Liver Transplant Hospital in Chennai

Alcohol-Related Liver Disease Overview

Alcohol-related Liver Disease is characterised by damage to the liver caused by years of alcohol abuse. The liver damage caused by excessive alcohol consumption causes swelling, inflammation and reduces liver function. The final stage of this degeneration is cirrhosis, where the liver fails.

Signs and symptoms of Alcohol-Related Liver Disease

Alcohol-related liver disease has three stages of severity –

• Alcoholic fatty liver disease – Fat accumulates within the liver and slowly starts affecting its function. There may be little or no symptoms, but mild changes in blood tests and scans can be identified. This stage can be completely reversed by stopping alcohol consumption.
• Acute Alcoholic Hepatitis – The liver becomes inflamed and swollen. Patient may develop jaundice, fatigue, swelling in the abdomen and feet. Blood tests are usually very abnormal. This stage is reversible with medical treatment and complete and permanent abstinence from consuming alcohol. Occasionally however, this stage may progress into a rapid deterioration in liver function with worsening jaundice, bleeding tendency and coma, which may be life-threatening.
• Liver cirrhosis – This is a late-stage and the liver becomes scarred from continued liver damage and liver function is permanently reduced. It also becomes very susceptible to any further injury. A patient suffering from alcohol-related liver disease would experience jaundice, nausea, loss of appetite, abdominal cramps or pain, fatigue and dark stools. They may also experience unexplained weight loss, fainting, agitation, mood swings, disorientation, and bleeding gums.

Causes and risk factors of Alcohol-Related Liver Disease

The cause of alcohol-related liver disease is alcohol abuse. These patients also have associated malnutrition due to a lack of a healthy balanced diet.

Complications of Alcohol-Related Liver Disease

Alcohol-related liver disease could cause permanent scarring and loss of liver function. It could also cause portal hypertension, hepatic encephalopathy and bleeding of ruptured oesophageal varices.

Diagnosis of Alcohol-Related Liver Disease

Alcohol-related liver disease is one of many diseases that cause extensive liver damage. In addition to a detailed patient history, the doctor will need to perform multiple tests to rule out the other conditions. The doctor may require a complete blood count, a liver function test, an abdominal ultrasound, an abdominal CT scan, and a liver biopsy. A liver enzyme test will also be required.

Treatment and Surgical Interventions of Alcohol-Related Liver Disease

The treatment of alcohol-related liver disease is geared to address the liver disease as well as alcoholism. This is necessary to prevent further liver damage and help the liver heal. The doctor may recommend an alcoholics rehabilitation program and an increase in vitamin intake. In case severe cirrhosis has already set in, a liver transplant may be the only option which can help the patient lead a good quality life. However, transplant rules are strictly subject to the patient’s commitment to de-addiction.

Prevention of Alcohol-Related Liver Disease

Avoiding the consumption of alcohol can help prevent alcohol-related liver disease.

Non-Alcoholic Fatty Liver Disease Overview

Non-alcoholic fatty liver disease (NAFLD) is an umbrella term for a plethora of diseases in people with negligible alcohol consumption that causes excess fat to be stored in the liver. NAFLD has three stages – inflammation, cirrhosis, and liver failure. NAFLD’s symptoms are very similar to those caused by long-term alcohol abuse.

Signs and symptoms of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease usually causes no symptoms in the initial stages. Mild symptoms like stomach ache in the upper right abdomen and fatigue may be present. When the disease progresses to cirrhosis, patients usually experience abdominal swelling (ascites), enlarged spleen, jaundice, red palms and enlarged blood vessels beneath the skin.

Causes and risk factors of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease is associated with obesity, high cholesterol and type 2 diabetes. This is mainly associated with a sedentary lifestyle, prolonged duration of high-calorie food intake and limited exercise. However, a small proportion of patients- especially of South Asian origin develop this problem despite the absence of any of these risk factors (Lean NASH). People with polycystic ovary syndrome, hypothyroidism and hypopituitarism are also at a higher risk of developing Non-alcoholic fatty liver disease.

Complications of Non-Alcoholic Fatty Liver Disease

The main complication of this disease is cirrhosis. Cirrhosis is a response to inflammation. Progression of cirrhosis will lead to its usual complications such as oesophageal varices, hepatic encephalopathy or disorientation, liver cancer and end-stage liver failure.

Diagnosis of Non-Alcoholic Fatty Liver Disease

Since most patients do not have any symptoms, it is challenging to diagnose Non-alcoholic fatty liver disease at an early stage. The doctor may diagnose the disease based on patient medical history, a physical exam, blood tests, liver function tests, and an ultrasound, CT scan or MRI to check for fat deposits.

Treatment and Surgical Interventions of Non-Alcoholic Fatty Liver Disease

There are currently no approved drug therapies for Non-alcoholic fatty liver disease. However, weight reduction with a combination of healthy, low-calorie diet and exercise is usually the first course of action. Extreme fasting or attempting to follow rigid diet regimens may be counter-productive and should be followed only after careful discussion with your hepatologist. Occasionally, weight-loss surgery or gastric by-pass surgery may be recommended to help the patient lose weight. For patients with cirrhosis and its complications, a liver transplant may be needed.

Prevention of Non-Alcoholic Fatty Liver Disease

To reduce your risk of developing non-alcoholic fatty liver disease, maintain a healthy weight and body mass index. Eat a healthy, balanced diet and exercise regularly.

Autoimmune Liver Disease Overview

Auto-immune hepatitis occurs when the body’s immune system attacks the liver cells, causing inflammation and scarring in the liver. The exact cause of autoimmune hepatitis is unknown, but the reasons appear to be influenced by genetic and environmental factors. If drug therapies are ineffective, or in case of severe liver damage, the patient may require a liver transplant.

Signs and symptoms of Autoimmune liver disease

The signs and symptoms of autoimmune hepatitis vary from patient to patient. Patients usually experience a combination of increasing fatigue, nausea, abdominal discomfort, jaundice progressing over many years to cirrhosis. Occasionally, it may present very rapidly over a few weeks with jaundice, bleeding tendency and even coma.

Causes and risk factors of Autoimmune liver disease

Auto-immune hepatitis is caused by the body’s immune system attacking the liver cells. This immune response could cause inflammation, which over time would lead to scarring and cirrhosis. Women have a higher risk of autoimmune hepatitis. People with a personal or family history of other auto-immune conditions have higher chances of developing auto-immune hepatitis.

Complications of Autoimmune liver disease

Auto-immune hepatitis could cause oesophageal varices, ascites or fluid in the belly, liver cancer or liver failure.

Diagnosis of Autoimmune liver disease

Auto-immune hepatitis could be easily confused with other liver diseases. Blood tests would be required to rule out viral hepatitis and check for immunoglobulin antibody levels. Occasionally a liver biopsy may be necessary to confirm the diagnosis.

Treatment and Surgical Interventions of Autoimmune liver disease

Auto-immune hepatitis can be slowed down and even reversed with appropriate drug therapies. The patient may be prescribed immunosuppressants and corticosteroids. In case of severe liver damage or cirrhosis, a liver transplant can prove effective. However, in some cases, the patient rejects the liver, or the body’s immune response damages the donor liver as well.

Prevention of Autoimmune liver disease

There is no proven way to avoid autoimmune hepatitis. However, regular checkups may detect it at an early stage.

Primary Biliary Cholangitis Overview

Primary biliary cholangitis, formerly called primary biliary cirrhosis, is a disease that causes slow but persistent damage to the bile ducts within the liver. When the bile ducts get damaged, bile made in the liver cannot reach the bloodstream to digest fats. The backed-up bile can cause inflammation and scarring in the liver. Primary biliary cholangitis is considered an auto-immune condition. It is caused by the body’s immune system launching an attack on the bile ducts.

Signs and symptoms of Primary Biliary Cholangitis

Many patients diagnosed with primary biliary cholangitis experience no symptoms. However, some of the common symptoms that patients experience in the early stages are dry eyes and mouth, severe and persistent itching and extreme fatigue. In the late stages, the condition can cause upper abdominal pain, spleen enlargement, swelling of ankles and feet, jaundice, diarrhoea and weak bones.

Causes and risk factors of Primary Biliary Cholangitis

Primary biliary cholangitis is considered an auto-immune condition where the lymphocytes attack one’s own bile duct lining causing progressive damage. It is more common in women between the age of 30 to 60, while family history also plays a role in increasing this risk. Environmental factors that could trigger primary biliary cholangitis include smoking, infections and exposure to toxic chemicals.

Complications of Primary Biliary Cholangitis

In late stages, primary biliary cholangitis can cause portal hypertension, liver cirrhosis, enlargement of the spleen, gallstones in the bile duct, oesophageal varices, and hepatic encephalopathy. The condition also increases your risk of osteoporosis, liver cancer and vitamin deficiencies.

Diagnosis of Primary Biliary Cholangitis

Primary biliary cholangitis is diagnosed based on a patient’s medical history, a physical exam and a blood tests panel for liver function and antibodies. The doctor may also require scans to ascertain the degree of liver damage and rule out other conditions with similar symptoms.

Treatment and Surgical Interventions of Primary Biliary Cholangitis

There is no cure for primary biliary cholangitis. However, further progress and complications can be slowed down using drug therapies. If medications are ineffective and the liver is compromised, the doctor may recommend a liver transplant surgery, which has shown good long-term outcomes for patients with this condition. In addition to these, the doctor may recommend diet and lifestyle changes to help cope with the disease.

Prevention of Primary Biliary Cholangitis

Primary biliary cholangitis cannot be prevented as the cause is uncertain.

Primary Sclerosing Cholangitis Overview

Primary sclerosing cholangitis is an autoimmune condition leading to inflammation and damage of the bile ducts. When the bile ducts get damaged, bile made in the liver cannot reach the small intestine to digest fats. The backed-up bile can cause inflammation and scarring in the liver. It is a chronic, progressive disease and can co-exist with certain autoimmune conditions of the intestine. It is diagnosed commonly in older children and young adults.

Signs and symptoms of Primary Sclerosing Cholangitis

Itching, episodes of jaundice with fever, weight loss, and fatigue are common early symptoms. As the condition progresses, all features of liver failure can develop. This condition is also associated with an increased risk of tumors in the liver and the bile ducts.

Causes and risk factors of Primary Sclerosing Cholangitis

Primary sclerosing cholangitis is considered an auto-immune condition. An immune response to an infection or a toxin occurs in genetically predisposed patients, triggering an auto-immune attack on the bile ducts. Patients with inflammatory bowel disease such as ulcerative colitis have a higher chance of developing this condition.

Complications of Primary Sclerosing Cholangitis

Complications include liver failure, repeated liver or bile duct infections, portal hypertension and an increased risk of colon and bile duct cancer.

Diagnosis of Primary Sclerosing Cholangitis

Primary sclerosing cholangitis is diagnosed based on patient’s medical history and examination, liver function tests, auto-antibody levels and scans to examine the liver and the bile ducts. A liver biopsy may also be required.

Treatment and Surgical Interventions of Primary Sclerosing Cholangitis

There are currently no accepted drug therapies used to treat primary sclerosing cholangitis. Most medical interventions focus on minimizing complications and relieving symptoms. If the bile ducts are blocked, the doctor may opt to endoscopically re-open them and restore function. Extreme cases may require a liver transplant.

Prevention of Primary Sclerosing Cholangitis

Primary sclerosing cholangitis cannot be prevented as the cause is uncertain.

Hepatitis A Overview

This is a highly infectious liver condition caused by the hepatitis A virus. Most cases are mild and can recover completely with no permanent liver damage. Practicing good hygiene and washing hands frequently are good preventive measures to protect yourself from hepatitis A. A vaccine is also available for hepatitis A.

Signs and symptoms of Hepatitis A

Once infected, the symptoms of hepatitis A usually appear in the patient after 2-3 weeks. The symptoms include fatigue, nausea, vomiting, abdominal pain, clay-coloured stools, loss of appetite, low-grade fever, dark urine and jaundice. The symptoms could be mild and disappear within a few weeks, or they could last up to a few months.

Causes and risk factors of Hepatitis A

Hepatitis A is caused by a viral infection in the liver. The virus typically spreads via contaminated food and water and by eating with contaminated hands. People who travel frequently are at risk for acquiring hepatitis A infection.

Complications of Hepatitis A

Unlike other types of hepatitis, hepatitis A infection is usually mild and doesn’t cause any permanent liver damage. Occasionally, it may cause very severe liver injury causing acute liver failure and may even need an emergency liver transplant.

Diagnosis of Hepatitis A

After an initial patient medical history and physical exam, the doctor will confirm hepatitis A with a blood test.

Treatment and Surgical Interventions of Hepatitis A

There is no formal treatment for hepatitis A. In a typically mild infection, the body fights it on its own within a few weeks. Treatment is usually focused on mitigating the symptoms. Very severe liver injury may cause acute liver failure and the patient may need ICU care or even a liver transplant.

Prevention of Hepatitis A

Hepatitis A can be prevented by the hepatitis A vaccine. It is typically administered in 2 doses. The initial dose is followed by a booster dose after 6 months.

Hepatitis B Overview

This is a severe and contagious liver disease caused by the hepatitis B virus. It causes severe inflammation and affects liver function. Most adults recover completely from a hepatitis B infection. However, it can become chronic and cause prolonged liver injury and scarring of the liver. Children and infants tend to develop chronic hepatitis B, which can cause permanent liver damage. There is a very effective vaccine to prevent hepatitis B.

Signs and symptoms of Hepatitis B

Once infected, the symptoms of hepatitis B usually appear in the patient after 1-4 months. However, they could appear as early as two weeks post-infection. Symptoms of hepatitis B include nausea, vomiting, abdominal pain, fatigue, loss of appetite, low-grade fever, dark urine and jaundice.

Causes and risk factors of Hepatitis B

Hepatitis B typically spreads via cross-contamination of blood, semen and other bodily fluids. It does not spread via sneezing or coughing. The disease commonly spreads through shared needles, contaminated needle use and unprotected sexual contact. If a pregnant mother has hepatitis B, the risk of it passing onto the baby is also very high.

Complications of Hepatitis B

Chronic infection with Hepatitis B can cause cirrhosis, liver cancer, kidney disease and acute liver failure.

Diagnosis of Hepatitis B

After an initial patient medical history and physical exam, the doctor will confirm hepatitis B with a blood test. A liver ultrasound and biopsy may also be required.

Treatment and Surgical Interventions of Hepatitis B

There is no formal treatment for acute hepatitis B as the symptoms usually recover spontaneously. The doctor may recommend rest, fluids and some painkillers. In very severe cases, anti-viral drugs may be prescribed, and if the liver damage is extensive, it may even need an emergency liver transplant as a life-saving measure. Chronic hepatitis B patients are treated with antiviral drugs, Interferon injections and, in case of cirrhosis, a liver transplant.

Prevention of Hepatitis B

Hepatitis B can be prevented by taking the hepatitis B vaccine. It is administered in 3 or 4 doses over six months. Chronic hepatitis B infection may sometimes be diagnosed incidentally on routine tests in a completely healthy individual. If this is diagnosed, the individual should be on a regular follow-up with a liver specialist to monitor liver function and development of tumours.

Hepatitis C Overview

This is a serious, contagious liver disease caused by the hepatitis C virus. It causes severe prolonged inflammation and injury to the liver leading to cirrhosis and its complications and liver cancers. Unlike hepatitis A and B, hepatitis C has no vaccine. Until recently, medications to treat it effectively were not available. However, over the last decade, several new drugs have become available with success rates of nearly 100%.

Signs and symptoms of Hepatitis C

Patients with acute hepatitis C may experience abdominal pain, jaundice, fever, fatigue, nausea, vomiting, joint pain between 2 to 12 weeks after exposure to the virus and settle spontaneously. However, the virus remains within the body and continues to cause slow continued liver damage. Many infected patients never develop symptoms, and the diseases may go undiagnosed for years.

Causes and risk factors of Hepatitis C

Hepatitis C is caused by a viral infection in the liver. The virus typically spreads via cross-contamination of blood. Hepatitis C commonly spreads through shared needles, contaminated needle use , and unprotected sexual contact. Casual contact does not spread the infection.

Complications of Hepatitis C

Chronic hepatitis C causes cirrhosis, increased risk of liver cancer, kidney disease and acute liver failure. Early diagnosis is key to preventing any serious complications.

Diagnosis of Hepatitis C

After an initial patient medical history and physical exam, the doctor will confirm hepatitis C with a blood test. Blood tests and scans will help in assessing the severity of liver damage. Occasionally, a liver biopsy may also be required.

Treatment and Surgical Interventions of Hepatitis C

Hepatitis C can now be treated with highly effective anti-viral drugs, which can clear the virus from the body with a 12-week of treatment. The patient should be closely monitored during the course of the treatment. A liver transplant may be required in case of serious complications due to extensive liver damage or multiple liver tumors. The liver transplant will not cure the infection, so antiviral drugs are used to treat the condition even after transplant.

Prevention of Hepatitis C

There is no vaccine available to protect against hepatitis C. However, you can protect yourself by avoiding sharing needles, personal grooming items and practicing safe sex.

Hepatitis E Overview

This is an infection of the liver caused by the hepatitis E virus. It causes severe inflammation and affects liver function. It is transmitted through the oral-faecal route. Practicing good hygiene and washing hands frequently are good preventive measures to protect yourself from hepatitis E. There is no vaccine available for Hepatitis E.

Signs and symptoms of Hepatitis E

Hepatitis E infections cause abdominal pain, clay-coloured stools, dark urine, fever, fatigue, nausea, vomiting, joint pain and jaundice. The symptoms may begin anywhere from 2-6 weeks after exposure to the virus. In extreme cases, it can cause liver cirrhosis and liver failure.

Causes and risk factors of Hepatitis E

The disease is transmitted via the oral-faecal route, i.e. through water contaminated with faeces. Inadequate sanitation facilities put a person at greater risk of contracting a Hepatitis E infection. It can also be transmitted by eating infected animal products. Pre-existing liver damage puts the patient at a higher risk of developing complications from a hepatitis E infection.

Complications of Hepatitis E

People who contract Hepatitis E usually recover within a few weeks. Still, in some cases, it causes severe liver damage. Pregnant women, people with weak immune systems and older people have a higher risk of developing serious complications.

Diagnosis of Hepatitis E

Hepatitis E infections are diagnosed based on patient medical history, physical exam, blood and stool tests.

Treatment and Surgical Interventions of Hepatitis E

Hepatitis E is usually cleared by the body’s own immune system in 4-6 weeks, provided the patient rests, drinks plenty of fluids and eats healthy, nutritious foods. However, in high-risk patients such as the pregnant, elderly or those with prior liver damage, the doctor may recommend a hospital stay until recovery is confirmed. Very sick patients will need hospital admission, may need ICU care and rarely a liver transplant as a life-saving treatment.

Prevention of Hepatitis E

To prevent hepatitis E infections, always wash your hands before eating and using the bathroom. Practice good hygiene and be careful with your drinking water.

Liver Cyst Overview

Liver cysts are collections of clear fluid within the liver and can range from a few mm to the size of a football. They are usually benign (non-cancerous) growths that typically don’t cause significant symptoms unless they become very large or infected. The liver can continue to function normally, even if cysts are present.

Signs and symptoms of Liver Cyst

Small cysts are common in healthy people and usually don’t cause any symptoms. However, as they get bigger, the patient may develop abdominal pain and bloating in the upper right quadrant.

Causes and risk factors of Liver Cyst

Liver cysts are of several types. The commonest type are simple liver cysts and can be seen in normal healthy people who have routine scans. Some cysts may be related to infection with a parasite present in pet dogs. This is called a hydatid cyst and can grow within the patients liver. Occasionally, abnormalities in the growth of bile ducts can lead to the development of cysts in the liver called biliary cystadenoma.

Complications of Liver Cyst

Large cysts can get complicated by infection or bleeding. Hydatid cysts can grow and form daughter cysts within the liver. Around 5% of liver cysts develop into cystic tumours. In that case, complete cyst removal might be recommended. Cystic tumours can occasionally turn malignant and spread beyond the liver.

Diagnosis of Liver Cyst

Imaging investigations such as an ultrasound or a CT scan is used to diagnose liver cysts.

Treatment and Surgical Interventions of Liver Cyst

Small, simple liver cysts usually do not require treatment. However, if the cyst grows and becomes painful, the doctor may recommend surgical procedures for drainage or complete removal of the cyst. Complete removal with surgery is usually recommended for hydatid cyst and biliary cystadenoma. Polycystic Liver Disease (PLD), where a congenital defect causes a huge number of cysts can cause severe symptoms of pain, breathing difficulty and may rarely need a liver transplant.

Prevention of Liver Cyst

Liver cysts cannot be prevented. However, any cysts identified on routine scans should be carefully studied by a liver surgeon to determine their nature and decide on a course of action.

Liver Adenoma Overview

Hepatic Adenoma or Liver adenoma is a non-cancerous tumour that develops on the liver. It is rare, occurs more commonly in women and is linked to the use of some birth-control pills.

Signs and symptoms of Liver Adenoma

Liver adenoma may cause pain and nausea if large. If a liver adenoma ruptures, it results in severe abdominal pain and internal bleeding.

Causes and risk factors of Liver Adenoma

The use of birth control pills is linked to the formation of liver adenomas. Pregnancy can also increase the risk.

Complications of Liver Adenoma

Spontaneous rupture is the biggest risk with liver adenoma. The risk is more in large tumors or those present on the liver’s surface. A rupture would cause intense pain, internal bleeding and low blood pressure. Large liver adenomas can also turn cancerous.

Diagnosis of Liver Adenoma

The diagnosis begins with patient medical history and a physical exam. A panel of blood tests may also be required. If a liver tumour is suspected, the doctor may require imaging tests (Ultrasound scan, CT scan or MRI) to confirm the presence of the adenoma. A biopsy is needed very rarely when the exact nature is unclear on scans.

Treatment and Surgical Interventions of Liver Adenoma

For small adenomas within the liver, periodic observation is recommended. Large tumours are more likely to result in rupture, so the doctor may recommend surgical liver resection.

Prevention of Liver Adenoma

Risk of adenoma can be reduced by avoiding oestrogen-based birth control pills and avoiding anabolic steroid intake for muscle building.

Liver Haemangioma Overview

A liver haemangioma is a mass in the liver made of a tangle of blood vessels. Small liver haemangiomas are common on scans. They usually cause no symptoms and require no treatment. Liver haemangiomasarenon-cancerous.

Signs and symptoms of Liver Haemangioma

Liver haemangioma, when large, can cause abdominal pain and discomfort, bloating, nausea and loss of appetite. Occasionally, bleeding and infection can cause symptoms of severe pain.

Causes and risk factors of Liver Haemangioma

There are no apparent risk factors though a genetic link is suggested.

Complications of Liver Haemangioma

Large haemangioma can rupture, leading to fatal internal bleeding. Occasionally they can get infected or have bleeding within the tumor causing pain.

Diagnosis of Liver Haemangioma

Since liver haemangioma causes no symptoms, they are often discovered accidentally during medical imaging tests like ultrasound scans, CT scans or MRIs.

Treatment and Surgical Interventions of Liver Haemangioma

Smaller liver haemangioma can be monitored periodically and left alone. If the haemangioma is large, causing symptoms such as pain or bleeding or if the precise nature of the mass cannot be clarified, removal by surgery is the best option.

Prevention of Liver Haemangioma

Since the cause is uncertain, liver haemangioma cannot be prevented.

Hepatocellular Carcinoma Overview

Hepatocellular carcinoma is a primary liver cancer, which means it originates in the liver. If diagnosed early, it can be treated and completely cured. However, many patients develop symptoms only when the tumor has grown to an advanced stage, thus limiting treatment options.

Signs and symptoms of Hepatocellular Carcinoma

In the early stages, hepatocellular carcinoma may not exhibit any symptoms. However, as the carcinoma grows, the patient may experience abdominal pain, heaviness in the upper belly, bloating, loss of appetite, unexplained weight loss, fatigue, nausea, fever, jaundice, chalky stools, and dark urine.

Causes and risk factors of Hepatocellular Carcinoma

The well-known risk factors for hepatocellular carcinoma are hepatitis B and C infections, alcohol abuse, high cholesterol and obesity. Any patient who develops chronic liver disease or cirrhosis is at risk of developing hepatocellular carcinoma. Exposure to certain toxins can also increase your risk of liver cancer.

Complications of Hepatocellular Carcinoma

Hepatocellular carcinoma can spread through the liver and involve other organs such as lungs, bones. Tumour rupture and internal bleeding could also occur in some large tumors when they grow rapidly within the liver.

Diagnosis of Hepatocellular Carcinoma

Hepatocellular carcinoma is diagnosed based on a physical exam, a patient medical history, a panel of blood tests, CT or MRI scans to provide detailed visualisation of the tumours. Current scan technology and blood tests can make a very accurate diagnosis of hepatocellular carcinoma. A biopsy to confirm the diagnosis is very rarely required and should be performed only under careful supervision.

Treatment and Surgical Interventions of Hepatocellular Carcinoma

A variety of treatments are available for hepatocellular carcinoma. The treatment plan for each patient should be individualised based on the stage of the tumor, condition of the liver and the patient’s overall condition. Surgery to remove the tumor (liver resection) and liver transplantation (complete replacement of the damaged liver) are the best options for long term cure, while effective disease control in advanced tumors may be possible with local therapies and newer anti-cancer medications. The patient is best managed in a multi-disciplinary facility where liver surgery, liver transplantation, interventional radiology, radiotherapy and oncology are all accessible.

Prevention of Hepatocellular Carcinoma

Hepatocellular carcinoma can be prevented by reducing the risk of liver damage and chronic liver disease. Reduce alcohol consumption and maintain a healthy diet and practice safe sex. Patients with known liver disease should have at least 6 monthly scans and blood tests to diagnose these tumors at an early stage when curative treatments are very effective.

Hepatoblastoma Overview

Hepatoblastoma is a rare cancerous growth in the liver cells, seen mainly in infants and small children. It is the commonest liver tumor in children. When correctly treated, it has excellent long-term cure rates.

Signs and symptoms of Hepatoblastoma

Hepatoblastoma causes an abnormal mass in the abdomen which is usually noted by the baby’s mother. In older children, it may present with pain and loss of weight.

Causes and risk factors of Hepatoblastoma

There are no known risk factors for this tumor. However, it is more common in pre-term babies and boys.

Complications of Hepatoblastoma

As the tumor grows larger, it can cause weight loss, poor growth. It can also spread to other organs such as the lungs and bones, ultimately leading to death.

Diagnosis of Hepatoblastoma

If the child has a lump or abnormal growth in the stomach, the doctor may investigate further by a panel of blood tests, imaging tests to look for abnormal growths and a biopsy of the mass.

Treatment and Surgical Interventions of Hepatoblastoma

Hepatoblastoma can be completely cured in over 90% of children when effectively treated. The treatment usually includes pre-operative chemotherapy followed by surgery to remove the tumor. In children with large tumors where surgical removal is not possible, liver transplantation after chemotherapy also has excellent results. However, a small number of tumors, especially in older children, may not respond well to chemotherapy.

Prevention of Hepatoblastoma

As the cause is presently unclear, hepatoblastoma cannot be prevented.

Liver Metastases from Bowel Cancer Overview

Cancer that begins in one organ can spread or metastasize to other organs. Colon cancer can spread to the liver and form liver metastases. The liver is usually the first major organ affected by colon cancer as all blood from the intestines is first filtered through the liver before reaching the heart. While the spread of a tumor to other organs is usually considered as an advanced stage, significant advancements in surgery and chemotherapy have provided new methods to treat this condition, and at least half of such patients can still look forward to a long healthy life.

Signs and symptoms of Liver Metastases from Bowel Cancer

Patient with bowel cancer may experience symptoms like blood in the stools, abdominal swelling, fatigue and weight loss. In a patient who has liver metastases, pain in the right side of the abdomen, fatigue, weight loss, and jaundice may be the presenting symptoms.

Causes and risk factors of Liver Metastases from Bowel Cancer

Liver metastases are caused due to the spread of cancer from the bowel. Patients with pre-existing colon cancer develop liver metastases as a complication.

Complications of Liver Metastases from Bowel Cancer

Liver metastases can grow and involve large parts of the liver affecting liver function. They may also spread to other organs such as lungs and bones.

Diagnosis of Liver Metastases from Bowel Cancer

The patient’s follow-up CT scans and MRIs would be indicative of the metastases in the liver. The doctor may also require blood tests to check on liver function. A liver biopsy may be performed to test for malignant cells.

Treatment and Surgical Interventions of Liver Metastases from Bowel Cancer

Liver metastases from colon cancer can be treated in one or a combination of the following ways – Surgical resection, Chemotherapy, Radiation therapy, Targeted therapies like biologics and immunotherapy. Recently, there is increasing interest in the role of liver transplantation as a definite treatment for large liver metastases.

Prevention of Liver Metastases from Bowel Cancer

No known preventative treatments or measures are available currently.

Gallstone disease Overview

Gallstones are made of cholesterol, excess bilirubin and bile salt deposits and are more common in women. Gallstones vary in colour, from yellow-green to red-brown. They can range in size from a grain of sand to a golf ball. Some people develop only one gallstone, while others develop multiple gallstones simultaneously.

Signs and symptoms of Gallstone Disease

Gallstones may not cause any symptoms until they get stuck and cause a blockage to bile drainage from the gall bladder. This leads to inflammation, bloating and pain. It may present as a sudden, intense pain in the upper right abdomen, between the shoulders or the right shoulder. The patient may also experience nausea.

Causes and risk factors of Gallstone Disease

Gallstones could be caused by excess cholesterol and bilirubin in the bile or due to improper emptying of the gallbladder. Being overweight, eating a high cholesterol diet or having certain diseases of red blood cells puts one at a higher risk for Gallstones.

Complications of Gallstone Disease

Gallstones can cause inflammation of the bile ducts, blockage of the common bile duct, blockage of the pancreatic duct or gall bladder cancer.

Diagnosis of Gallstone Disease

The diagnosis begins with a physical exam and a patient history. The doctor may require a series of blood tests to check liver function and imaging tests to visualise the gallstones.

Treatment and Surgical Interventions of Gallstone Disease

Treatment isn’t necessary for gallstones unless they cause symptoms. If there is pain, the doctor may go in for surgical removal of the gall bladder, which can usually be performed laparoscopically.

Prevention of Gallstone Disease

You can reduce your risk of gallstones by maintaining a healthy diet, eating high-fibre foods, losing weight in a phased manner.

Bile duct stones Overview

Bile duct stones are made of cholesterol, excess bilirubin and bile salt deposits. Bile duct stones usually arise in the gall bladder (gall stones) and slip into the bile duct and cause problems. Rarely, these stones may be formed in the bile duct itself. These stones may be asymptomatic or may cause obstruction of the bile duct, causing jaundice, bile duct infection (cholangitis) or inflammation of the pancreas (pancreatitis).

Signs and symptoms of Bile Duct Stones

Bile duct stones may not cause any symptoms until they get lodged in the common bile duct and cause a blockage. This leads to inflammation, bloating and pain. It may present as a sudden, intense pain in the upper right abdomen, between the shoulders or the right shoulder. The patient may also experience nausea, jaundice, lack of appetite and fever.

Causes and risk factors of Bile Duct Stones

Bile duct stones could be caused by excess cholesterol and bilirubin in the bile or due to improper emptying of the gallbladder. Presence of many small gall stones increases the risk of bile duct stones as they can easily slip into the bile duct. Some parasitic infections common in Northern and Eastern India can cause bile duct stones and stones in the small bile ducts within the liver (hepatolithiasis)

Complications of Bile Duct Stones

Bile duct stones can cause inflammation of the gallbladder, blockage of the pancreatic duct, cholangitis or gallbladder cancer.

Diagnosis of Bile Duct Stones

The diagnosis of gallstones begins with a physical exam and a patient history. The doctor may require a series of blood tests to check liver function and bilirubin levels and imaging tests to visualise the bile duct stones.

Treatment and Surgical Interventions of Bile Duct Stones

Bile duct stones are first treated with antibiotics to prevent infection and medications to make the bile thin and facilitate their dissolution. Additional procedures may be necessary if the stones are causing jaundice or other complications. This usually includes endoscopic removal of stones or, occasionally, surgery. It is recommended that the gall bladder be removed in these patients to prevent recurrent bile duct stones.

Prevention of Bile Duct Stones

A high-fibre, low cholesterol diet helps reduce the risk of developing gall stones and bile duct stones.

Cholangitis Overview

Cholangitis is inflammation of the bile duct. It is usually caused by a bacterial infection when there is a complete or partial blockage of the bile duct. Occasionally it can be caused by autoimmune conditions where the individual’s immune system damages the bile duct lining.

Signs and symptoms of Cholangitis

The symptoms of acute cholangitis can develop over a period of hours to days and include pain in the upper right abdomen, fever with chills, jaundice, nausea and vomiting, blood in the stools, and dark urine. The patient may also experience lethargy and disorientation. Chronic cholangitis, which develops over a period of months and years, can cause swelling of the feet, weight loss, mood swings and problems with memory. Some patients also experience bone and muscle pain.

Causes and risk factors of Cholangitis

In most of cases, cholangitis is caused by a blockage in the bile duct due to gallstones or sludge. The blockage could also be caused by a tumour, blood clots, narrowing of the passage due to injury or scar tissue formation, or a swollen pancreas. People having an auto-immune condition like Crohn’s or ulcerative colitis, could be at greater risk of cholangitis. Having HIV infection or recent exposure to parasites also increases the risk of cholangitis.

Complications of Cholangitis

Acute cholangitis can be life-threatening due to overwhelming sepsis unless urgently treated. Chronic cholangitis can lead to serious complications like liver cirrhosis, liver swelling and portal hypertension. It can also cause swelling and enlargement of the spleen, enlarged and broken veins in the stomach and liver, gallstones, and sepsis.

Diagnosis of Cholangitis

To diagnose cholangitis, doctors will first conduct a patient medical history survey and a physical exam. Blood tests, radiology and endoscopic investigations are usually necessary to make a diagnosis and find the cause of the problem.

Treatment and Surgical Interventions

The key to treating cholangitis is early diagnosis and treatment with effective antibiotics and procedures to treat the blockage of the bile duct. Patients may need monitoring and treatment in an intensive care unit due to the seriousness of the condition. Bile duct blockage can be effectively treated by endoscopic or radiological procedures in well-equipped centers. Surgical intervention may be required if these procedures fail and to perform definitive treatment of the cause of cholangitis after initial stabilisation.

Prevention of Cholangitis

Awareness of early symptoms of bile duct blockage such as right upper abdomen pain, fever or jaundice is vital to prevent complications such as cholangitis. Early consultation with a liver specialist is necessary.

Cholangiocarcinoma Overview

Cholangiocarcinoma is a cancerous tumour that forms in the bile duct. This is a rare form of cancer that mainly occurs in patients above 50 years. Intrahepatic cholangiocarcinoma occurs in the parts of the bile duct within the liver. Hilar cholangiocarcinoma occurs in the bile ducts just outside the liver. Distal cholangiocarcinoma occurs in the parts of the bile duct adjoining the small intestines.

Signs and symptoms of Cholangiocarcinoma

Symptoms of cholangiocarcinoma include jaundice, itchy skin rashes, fatigue, unexplained weight loss, abdominal pain and white stools.

Causes and risk factors of Cholangiocarcinoma

Cholangiocarcinoma occurs when there is a mutation in the cells of the bile duct. The cause of the mutation is unclear, but it causes the cells to multiply uncontrollably, resulting in cancerous growth. Pre-existing liver conditions like primary sclerosing cholangitis, chronic liver failure, bile duct abnormalities can increase the risk of cholangiocarcinoma. Smoking also increases this risk.

Complications of Cholangiocarcinoma

Cholangiocarcinoma causes jaundice by blocking the bile ducts. Patients can develop severe infection within bile ducts. The tumor can block the blood supply into the liver causing liver failure. As the tumor spreads to other organs, it can cause cough, breathlessness, bone pains and fractures.

Diagnosis of Cholangiocarcinoma

Liver function tests, tumour marker test, an endoscopic retrograde cholangiopancreatography (ERCP), CT scans, MRI scans, and rarely a biopsy may be required to make the diagnosis.

Treatment and Surgical Interventions of Cholangiocarcinoma

The course of treatment varies for different patients. It depends on the stage of the tumor, extent of spread, function of liver and condition of the patient. The main options are surgery, radiation therapy and chemotherapy. Most patients with tumor limited to the liver will need surgery in combination with radiotherapy or chemotherapy. In a small group of patients, liver transplantation is the best treatment option with excellent results.

Prevention of Cholangiocarcinoma

There is no proven way to prevent cholangiocarcinoma. However, individuals with risk factors such as cirrhosis, primary sclerosing cholangitis should be regularly screened for these tumors with blood tests and scans. Quitting smoking may reduce your risk.

The pancreas is an organ present in the back of the abdomen behind the stomach and drapes over and in front of the backbone. It is a delicate yet complex organ that has two main functions. The pancreas produces several digestive enzymes, which help in the digestion of sugars, proteins and fats in our diet, breaking them into small molecules which are then absorbed into the bloodstream in the intestine. Pancreas also has small clusters of specialized cells which produce hormones to maintain stable blood glucose levels in the body- the most well-known of these is the hormone insulin, whose deficiency leads to diabetes.

Pancreas can be easily damaged by alcohol consumption leading to potentially life-threatening diseases such as pancreatitis. Chronic smoking can also cause injury to the pancreas leading to the development of pancreatic cancer.

Acute Pancreatitis Overview

Acute pancreatitis is a sudden inflammation of the pancreas. It can develop quickly and trigger other complications. The most common causes are alcohol abuse and gall stones.

Signs and symptoms of Acute pancreatitis

Patients usually experience sudden pain in the centre of the abdomen, right below the breast bone. The pain is accompanied by vomiting, loss of appetite, rapid pulse, fever, breathlessness and sometimes, jaundice.

Causes and risk factors of Acute pancreatitis

Acute pancreatitis is mainly caused by alcohol abuse or gallstones. Occasionally auto-immune diseases, metabolic diseases, drug side-effects, and trauma can also cause acute pancreatitis.

Complications of Acute pancreatitis

Serious cases of acute pancreatitis face a risk of developing infections in the pancreas, obstruction in the bile duct or pancreatic duct, pseudocyst with a risk of rupture and internal bleeding, and splenic vein thrombosis. Heart, lung and kidney failure may also occur.

Diagnosis of Acute pancreatitis

To diagnose the condition, the doctor will require a patient’s medical history, a physical exam, a panel of blood tests, a chest X-ray, an abdominal ultrasound and an endoscopic retrograde cholangiopancreatography.

Treatment and Surgical Interventions of Acute pancreatitis

Treatment for a mild case of acute pancreatitis, where the risk of complications is low, focuses on relieving symptoms while allowing the body to repair the pancreas. This involves painkillers, intravenous fluids. In more severe cases of acute pancreatitis, tissue necrosis (death) has usually already occurred. This increases the risk of sepsis. Severe acute pancreatitis cases are treated with antibiotics, breathing assistance with a ventilator, surgical intervention to remove the necrosed tissue, and intravenous fluids to prevent dehydration and hypovolemic shock.

Prevention of Acute pancreatitis

Alcohol consumption is the biggest risk factor for acute pancreatitis. Repeated episodes of pancreatitis can develop if alcohol intake is not stopped.

Chronic Pancreatitis Overview

Chronic pancreatitis is an inflammation of the pancreas which doesn’t subside or improve over a long-term period, leading to permanent damage. Calcium stones and cysts may develop, causing blockages in the bile and pancreatic ducts and other complications.

Signs and symptoms of Chronic pancreatitis

The condition causes severe pain in the upper abdomen, diarrhoea, fatty stools, nausea, vomiting, shortness of breath, fatigue and unexplained weight loss. The patient may also experience fluid build-up in the pancreas, jaundice, internal bleeding and intestinal blockages as the disease progresses.

Causes and risk factors of Chronic pancreatitis

The most common cause of chronic pancreatitis is long-term alcohol abuse. Pre-existing inflammatory bowel syndrome, chronic liver disease and primary biliary cholangitis are associated with an increased risk of chronic pancreatitis. Smoking and drinking also increase your risk of developing chronic pancreatitis.

Complications of Chronic pancreatitis

Chronic pancreatitis can lead to complications like nutrient malabsorption, diabetes, and pseudocysts which can rupture and get infected.

Diagnosis of Chronic pancreatitis

To diagnose the condition, the doctor will require the patient’s medical history, a physical exam, a panel of blood tests, a chest X-ray, an abdominal ultrasound and an endoscopic retrograde cholangiopancreatography.

Treatment and Surgical Interventions of Chronic pancreatitis

Treatment for chronic pancreatitis focuses on reducing pain and improving digestive function. The patient is administered pain medication, insulin, artificial digestive enzymes and steroids as required. Some treatment programs use endoscopy to relieve pain and eliminate blockages. Surgical intervention is usually not required but may help patients with severe symptoms and complications.

Prevention of Chronic pancreatitis

To prevent chronic pancreatitis, quit alcohol and tobacco consumption.

Pancreatic duct stones Overview

Pancreatic stones are hard, calcified deposits that occur in the pancreatic duct. Pancreatic duct stones are an indicator of chronic pancreatitis.

Signs and symptoms of Pancreatic Duct Stones

Pancreatic stones may cause chills, fever, jaundice, nausea, upper abdominal pain and vomiting.

Causes and risk factors of Pancreatic Duct Stones

Excessive alcohol consumption can lead to repeated damage to the pancreas and the normally watery pancreatic secretions become thick and deposit as small stones. Occasionally some infections can also cause pancreatic duct stones.

Complications of Pancreatic Duct Stones

Pancreatic duct stones can cause serious complications if left untreated, including cholangitis, jaundice and pancreatic necrosis.

Diagnosis of Pancreatic Duct Stones

The condition is diagnosed based on patient medical history, a physical exam, and a panel of blood and imaging tests to identify the extent of pancreatitis and the location of the obstruction.

Treatment and Surgical Interventions of Pancreatic Duct Stones

If the inflammation of the pancreas is mild, the issue may be resolved by replacing eating and drinking with IV fluids for a few days. In more severe cases, the stone is removed surgically or in an endoscopic procedure known as ERCP.

Prevention of Pancreatic Duct Stones

Pancreatic duct stones are not entirely preventable; However, the risk can be managed by eating healthy, exercising and controlling your cholesterol levels.

Pancreatic Cancer Overview

Pancreatic cancer occurs in the digestive juice producing tissues of the pancreas. Due to the location of the pancreas in the abdomen, pancreatic cancer may be difficult to detect and is often diagnosed in the later stages.

Signs and symptoms of Pancreatic Cancer

Early pancreatic cancer doesn’t usually cause any symptoms. In the advanced stages, pancreatic cancer causes loss of appetite, unexplained weight loss, abdominal and lower back pain, blood clots and jaundice. The patient may also experience an enlarged gall bladder and dark urine output.

Causes and risk factors of Pancreatic Cancer

The cause of pancreatic cancer is unknown. However, inherited gene mutations and acquired gene mutations are known risk factors for pancreatic cancer. Smoking increases your risk of pancreatic cancer.

Complications of Pancreatic Cancer

As the tumor grows, it can involve surrounding organs, causing jaundice, vomiting, back pain.

Diagnosis of Pancreatic Cancer

Early diagnosis of pancreatic cancer increases the chances of cure. The doctor will review the patient’s medical history, conduct a physical exam, a panel of blood tests, CT scans, and endoscopic ultrasound and if necessary, a biopsy of the tumor.

Treatment and Surgical Interventions of Pancreatic Cancer

Pancreatic cancer is difficult to cure as it is usually diagnosed at late stages. There are two surgical procedures performed to remove a cancerous tumour in the pancreas depending on the location of the tumor. A Whipple’s surgical procedure is used when the tumor is in the head region of the pancreas, while a distal pancreatectomy is used when the tumor is in the tail region of the pancreas.

Prevention of Pancreatic Cancer

To reduce your risk of developing pancreatic cancer, quit smoking. Reducing your alcohol intake and maintaining a healthy weight are also recommended.

Pancreatic Cysts Overview

Pancreatic cysts are fluid-filled sacs present within the pancreas. Pancreatic cysts are usually found during imaging tests to treat other conditions. Pancreatic cysts are of two types based on their potential to become cancerous– neoplastic cysts and non-neoplastic cysts. Most pancreatic cysts are not cancerous and develop as complications of inflammation in the pancreas (pancreatitis).

Signs and symptoms of Pancreatic Cysts

Pancreatic cysts may cause persistent abdominal pain, nausea, vomiting, weight loss, and bloating. Sometimes, the cyst may become infected and cause fever as well.

Causes and risk factors of Pancreatic Cysts

The cause of pancreatic cysts is unknown. Some are caused by rare illnesses like Polycystic kidney disease or von Hippel-Lindau disease. Acute or chronic inflammation of the pancreas (Pancreatitis) or abdominal trauma increases your risk of developing pancreatic cysts.

Complications of Pancreatic Cysts

The risk of complications increases as the size of the pancreatic cyst increases. Cysts may rupture, get infected, have interval bleeding or press on surrounding organs, causing pain, vomiting or jaundice.

Diagnosis of Pancreatic Cysts

Most pancreatic cysts are diagnosed incidentally during abdominal scans for other conditions. The doctor will also consider the patient’s medical history and a physical exam. A biopsy may also be required to rule out a malignancy.

Treatment and Surgical Interventions of Pancreatic Cysts

Small benign cysts can be left untreated as long as they are being monitored. Very large cysts may be drained endoscopically or through the skin. Cysts with a risk of cancer may require surgical removal.

Prevention of Pancreatic Cysts

The key strategy to pancreatic cyst prevention is to avoid pancreatitis. This can be done by avoiding alcohol consumption and gallstones.

Neuroendocrine Tumor Overview

Neuroendocrine tumours are cancers that begin in the specialised neuroendocrine cells in the pancreas. There are many types of neuroendocrine tumours, and they progress at different paces. These tumours cause a change in the patient’s hormone levels and can cause symptoms unrelated to the organ involved.

Signs and symptoms of Neuroendocrine Tumor

Neuroendocrine tumours cause a lump in the abdomen along with pain, fatigue and unintended weight loss. The hormones produced in these tumors may cause diarrhoea, dizziness, frequent urination and increased thirst.

Causes and risk factors of Neuroendocrine Tumor

Cause of neuroendocrine tumours is unknown, though there appears to be a genetic link. The risk is higher in patients with genetic diseases like von Hippel-Lindau disease, tuberous sclerosis, neurofibromatosis.

Complications of Neuroendocrine Tumor

The most significant complication associated with neuroendocrine tumours is metastases, where the tumors can spread to other organs such as the liver. Once such a spread occurs, a complete cure is more difficult to obtain.

Diagnosis of Neuroendocrine Tumor

Neuroendocrine tumours are diagnosed based on a physical exam, a patient medical history, a panel of blood and urine tests, imaging tests and a biopsy.

Treatment and Surgical Interventions of Neuroendocrine Tumor

The treatment for neuroendocrine tumours depends on the type of tumour, the size and number of tumours in the pancreas. One of the most common treatments is the surgical removal of the tumours. Radiofrequency ablation, hormone therapy, radiation therapy, chemotherapy, embolization therapy and liver transplantation have also proven effective against neuroendocrine tumours especially in advanced cases.

Prevention of Neuroendocrine Tumor

As the cause of the condition is unknown, neuroendocrine tumours cannot be prevented.

Biliary Atresia Overview

Biliary atresia is a congenital condition in which the bile ducts do not develop properly. Babies develop biliary atresia in utero, but most infants show symptoms 2-6 weeks after birth. Prolonged obstruction leads to accumulation of the bile secretions within the liver cells, damaging them and leads to complications.

Signs and symptoms of Biliary Atresia

The most obvious symptom of biliary atresia is jaundice in the infant. While many newborns have jaundice, it usually improves over the first few weeks. Persistent jaundice beyond the first month, especially in association with pale clay-coloured stools, is strongly suspicious of biliary atresia and needs urgent medical attention.

Causes and risk factors of Biliary Atresia

The exact cause of the disease is unknown but it appears to be triggered by viral infections, auto-immune conditions, exposure to harmful chemicals or a gene mutation. Premature babies seem to be most at risk.

Complications of Biliary Atresia

Biliary atresia causes early permanent liver scarring, loss of liver function and cirrhosis. When untreated children develop serious complications within the first few years of age.

Diagnosis of Biliary Atresia

Jaundice beyond the first month after birth, along with pale clay coloured stools, is an important finding and can be easily detected by the parents. Diagnosis is based on a physical exam, an abdominal ultrasound, a panel of blood tests, a cholangiogram and possibly a liver biopsy.

Treatment and Surgical Interventions of Biliary Atresia

Biliary atresia can sometimes be corrected by performing a surgery called Kasai procedure early after birth. The procedure connects the liver to the small intestine, bypassing the abnormal bile ducts. The liver can recover in about half the children with reduction in jaundice depending the severity of the biliary atresia and the age at surgery (ideally within 3 months). Non-treatment or an unsuccessful result can lead to continued jaundice, portal hypertension, repeated infections and failure to grow Liver transplantation is the only curative option in this stage and gives very successful long-term results.

Prevention of Biliary Atresia

Biliary atresia is a congenital condition and cannot be prevented.

Progressive Familial Intrahepatic Cholestasis Overview

Progressive familial intrahepatic cholestasis (PFIC) is a group of congenital defects of bile secretion that causes progressive liver damage and leads to liver failure. PFIC is of 3 types – PFIC1, PFIC2 and PFIC3, each characterized by the deficiency of different proteins required for bile secretion.

Signs and symptoms of Progressive Familial Intrahepatic Cholestasis

PFIC symptoms start in infancy. All 3 types of PFIC cause jaundice, severe itching, malnutrition, slowed growth, portal hypertension and an enlarged spleen. People with PFIC 1 may also experience deafness, diarrhoea, inflammation of the pancreas and have low levels of fat-soluble vitamins (A, D, E and K). PFIC 2 and 3 cause symptoms mainly related to liver disease, but they are more intense than in PFIC1. Liver failure often results within a few years.

Causes and risk factors of Progressive Familial Intrahepatic Cholestasis

PFIC is caused by mutations in genes that manufacture a protein that controls bile secretion. This causes a build-up of bile acids in the liver cells, leading to liver inflammation, damage and liver function loss. The condition is inherited in an autosomal recessive pattern. Hence, both parents have a recessive copy of the gene, but show no symptoms themselves. This is more common in consanguineous marriages.

Complications of Progressive Familial Intrahepatic Cholestasis

The bile trapped in the liver can cause progressive damage and cirrhosis. This could in turn, cause oesophageal varices, fluid in the belly, portal hypertension and an enlarged spleen. The risk of liver cancer and liver failure also increases.

Diagnosis of Progressive Familial Intrahepatic Cholestasis

PFIC is diagnosed by testing for the genetic markers for the condition. The doctor will also require a panel of blood tests and a liver biopsy.

Treatment and Surgical Interventions of Progressive Familial Intrahepatic Cholestasis

Initial treatment for PFIC involves drug therapies. If this is ineffective, a surgical approach may be adopted. In selected early cases of PFIC, a diversion of bile from the liver directly into the large colon can give good symptomatic relief from itching and improve liver injury. If the liver damage is severe, a liver transplant may be required.

Prevention of Progressive Familial Intrahepatic Cholestasis

PFIC has a genetic cause and hence cannot be prevented. However, genetic screening of the parents to identify risk factors is possible.

Wilson’s Disease Overview

Wilson’s disease is a genetic condition that causes excessive accumulation of copper in the liver, brain and other organs. It is one of the common causes of liver disease in children in India. Early diagnosis is key to treating and managing Wilson’s disease.

Signs and symptoms of Wilson’s disease

Wilson’s disease causes liver-related symptoms such as fatigue, nausea, jaundice, loss of appetite, abdominal bloating and pain, muscle cramps and spider angiomas. In addition to the liver-related symptoms, some patients with involvement of the brain may also experience memory, speech or vision impairment, migraines, disorientation, changes in personality and mood, muscle spasms and seizures. Patients may develop sunflower cataracts (copper deposits) in the eyes. Occasionally, Wilson’s disease may present with sudden onset of liver failure and may be rapidly lethal if untreated.

Causes and risk factors of Wilson’s disease

Wilson’s disease is caused by a mutation in the ATP7B gene, which carries instructions on the transportation of copper around the body. If both the parents are carriers of the gene mutation, the child has a 50% chance of being a carrier and 25% chance of acquiring Wilson’s disease.

Complications of Wilson’s disease

Left undiagnosed and untreated, Wilson’s disease can cause fatal complications including cirrhosis, acute liver failure, neurological issues like tremors and speech difficulty, psychological trauma and haemolysis leading to anaemia.

Diagnosis of Wilson’s disease

The disease should be suspected in children and adolescents with symptoms of chronic liver disease. Diagnosis is confirmed based on a physical exam, patient and family medical history, blood tests, urine tests and a series of imaging tests to look for brain and liver abnormalities. A liver biopsy may also be required. Once diagnosed, the doctor may recommend that the family also undergo screening to understand their risk of passing on Wilson’s disease to their children.

Treatment and Surgical Interventions of Wilson’s disease

The treatment for Wilson’s disease is done in 3 stages. First, the copper deposits in the body are expelled by administering chelating drugs, which remove excess copper from the body. The second stage of treatment focuses on preventing further copper absorption. This is done by prescribing oral zinc tablets. In the last stage of treatment, once symptoms have improved, and zinc levels are normal, the patient will require regular monitoring of copper levels and periodic chelating therapy. The treatment becomes less effective with the age of the patient. Patients with severe liver disease who deteriorate on medical treatment or who do not tolerate the medications may need liver transplantation as a definitive curative treatment.

Prevention of Wilson’s disease

Wilson’s disease cannot be prevented. Still, with early genetic screening, the symptoms can be prevented and managed more easily.

Acute liver failure Overview

Acute liver failure refers to the sudden onset of severe liver failure symptoms within few days to weeks in a person with no pre-existing liver problems.

Signs and symptoms of Acute liver failure

Patients develop symptoms of fatigue and general ill-health for the initial few days followed by yellowing of the skin and eyes, excessive bleeding tendency. They may rapidly become drowsy and comatose.

Causes and risk factors of Acute liver failure

Acute liver failure is commonly caused by acute viral hepatitis. Overdose of certain drugs like paracetamol and antibiotics, poisoning with rodenticides are other common causes. Anti-tuberculosis medications when taken without close monitoring of liver tests are a common cause of acute liver failure in South Asia. Vascular diseases in the liver, metabolic diseases like Wilson’s disease, and shock associated with sepsis can also cause acute liver failure.

Complications of Acute liver failure

Acute liver failure can cause complications due to the shut-down of many of the liver’s life sustaining functions. This can cause excessive bleeding, brain involvement causing seizures and coma, or affect other organs such as the kidneys, heart and lungs.

Diagnosis of Acute liver failure

Acute liver failure is diagnosed with a series of blood tests, Ultrasound, CT scan and MRI of the liver, and in some cases, a liver biopsy.

Treatment and Surgical Interventions of Acute liver failure

Patients with acute liver failure can become extremely unwell and need intensive treatment to support the liver and other affected organs. Many of these patients will need dialysis and plasmapheresis to support them until recovery. Some may need ventilation unless the brain functions fully recover. Some patients with irreversible liver injury may need emergency liver transplantation as the only life-saving treatment. Hence these patients should be treated in the ICU of a hospital with specialist liver teams who are trained and authorized to perform liver transplantation like GGHC.

Prevention of Acute liver failure

To reduce your risk of acute liver failure, take care to maintain a healthy liver. Medications should be taken in the correct dosages and only under proper medical guidance. It is important to keep toxic substances such as rat killer poisons away from reach of children. Vaccination against hepatitis A and B will give excellent protection against acute liver failure caused by these infections.

Cirrhosis Overview

Cirrhosis refers to liver’s extensive scarring, which usually occurs after repeated and long-standing liver damage over a period of several years. Generally, loss of liver function due to cirrhosis is permanent, and symptoms worsen over time.

Signs and symptoms of Cirrhosis

Early cirrhosis has no symptoms. However, as scarring increases, symptoms such as fatigue, lack of appetite, unexplained weight loss, and nausea begin to appear. The patient may also experience nose bleeds, jaundice, abdominal swelling, leg swelling, and disorientation. In very severe cases, the patient may vomit blood, develop jaundice, develop fluid accumulation in the abdomen, and become confused, forgetful and drowsy.

Causes and risk factors of Cirrhosis

Cirrhosis could be caused by any disease that causes liver damage. Chronic alcohol abuse, viral hepatitis infections and fatty liver disease are the prominent three causes of cirrhosis in adults today.

Complications of Cirrhosis

The complications of cirrhosis include excessive bleeding, jaundice, fluid accumulation in the body and infections. Cirrhosis could also cause portal hypertension (high blood pressure in the intestinal blood vessels), and enlargement of the spleen. Some people with cirrhosis experience lower bone strength and are more prone to fractures. Cirrhosis reduces the liver’s ability to filter the toxins out of the patient’s blood. The increased concentration of toxins in the blood can cause mental deficits, confusion and difficulty in concentrating. Cirrhosis also increases the risk of development of liver tumors such as hepatocellular carcinoma and cholangiocarcinoma.

Diagnosis of Cirrhosis

To diagnose cirrhosis, the doctor will start with a medical history, and a physical exam to look for signs such as jaundice and enlarged liver and spleen. A detailed panel of blood tests, liver function tests and ultrasound scans are also required. The doctor may also prescribe a CT scan, an MRI scan, an endoscopy and a liver biopsy.

Treatment and Surgical Interventions of Cirrhosis

The treatment of cirrhosis depends on the cause and the severity of the condition. Treatment of early cirrhosis is usually with medications and lifestyle modifications. Complications may need additional treatment such as antibiotics for infections, endoscopic procedures for bleeding and fluid removal from the abdomen for severe discomfort due to fluid accumulation. In case of severe cirrhosis or when a liver cancer develops on a background of cirrhosis, liver transplantation may be the only life-saving treatment.

Prevention of Cirrhosis

Most common causes of cirrhosis can be prevented completely by a healthy life style of diet and exercise, avoiding excessive alcohol and protecting against viral hepatitis with immunisation against hepatitis B.

Portal hypertension Overview

Portal hypertension is increased blood pressure in the portal vein, the main blood vessel that carries blood from the digestive system and spleen to the liver. The increase in pressure is usually due to an obstruction to the blood flow, either due to liver cirrhosis or a blockage in the portal vein. The increased pressure causes varices (high-pressure engorgement of delicate veins surrounding the food pipe and intestines), which are at risk of rupturing.

Signs and symptoms of Portal hypertension

The main symptoms of portal hypertension are gastrointestinal bleeding which can present as blood in the stools or vomit. The patient usually also experiences fluid build-up in the belly, with associated bloating, cramping and shortness of breath. They may also feel disoriented or confused as a result of encephalopathy. The increased blood pressure can cause distension of the spleen, which may present with left-sided abdominal discomfort.

Causes and risk factors of Portal hypertension

The most common cause of portal hypertension is cirrhosis. The scarring in the liver causes blockages in the portal vein, leading to increased blood pressure and varices. People with hepatitis, chronic alcoholism and cystic fibrosis are at increased risk for cirrhosis and portal hypertension. Portal hypertension could also be caused by blockage of the portal vein by blood clots, parasitic infections, injury or rare congenital (present at birth) problems.

Diagnosis of Portal hypertension

Portal hypertension is diagnosed based on patient medical history, physical exam, ultrasound and CT scan, and an endoscopy. Sometimes specialised procedures in the cath-lab may be necessary to investigate portal hypertension.

Treatment of Portal hypertension

Portal hypertension is treated with medications such as beta-blockers to reduce blood pressure and decrease the chances of internal bleeding. If there is fluid build-up in the belly, salt intake may be restricted, and diuretics may be prescribed. In case of bleeding, the doctor may need to perform endoscopic procedures such as sclerotherapy or banding to control and prevent bleeding. Some patients with severe portal hypertension may require surgery in the form of surgical shunt procedures. Portal hypertension secondary to cirrhosis may need liver transplantation.

Prevention of Portal hypertension

As cirrhosis is the most common cause of portal hypertension, avoid alcohol and drug abuse, hepatitis and vascular disease to prevent cirrhosis. Eat a balanced diet, and maintain a healthy weight.

Portal Vein Thrombosis Overview

Portal vein thrombosis is a blockage due to a blood clot in the portal vein. The portal vein allows blood to flow from the intestines to the liver for detoxification. With a clot in the portal vein, the toxin levels in the blood increase the risk of other complications. Although portal vein thrombosis is treatable, it can be life-threatening if not detected early.

Signs and symptoms of Portal vein thrombosis

Portal vein thrombosis may not cause any symptoms at all until it is very severe. In severe cases, it presents as upper abdominal pain, the build-up of fluid in the abdomen and fever. Some patients also experience chills, vomiting blood, jaundice, varices in the liver and gastric bleeding.

Causes and risk factors of Portal vein thrombosis

Blood clots tend to form in the vessels where blood flows slowly or irregularly. Hardening of the liver (cirrhosis), liver injury or liver cancer increases the risk. Inflammatory conditions, including infections in the pancreas, intestines and appendicitis, can also cause the condition. In infants, an infection of the umbilical cord stump can trigger blood clots in the portal vein too. Some individuals may be genetically predisposed to increased blood clotting and have an increased risk of portal vein thrombosis.

Complications of Portal vein thrombosis

Portal vein thrombosis causes portal hypertension, which can cause bleeding from the gullet and intestines (variceal bleeding), fluid accumulation in the abdomen (ascites) and even liver failure.

Diagnosis of Portal vein thrombosis

Portal vein thrombosis is usually suspected based on a detailed clinical history and examination. Diagnosis required imaging with a Doppler ultrasound scan or a CT scan.

Treatment and Surgical Interventions of Portal vein thrombosis

The treatment for portal vein thrombosis aims to dissolve existing blockages and address their cause. Drug therapies can dissolve the blood clots. If there is oesophageal bleeding, the patient may be prescribed beta-blockers. If the bleeding is severe, the doctor may perform endoscopy and banding- a procedure in which rubber bands are used to tie off the varices in the oesophagus to stop the bleeding. In the case of a total blockage due to portal vein thrombosis, the surgeon may sometimes perform a shunt procedure to reduce the portal hypertension or bypass the blockage and restore blood flow to the liver.

Prevention of Portal vein thrombosis

Healthy lifestyle, regular exercise, avoiding excess alcohol consumption and hepatitis vaccination can prevent cirrhosis and liver tumors which are the most common causes of portal vein thrombosis. Dehydration increases blood viscosity and can cause portal vein thrombosis. Maintaining good hydration status at all times is hence essential.

Liver Transplantation

Liver transplantation involves removing the damaged liver in a patient with liver disease and replacing it with a healthy liver from a deceased donor (cadaveric liver transplant) or a part of a healthy liver from a normal living donor (living donor liver transplant).

Who Requires a Liver Transplant?

Liver transplant is the only treatment that can cure liver failure either due to chronic liver disease or acute liver failure.

Cirrhosis is the common cause of chronic end-stage liver disease. Common causes of cirrhosis are

• Alcohol Consumption
• Non – Alcoholic Steatohepatitis (fatty liver disease )
• Hepatitis B
• Hepatitis C
• Hepatocellular carcinoma
• Auto immune liver diseases
• Biliary atresia
• Metabolic liver disorders

Acute liver failure, when not improving with medical treatment, may need emergency liver transplantation. Causes of acute liver failure are

• Drug over dose
• Poisons such as consumption of Rat killer (Ratol)
• Hepatitis A,B or E infection
• Genetic diseases like Wilson’s disease

Timing of Liver Transplantation

Patients with acute liver failure who are unlikely to recover with medical treatment alone will require an emergency liver transplantation as a life-saving measure. These patients are usually admitted to the hospital or the ICU and are managed with supportive treatment and close monitoring. Worsening bleeding tendency or deterioration of sensorium (coma or encephalopathy) indicates that medical treatment alone will not salvage the patient. In such patients, emergency liver transplantation is the best treatment option.

The timing of liver transplant for a patient with cirrhosis is more complex. It depends upon the relative balance between the benefit of liver transplantation and the small but definite risk associated with major surgery.

Several factors are considered to decide when a patient with cirrhosis is better off with a liver transplant rather than continued medical treatment. In general, the patient should be of such physical and mental health to survive the complex transplant surgery and withstand the potential postoperative complications, be reliably able to take the medications on time and come for regular blood checks and follow up to the clinics.

Factors affecting the timing of liver transplantation in cirrhosis

• Degree of severity of liver failure, MELD score
• Presence of liver cancer within transplantation criteria
• Other comorbid conditions like diabetes, heart disease
• Presence or absence of chronic or active infections
• Overall physical and psychological condition of the patient
• Level of social support from the family.
• Abstinence from substance abuse like chronic alcoholism

What is Liver Transplant assessment?

Liver transplantation is a major operation and has associated risks of complications. The liver transplant team will evaluate the fitness of a patient who needs liver transplantation to decide whether this can be performed safely. A multi-disciplinary team including cardiologist, chest physician, anesthesiologist, general physician and psychologist evaluates the fitness. Additional specialists are also involved in this process if necessary. The patient will undergo blood investigations and scans as part of this process. The whole process will take 2-3 days. Once all the required tests are completed, these are all discussed in a multi-disciplinary meeting and clearance is given once the team is satisfied that the patient needs liver transplantation and the benefit of the surgery far outweigh the risk of the surgical procedure.

Types of liver transplantation

Living Donor Liver Transplantation (LDLT)

The liver has the unique ability to regrow when a part of it is removed by surgery.

In Living Donor Liver Transplantation, a healthy donor, who is a near -relative of the patient is carefully evaluated to see if he/she can safely donate a part of their liver for performing transplantation to their loved one. If the donor is found to be suitable, then after necessary legal clearances, the liver transplantation is performed.

A portion of the donor’s liver is carefully removed during surgery and is transplanted into the sick patient. Both donor and recipient surgeries are performed nearly simultaneously. The donor makes a full recovery in 5-6 days, and the remaining liver grows back to its usual size in 4 to 6 weeks. The recipient’s liver grows slowly to its usual size in 3 months as the patient makes a full recovery.

Deceased donor liver transplantation (DDLT)

Here the liver is recovered from a patient who had a severe irreversible brain injury and after the patient has been certified by an independent medical committee to be ‘brain dead’. If the donor’s relatives agree to donate his/her organs for transplantation, these are carefully removed by surgery for transplantation. Usually, the full donor liver is used for transplantation. However, in selected cases, a donor liver may be surgically divided into two parts and used for transplanting two patients needing liver transplantation- usually an adult and a child.

In India, the number of deceased donations is very low. The chance of a patient receiving a suitable donor liver is unfortunately low. Living donor liver transplantation is hence the best option for patients who need a timely transplant. However, if a patient has no suitable donors in the family, the patient is then listed on the Tamil Nadu Waiting list for liver transplantation. The waiting time may take three months to one year, depending on the blood group and several other factors.

Split Liver Transplantation

This is a type of deceased donor liver transplantation, where a liver from a deceased donor is divided during surgery into two parts and each part is transplanted into two patients needing liver transplantation. Commonly it involves splitting a liver to transplant one adult patient and a child. This helps in better utilization of donor livers and benefits more patients awaiting liver transplantation. There are strict criteria for doing this procedure, and the surgical team will decide the feasibility of doing such a procedure.

Auxiliary liver transplantation

This is a modified type of liver transplantation performed occasionally in selected patients with acute liver failure where the patient’s own damaged liver is likely to recover slowly after a few months. In such cases, a part of the donor liver (either as split liver transplantation or living donor liver transplantation) is transplanted while a part of the patient’s own liver is left behind. The newly transplanted liver ensures that the patient recovers from acute liver failure. Then over a period of 12-18 months, the doctors gradually modify the anti-rejection medications to stimulate the growth of the patient’s own liver. Ultimately, the aim is to stop anti-rejection medications completely. This procedure is particularly ideal for small children who need liver transplantation for acute liver failure.

Liver transplantation surgery

A liver transplant involves the removing of and preparing the donor liver, removing the diseased liver, and implantation of the new organ. Duration of the surgery will take anywhere between 6 to 12 hours and the procedure is performed by a team of surgeons. The liver has several key connections that must be re-established for the new organ to receive blood flow and to drain bile from the liver. The structures that must be reconnected are the portal vein and the hepatic artery to take blood into the new liver and the hepatic veins to take blood out of the liver and into the heart, and the bile duct to transport the bile produced by the new liver to the intestine. The exact method of connecting these structures varies depending on specific donor and anatomy or recipient anatomic issues and, in some cases, the recipient disease.

Post-operative recovery after liver transplantation

After liver transplantation, the patient is shifted to the ICU under sedation and on respiratory support. The following day, multiple blood tests, including liver function tests are performed. Hepatic Doppler ultrasonography of the liver is done to ensure proper blood flow in the newly reconstructed blood vessels that supply the liver. After reviewing the patient’s clinical condition and the investigations, the sedation is stopped and the patient is made to wake up gradually and then removed from the ventilator. After this, the patient can communicate with others.

Usually the patient needs to be in the ICU for 3 to 5 days and then shifted to the ward for another 10-14 days. Oral liquid diet is gradually started from the day after surgery. By day 2 or 3, the patients are allowed to take soft, solid diet.

Immunosuppression (Anti-rejection medications)

Human body immune machinery has evolved over millions of years, and it works such that it destroys anything foreign to the body – whether it is a bacteria, virus or a transplanted organ. To dampen the immunological attack on the transplanted liver and allow the body to accept the new liver, all transplant recipients are given anti-rejection medications. Some of the commonly used immunosuppressive drugs post transplant are steroids, calcineurin inhibitors (tacrolimus , cyclosporine) , mTOR inhibitors (sirolimus, everolimus) and mycophenolate mofetil. Your doctor will decide the best medication and the best dose for you.

Initially, the dosage and strength of these immune suppressants will be high and gradually over a few weeks the dosage will be reduced appropriately to maintain a sufficient level that will allow the transplanted liver to work normally. Over some time, the dosage and the number of drugs will be decreased, but they can never be stopped completely. The transplant recipient has to take these drugs life-long regularly with regular follow up.

Complications after Liver Transplantation

Bleeding and risk of infection are the two common complications that one can expect after any major abdominal surgery. Complications that are specific to liver transplant include blockage of blood vessels, bile leaks and graft rejection. In the long-term, patients can develop complications related to the use of immunosuppressive medications such as diabetes, kidney problems or few types of tumors.

Outcomes after Liver Transplant

Outcomes following liver transplantation are excellent due to improving technical expertise and experience. Gleneagles Global Health City hospital is one of the high volume centers for liver transplant in South India. Our success rate for both adult patients and children is more than 95%.

Living Liver Donation

Living donor liver transplantation is currently the best way of receiving a liver transplant in India due to the severe shortage of brain-dead deceased donation in our country. In this process, a healthy person who is a close family member of the patient voluntarily comes forward to donate a part of his/her liver to their patient. Any healthy individual aged from 18 years to up to 50 years of age can be a liver donor.

Liver Donor assessment process

The prospective liver donor undergoes a battery of tests to assess their fitness to proceed with donation. These include blood tests to assess his/her medical condition, heart and lung function, CT and MRI scans to check the size and health of their liver and calculate the size of the liver portion which can be safely donated. Once the entire workup is completed, the reports are discussed in a multi-disciplinary team before the donor is approved. The process takes 2-3 days, and each donor is assigned a coordinator to help them during every step of the process.

Live Donor hepatectomy

The portion of liver which is donated by the donor depends on several factors. The most important aspect is the safety of the donor. As a rule, at least 30% of the donor’s liver is left with the donor after the operation. This amount of liver is sufficient to grow back to its usual full size in 4-6 weeks while supporting the liver function. The actual amount of liver donated is usually smaller and depends on the weight of the patient. Usually, the smaller left part of the liver is donated when a child is being transplanted, while the right part of liver is donated for an adult patient.

The surgery is performed using open surgical technique and takes 5-6 hours. The patient is cared for in the ICU for 2 days after surgery and is then shifted to ward level care. Most donors are fully independent and can take normal diet by the 3rd or 4th day after surgery. They are usually discharged 5 to 6 days after the operation.

Risks of Liver Donation

Live donor hepatectomy is a safe and highly standardised procedure. Precautions are taken at every point right from initial testing until discharge to ensure that the post-surgery course is smooth and uneventful. Minor complications such as nausea, post-operative pain at the incision site can occur in about 10% of donors and can be easily managed with medications. About 2 out of 100 donors may need additional procedures during post-surgery admission. The risk of serious complications, including donor death, is very low and is reported in 1 out of 300 to 500 donor operations.

Life after Donor Hepatectomy

The remaining liver will grow back to its original size in 4-6 weeks. Normal work can be resumed one month after surgery, but donors are advised to avoid heavy exertion for three months. There are no long term restrictions after live donor hepatectomy, and the donor is free to eat, travel, study and work as normal. Donors can have a normal family life, and female donors can get pregnant safely after liver donation.

Liver resection is the surgical removal of a portion of the liver. It is also referred to as hepatectomy. Most liver resections are performed for tumors in the liver- either benign or malignant. Benign neoplasms which may need hepatectomy include hepatic adenoma, hemangioma and focal nodular hyperplasia. Common malignant neoplasms include hepatocellular carcinoma (HCC) or cholangio-carcinoma and secondary liver tumors arising from colorectal cancer or neuroendocrine tumors. Hepatectomy may also be the procedure of choice to treat intrahepatic gallstones or parasitic cysts of the liver. The type of liver resection and the amount of liver removed depend on the location and size of the tumor and the remaining liver tissue’s health.

Surgery and post-operative recovery

Liver resection is a major surgery, and it is done under general anaesthesia. The surgery usually takes 3-6 hours, depending on its complexity.

The surgery can be performed by either traditional open surgery or by laparoscopic surgery (Keyhole surgery). The surgeon will discuss the best possible option with the patient depending on various factors such as the general condition of the patient, type, location and size of the tumor and the health of the remaining liver.

Once the surgery is over, the patient will be shifted to ICU for observation. Our dedicated team of Liver intensivists, Surgeons and staff nurses will provide round the clock services in Liver ICU. Pain will be controlled by either postoperative intravenous patient-controlled analgesia pump or via catheter placed by the anesthesiologist at the end of the operation. After 2-3 days pain can be controlled with oral medications. Usually, oral liquid diet will be started from the day after surgery and slowly progressed to soft diet in 2-3 days. You will be mobilised to chair on the first postoperative day and made to walk from 2nd day onwards. Usually, by 3rd day, you will be shifted to the ward after removing all the lines and catheters. From the ward, you will be discharged on day 6-7. Follow up visits will be scheduled in liver OPD – usually 3 days from discharge.

A laparoscopic cholecystectomy is the surgical procedure to remove the gallbladder. A laparoscopic cholecystectomy is less invasive than an open cholecystectomy (other form of gallbladder removal involves a larger incision).

A laparoscopic cholecystectomy helps people with gallstones that are causing pain and infection. Gallstones are crystals that form in the gallbladder. They can block the flow of bile out of the gallbladder into your digestive system. This roadblock causes cholecystitis (inflammation of the gallbladder). Gallstones can also move to other parts of the body and cause problems.

Laparoscopic cholecystectomy takes about an hour or two. Using the special tools, gallbladder is detached from the liver and removed. Occasionally, the gall bladder may be severely inflamed due to repeated infections and may be considered unsafe for laparoscopic removal. In about 5% of such cases, the patient may need an open cholecystectomy using a small right-sided incision.

The patient can usually go home after laparoscopic cholecystectomy the same day evening or the next day. After an open cholecystectomy, one may have to stay in the hospital for a day or two. The patient should be able to eat normally in a day or two, and return to work and other daily activities in about a week.

Extended cholecystectomy/ Radical cholecystectomy is used for patients with tumors in the gallbladder. This involves removing the gallbladder, part of the liver, and surrounding lymph glands. A more extensive operation may be needed to remove a larger portion of the liver, the bile duct or additional lymph nodes in some advanced cases.

The procedure is done under general anaesthesia. This is a safe procedure, and complications are uncommon. Post-procedure, the patient needs a hospital stay for 3 to 5 days.

The hepatic duct is the tubular channel that carries bile from the liver to the small intestine to aid digestion. A hepaticojejunostomy is a surgical procedure to make a connection (anastomosis) between the hepatic duct and the jejunum, which is the middle portion of the small intestine. This technique is called the Roux-en-Y hepaticojejunostomy.

Normally, the hepatic duct joins the cystic duct (the duct that carries bile from the gallbladder) to form the common bile duct that drains the bile into the duodenum. When disease or injury in the biliary system obstructs the free flow of bile, digestion is impaired. A hepaticojejunostomy is performed to ensure that the bile from the liver freely drains into the intestine. Benign strictures in the common bile duct due to stones, injury or inflammation and cancers of the bile duct or gall bladder can be treated with this procedure.

A hepaticojejunostomy is performed under general anesthesia. The patient may need hospitalization for up to a week. Usually, oral diet is started after 1-2 days and the patient is on normal diet by 5 days after surgery.

A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), a part of the stomach, the gallbladder and the bile duct. After performing the Whipple procedure, remaining organs are reconnected to allow the food digestion process normally after surgery

Whipple procedure is used to treat

• Pancreatic cancer
• Pancreatic cysts
• Chronic Pancreatitis
• Ampullary cancer
• Bile duct cancer
• Neuroendocrine tumors
• Duodenal cancer
• Trauma to the pancreas or small intestine

The goal of doing a Whipple procedure for cancer is to remove the tumor and prevent it from growing and spreading to other organs. This is the only treatment that can lead to prolonged survival and cure for most of these tumors.

Surgery and post-operative recovery

Patients planned for this operation should be carefully evaluated by a specialist HPB surgeon to assess suitability. Only a few centre have the expertise to safely perform this surgery when the tumor is advanced and involves adjacent blood vessels. Then this will involve removing and reconstructing parts of blood vessels along with removing tumour.

Surgery may take six to eight hours, depending on which approach is used and the complexity of the operation. Whipple surgery is done using general anesthesia.

After surgery, need to stay in ICU for 1 or 2 days depending of the speed of recovery, following which need to stay in ward for 3 to 5 days after which can be discharged if recovered well. Initially, feeding is done through a tube placed inside the intestine through the nose during surgery. Normal oral feeding restarted by around 5 days after surgery. Post-operative complications are uncommon and primarily related to the new joints made between the pancreas and the intestine and the stomach and intestine. Most of these complications can be managed with medications and nutritional support, though occasionally surgery may be required.

After discharge, the patient will be reviewed in the outpatient clinic a couple of times for the first two weeks to ensure all is well. If the surgery is done for a cancer, then the patient may need chemotherapy depending on the stage of the tumour on the final biopsy report after multidisciplinary tumour board discussion. After completion of cancer treatment patient should be on regular follow up.

Distal pancreatectomy is a surgery to remove a tumour or cyst from the body or tail of the pancreas. A distal pancreatectomy may be performed by open technique or by laparoscopic means depending on the clinical situation. Occasionally, the spleen is located next to the pancreas may also be involved and may need to be removed. The surgical team will discuss the best option with the patient.

Surgery and post-operative recovery

Surgery may take 3 to 5 hours, depending on which approach is used and the complexity of the operation. Surgery is done using general anaesthesia.

After surgery, the patient needs to stay in hospital for 3 to 5 days after which he/she can be discharged if recovered well. Normal oral feeding can be restarted by the next day after surgery.If the surgery is done for a cancer, patient may need chemotherapy depending on the tumour stage on final biopsy report after multidisciplinary tumour board discussion. After completion of cancer treatment patient should be on regular follow up life long.

Few patients may develop side effects due to enzyme insufficiency as part of the pancreas is removed. In that case, patient may have to take regular enzyme supplements. Few patients may develop diabetes following this procedure which will require life long treatment for the same. Because the spleen helps the body ward off infection, one may need certain vaccines before and/or after surgery.

Chronic pancreatitis can cause blockage in the pancreatic duct. Surgery is used to drain an enlarged pancreatic duct. During this procedure, the main pancreatic duct is opened and connected to the jejunum, part of the small intestine. This allows pancreatic juices to drain while leaving the pancreas and duodenum (first part of the small intestine) intact.

The operation itself doesn’t necessarily result in diabetes. In fact, it may even improve pancreas function. One may end up needing insulin if the disease continues destroying pancreatic tissue after the operation. This operation can relieve pain in around 80 percent of patients and help stabilise the function of the remaining pancreas.

Chronic pancreatitis can cause blockage in the pancreatic duct. Surgery is used to drain an enlarged pancreatic duct. During this procedure, the main pancreatic duct is opened and connected to the jejunum, part of the small intestine. This allows pancreatic juices to drain while leaving the pancreas and duodenum (first part of the small intestine) intact.

The operation itself doesn’t necessarily result in diabetes. In fact, it may even improve pancreas function. One may end up needing insulin if the disease continues destroying pancreatic tissue after the operation. This operation can relieve pain in around 80 percent of patients and help stabilise the function of the remaining pancreas.

This is a relatively new operation combining drainage and limited resection (removal of pancreatic tissue), with potentially fewer side effects.

During this procedure, a part of the pancreas head, along with the diseased areas of the pancreatic duct within the head of the pancreas, is removed, and the remaining pancreatic duct is opened and connected to the jejunum (Small intestine), allowing pancreatic juices to drain. This procedure is typically used in patients where the main blockage is in the head of the pancreas.

There is a lower risk of developing diabetes after a Frey’s procedure compared to pancreatic resection. The Frey’s procedure is more likely to result in permanent pain relief compared to other surgeries for chronic pancreatitis.

Transarterial Chemo embolization (TACE) is a minimally invasive treatment performed by an interventional radiologist for treating liver tumors such as hepatocellular carcinoma, neuroendocrine tumors or cholangiocarcinoma. The doctor makes a tiny cut in the skin and inserts a catheter (a thin, flexible tube) into the femoral artery (the large artery of the leg). The catheter is then manoeuvred into place, guided by live X-rays. Using image guidance, a chemotherapy agent is delivered into the tumor and a blood vessel blocking agent (embolic) is introduced through the blood vessel supplying the tumor to stop its blood supply and to deliver chemotherapy in the same setting.

Disease / Conditions treated: Liver cancers (Hepatocellular carcinoma, neuroendocrine tumors or cholangiocarcinoma, Colo-rectal liver metastasis)

Type of stay: Inpatient

Expected duration of stay: 2 days.

Benefits:

• Controls tumour progression and reduces tumour load significantly. In large tumours, repeat procedure may be required to achieve maximum tumour treatment.
• Proven treatment option for unresectable liver tumours.
• Short hospital stay

Side effects: Post-embolisation syndrome (Tiredness, Nausea, in some cases vomiting)

Transarterial Radioembolization (TARE), or selective internal radiation therapy (SIRT), is a treatment used to destroy liver tumors. The doctor makes a tiny cut in the skin and inserts a catheter (a thin, flexible tube) into the femoral artery (the large artery of the leg). The catheter is then manoeuvred into place, guided by live X-rays. Once at the tumor site, the doctor injects the radioactive beads into the blood vessels that supply the tumor. The beads give off radiation over a very short distance, which concentrates the radiation inside the tumor, helping to reduce radiation exposure to the rest of the body. This treatment may also be referred to as Y-90 because it commonly uses a radioactive isotope called Yttrium 90.

Disease / Conditions treated: Liver cancers (Hepatocellular carcinoma, Colorectal liver metastasis)

Type of stay: Inpatient

Expected duration of stay: 1 day for lung shunt assessment and 2 days for TARE.

Benefits:

• Causes destruction of tumour cells exposed to the radiation isotope.
• Proven treatment option for unresectable liver tumours.
• Short hospital stay

Side effects:

Post-embolisation syndrome (Tiredness, Nausea, in some cases vomiting)

Duodenal ulcers may occur in a few patients.

Microwave ablation (MWA) uses electromagnetic waves to destroy a tumor. The tumor is localized via image guidance, and a thin microwave antenna is placed directly into the tumor. A microwave generator emits an electromagnetic wave through the antenna, and these waves agitate water molecules in the surrounding tissue. The friction and heat generated by this action cause cell death helping to destroy the tumor.

Disease / Conditions treated: Liver cancers (Hepatocellular carcinoma, Colorectal liver metastasis)

Type of stay: Inpatient

Expected duration of stay: 2 days.

Benefits:

• Causes thermal ablation of the tumour and a very small volume of surrounding normal liver.
• Curative treatment option in small liver tumours less than 3 cms and less than three in number.
• Short hospital stay

Side effects:

Mild discomfort for a day or two in the upper abdomen.

Radiofrequency ablation (RFA) uses radio waves to create heat and damage tissue. RFA is used to decrease pain by damaging pain-sensing nerves or to treat cancer by damaging tumor cells. A probe is placed into the target tissue where they emit an electrical current to transmit radio waves to the surrounding tissue, which heats up, causing cells to die.

Disease / Conditions treated: Liver cancers (Hepatocellular carcinoma, Colorectal liver metastasis)

Type of stay: Inpatient

Expected duration of stay:2 days.

Benefits:

• Causes thermal ablation of the tumour and a very small volume of surrounding normal liver.
• Curative treatment option in small liver tumours less than 3 cms and less than three in number when surgery is not possible.
• Short hospital stay

Side effects:

Mild discomfort for a day or two in the upper abdomen.

Transjugular intrahepatic portosystemic shunt (TIPS) is a technique used to reduce internal bleeding in the stomach and esophagus in cirrhosis patients by creating a shunt to bypass the liver. A stent (a tiny mesh tube) is placed to keep the connection open and allow it to bring blood draining from the bowel back to the heart while avoiding the liver.

Disease / Conditions treated: Portal hypertension in cirrhotic patients, Patients with variceal bleeding.

Type of stay: Inpatient

Expected duration of stay: 3 days.

Benefits:

• Reduces portal hypertension and in turn variceal bleeding.
• Reduces fluid formation in patients with refractory portal hypertension.
• Bridge to surgery in patients waiting for liver transplant

Side effects:

Hepatic encephalopathy (uncommon)

Portal vein Embolisation(PVE) is a special procedure used to grow the patients liver before surgery is performed. This is considered when the amount of liver that can be left behind for the patient after liver resection for tumor removal is judged to be too small. Here the radiologist blocks the blood supply to the part of the liver, which is planned for removal. This leads to increased blood supply to the healthy part of liver leading to its growth in 4-6 weeks. Surgery can be performed safely after that.

Disease / Conditions treated: Patients with resectable HCC, Cholangiocarcinomas, Hemangiomas

Type of stay: Inpatient

Expected duration of stay: 3 days.

Benefits:

• Reduces risk of liver decompensation after surgery

Side effects:

Mild discomfort for a day or two in the upper abdomen.

Percutaneous transhepatic biliary drainage is a minimally invasive procedure, through the skin, to drain the bile juice, when its flow gets blocked due to stones in its path or by malignant or non-malignant causes. The procedure involves introducing a pen refill sized small tube into the body under ultrasound and Fluoroscopic guidance.

Disease / Conditions treated: Klatskin tumour, Cholangiocarcinoma, Carcinoma head of pancreas causing bile stasis.

Type of stay: Inpatient

Expected duration of stay: 3 days.

Benefits:

• Reduces bilirubin level (jaundice).
• Reduces risk of liver decompensation.
• More useful in patients in septic shock due to cholangitis.

Side effects:

Mild discomfort for a day or two in the upper abdomen.

Hepatic Venous Portal Gradient (HVPG) is a short, minimally invasive procedure, that helps an Interventional Radiologist assess the exact pressure gradient between the inflow and outflow blood in the liver (portal vein and hepatic vein respectively). The pressure gradient is useful in decision making in prospective transplant candidates and people having variceal bleeding.

Disease / Conditions treated: Pateints with resectable HCC, Cholangiocarcinomas, Hemangiomas to assess portal pressures

Type of stay: Daycare

Expected duration of stay: 1 day.

Benefits:

• Aids decision making for surgery / TIPS

Side effects:

Nil