, people with NASH or fibrosis (more advanced stages of the disease) may experience a dull or aching pain in the top right of the tummy (over the lower right side of the ribs)fatigue (extreme tiredness) unexplained weight loss    weakness If cirrhosis (the most advanced stage) developsyou can get more severe symptoms such as yellowing of the skin and the whites of the eyes (jaundice) itchy skin swelling in the legs, ankles, feet or tummy.How NAFLD is diagnosed NAFLD is often diagnosed after a blood test called a liver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. However, blood tests don't always pick up NAFLD.The condition may also be spotted during an ultrasound scan of your tummy. This is a type of scan where sound waves are used to create an image of the inside of your body. If you're diagnosed with NAFLD, further tests may be needed to determine which stage you have. This may involve a special blood test or having another type of ultrasound scan (Fibroscan). Some people may also need a small sample of liver tissue (biopsy) taken using a needle to have it analysed in a laboratory.Treatment for NAFLDMost people with NAFLD won't develop any serious problems, but if you're diagnosed with the condition it's a good idea to take steps to stop it getting any worse. There's currently no specific medication for NAFLD, but making healthy lifestyle choices can help and treatment may be recommended for associated conditions (high blood pressure, diabetes and cholesterol) or complications.You may be advised to have regular appointments with your doctor to check your liver function and look for signs of any new problems.Healthy diet and lifestyle Adopting a healthy lifestyle is the main way of managing NAFLD. The following can all help  Lose weight – you should aim for a BMI of 18.5-24.9; use the BMI calculator to work out your BMI. Losing more than 10% of your weight can remove some fat from the liver and improve NASH if you have it.    Eat a healthy diet – try to have a balanced diet high in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt. Eating smaller portions of food can help too.    Exercise regularly – aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week. All types of exercise can help improve NAFLD, even if you don't lose weight.    Stop smoking – if you smoke, stopping can help reduce your risk of problems such as heart attacks and strokes.NAFLD isn't caused by alcohol, but drinking may make the condition worse. It's therefore advisable to cut down or stop drinking alcohol.MedicationSome Helpful Herbs Bhumyamalaki – Phyllanthus niruriAmalaki – Emblica officinalisSharapunka – Tephrosia purpureaKatuki – Picrorrhiza kurroaPunarnava – Boerhavia diffusaKakamachi – Solanum 

Consuming These Foods Will Boost Your Liver Function!

Dr. Saurabh Gupta, Dentist
Garlic as a cleansing dietGarlic can help you drench out all the toxins by activating liver enzymes. It is high on selenium and allicin, these compounds are known to help cleanse liver. Allicin found in garlic can protect one against liver cancer. It can also reduce fat accumulation in the liver.Avocados for liver cleanseAvocados are high on antioxidants and help your body create glutathione that can elevate the natural cleansing mechanism. Avocados can help you boost detoxification enzymes of liver and help you get rid of toxins like carcinogens.Broccoli as a cleansing dietBroccoli helps you to increase the secretion of glucosinolate enzyme in your body that ultimately helps in cleansing your body and your liver. This green vegetable is one of the healthiest vegetable and is a part of healthy liver diet.Carrots as a cleansing dietCarrots are enriched with plant-flavonoids and beta-carotene. Consumption of carrots can boost overall liver function. Carrot can help protect liver against the poisoning induced by chemicals such as tetrachloride that can damage liver.Cabbage is an excellent liver cleansing foodThere are two important liver detoxifying enzymes that can be stimulated by eating cabbage and get rid of all the toxins. Green cabbages contain more chlorophyll and chlorophyll helps strengthen the liver.LemonLemons are a rich source of Vitamin C, which aids the body in synthesizing toxic materials into substances that can be absorbed by water. It will eventually help your liver function. Add these foods to your diet for a healthy liver.Leafy Green VegetablesGreen and leafy vegetables are quite popular as a healthy food. One of the several health benefits these vegetables offer is liver cleansing. The plant chlorophylls present in these vegetables offers a protective mechanism for liver by removing environmental toxins from the blood stream.Green TeaGreen tea is rich in catechins antioxidants which support liver function. Green tea is not just good for your health; it can be very good for your liver. A cup of green tea daily can keep your liver clean and healthy.Olive OilOlive oil, when used in moderation, can be very healthy for your liver. Olive oil helps in removal of harmful toxins through lipid base which in turn reduces the burden on the liver.GrapefruitGrapefruit is rich in Vitamin C and antioxidants which supports liver function. These contents of grapefruit help it increase the liver cleansing process. Add this tasty and healthy fruit to your diet for a healthy liver.

Can Strawberries Lower Cholesterol?

Ms. Swati Kapoor, Dietitian/Nutritionist
Strawberries are known for their flavour, flashy red colour and pleasant aroma. It’s favourite among all age groups and geographies. It is probably the most desired fruit in the world. The strawberry flavour is incorporated into various sweets and delicacies across the world. This delicious and healthy fruit can be easily incorporated in salads, healthy desserts, smoothies and other healthy snacks.Strawberries contain many vitamins, minerals and antioxidants such as flavonoids, anthocyanins and ellagitannins. These antioxidants have anti-inflammatory properties which can prevent certain cancers and heart ailments. Additionally, strawberries also help control blood sugar level.A recent research study has also examined the effect of strawberry consumption on cholesterol levels, and the results of these studies appear to show a promising link between the two.The research team set up an experiment in which they added 500 grams of strawberries to the daily diets of 23 volunteers over the duration of a month. They took blood samples before and after this period to compare data.Researchers found that the total amount of bad cholesterol level, that is the level of low density lipoprotein (LDL or bad cholesterol) or triglycerides fell by 8.78%, 13.72% and 20.8% respectively. The high-density lipoprotein (HDL or good cholesterol) remained unchanged.The reason behind this was the presence of anthocyanins, which are a sub-class of flavonoids that can help dilate arteries and prevent plaque build up, thus improving heart health and cholesterol levels.Strawberries also contains soluble fibre, which is known as pectin. Fibre lowers the blood cholesterol by interfering with the re-absorption of bile salt in the intestine. The bile gets excreted in the faeces. To make up for this loss of bile, the liver produces more bile salts. The body require cholesterol to make bile salts. So in order to obtain the cholesterol necessary to make more bile salts, the liver increases its production of LDL receptors, thus eating into the body’s bad cholesterol levels.Not only bad cholesterol level, but strawberries even improve other parameters like plasma lipid profile. Strawberries contain antioxidants like vitamin C that has anti aging properties and helps in wound healing, apart from playing a role in collagen formation. Strawberries even contain antihemolytic factors, which prevents breakdown of Red Blood Cells.Fresh strawberries are available only seasonally, so indulge in them when they’re available to derive maximum benefit. But their benefits are only limited to the consumption of the actual strawberry, not the unhealthy sugary desserts and cakes that just have their flavour and none of strawberry’s actual benefits.

Gallstones -- Does Everybody Need Surgery?

Dr. Maruthesh Gowda, Bariatric Surgeon
What causes gallstones? It is difficult to tell what causes gallstones as there are so many associated risks. Its more in females (3:1 compared to men). Incidence increases with age. More in overweight/obese patients. Can be familial. Its also more in people who starve for long time or have drastic weight loss. Commonly associated with people who eat lot of oily food. As you can understand there is no specific reason.What is the incidence of gallstones in India?Incidence of gallstones varies in different parts of the world. In India there is huge variations in different parts of the country. North East and Bengal (10%) has highest incidence and south india has lowest (2-3%). In North east and Bengal gallstones can be detected at very early age compared to south India.Can medicines cure gallstones?Main question which worries the patients is what to do when diagnosed with them. It is more confusing as they get different answers from different doctors.If one tells them they can be resolved then should be very careful. If there was ever medicine to dissolve gallstones permanently then the person who discovered it would probably get Nobel Price and can be richest man as western counties spend billions on surgery and complications. In short, there is no medicine to dissolve them permanently.What complications does gallstones cause?Before answering the question whether one needs surgery or not we need to understand risks of gallstones and surgery.  They arePAIN (BILIARY COLIC): Normally comes after food especially fatty foods. Across upper abdomen and can radiate to back. Can last upto few hours. If any one experiences these symptoms repeatedly and is found to have gallstones then it is symptomatic gallstones. Patients are strongly advised to have surgery (Laparoscopic Cholecystectomy -- Key hole procedure to remove gall bladder with stones) before having any of other complications listed below.INFECTION -- CHOLECYSTITIS: This is infection of gall bladder usually happens when gallstone blocks the cystic duct (See Picture). This would need admission and prompt treatment with intravenous antibiotics atlas for 48 hours and surgery (Laparoscopic Cholecystectomy -- Key hole procedure to remove gall bladder with stones) on same admission.INFECTION  -- CHOLANGITIS: This happens when there is infection  with blocked bile duct caused by the stone in the bile duct. This is very serious condition as infection can spread to blood in very short term and cause serious organ damage (Renal failure/cardiac failure/liver failure). This is associated with high risks so patients would be in ICU. Patient will need ERCP ( Camera procedure to remove stone in bile duct). Once recovered from the infection will need surgery (Laparoscopic Cholecystectomy -- Key hole procedure to remove gall bladder with stones) on the same admission. JAUNDICE: This can happen when gallstone slipped from gallbladder to common bile duct causes obstruction to flow of bile (See picture). patient will need ERCP ( Camera procedure to remove stone in bile duct). Some times stone can pass on its own. This will be determined by serial blood tests. Once recovered from the infection will need surgery (Laparoscopic Cholecystectomy -- Key hole procedure to remove gall bladder with stones) on the same admission.PANCREATITIS: Most serious complication of gallstones with serious threat to life depending on the severity of pancreatitis. Most patient will need ERCP ( Camera procedure to remove stone in bile duct). Vary rarely stone can pass on its own. Once recovered from the pancreatitis will need surgery (Laparoscopic Cholecystectomy -- Key hole procedure to remove gall bladder with stones) on the same admission. What function does gallbladder have in our body?Function of Gall bladder: Its main function is to store bile and release it when needed (usually after food). Losing it will not interfere with digestion. After surgery main bile duct takes over the function of gall bladder. Contrary to belief there is restriction of food after surgery to remove gall bladder (Laparoscopic Complications)What are the complications of gallbladder surgery/Laparoscopic Cholecystectomy and what percentage have complications?Complications of Gall bladder surgery (Laparoscopic Cholecystectomy): These happen in 0.2% of cases. That is 1 in 500 cases of Laparoscopic Cholecystectomy world wide. Complications include bleeding, bowel injury and bile duct injury. The complication risks are higher in people who have had one of the above discussed complication from gall stones.Who needs gallbladder surgery/Laparoscopic Cholecystectomy?Now consider whether to have Laparoscopic Cholecystectomy -- Key hole procedure to remove gall bladder with stones). You can make educated decision.If the gallstones are symptomatic or you had any one of above complications then there is absolute indication for surgery on same admission or as soon as possible before you have other complications.If gallstones are incidental (This is the controversial part which patient needs to take decision)-- found on scan for some other reason and are not causing any complications then you have to decide whether to have surgery or not. The above article will help you to make that decision. If someone is diagnosed with gall stones then they have 2%-5% risk of above complications every year Vs 0.2% risk of complication from surgery to remove gallbladder. If have complication then you would need atleast 3-5 days admission, more time to recover and cost of treatment also increases with each complication.  It is ones decision whether to risk complications then face complicated surgery with higher risk of complications and prolonged recovery with added extra expenditure or have elective surgery where you can go home same or next day. If one does not live in select few cosmopolitan cities with access to all the healthcare facilities then it does not make sense to wait till the complication happens as it will be difficult to deal with them in small cities with limited resources and facilities. One's life is put to serious risk then.Do we need to avoid any food after surgery? Absolutely nil. One can start having food few hours after surgery and can eat all the food throughout the life without any restriction and malabsorption. 

Did You Say Jaundice?

Dr. Kunal Das, Gastroenterologist
Jaundice is a common health problem especially during the monsoons/summers. There are several reasons for jaundice, most common causes include liver infection due to viruses (Hepatitis A, B, C, D, E), blockage of the biliary system due to stone or cancer, liver abscess and increased breakdown of red blood cells.Hepatitis B affects more number of people than the HIV virus.Despite there being a vaccine, Hepatitis B virus kills one person every 30-45 seconds.Most people who are infected (almost three-fourths) are unaware of their infection.The infection can kill 25% of the infected people due to liver cancer or liver failure from cirrhosis.Liver infection due to liver virus can be due to five virus which are named alphabetically – Hepatitis A,B,C,D and E.Hepatitis A and E are transmitted by contaminated food and water, bad sanitary practices etc. and causes short term disease lasting less than 6 months. The infection usually resolves on its own with medicines.Hepatitis B and Hepatitis C are transmitted by contaminated blood and syringes, sexual route, needle stick injuries, intravenous drug abuse etc. Hepatitis D only occurs in presence of Hepatitis B. Infection by hepatitis C can be potentially long term and may require treatment. However, hepatitis B usually resolves in >90%cases and does not require treatment. Hepatitis B is 1000 times more infectious than HIV, but is preventable by vaccination.Diagnosis is done by special blood tests like Liver function test and others. In some cases, the disease may become severe and cause bleeding, altered behaviour, abdominal swelling and even coma called as fulminant hepatitis. This condition requires ICU care and even liver transplantation.There is no specific treatment for Hepatitis A and E. Treatment for Hepatitis B and C is done only in certain special circumstances.Blockage of bile duct due to stone or cancer is another common cause of jaundice. Presence of stones is diagnosed by Ultrasound and is removed by an endoscopic procedure called ERCP (Endoscopic retrograde cholangio-pancreatography). Cancer of gall bladder or bile duct usually presents with itching, weight loss and can be diagnosed using ultrasound and CT scan. If the cancer is in early stage, surgery may be done. However, if the cancer is advanced and surgically non-removable, then palliative management with stenting can be done to relieve symptoms and improve quality of life.Liver abscess which means pus in the liver, presents with fever, pain abdomen, jaundice and nausea/vomiting. It may occur due infection by parasite of amoeba or due to blockage of bile duct. This is treated with intravenous antibiotics, and in some severe cases aspiration of pus from the liver. The most dangerous complication is rupture of the abscess cavity, in which case emergency surgery may be required.

Gallstone Disease More Prevalent in North India

Dr. Atul Krishan Sharma, Gastroentrology Surgeon
Gallstone disease (cholelithiasis) has increasingly become a major cause of abdominal pain and discomfort in the developing world.  Its occurrence has been found to be high (7.4%) in the adult population in the cities of Chandigarh and New Delhi in North India, which is interestingly seven times more frequent than in south India.Female vs MalesAt one time considered to be a disease commonly afflicting the fat, fertile, flatulent, female of around forty years, it now also more often seen in the postpartum primipara, who was a pre-pregnancy contraceptive pill user. Meaning thereby, that there is a definite shift in the trend of gallstone disease from middle aged, fertile, over weight females to young asthenic females in their twenties. Gallstones are much more common in the female population (61%) as compared to males (39%). The age group most affected is 45–60 years (38.5%) among females, and above 60 years in males (20.8%). A relatively higher prevalence of 39% among males when compared to reports from past studies indicates a significant shift in the pattern of prevalence of gallstone disease.Dietary factorsIn a recent study conducted the factors that emerged significant to cause the formation of gallstones are inadequate physical activity, high waist hip ratio (truncal obesity) and excessive intake of saturated fats. High total fat intake of the polyunsaturated kind, especially of animal origin in diet, may lead to loss of bile acids in stools, decreasing the bile acid pool and promoting super-saturation of cholesterol in bile rendering it more prone to form stones in the gallbladder. Low fiber intake and high refined sugars were similarly associated with tendency to gallstone formation. Those who take a higher proportion of vegetable proteins have a lower incidence of gallstones.Sachdeva S, Khan Z, Ansari MA, Khalique N, Anees A. Lifestyle and Gallstone Disease: Scope for Primary Prevention. Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine 2011;36(4):263-267. doi:10.4103/0970-0218.91327.How do gallstone form?Gallstones are either cholesterol gallstones (pure and mixed) or pigment stones (black or brown). Super-saturation of bile with cholesterol and stagnation of bile in the gallbladder are the two major causative factors which predispose to cholesterol gallstone formation. Mixed cholesterol gallstones are the commonest stones in adults and in adolescent girls. Pigment stones are more common in children. The composition of gallstones is also different in different parts India. In north and eastern India gallstones are predominantly cholesterol stones. The myth that seeds in vegetables lead to gallstone formation needs to be dispelled. Do gallstones cause cancer?The incidence of gallbladder cancer parallels the prevalence of gall stone disease; large and long-standing gall stones being associated with a higher risk of gallbladder cancer. Gall stone disease is common in north India and occurs at a younger age than in the western populations. Moreover, patients with gall stone disease present for treatment a long time after the onset of symptoms. Both these factors result in prolonged exposure of the gallbladder to stones. Besides gall stone disease, various other factors may also play a role in the causation of gallbladder cancer which is a North Indian disease.Symptoms of gallstone diseaseAsymptomatic Gallstones:Most do not develop symptoms even after follow up periods as long as 20 years. Approximately 20% of patients develop symptoms by 15 years. Asymptomatic gallstone disease does not need surgery but there are important exceptions tabulated below.1. High risk for gallbladder cancerNorth Indian women with gallstonesGallstones larger than 3 cm in diameterPorcelain gallbladder (calcification in the wall)Gallbladder polyps larger than 12 mmNote: The role of prophylactic cholecystectomy in young patients from various parts of India has been emphasized in many recent papers.2. DiabetesInfection in the gallbladder in patients with gallstones can be life threatening3. LifestyleWorking for prolonged periods in remote parts of the world with poor medical facilitiesSymptomatic Gallstone Disease:Although dyspepsia (upper abdominal fullness, flatulence or gas formation, heart burn, hyperacidity) are not considered typical symptoms of gallstones, in a study from AIIMS new Delhi of the 1,680 consecutive dyspeptic patients, 500 (29.8%) had gallstones. The common presentation of patients with gallstones is:Biliary pain:The typical first symptom is frequently characterized as pain in the right upper abdomen after a meal, more so after fatty foods.Complications of gallstone diseasea. Acute Cholecystitis: Often patients will have history of biliary pain which lasts for > 3 hours, associated with fever and right upper quadrant tenderness (Murphy’s sign).b. Chronic Chlolecystitis: Patients will have episodic epigastric or right upper abdominal pain lasting for more than 30 minutesc. Choledocholithiasis: When a stone from the gallbladder slips into the common bile duct it can lead to biliary colic, obstructive jaundice followed by acute cholangitis or pancreatitis.d. Acute Cholangitis: is a medical emergency. Patients may present with right upper quadrant abdominal pain, fever and jaundice. (Charcot’s triad)e. Pancreatitis: A most dreaded and life threatening complication of gallstones presents with very severe, persistent central upper abdominal pain, retching and prostration.DiagnosisThe diagnosis can be made best by an upper abdominal ultrasound examination, carried out in the fasting state. In case the patient has jaundice or history of pancreatitis an MRI (MRCP) is required to confirm / exclude stones in the common bile duct before surgery is undertaken.Technique of laparoscopic surgery ManagementLaparoscopic cholecystectomy (Lap Chole) is the gold standard for the treatment of gall stones. Unlike in kidney stones only the stones are never removed from the gall bladder, but the entire gallbladder is removed after clipping or ligating the cystic duct and cystic artery, and dissecting the gallbladder off its liver bed. For a Lap Chole the patient is admitted to hospital after an overnight fast at about 6 AM. Certain preparations are done before sending the patient to the operation theatre. Surgery usually lasts for 30 – 45 min and the patient is warded in thereafter. He / she can usually take some fluids the same evening and a light breakfast next day and is almost invariably fit for discharge to home by noon. Since the procedure is done through four tiny incisions the scars are barely visible after three months.In case the gallbladder has too many adhesions or the anatomy is obscured by repeated attacks of cholecystitis the procedure may need to be converted to the conventional operation through an oblique, (subcostal) incision. 

Knowledge Is Power for Preventing Hepatitis C

Dr. Gautama Ramakanthan, Gastroenterologist
What is hepatitis C?Hepatitis C is one of the leading causes of ESLD. It is one of the three leading causes of cirrhosis of liver and liver cancers. About 20-25% of the patients undergoing liver transplantation at our Centre in Thane and pretty much the whole world has Hepatitis C. Hepatitis C is transmitted through the use of infected blood, blood products and unprotected sex and sharing of infected needles.In India, blood banks did not test for Hepatitis C prior to 2000. Also GP’s in the past would use reusable glass syringes for IM injections; it would be good idea to get yourself tested for Hepatitis C if you have received blood and blood products before 2000 or exposed to injections with a glass syringe with reusable needles. Unfortunately, we don’t have a vaccine like we have for Hepatitis B. However, the good news is that excellent oral anti hepatitis C drugs are available in India at a fraction of the cost in the US.PreventionAs Hepatitis C is spread through blood and blood products, whenever you receive these they should be from an NABL accredited lab so that one is sure that it has been screened properlyAll hospitals nowadays use disposable products, so you are pretty much protectedIf you are considering tattooing or body piercing, ensure that disposable products are usedDo not undertake unprotected sexSigns and symptoms of Hepatitis CAcute hepatitis C is asymptomatic in most. One could get symptoms of an acute viral illness and if liver function tests are done, then they would be abnormalIn majority of the cases, the diagnosis is made when one develops cirrhosis or end stage liver disease. Symptoms will be fatigue, jaundice, swelling of the feet, swelling of the abdomen, vomiting of blood, change in conscious levels.Cirrhosis of Liver-End Stage Liver Disease, develops about 20 to 25 years after the acute infection during which period the patient is relatively free of symptomsTreatmentExcellent oral Anti viral agents are available to give cure rates up-to 95%The common Genotypes seen in India are Genotype 3 which makes up the majority and Genotype 1 which is second common agentFor Genotype 1 a combination of Sofusbuvir and Ledipasvir is given for 12 weeks irrespective of weather one has cirrhosis or not and if one is treatment experienced or not. This gives a cure rater of about 95%For Genotype 3 a combination of Sofusbuvir with Daclatasavir is given for 12 to 245 weeks depending on weather you have cirrhosis or not. Ribavarin is also recommended for cirrhosis to improve success rates. Generally, for this genotype the success ranges from 70 to 90% depending on previous treatment taken and the presence of cirrhosisThe good news is that in a significant percentage of cirrhotics there is regression of the disease and improvement in clinical status once the virus has completely clearedIn a large number of patients, the treatment is Liver Transplantation wherein the diseased Liver is removed and replaced by a new liver. This can be from a Cadaver donor when the whole liver is replaced or from a Living Donor when the partial liver is replaced

She Was 30,suffering From Pain Abdomen for 5 Years &There Were No Ultrasounds in 1982

Dr. Neelam Nath Bhatia, General Physician
Dear Colleagues, please make it a habit to get ultrasound abdomen done on every woman reporting to you with vague pain abdomen and during pregnancy also while you send the woman for ultrasound examination to detect congenital defects in the baby.Do Not Let Any Woman Suffer in Silence with acute pain abdomen for 5 years plus during late seventies and early eighties when ultrasound machine was just 1 in entire Delhi managed by a UK returned doctor ,who had PROs to visit hospitals looking for women wanting to get selective abortions , killing female fetuses detected on ultrasound. He had a monoply ,lived in a posh farm house with every gadget imported from UK along with ultrasound machine.I am not bitter or a cynic to feel jealous.PNDT act was introduced in 1994 & we have no data about Numbers of female fetuses killed in Delhi ,as it was Free for all after paying a reasonable amount of money to the Ultrasound doctor and to the doctor at Nursing home to carry out advanced abortions to kill females.It was a Chance detection of gall stones for this woman who would have otherwise died due to complications of a gall bladder disease. She had lost appetite, was running low grade fever , had pain after eating little food, had pimples on face indicating high levels of Cholesterol in blood due to failing liver & on top of that she was given Anti TB treatment by an MD quack for 10 months ( because every quack gives anti TB treatment to every person suffering from low grade fever with no appetite)This woman was diagnosed with innumerable gall stones , beyond count when she was taken to ultrasound doctor to get a test for sex determination after 5th pregnancy in a row bearing girls only with 3 girls alive.She was carrying another female fetus - 6th one in a row and MTP was carried out in best nursing home as a Show off being Cared despite bearing daughters only !Gall bladder is a pear shaped reservoir of bile digestive juices ,made by liver but secreted by pipes into the food pipe to make food soft and easy to digest during the churning process carried out in the stomach for 4 hours , the food stays here to be passed on further in the food pipe for absorption of important ingredients.In general in Affects women who are FatFortyFairFertileBut that was long time ago , these days we come across women during thirties ,because of high intake of Estrogen hormones through pills ( this is pregnancy hormone too )Get Every woman investigated by Ultarsound and say Thanks to advanced Technology, because if detected early , treatment is Simple operation by Key hole Surgery !People do ask for alternatives to operation and Fear factor regarding surgery is Genuine.There are medicines, there are Shock wave treatments but They are Not Effective.One can live for years Minus a gall bladder with little restrictions on food like avoiding fats ( which all of should do to remain healthy ) & No Fast or Feast !If a senior visits us with gall stone of size of a rice but no symptoms , she can be advised surgery later in case she starts getting symptoms like pain in upper central abdomen rather too often , or she shows signs of liver being affected by symptoms like no appetite / jaundiceMultiple Stones in gall bladder May Require conventional Surgery in place of Key Hole Surgery,because it is Stuck due to Huge size !A single stone , size of a pea can get obstructed in pipe carrying juice to stomach-Bile duct And it is an Emergency.What happens if a woman with Multiple Stones does not get Operated at all She can get Chronic infection in gall bladder / Pancreas & both can be as fatal as Cancer of Gall Bladder ( 10% cases of untreated gall stones do get CA GB)As a Routine Every pregnant Woman should be advised ultrasound of upper abdomen along with lower abdomen.We do chance upon stones in kidneys and gall bladders , for which all through pregnancy only counselling about diet can be given.No Surgery is possible during Pregnancy for GB stones or Shock wave therapies for Kidney stones.And do get woman tested for Liver Function Tests- If Liver enzymes are High, it indicates low functions of liver & if Alkaline Phosphatase is High , it indicates Obstruction in bile duct.And if Cholesterol is 600 , it shows for sure a mal functioning Liver And Tell the Fertile woman- Enough is Enough .No More Selective MTPs to get that Coveted Male Heir.Take Care of the Living tiny little Females with full Dedication as if every day is a Ritual to Worship The Goddesses Incarnations in Human Form.