● Multiple episodes of upper GI bleeding in last 5-6 years
● Had developed cirrhosis and has huge collaterals
● Due to such spleen, he has developed symptoms of hypersplenism (low platelet count, Low Hemoglobin, and low white cell count)
An Overview of the Case
Master X was diagnosed with Budd Chiari syndrome at age six years. He had multiple episodes of upper GI bleeding in the last 5-6 years. He had developed cirrhosis and had huge collaterals (veins that can bleed).
The patient had a huge spleen reaching up to his right side. The size of the spleen was 27 cm. Due to such a large spleen, he developed symptoms of hypersplenism. like –
Low platelet count
Low Hemoglobin
Low white cell count
The large splenic aneurysm was a serious reason to worry. Any rupture of splenic aneurysm can be catastrophic. Because of collaterals, low platelet count, and such a big aneurysm, operating was a technical challenge.
Luckily, the patient was able to tolerate the surgery very well. The excision of the aneurysm and spleen went very well without any blood loss. The weight of the spleen was more than 2.5 Kg.
Treatment Provided to the Patient
surgery
Medical Tests Performed
Routine CT scan
Blood platelet count
Feedback from the Patient
The surgery saved the life of Master X. He became fit in few days right after the surgery. Now, after the complete recovery, he can lead a healthy life. His parents were also pleased with the treatment.
Mr. Gajanan Thamke visited Dr. Gaurav Gupta with symptoms of coagulopathy andascites. After diagnosis, Dr. Gaurav and his team concluded that Mr. Gajanan has Non-alcoholic steatohepatitis (NASH) and he would require an immediate liver transplant. The patient’s blood group was B+, so liver donation can only be done by family members with a B+ or O+ blood group.
Unfortunately, none of the family members of Mr. Gajanan suited the blood group requirement. Dr. Gaurav and his team decided to wait in case a suitable liver donor could be found. However, time was running out for Mr. Gajanan, his condition was getting worse. He needed frequent ascitic tapping and his kidney was getting injured.
Dr. Gaurav Gupta, one of the best liver transplant surgeon in Mumbai and his team had a frank discussion with Mr. Gajanan and his family stating that there was not much time left and he required a liver transplant urgently. The team discussed with patient about the possibility of ABO incompatible liver transplant, where a transplant is performed from any blood group donor. The patient’s 23 year old daughter – Ms. Jayshree had an AB+ blood group which was incompatible. After some CT scans and tests, Jayshree was found suitable for the liver transplant.
So, Dr. Gaurav decided to proceed with utmost precaution as such transplants are at risk of developing biliary complications. The doctor decided to modify the surgical procedure by making changes in how they would cut and join the bile duct.
Medical Tests Performed
Tests
Feedback from the Patient
This feedback is from the patient Mr. Gajanan: “During this difficult period for our family, Dr. Gaurav Gupta and his whole staff were very helpful. I had given up hope when I was running out of time and we could not find a suitable donor. Yet Dr. Gaurav Gupta and the rest of the team gave me new hope. I am doing a lot better after my liver transplant, and I have no words to express my gratitude to the entire team.”
Relevant Questions
Q. Hello, I’m a 49-year-old male whose platelet count has dropped to 27000 in the last several months. Gastroenterologists use sonography and endoscopy to detect compensated liver cirrhosis. I’m curious about the long-term effects and what kind of diet I should follow. Thanks
If your doctor has told you that you have compensated cirrhosis, this means you are in the early stages of the disease. The cause of cirrhosis in such patients must be thoroughly investigated. These individuals must also be monitored by liver experts on a frequent basis in order to diagnose and treat issues when they emerge. These individuals must also adhere to a rigorous liver-related diet. Diets are usually changed and tailored to the specific needs of each patient. I hope this answers your question, and please contact me if you have any other questions!
Q. My brother is hospitalized in Nair hospital since last 15days because of alcoholic liver infection, not getting improvement .. So i want to consult with you.
If a patient has alcohol-related liver injury generally treatment depends upon the degree of liver injury. some of the patients will recover after alcohol-related liver injury but in case of severe alcoholic hepatitis, liver transplant may be needed.
Q. My wife has issue with abdomen pain & according to Dr the lever is fatty We have done USG of upper & lower abdomen & it shows bit enlargement of lever What shall we do next
If on USG liver is fatty, the Patient should undergo some more blood tests to find the cause and degree of fatty liver. We should also check whether this fatty liver is causing hepatitis or not. Treatment will depend upon finding of these tests. I will suggest you to consult a liver specialist and then further treatment can be started.
The 3 main causes of liver damage are: Obesity, undiagnosed hepatitis infection and alcohol misuse. There are some other factors that lead to liver damage. That is,
Q. I have had high chronic liver enzymes for the past 10 years, and in this time i visited several doctors, some of them diagnosed my condition to be gilbert syndrome. My bilurbin range is 2 to 5 as both direct and indirect, whereas elevated Alt range is 60 to 100, and my Alp remains within the normal range. Hcv pcr is negative, hbv is also negative, wilson disease is negative, and no hemochromatiis has been detected. I had got my ultrasound done in January this year (2021), everything was normal then and my mrcp was fine too. For the past few months my upper right part of the abdomen has been aching, but that happens only when i walk, otherwise i don’t experience any pain at all. Can i know what is the cause of high alt and bilurbin? Do i have some issue related to liver or is it something else?
Gilbert syndrome does not generally cause high Liver enzymes (AST and ALT), it can cause a rise in bilirubin. Secondly, Gilbert syndrome causes only indirect bilirubin to be high and it doesn’t cause pain in the abdomen. Some of ur symptoms don’t match with Gilbert syndrome. Any rise in liver enzymes needs to be thoroughly evaluated. I will suggest you to consult a liver specialist and get evaluated.
At a private hospital in Kolkata, the Kundu family of Raipur was blessed with a baby boy, Piyush. However, the baby was diagnosed with jaundice shortly after birth. Doctors at the hospital ran tests and determined that the baby had Biliary Atresia, a condition in which the bile ducts around and inside the liver are scarred and blocked. The doctors determined that the baby needed a liver transplant as a lifesaving procedure.
The family was informed about the procedure. The baby’s mother agreed to a liver transplant in Mumbai, and the patient was transferred to Mulund’s Fortis Hospital to the pediatric ICU. After evaluation, it was found that the patient was having jaundice and a chest infection. The baby was severely underweight and had developed liver failure signs and symptoms. The patient was cared for by a pediatric intensivist team in the PICU.
Antibiotics, physiotherapy, and dietary supplements were used to treat the patient over the next two weeks. Aggressive optimization was done to improve the baby’s chances of a successful Liver Transplant. The patient’s grandmother was examined by a team led by Dr. Gaurav Gupta, who determined that she was a good candidate for liver donation. The patient underwent a liver transplant surgery which, although demanding, went smoothly. Postoperatively baby has a smooth recovery.
Even though it was difficult to manage the patient as he was a baby, the concentrated efforts of Dr. Gaurav Gupta and the entire team ensured that the patient recovered smoothly without any complications.
Medical Tests Performed
Tests
Feedback from the Patient
This feedback is from the patient Piyush’s mother “Dr. Gaurav Gupta and the entire team were very supportive during this trying time for our family. When Piyush was diagnosed with biliary atresia, I had lost all hope. But, Dr. Gaurav Gupta and the entire team were a new light of hope for me. My child Piyush has recovered after the liver transplant, and I have no words to express my gratitude to the entire team.”
Relevant Questions
Q. I have had high chronic liver enzymes for the past 10 years, and in this time i visited several doctors, some of them diagnosed my condition to be gilbert syndrome. My bilurbin range is 2 to 5 as both direct and indirect, whereas elevated Alt range is 60 to 100, and my Alp remains within the normal range. Hcv pcr is negative, hbv is also negative, wilson disease is negative, and no hemochromatiis has been detected. I had got my ultrasound done in January this year (2021), everything was normal then and my mrcp was fine too. For the past few months my upper right part of the abdomen has been aching, but that happens only when i walk, otherwise i don’t experience any pain at all. Can i know what is the cause of high alt and bilurbin? Do i have some issue related to liver or is it something else?
Gilbert syndrome does not generally cause high Liver enzymes (AST and ALT), it can cause a rise in bilirubin. Secondly, Gilbert syndrome causes only indirect bilirubin to be high and it doesn’t cause pain in the abdomen. Some of ur symptoms don’t match with Gilbert syndrome. Any rise in liver enzymes needs to be thoroughly evaluated. I will suggest you to consult a liver specialist and get evaluated.
The 3 main causes of liver damage are: Obesity, undiagnosed hepatitis infection and alcohol misuse. There are some other factors that lead to liver damage. That is,
Hello, I’m a 49-year-old male whose platelet count has dropped to 27000 in the last several months. Gastroenterologists use sonography and endoscopy to detect compensated liver cirrhosis. I’m curious about the long-term effects and what kind of diet I should follow. Thanks
Answer: If your doctor has told you that you have compensated cirrhosis, this means you are in the early stages of the disease. The cause of cirrhosis in such patients must be thoroughly investigated. These individuals must also be monitored by liver experts on a frequent basis in order to diagnose and treat issues when they emerge. These individuals must also adhere to a rigorous liver-related diet. Diets are usually changed and tailored to the specific needs of each patient. I hope this answers your question, and please contact me if you have any other questions!
My brother is hospitalized in Nair hospital for the last 15days because of alcoholic liver infection, not getting improvement… So I want to consult with you.
Answer:
If a patient has alcohol-related liver injury generally treatment depends upon the degree of liver injury. some of the patients will recover after alcohol-related liver injury but in case of severe alcoholic hepatitis, a liver transplant may be needed. If you want to know more, you can refer to the article on Alcohol Liver Disease.
