What do these lab reports indicate?

Posted on Fri, 11 May 2018 in Digestion and Bowels
Question: This is a second opinion I am seeking. Attached four reports. Medical Summary (test results) of two dates 9/11/2017 and 4/12/2017. Also doctor notings of the above dates. Doctor has said after the second test that the patient's condition is improving and no hasty decision be taken for liver transplant. Please study carefully both Medical Summaries and both doctor observations and give your opinion whether the patient can manage without transplant and if yes, how long. I am not the patient. The patient is my neighbour and he wants reassurance. He has already visited Global Hospital, XXXXXXX and is prepared for transplant if absolutely essential. My request is - kindly study carefully both reports done with one month interval and let us know whether liver can regenerate itself without transplant. I have retired from XXXXXXX as XXXXXXX General Manager and I am doing this only to help my neighbor. Kindly help.
Uploaded report XXXX6 as the same report dated 02/12/2017 (XXXX3) uploaded earlier was not clear. The purpose of m query is to decide on liver transplant - whether it can be avoided or postponed, consequences of not doing liver transplant and possible outlook for the future if liver transplant is done.

Answered by Dr. Ramesh Kumar 45 minutes later
Brief Answer:
Sir don't be in haste

Detailed Answer:
Thanks a lot for query,
I am a Gastroenterologist and would take your call,
I have gone through all 5 attachements in detail.
Before answering i have some questions sir-
1)I can't see reports of MRI abdomen or at least a CT scan.
2)Secondly fibroscan reports are not there.
All i can see are some routine blood tests like PTINR etc.I mean when we are deciding whether to go for a surgery like Liver transplant(50 lakh bucks) i should have these reports i hand with me.PEROID!
See sir as a matter of fact what i can see is that there are just 4-5 normal blood tests that are definitely AND would be deranged as patient has liver issues but that does not mean he needs transplant.
Its not that easy .for years you have to follow hundreds of restriction pain etc.
Was a serology done?
Hepatitis A,C,B,D,E? i cant see reports?

Suggestion (sir most of my patients are always happy with my answers) so my protocol would be

Whether he is a candidate or not.
For that i need few reports
1)Fibro optic scan of liver.
2)MRI with contrast of Liver
3)If money is not a issue i need a PET scan reports.
Dear sir how can we touch liver without even knowing the amount of losses,

And please don't worry a person could survive for years with even 20% liver,
So don't be in any haste.Once you are on table nothing could be revert.
See these are all corportate worlds hospitals (target based working) no one would reject a 450lakh operation.
Your patient your duty.Do maximum research.
As a last advice i would want you to to take a consulatton from one of the top and best renound liver surgeon in XXXXXXX DR A.S SON at Medanta(My mentor my guru).
If he says yes go for it otherwise i think he should pick up on medical therapy.
Take a ticket from XXXXXXX to XXXXXXX -2 hours with hepatologist and you are back.
In case if you allow me some time i can take opinions from my fellow gastroenterologists also.

If possible ask your treating doctor why transplant is required just ask him you brother is a doctor and wants some explaination.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Ramesh Kumar 35 minutes later
Sir, Thank you so much for a very detailed reply which displays the concern you have for your patients. This patient is my neighbour and I will get the reports specified by you (1)Fibro optic scan of liver, 2)MRI with contrast of Liver) if available. He has been seen by a gastroenterologist at XXXXXXX Hospital, a well-known corporate hospital in XXXXXXX He was hospitalised for more than week and a number of tests were done. The gastroenterologist, after seeing reports dated 04/12/2017, has also advised the patient not to hurry stating that he is able to see some improvement in some keyy tests.

I will get back to you with more reports and please help to reassure my neighbour who is going through a stressful period. Thanks again for a concerned friendly advice

I have added one more report- XXXX. I will check if other scan reports are available and get back to you.
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
follow up.

Detailed Answer:
Take your time sir and enclose as many reports as possible.
No hurry at all.Talk to your neighbours.
I am alwas there to help you.Dont worry two three days are not going to make any change.
Take you time sir gather all possibile reports and message me after that so that i can give you a perfect professional advice.
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Ramesh Kumar 6 hours later
Kindly see the Ultrasound Abdomen Bedside sent by me after receiving your reply. This is report titled XXXX.

If this report throws any light on the query raised by me about the need or otherwise of a liver transplant and the status of the liver as on the date of the report (30/10/2017), please let me know.
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
follow up.

Detailed Answer:
My respected patient,
I have already seen the ultra sound.
The only poinu useful
is that it appears shrunken.
Sir bh what degree? S ot mild moderate severe.
Which lobes of liver are effevted?
What are the chances of recovery?
Sir ultrasound is just a primary test for abdomen.
Just like if one is learning english A,B,C,D is must.
Hope now you can understand why other tests are required.
As of now by going through usg and blod reports i dont feel liver need to be replaced.
But i need at least a MRI or Fibroscan report for what you would say a professional advice.

Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Ramesh Kumar 1 hour later
Sir, thank you for your patience. I have uploaded two more reports:

XXXX - Doppler Study of Portal Venous System

XXXX: Multislice CT -Abdomen (P & C)

Both done at Government XXXXXXX Hospital, XXXXXXX on 15/11/2017.

Hope this throws some more light on my specific query - Is some liver function still intact ? How long can he manage with the liver function still left? Can liver transplant be avoided totally ? What else the patient needs to do in the next three months period?

Waiting for your reply.

Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
follow up

Detailed Answer:
Hi dear ,
The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis is scarring which accompanies the healing of liver injury caused by hepatitis, alcohol, or other less common causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver..The increase in spleen size is followed by an increase in splenic blood flow, which participates in portal hypertension actively congesting the portal system .In easy language when blood cant reach liver as liver is shrinked it refluxes back to speen hence causing congestion and increase in size of spleen.
I would like to quote that-
Researchers followed 100 patients with alcoholic liver cirrhosis who continue to drank at least 3 1/2 ounces of alcohol per day for about 16 years. None of the patients received a liver transplant and the results show 90 percent of them died by the end of the 15-year studySo even when they dint stopped they survived 15 years

However the disease cannot be reversed or cured except, in some cases, through a liver transplant. but good news is that it could be fully controlled.

Cardinal Sign that patient needs liver transplant are-
Gastrointestinal bleeding marked by black, tarry stools or blood in the stools, or vomiting of blood due to the spontaneous rupture and hemorrhage from varices
Ascites (an accumulation of fluid in the abdomen)
Encephalopathy or confusion and forgetfulness caused by poor liver function
Reduced levels of platelets, blood cells that help form blood clots, or white blood cells.
Sir do your patienh have any of them?

Please attach a photo of patient.
BMI appetite
overall health
Able to do normal work
alcoholic or smoker.
History of ascitis.
Neurological problem.
I am sorry but i need all details.
I just can’t allow my patient to go for a life threatening operation.
He has developed collaterals his body is responding well.
I need his diet plan also.
Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Ramesh Kumar 2 hours later
Age -56
weight - 66 K (was 80 Kg before falling sick 8 months back)
height - 168 cms
BMI appetite -
overall health - now convalescing and in good health
Able to do normal work - not resumed yet,
alcoholic or smoker. - was alcoholic for over 20 years not given up - never smoked
History of ascites. - Had abdominal bloating before hospitalisation now nothing
Neurological problem. - nothing now
Diet - Now strict vegetarian. Non-vegetarian in the past

Photo uploaded XXXX

I will not be able to get more reports or details. Based on the data available, please give your advice on the following:

What diet he should take (protein supplement allowed or not)
Is non vegetarian permitted
Can he go for morning walk
Anything that you want to tell him
And finally what decision should he take on liver transplant

alcoholic or smoker. - was alcoholic for over 20 years not given up - never smoked

Please read as 'now given up'

Answered by Dr. Ramesh Kumar 4 hours later
Brief Answer:
I would like to watch him for 6 months.

Detailed Answer:
If i would be his primary doctor right now going through his reports and general conditions i wont have recommended him for a liver transplant.
He is doing fine.He is physically active.His reports are not that bad and most importantly he is willing to improve things.He is a motivated patient.
Have gone through the medications he is on they are ok.
Only thing would like to add is sylimarin or milk of thistle.Its a potent liver rejenuvator(natural) and has shown good results in trails.

Diet suggestion-
Some food plans are-
-Whole grains are very beneficial to consume.These can be in the form of XXXXXXX whole wheat bread or cereal, brown rice, whole grain pasta,grains such as whole oats, wild rice, rye, oatmeal and corn are also beneficial and can be taken if suits your fooding pattern.
-Fruits and vegetables should be a significant part of any diet to help in recovering from a liver disease. They are full of essential nutrients and are easy to digest.When on recovery diet follow a high carbohydrate diet,Fat contents of diet should be very low.However Olive oil, canola oil and flaxseed oil are all healthy fats that are recommended as part of a diet for patients.
-Healthy proteins in the form of low-fat milk and dairy products along with lean meats, beans, eggs and soy products can also be a part of a healthy liver diet.
I would recommend himmto take Optimum Nutrition whey isolates two scoob a day.Its a good source of predigestied whey protein supplements.

- Consume high fiber foods as a part of high fiber diet. Grain products: (6-11 servings of grain product in your diet is required daily) whole grain breads, whole wheat, whole grain mixed grain, cracked wheat, buns, muffins. Brown ricewhole wheat pasta or brown rice pastacereals made from whole grain oatmeal ground flax, wheat germ or wheat XXXXXXX in baked goods vegetables: (3-5 servings daily) dark green leafy vegetables contain heigest amounts of fiber e. G. Spinach, broccoli, green peas, green beans, turnip greens. Fruits: (2-3 serving of fruits) apples. Oranges, pears, peaches. Berries (strawberries, raspberries, blueberries, and blackberries) dried fruits (dates, prunes apricots legumes, nuts and seeds).

Vitamin c: it maintains the healthy blood vessels and maintain tissue matrix. And increases the body immunity also. Rich source are blackberries, raspberries, broccoli, spinach, guavas, amla, lime melon, orange, papaya, pineapple, tomato.Vitamin e: it is a fat soluble vitamin which maintains healthy cell membrane as well as the prevention of inflammation.

Silibinin, also known as silybin, is the major active constituent of silymarin, a standardized extract of the milk thistle seeds, containing a mixture of flavonolignans consisting of silibinin, isosilibinin.It should be taken two times a day.Its a very potent liver rejenuvator and is very effective in maintaining liver healthy.

Ayurvedic tablet Liv 52 DS should be taken twice daily daily.

Oil should be restricted.Use PAM spray for cooking.Maximum 10 ml oil a day.

Repeat blood tests after 8 weeks and let me know the results.
Don’t worry he would pick up.
Hope i was helpful.
Keep enjoying your life dear.
Wish you a great day ahead
Please do rate the answer if you feel in was helpful.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Ramesh Kumar 36 hours later
Before closing, I have one or two questions. I have already recharged once with 599/-.

Exercise: Can he go for walk? How much and how often?
Diet: Can he take protein supplements like ? Is Threptin good?
Salt: He is advised just half teaspoonful a day. Is this very important?
Food: He is basically a non-vegetarian. Should he avoid non-vegetarian food totally?
Egg: Which part of egg is permitted.
Infections: How to prevent infections in view of his delicate health? He is already avoiding food outside. Some tips from your side will help.
Future Course: He will continue to consult Dr.Vadivel Kumara, Gastroenterologist at Kauvery Hospitals, XXXXXXX as he knows the history of the patient and is easily accessible. May be after three or four months, I will send a fresh query if necessary. If you feel it necessary, suggest some gastroenterologist based at XXXXXXX
I may send one more query before my quota end. I have briefed the patient on your advice that liver transplant is not a solution and should be done only when all other measures fail. I truly appreciate the interest you have evinced. It has been very reassuring for the patient.

Answered by Dr. Ramesh Kumar 30 minutes later
Brief Answer:
follow up.

Detailed Answer:
Hello again my dear patient
Its not for money its for self satisfaction.

1)Yes he should ambulaye daily.He should avoid going beyond his limits bit he can walk if he is confortable with.Ambulation is very important.If heis fine with 200 metres a day he should.If he can walk even more(without any problem) then he can walk more also.

2)Lean protein supplements would be good for him.Those buiscults are good but if you take my opinion i would suggest him to take one scoob of Hydrolysed whey protein(Syntha 6) once in morning and once in evening.Easily available online.

3)Most doctors dont even understand the concept behind salt.Patient has sodium restriction not salt restriction.If we talk about chemistry salt compromises of 33% sodium and rest chloride.So as per my knowledge and studies its about 2-3 gram sodium which means about 5 gram common salt.If you use low salt substitute he can take upto 6-8 gram low salt substitute(more then enough for 3 meals).

4)No chicken breast is good for hin source of lean protein.
Avoid red meat like mutton.
5)2 egg whites a day will be good for him.No yellow yolk please.
6)Chennai sorry have no idea.In XXXXXXX Medanta hospital you could consult dr Randheer Sood.

Taking high protein diet would help to imprve his immunity and would prevent infections.
Take a multivitamin and anti oxidant regularly.

Tell him that his doctor is also a stroke patient.
Its quality not quantity of life which matters.
Ask him to remain happy and try his best to help himself and others.
Ups and downs are part of life.
Keep me informed about his progress.

Hope i was helpful.
Warm regards to you and my patient!
Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Ramesh Kumar 24 hours later
Thanks a lot for the counselling and reassuring advice. I was just a go-between and your patient wants me to convey to you his sincere heartfelt thanks. I am closing this discussion with my best wishes for a great 2018 for all of us.
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:

Detailed Answer:
I wish my patient and you a very happpy new year.
Thanks for appreciation.
Please do rate answer and any suggestion to improve answers quality(if you felt so) is welcome.
For any query in future you can follow the below mentioned link.
Warm regards and get well soon(for my patient) and you remain healthy!
Above answer was peer-reviewed by : Dr. Kampana
Answered by
Dr. Ramesh Kumar


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