Brief Answer:
exclude other auto immune diseases

Detailed Answer:
Dear

Thanks for contacting Ayurveda with your health concern.

1. since ANA is positive which is an autoimmune disease thus can cause symptoms of liver disease and also associated with development of AIH [auto immune hepatitis]
PS. make sure to exclude other auto immune disease like Inflammatory bowel disease, type 1 diabetes, thyroiditis.

2. since both conjugated and unconjugated bilirubin are increased which means there is involvement of liver with impaired conjugation and impaired excretion [due to chronic AIH resulting in inflammation of liver cells and causing obstruction]
PS.
i. ALP is on higher side which means cholestasis is there thereby producing symptoms of intense itching.

3. since liver parameters are very high [in history] make sure that complications due to liver damage doesn't sets in.
PS. do let me know about the values of globin/albumin ration and since biopsy is normal thus late complications of AIH are not there which is a good sign.

4. protein deficiency signifies that protein in liver [albumin] is not synthesized properly as such there is swelling

PS. make sure to prefer plant protein over animal protein.

5. please revert back with value and any other autoimmune disease seen/present in patient for Ayurveda Dietary Regime and Management

Dr. Munish Sood
Consultant & Physician
Naimittika Clinic

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Brief Answer:
Consideration and Management

Detailed Answer:
Dear

Thanks for reverting back.

1. Since biopsy report for liver is normal [to exclude liver cirrhosis], also ultrasonography reveals mild hepatomegaly, and is negative for Hepatitis [make sure ultrasonography has also excluded portal hypertension], thus one has to look for liver as the source of swelling.

2. Since bilirubin is raised both direct and indirect [but as rule, excretion is the rate limiting step] thus one can assume direct bilirubin or conjugated bilirubin to be dominant in such patients.

PS. Since problem is with liver, thus following points are worth mentioning:
i. could be blockage of bile duct. [ultrasound is advisable, although report is there was it excluded?]
ii. could be complication of AIH [persistent jaundice resulting in persistent itching] as mentioned in reports
iii. where liver is unable to synthesize albumin [which is a protein], resulting in reverse of albumin:globulin A:G ratio [which can result in swelling, thus check with the values]
iv. As SGPT is raised [which is normally present in liver] but still is not increased [75IU/L] in relation to jaundice or liver damage, in comparison to SGOT [175IU/L] which is found in liver,heart,kidney,brain,muscle, thus one has to exclude any pathology related with these systems also.
PS. Keep in mind, that SGOT/SGPT detect type of liver injury or damage done to the liver due to any type of infection and inflammatory changes. The liver may keep functioning normally even in cases when both of these enzymes are highly raised.

3. Since ANA is positive, which means one auto immune disease has caused another autoimmune disorder [which is an important risk factor].

4. Take: old brown rice, arhar/moong dal,raw papaya,bitter gourd,potato,amla, pomegranate,black grapes,apple XXXXXXX ghee from cow's milk,butter milk, guduchi,rest,unction,orange juice,mild purgation,spinach,bottle gourd,radish, raw banana.

Avoid: oily/spicyfried/fat/heavy/slimy food,peas,black gram,mustard oil,garam masala, hing,blood letting,therapeutic emesis,suppression of natural urges,day time sleeping,sun bath,physical exertion,anger,excess walking and drinking water, fish, citrus food/fruit, besan and maida.

5. mix 4 spoons of honey in smashed ripe banana and eat for 2 weeks.
. take 40 ml raw radish juice and mix with 10gm jaggery and drink, thrice daily
. since it is an autoimmune disease, thus Rasayan [Immunomodulation] Chikitsa is also necessary:
. XXXXXXX Mandur 2 tablet with Punnarnava asav: 20 ml with equal amount of water,[twice daily] after meals

Dr. Munish Sood
Consultant & Physician

Naimittika Clinic

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Brief Answer:
Prognosis & Management of Swelling

Detailed Answer:
Dear

Thanks for reverting back with your concerns.
1. since it is not a direct interaction, thus the reply given is to have an insight in your disease, which you can discuss with your attending physician who can also explore other possibilities and investigations.
2. regarding time frame one has to check regularly with
. liver function tests which are indicator of progressive liver injury [since AIH is a chronic long lasting disease]
PS. since the test report shows normal liver architecture [no cirrhosis] which means normal flow of blood to liver is still present but problem will occur once fibrosis [scarring] starts and since liver has tremendous power of regeneration it is only TIME that will let physician/patient know. [it might take 5-10 years for cirrhosis/fibrosis to occur]
. starting of bleeding, altered sensorium, deep jaundice,disorientation, hand tremors, personality behavior will suggest liver failure [when the liver stops working] so remain under constant supervision which might require liver transplant

3. For swelling:
. As described earlier, if it is due to low albumin then either
Diet: protein [milk, cheese, meat, fish, poultry, eggs, tofu, peanut butter, and legumes], sodium restricted diet,
Drug: Albumin Infusion, and/or use of diuretic.

Dr. Munish
Naimittika

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