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Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy?

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i have repeated jaudice during six three months . Before this i had operation for piles and fistula wherein i consumed pain killer and antibiotics for two and half months. My bilirubin level 3.7, sgot570 sgpt 450 when jaudiced was first diagnoised , it came down to normal and again went up ,, like it happend six times ,, now again i am having jaudice .. Based on the advice given by your genral pratitioner i have done all test , hep c was detected with viral load of 0000 rna copies . The ultrasound is normal. But my sgpt level yesterday was 170 , sgot 117 , and total bilirubin .2.39 with direct bilirub 0.31 and balance indirect. I have visted gastrantollgist , who told not to take any treatment , However later he told me that liver biopsy to be carried out . I need second opinion in this respect.
Posted Fri, 27 Apr 2012 in Liver and Gall Bladder
 
 
Answered by Dr. Vaibhav Banait 11 hours later
Hi,

Thanks for the query.

I would like to have clarifications about duration of symptoms. The reason being if it is less than six months and if there is no clinical evidence of chronic disease , you have acute hepatitis c and have a very good chance of cure with interferon based treatment. If it is more than 6 month, I would recommend getting total proteins , albumin, UGIscopy, ultra sound abdomen, hepatitis genotype and liver fibroscan or biopsy . These investigations help assess severity of inflammation and stage of disease. If it is mid disease, you should wait for telepravir or bosepravir to become available in india . Combined with peg interferon, they increase the response rate significantly. If disease is severe, you should be treated with peg interferon. Biopsy will also help rule out other causes.

I think I made myself quite clear . I am available for further queries if you have any.

Dr Vaibhav Banait,
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 11 hours later
Regarding duration of the smptoms , i am having recurring jaudice from Feb 22. On feb 22 my bilirubin level was 3.5 with sgot and sgpt 700 and 600 respecively . AFter that i had jaudice 5 times till today with bilirubinb levle of 2.5 and sgpt and sgot of 200 and 150 respectively. Although its not severe jaudice but i am very much disturbed by its recurring nature depiste of my fat free diet. I was diagonosed from hep c on 12 sep 2011 with viral load of 5650 iu/ml. My question is " Is hep c responsible for such recurring jaudice or there is any other kind of liver dis order" " Can hep c go of its own without treatment as told by me by the gastrotologist i visited
 
 
Answered by Dr. Vaibhav Banait 16 hours later
Hi,

Thanks for clarifying.

Roughly 20% of patient of acute hepatitis c resolve spontaneously, most within twelve weeks.

As I could see from the duration of your illness, it seem less likely that you would have spontaneous resolution. Hence I would agree with your consultant regarding the need for biopsy.

If you have genotype one and early /mild disease, you should wait for new drugs to come in market. I recommend starting treatment if you are non-genotype 1 and /or have advanced fibrosis on biopsy.

Hope I have answered your query. Should you have any additional concerns, I will be available to address them.

Regards
Dr Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 7 hours later
Thanks for the reply . But why does jaudice recur so many times ? Is Hep C responsble to it > As mentioned the viral load is very less i.e 5650 . Does such low viral load responsible for cuasing reucrring jaudice.
 
 
Answered by Dr. Vaibhav Banait 8 hours later
Hi,
Thanks for the follow up.

There are two possible causes :

1. There is fluctuation in inflammation of liver, which when increased result in jaundice. HCV(RNA level also fluctuates. So do not conclude anything based on single reading.

2. There is additional cause eg: advanced liver disease due to fatty liver.

Biopsy should sort the issue out. Go ahead with biopsy only after discussing the problems with biopsy (bleeding, damage to surrounding organ, rare but do occur) with your doctor.

Hope I have answered your queries adequately. Should you have any more doubts, I am available to address them

Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 33 minutes later
Thanks , there is time to get genotype say around 15 days ,, Based on that , docter here told they will fix stretegy regarding biospy ,, whether to carry the same or not . Till the time i dont get the results say ateleast 15 -20 days more ,, should i completely restrict fats , salts etc or resume to normal food
 
 
Answered by Dr. Vaibhav Banait 5 minutes later
Hello.

Thanks for writing agai.

I think you should have normal diet. Mild salt restriction may be advisable. Apart from that there are no dietary restriction. Avoid alcohol, and sleeping pills/ pain killers.

I would be interested to know about genotyping.

I hope I have answered your quwry.

Wish you good health.

Regards.



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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 3 hours later
you just now mentioned pain killer not to be taken . But i have sometime heaache on the right hand side of the head, i take crocin . Is that ok ? I would further like to ask you , if under jaudice conditons i have some type of viral infection like throat , cough , which necceatates admininstation of antibiotics, then will i be able to take these medicines ? Or i will not be able to take any antibiotics and try to clear the infection with the passage of time.
 
 
Answered by Dr. Vaibhav Banait 15 hours later
Hi,
Thanks for the follow up.

1. You can take crocin for headache. But restrict youself to minimum one to three dosage per day. Seek neurological help if headache is severe and/or frequent.

2. As such antibiotics are not contraindiacated in chronic liver disease, but may require dose modification.

Avoid, unless you really need them.

Wishing you good health.

Dr Vaibhav Banait, DM
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 55 minutes later
ok , that is quite good advice. I also forgotten to ask in my last follow up question , docter has also advised one more test i. e Prothrombin time and index. What is this test. He has asked me to do this test one day beofre i go to hospital with genotype test resuts . Can you plesae expalin me what is this test for and and why one day prior to going to hospital. Also i would like to inform you that i had taken ultra sound of liver just for my satisfaction , the radio logist told me liver seems to be absolutely normal and show no scars or any type of cirocratic smptoms ? Does it mean condions are more worse as something bad is taking place very much inside the liver?
 
 
Answered by Dr. Vaibhav Banait 5 hours later
Hello.

Thanks for writing again.

When you get injured, there is bleeding. The bleeding stops after some time because of intrinsic mechanism known as clotting. Our body maintains a delicate balance by which blood flows inside vessels without forming a clot and clot forms when there is injury.

This clotting is achieved using certain chemicals that are synthsized by liver. If liver is damagd, the clotting is delayed and there is tendency to bleed. This is measured in lab using "prothrombin time" (PT). Normal PT is 4 seconds. (DIFFERENCE BETWEEN PATIENT AND CONTROL).

Your doctor has suggested this because, he
1. Wants to know about status of liver (higher value indicate poor live function).
2. Risk of bleeding if liver biopsy is done.

USG (Ultrasound) is a poor test o assess livr function. It is primarily done in liver disease to know for Hpatocelluar carcinoma, Portal vein thrombosis, Ascites. It can also suggest whether you have fatty liver. You possibly do not have any. So do not worry.

I hope, this answers your query.

Wish you good health.

Regards.
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 38 minutes later
ok good. I am not that much interested in liver biopsy right now . Do we have any other alternatives.... like liver fibro scan to diagnosis the liver ? Or there is no other option other then liver biopsy
 
 
Answered by Dr. Vaibhav Banait 21 hours later
Hi,
Thanks for the follow up.

Fibroscan is helpful in detecting whether liver does not have fibrosis or has significant fibrosis/cirrhosis.

It is available at super speciality hospital at nagpur (Govt).

But it will not give you any information regarding inflammation or additional pathology.

Wishing you good health.

Dr Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 59 minutes later
ok , where is the super speciality hospital , and i also want to know in how much time liver biospy is done , is the procedure harmful , and which is the the best place to do it in Nagpur , and how much does it normally cost.
 
 
Answered by Dr. Vaibhav Banait 4 hours later
Hello.

Thanks for the query.

Super speciality hospital is near Government Medical College.

Liver biopsy is best done at Gastroenterology center or by intervention Radiologist .

Cost varies from centre to centre, you might have to enquire at the hospital you are attending.

Though rare, liver biopsy is associated with some complications. Minor complication include pain at the site of puncture, and small hematoma at the puncture site. But extremely rarely excessive bleeding, hemoperitonium and shock has been seen. Therefore it is best to get it done at a site where intervention radiology backup is available. Damage to surrounding organ resulting in pneumothorax, biliary leaks has been seen rarely.

But as liver biopsy provides enormous information which may not be matched by any other, so it is recommended.

I hope this helps to clarify your doubts.

Wish you good health.

Regards.
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 30 minutes later
ok . Till the time mygenotype results come ,, is it adviseable to get hep a vaccination .. I had already taken hep b vaccinaiton 8 years back.
 
 
Answered by Dr. Vaibhav Banait 1 hour later
Hi

Most indians get infected , symptomatic or asymptomatic by age nineteenth and are thus immunized against hepatitis a naturally, most world bodies advised for immunization against it. You may opt for it.

Hope I answered your queries adequately.

Regards
Dr Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 18 hours later
Can I take non veg food , like eggs, chiken , and fish . Mutton i normally dont take. Will these food load the liver and i should avoid them completly till Hep C virus is totally eradicated.
 
 
Answered by Dr. Vaibhav Banait 21 hours later
Hello.

No dietary restriction is advised in patient with chronic hepatitis C.

You should eat healthy diet with adequate fibers.

If there is swelling over feet or abdomen due to fluid inside, you should restrict salt to 2-3 mg per day.

hope I have answered your queries adequately. Should you have any more doubts, I am available to address them.

Wish you good health.

Regards.

Dr Vaibhav Banait.
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 4 days later
Under the situation where there is re curring Jaudice under Hep c ,, Can i do exercises especially XXXXXXX breathing exercising ( type of Yoga) . Will it hurt the liver . or I should restrict these excercises unless liver is fully recovred.
 
 
Answered by Dr. Vaibhav Banait 5 hours later
Hi again XXXXXXX

Thanks for the query.

Though you should avoid strenuous work / exercises when you had liver disease, light exercises/ breathing exercises can be undertaken without any problem.

Liver acts as a glucose reservoir in body. When you exercise , glucose is mobilized out of liver. This process is impaired in patients with advanced liver disease. Hence breathing exercises would benefit you.

Regards,
Dr. Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 3 hours later
Do you think my liver conditions can be categorised under advanced liver diseases. and how breathing excercise can bring liver functioning better , can you pl elucidaite this point....
 
 
Answered by Dr. Vaibhav Banait 23 hours later
Hello.

Thanks for the query.

I can not judge your liver status without examining you. From the partial reports that I saw here, I felt you may be harboring chronic hepatitis. The severity and stage may be assessed by clinical examination, labs, fibroscan/biopsy.

Breathing exercises are valuable for increasing respiratory capacity. The person who has good respiratory capacity fares remarkably well when he develop ascites or pleural effusion than person with poor respiratory reserve.

Normally, liver metabolises ammonia, a waste product which is formed after metabolism of proteins. It is implicated in metabolic encephalopathy (altered behiour and consciousness level in advanced liver disease). In liver disease, Muscle mass becomes important for metabolism of ammonia as it is the other site where ammonia is detoxified in body. So light execise is important in liver diseases though you should avoid strenuous exercises.

I hope, this explains your query.

Wish you good health.

Regards.
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 1 hour later
ok thanks for the good reply .. Also during my interactions with certain people with Hep C ,, I was told to reduce the intake of sugar ( particulary white Sugar) and potatoes . Is this the myth or there is some reality in it?
 
 
Answered by Dr. Vaibhav Banait 20 hours later
Hi,

Obesity is associated with faster progression of Hepatitis C. If you look at it in that context, excessive intake may not be advisable. But otherwise I do not think it has any relevence.

Regards,

Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 17 hours later
ok but some people advise me not to take high glycemic carbohydrates as it loads the liver ? Pototaotes , sugar etc have high gycemic carbohydrates . Is it truth ? Also i have one more query regarding food. You have advised me to take normal food . Normal Food do contain average amount of fats and certain other items which load the liver . Will normal food not load the liver when liver is already fighting the hep c virus? Or you mean to say liver is such a massive organ that it can take any amount of load ?
 
 
Answered by Dr. Vaibhav Banait 28 hours later
Hi,
Thanks for the follow up.

I appreciate the question. As previously mentioned, good muscles mass is important in Liver disease to prevent complication. Also, the repair of liver require proteins, lipids and vitamins.

These can be provided only with adequate healthy balanced diet. The question of high glycemic index comes only if you have diabetes.

It is also important to understand that obesity is associated with rapid progression of hepatitis c. And lower response rate. So it is important to avoid getting overweight .

So balanced vegetarian diet and adequate exercise is the key to success .

Wishing you good health.
Regards
Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 5 hours later
ok , Just now i received my genotype readings its 1b. What is the significance of this . As per your earlier suggestion , you have advised me to wait till the new drugs come . What is your take now ? Also further i would like to inform you that my apetite has gone up ,, my weight has icnreased from 75 to 77 in just one week. I have not taken LFT test, but i think they surely must not be abnormal. The abnominal pain has also reduced significantly and urination is yellow only few times in a day. Normal Urnine colour is pale yellow . Waiting for your advise, having said that , Biopsy is something which i still not much interested to take.
 
 
Answered by Dr. Vaibhav Banait 19 minutes later
Hello.

Thanks for writing again.

I would suggest you to get your fibroscan done. That should confirm advanced or mild disease.

Genotype 1 is relatively difficult to treat virus with lower response rate and treatment duration of one year.

I would suggest you to wait if you have mild disease on fibroscan and go ahead with treatment if fibroscan showed advanced disease.

I hope, this answers your query.

Wish you good health.

Regards
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 14 hours later
ok ,, do you think some conrete medicines would be available next year in india for treatement of this genotype . If yes what would be cure rate for the same. ? As you say present drugs for such genotype have low success rates , so i would rather wait then to do any experiments if waiting period is not so big..... I also would like to know the percentage of patients of hep c who come under this category of genotype.
 
 
Answered by Dr. Vaibhav Banait 2 days later
Hi,
Thanks for the follow up.

Telepravir and bocepravir is available in US market since march 2011. These drugs should be available to us also once the companies complete necessary formalities and obtain indian FDA approval.

This may take upto an year.

With present medication, success rate for genotype 1 is approx 60%. This goes to 80% once one of these drugs is added to regimen. This is big change!

I would put prevalence of genotype 1 to around 25% in India. Western countries have predominant genotype 1 patients.

wishing you good health.
Regards

Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 1 hour later
I have interacted with such patients with genotype a , their experience has been very bad . Many re lapses ,, and many side effects. Despite of such high treatment cost , successs rate is extremely variable . Under these secnarios would you recommend to wait till new drugs come to india i.e one year . And also would appriciate if you can tell me what would be the appoxmiate cost of this treatement (new drugs) which you have told.
 
 
Answered by Dr. Vaibhav Banait 47 hours later
Hi and thanks again.

I would recommend to wait in view of success rate with combination unless you have advanced disease. Follow up with your doctor regularly who can monitor your condition.

About cost in Indian market , I am not yet sure.

Do not go by experience of individual patient. Majority of patients are doing well.

Hope this helps.

Regards
Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 29 days later
hello doc, i hope you recollect my case, as i am writing after pretty long time. Mine liver symptioms were just above normal ( High Normal ) all these one month ever since i wrote to you last time. Based on the advice given by you , i am waiting for the new drugs of hep c to come into market. Meanwhile I have my chest infected with lot of cold . I was taking vicks from past 2 days . Today i consulted my family docter whol advised me to take ampliccin 300 mg for three days one morning and one evening to clear the chest infection. As you are aware of my liver conditions , do you advise taking such medicines. Will it aggrevate the liver problem ?
 
 
Answered by Dr. Vaibhav Banait 15 hours later
Hi XXXXXXX

Ampicillin use is not a problem in this circumstance. You can take them as suggested by your doctor.

As far as newer drugs are concerned, you should take opinion of your doctor before any decision. The drugs appear to be costly at present and I am not aware regarding exact cost and timeframe when these will be available in India. You may try and write the company to check about it.

Thanks again for writing back to me. Hope this answers your query.

Wish you good health.

Regards
Vaibhav
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 1 hour later
Are these new drugs available in India now, and what is the name of the company
 
 
Answered by Dr. Vaibhav Banait 2 hours later
Hi again,

No, the newer drug is not yet available in India.

Here is a US site that gives information regarding this drug.
WWW.WWWW.WW
Hope this helps.

Regards

Vaibhav
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 12 days later
hello doc ,, i had jaudice again two days back after a gop of 40 days with total bilirubin 2.6 and sgpt 400 and sgot 350. I have done biopsy , reports are awaited by thrusday . Meanwhile i want to ask you ,, the treament of this which seems to be costly . What is the chances of inurance companies reimburisng such expenses especially in the back drop of the fact its treatement does not require hospitalization and its day care treatement
 
 
Answered by Dr. Vaibhav Banait 31 hours later
Hi again,

Most health insurance companies are beneficial when there is hospitalization. They are again subjected to various clauses which I am unaware off.

I am also not aware of any health insurance companies that cover day care / non hospitalisation / investigation only expenses.

I think you need to contact the related customer care to get these details. I can address only your medical queries.

Yet again, I thank you for writing back to me again.

Please accept my answer in case you do not have further queries.

Wish you good health.

Regards.
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 1 hour later
ok , thank you for your continued guidance ,,, i have also have one query on how inferion treatment with reverberin is administerd. Is is simple injection ,, do we have to get admitted in the hospital or we can take the same in the home every week.
My biopsy results came - It reads as follows " SECTION SHOWS HEPATOCYTES IN CORDS. THERE IS MILD PERIPORTAL INFLAMATION (1) THERE IS NO FIBROSIS AND BILE DUCT PROLIFERATION. THERE IS NO EVIDENCE OF INTERFACE HEPATITIS OR ROSETTE FORMAITON. FINAL DIAGNOSIS CHRONIC HEPATITIS HAI SCORE (1) .

Please advise ,,,, whether to start inferion treatement or to wait . Also would like to tell you my jaudice is nearing normal after taking medicaiton. Also i had five time liver enzmie elations during the feb 0000 since i was first diagnosised on jaudice.
 
 
Answered by Dr. Vaibhav Banait 5 days later
Hi,

Thanks for writing back.

Interferon is administered by injections given intramuscular and this therapy does not need hospitalisation but may need to monitor blood cell counts.

The interferon treatment in you is good to be started now as it can prevent the complication of chronic hepatitis.Since the jaundice is now getting down , I would not consider the interferon therapy not as an emergency step now but surely it is beneficial.

Hope I cleared your doubts.

Regards,
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 8 hours later
Ok, what is the implication of having hepotocytes in chords as given in the biopsy report, and also I wud like to know HA1 score relevance.
 
 
Answered by Dr. Vaibhav Banait 2 days later
Hi,

Thanks for writing back.

Hepatocytes are normally arranged in chords in the liver.

It is HAI score HISTOLOGY ACTIVITY INDEX (HAI - Knodell Score) it indicates the extent of damage occurred.In the scale including mild , mod and marked damage HAI score of 1 means mild damage is seen microscopically.

Please follow this below link for better understanding of HAI score
WWW.WWWW.WW
Wish you good health.
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 5 hours later
Thanks for your valuable reply. On aug 21, I had tested viral load for the first time it was 11,700 RNA copies. Yesterday I had tested the same , viral load this time was was more then 1 million rna copies. Is such massive variation nececcitate treatment on emergency basis. You had already told based on biopsy results that treatment cannot be considered as emergency in this case.
 
 
Answered by Dr. Vaibhav Banait 9 hours later
Hi and thanks again,

There is day to day variation in viral load. That is very well known.

The variations can not be considered indication of emergency treatment.

Wish you good health.

Regards XXXXXXX
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 2 hours later
ok . I have also have query regarding biopsy. I understand that Biopsy is still the golden standard for measuring the liver conditions. But is there possibility of an smapling error in the Biospys ? Like for example the tissue removal process may be from that part which is good and there may be some part in the liver which is damaged and hence wrong conclusion can be formed on the basis of Biopsy report. if this is the case then how liver conditions can be assessed.
 
 
Answered by Dr. Vaibhav Banait 43 hours later
Hi,
Thanks for reverting.

As you said, certain amount of (small) sampling errors are expected especially with focal processes like tumor, but can also be there with diffuse disease like hepatitis C. This can be reduced by obtaining 1.5 -2 cm biopsy tissue or examining at least 5 portal structures. This may not happen in all the cases due to practical difficulties.

So the results of all the investigations are to be analysed together in addition to clinical inputs.

Regards
Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 23 minutes later
I have been asked to take Ursol 300 for one month, Can I prolong treatment with this medicines....
 
 
Answered by Dr. Vaibhav Banait 23 hours later
Hi again and Thanks for the reply.

Ursocol for practical purposes is placebo. No benefit to my knowledge is documented using this molecule.

Discuss about it with your treating physician.

Regards
Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 5 hours later
kindly advise the dosage of medicine peg interferon , as i have to speak to chemist considering my weight 76 kg . the chemist is asking for dosage of injection per week. I think the cost depends upon the dosage >
 
 
Answered by Dr. Vaibhav Banait 44 hours later
Hi,

I would not encourage you to take it directly from the chemist.

Today’s research indicates that a move toward individualizing the dosing of these prescription agents is warranted and it can happen only after physical consultation.

An expert Gastroenterologist shall consider Pegasys and Ribavarin in proper doses. He will be monitoring you regularly. A chemist will definitely not know about these higher agents. I do not want to misdirect you and it is against the rules laid to prescribe dose. If you approach the right expert he will know about these drugs.

This platform should not be misused for treatment purposes. Please excuse me.

Vaibhav Banait.
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 5 days later
thank you , i understand your contraints. , i wud like to kinow whether such treatement are available in Government hospital like medical college nagpur at governement subsidised rates.
 
 
Answered by Dr. Vaibhav Banait 1 hour later
Hello,

No. I do not think so. The consultation charges and inhospital charges may reduce, but drugs will have to be purchased.

Dr. Vaibhav
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 2 hours later
ok one more thing which i had to forget to ask you ,, whenever there are elevation in sgpt and sgot levels ,, i have some itching in the body mostly in the night. Is itching linked to liver inflation or hep c ? One more thing i want to ask you is whenver the elevations are there ,, should i continue taking normal food .
 
 
Answered by Dr. Vaibhav Banait 26 hours later
Hello again.

Itching in liver disease occurs because of two reasons:
1. Cholastasis: Accumulation of and failure to excrete bile salts resulting in irritation of nerve ending.
2. Caused by hep C virus.

Hepatitis C rarely result in cholastasis. So it appears to be hepatitis C virus related only.

Please continue to take normal meals even during enzyme elevations.

Hope, this answers your query. Please accept my answer in case if you have no follow up queries.

Regards.
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 3 hours later
thanks for clearing the above doubt,,, in the preceeding queries you had asked to take veg food . Is non veg food like chiken and eggs , advissable when one suffers from hep c .
 
 
Answered by Dr. Vaibhav Banait 17 hours later
Thanks for reverting.

Non-vegetarian food need not be avoided unless you have advanced cirrhosis. Hence for you "normal balanced vegetarian / non-vegetarian" diet is suggested considering almost normal biopsy report.

Regards,
Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 31 days later
hello doc ,, my jaudice is still borderline with sgpt and sgot 55 and 60 respectivley and bilirubin at 1.5 total from last two months.. There is no major elevations . Treatment options i still kept pending for a while. Meanwhil i have a tooth ache ,, dentist told me to take following medicines
1) phexin 375 ( Antibiotic) 1+1 ( four days)
2) Calpol ( Pain killer ) whenever required

pl let me know , whether the same should be taken
 
 
Answered by Dr. Vaibhav Banait 18 hours later
Dear XXXXXXX

You can safely take prescribed dosage of medication without any problem.

The recommended maximum dose of calpol in a 24 hour period is 4g or 8 tablets.

Hope that suffices.

Wish you rapid recovery.

Regards
Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 25 minutes later
ok thanks ,,,also would like to know ,,, that my alchohal intake prior to detectionof hep c was once in a week 90 Ml mixed with 200 ml of water . However i have not taken alchohol since hep c was detected one year back . Is alochohal consumption in such controlled qty ok ,,or alchohal should be totally not taken needless to mention that i use to take alchhoal with vegetegables boiled and chiken . I understand your silence. Meanwhile i have feeling of indigestion with temperature of 100 . I took crocine , now its normal. I have also lost taste and there is no feeling of taking food . The urination colour is however normal . The stool is sticky . Are these again smptions jaudice again or basically these are smptons of indigestion
 
 
Answered by Dr. Vaibhav Banait 6 days later
Hi XXXXXXX

I am sorry for not replying to your previous question in time.

Significant alcohol intake is associated with increased progression of liver fibrosis. This may not apply for occasional drink, but I would suggest abstinence.

The present symptoms may not be related to your liver disease. these are likely to be due to intestinal infection, which may resolve spontaneously in couple of days. If persists, please consult your doctor.

I hope I answered your question satisfactorily.

Regards,
Vaibhav Banait
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 8 hours later
ok thanks, this coming week i am trying to get my tooth extracted. This is is wisdom tooth which has partially grown and may require minior surgical procedures necessatating heavy use of antiobiotics and pain killers. Assuming there is minior elevations in liver enmzines , do u suggest such procedures.
 
 
Answered by Dr. Vaibhav Banait 2 days later
When there is no option, one has to take a risk. Anyway, your liver is not much affected. So, liver related risk is minor. Let your anesthetists and dentist know about your history. They should be able to get the things done safely.

Wish you rapid recovery.
XXXXXXX
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 17 days later
Hello doc ,, After 2 and half month of being normal , there are eleavations in liver reading with SGOT 75 , and SGPT 197 ,, The Bilirubin levels are also elevated to the extent of 1.95 . I am taking Normal diet , though sometimes even if i have nausia feeling. Do you advise any medication under the present circumstances or normalacy would return without medication .. Last time my treating gastrotologist advise me to take URSOL 300 ( Urcodeoxycholic Acid) twice after food. Will that benifit me .
 
 
Answered by Dr. Vaibhav Banait 25 hours later
Hi,

Thanks for writing back.

You may try ursodeoxycholic acid. I am not sure of the benefit. The fluctuations are expected. Do not worry.

Hope I have answered your query.

Regards.
Vaibhav
Above answer was peer-reviewed by
 
Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 8 hours later
ok , so without medication also the elavations can come down. Also would like to know the medicines which can be taken whenever there is feeling of nausia .
 
 
Answered by Dr. Vaibhav Banait 1 hour later

Hi,

Any anti emetic like domperidone should help you. I would not be able to prescribe the dosage.

It would be unethical and inappropriate to prescribe you scheduled drugs without doing a proper examination.

Please get it prescribed from your treating doctor.

Vaibhav
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Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 5 hours later
ok , i understand your constraints. Under elevations Can i take non veg food like chiken and fish or should stick to normal veg food.
 
 
Answered by Dr. Vaibhav Banait 18 hours later
Hi,

I do not think any dietary restriction is needed at present.

Enjoy a balanced healthy veg and non veg diet.

Regards

Vaibhav
Above answer was peer-reviewed by
 
Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 57 minutes later
thanks for your quick reply ,, I normally do XXXXXXX breathing excercises (yoga) , but during elevations , since there is slight pain in the abdoman , I stop these temporarity . In your earlier replies you told me tgat the XXXXXXX breakthing exercises are good for liver . Do you adivse doing such exercises during elevations when there is slight pain in the abnormal regions probabably emitting from inflated liver.
 
 
Answered by Dr. Vaibhav Banait 13 hours later
Hi,
Thanks for the query.
As mentioned earlier, XXXXXXX breathing exercises are good for you. You should continue to do these during period of enzymes elevations. At the same time, it is also important that you should not be subjected to undue pain. Therefore, I would suggest you to continue with these exercises if pain is mild and tolerable. Else you may take a short break and then restart whenever feasible.
Hope I answered your query in complete.
Regards
Vaibhav
Above answer was peer-reviewed by
 
Follow-up: Repeated Jaundice, bilirubin, SGOT, SGPT tests done, hep c with viral load, had piles and pistula operation. Liver biopsy? 7 hours later
ok thats good advice
 
 
Answered by Dr. Vaibhav Banait 3 hours later
Thanks.

Let me know if you have any further question.

Wish you speedy recovery.

Regards
Vaibhav
Above answer was peer-reviewed by
 
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