Hepatology

The doctors in the department of Hepatology involve a group of focused doctors specifically trained to diagnose and manage liver diseases.  The group of experienced doctors backed up by the state of the art diagnostic and interventional support renders a very comprehensive care in the field of liver diseases. The unit is well versed with the up to date standard of care regimens in liver diseases and also has a liver transplant unit and a dedicated liver intensive care unit for the critically ill patients. Emerging treatment modalities like regenerative liver therapies involving the use of stem cells are carried out as a research protocol in the Institute.

CONDITIONS WE TREAT 

• Preventive Hepatology: Liver diseases are one of the most common causes of morbidity in the present world. Lifestyle changes and lack of physical exercise has given rise to an emerging epidemic called non-alcoholic fatty liver disease and these patients can progress to liver cirrhosis which is an end-stage liver disease. We actively try to detect these patients of NAFLD and also counsel patients who visit the hospital regarding steps to prevent fatty liver which includes dietary and physical activity counselling. Coupled with NAFLD, alcohol is another common cause of liver disease and us at AIG Hospitals are committed to lending support to these patients to give up alcohol for a better life. Other preventable causes of liver diseases like hepatitis A  and B can be prevented by vaccination and a society who is fully vaccinated against these preventable liver diseases is desirable.  We at AIG hospitals are committed to trying to spread awareness for prevention of disease before they actually appear in the patients.
• Liver Cirrhosis: Cirrhosis in common terms means a liver which has become small and stiff in contrast to the normal sized liver which is soft with low stiffness. Cirrhosis can occur due to multiple causes: alcohol, hepatitis B, hepatitis c and NAFLD being the commonest causes. Cirrhosis of the liver can lead to the development of jaundice, ascites (water in the abdomen), edema (leg swelling), varices (swelling of veins in the food pipe), gastrointestinal bleed (blood vomiting or black stool) and even progress to liver cancer. Though at present the curative treatment of advanced liver cirrhosis is liver transplantation, we at AIG hospitals are capable of dealing with all modalities of supportive treatment backed by a liver ICU and department of regenerative medicine which is investigating newer modalities of treatment for cirrhosis of the liver.
• Viral Hepatitis: Affection of the liver due to multiple viruses like Hepatitis A, B, C and E can be managed and intact patients with hepatitis C with the newer medicines can now be totally cured of the disease. Hepatitis A and E are usually a self-limiting disease and are the commonest cause of jaundice. Patients of Hepatitis B are also managed by a group of highly trained and experienced doctors.
• Alcoholic Liver Disease: Patients who have not yet developed cirrhosis is a reversible and treatable condition and these patients are effectively managed at our unit by a multidisciplinary effort of hepatology, nutrition and psych-social support system
• Jaundice of Various Etiology: Other than the viral, other causes are also evaluated and treated at our centre. The state of art diagnostic back up helps in diagnosis rare causes of liver injury like autoimmune hepatitis, Wilson disease, Gilbert’s syndrome, drug induce liver injury etc which lead to proper management of these patients.
• Fatty Liver: Both alcoholic and non-alcoholic etiology are managed by a combined approach of lifestyle modification, dietary changes and medications. We at AIG hospitals also do genetic testing for NAFLD to identify patients who are at increased risk of progression to cirrhosis of the liver and these patients have to be more aggressively managed.

MEDICAL PROCEDURES

• Management of Acute Liver Failure: ALF needs a specialized care and we at AIG Hospitals manage these patients in the designated liver ICU which is backed by state of art support systems and doctors of high experience in this field.
• Medical Management of Cirrhosis of the Liver: Most of the patients of liver cirrhosis are managed conservatively with medical management and steps are taken care to prevent complications of the diseases. All patients are evaluated for the possible cause of cirrhosis and treatment of any correctable cause is done. Patients who need a liver transplant are evaluated and monitored. Patients who are willing for voluntary participation in ongoing stem cell study for cirrhosis are encouraged to discuss with the doctor the details of the same.
• Management of Viral Hepatitis and Hepatitis of other etiologies
• Management of Non-Cirrhotic Portal Hypertension and EHPVO: Portal Hypertension can sometimes develop without the presence of liver cirrhosis and this can happen with and without the presence of a blood clot (thrombosis) in the portal vein. The progression and natural history of this condition are different from liver cirrhosis and needed to be identified. Sometimes the bile duct gets blocked in these patients with EHPVO and this may lead to jaundice and cholangitis. We at AIG hospitals manage both medically as well as endoscopically these patients to give a better liver
• Management of Budd-Chiari Syndrome: Sometimes the liver is affected because the outflow of blood from the liver is blocked. When this happens patients can develop bleeding and ascites. Many of these patients are managed medically and some of them need stent placement within the liver and also liver transplantation. We are equipped with all modalities of treatment for these patients
• Management of Liver Tumours including Hepatocellular Carcinoma: Liver Tumours can be cancerous or non-cancerous and we are equipped to manage both these categories of liver tumours
• Liver Biopsies: A liver biopsy is required in some cases to diagnose the cause of the liver injury which helps in optimizing treatment. This can be done either percutaneously (i.e. through the skin) or transjugular ( ie through the vein ) or under laparoscopic guidance. Based on the requirement all three ways are feasible at our centre.
• HVPG: is a procedure by which the portal pressure within the liver is calculated. This is important to know the amount of pressure with the liver and for knowing the risks of bleeding from varices. This is done in the liver lab under the radiological guidance
• Endoscopic Variceal Ligation and Glue Injection: for patients who have a high risk of bleeding from these dilated veins in the food pipe or the stomach are routinely done. Even patients who are actively bleeding are taken care of by these procedures after adequate resuscitation.
• Argon Plasma Coagulation (APC): for treatment of GAVE in many patients of liver cirrhosis is routinely done
• BRTO and TIPPS ( in collaboration with the department of interventional radiology ): These are highly advanced procedures which are done to prevent GI bleed and ascites in a select group of patients with liver cirrhosis.
• TACE, TARE and RFA for liver cancers ( in collaboration with the department of interventional radiology )
• Shunt Surgeries and Hepatic Resections ( in collaboration with the Department of GI surgery)
• Liver ICU Care: This is a dedicated ICU for the liver patients who are managed round the clock by a trained intensivist, hepatologist, and a multidisciplinary approach is adopted for the benefit of the patient,
• Liver Dialysis: where the diseased liver can be supported for recovery is available at our centre
• Liver Transplantation: in conjunction with the department of surgical gastroenterology and headed by senior liver transplantation surgeon and hepatologist is one of the finest in the country.
• Regenerative Liver Medicine wherein patients who are unwilling or not logistically possible for liver transplant are offered for voluntary enrollment in a clinical study as approved by the ICSCR, IRB and IEC. The patients discuss with the principal investigators and co-investigators of the study and decide on the course of action.

CLINICS

• Viral Hepatitis Clinic: is specifically designed for the care of patients with viral hepatitis. It involves treatment of all viral related liver diseases and treatment of Hepatitis B and C. Advanced treatment of both these conditions are taken care of under the supervision of well-trained senior doctors.
• Fatty Liver Clinic: involves the management and treatment of a specifically nonalcoholic fatty liver disease which is emerging as the major cause of liver cirrhosis in the country. Along with standard care the clinic involves the services of the department of genetics and AHF to focus on identifying specific risk factors and genetic lineage for fatty liver. A team of a dietician and rehabilitative medicine works in close association for management of NAFLD
• Liver Transplant Clinic: All patients who are listed for liver transplant and also the post-transplant follow up patients are seen in the liver transplant clinic which involves a specialized care unit wherein the transplant surgeon, hepatologist, nutritionist, pharmacist, physiotherapist, ID specialist and intensivist works together for optimizing the care in these patients.
• Portal Hypertension Clinic: involves the care of patients of portal hypertension of both cirrhotic and non-cirrhotic etiology and adequate monitoring of their drugs and endoscopic variceal ligation and glue injection for gastric varices are routinely carried out.
• Liver Lab: This involves specialized tests for assessing the liver and includes measuring of liver stiffness by modalities like ARFI and transient elastography.  Monitoring of portal pressure (pressure within the liver) which can lead to bleeding from varices are measured in the liver lab. Liver biopsy both percutaneous and trans-jugular liver biopsy are routinely done in the Institute and these results are interpreted by a trained pathologist.
• Regenerative Hepatology Clinic: This clinic involves counselling of patients about recent advances in stem cell use in liver disease and also for follow up of patients who received stem cell infusion. Patients can talk with the investigators about the scope of enrollment in these clinical studies for these emerging modalities of treatment as the bridge of liver transplantation.