Dr Nikhil Nadkarni MD ,DM (PGI ,Chandigarh) Advanced fellowship Gastroenterology (Mayo Clinic ,USA) Associate Director Department of Gastroenterology & Hepatology Max Super specialty Hospital Mohali,Punjab

1. Live-r in Lockdown !!!
Dr Nikhil
MD ,DM (PGI ,Chandigarh)
Advanced fellowship Gastroenterology (Mayo Clinic ,USA)
Associate Director
Department of Gastroenterology & Hepatology
Max Superspecialty Hospital
Mohali,Punjab

2. Case 1
• 40 year old male
• Corporate employee
• Alcohol 30 ml daily x 10y

3. Alcohol : 30 ml per day

4. • Mild pain abdomen
• S. bilirubin 1
• OT/PT 150/100
• SALP normal
• USG fatty liver

5. Non Alcoholic liver disease
Alcoholic liver disease

6. Non Alcoholic liver disease
• Significant alcohol consumption
• 60-80 g of alcohol per day
• Obesity

7. Next step
• Viral markers
• TSH, sugar profile
• Lipid (F)
• Ceruloplamin
• Autoimmune work up
• TTGA

8. Anything more ?
• Fibroscan !!!
• XL probe a must for obese patients
• At higher OT/PT values can give falsely high
LSM value

9. Treatment
• Exercise
• Vit E
• UDCA
• Metformin
• Pioglitazone
• SAMe

11. Adviced
• No alcohol
• Fatty food restirction
• Exercise and weight reduction
• Vit E

12. Case 2
• 50 year old male
• Quarter daily

13. Why Alcohol ?

14. Videsi v/s Desi ?

15. • Alcohol + Chicken = Healthy Liver

17. Opening ceremony !!

18. • S. BIlirubin 2; OT/PT 300/200; SALP elevated
• USG bright liver with normal PV
• No biliary pathology

19. Non Alcoholic liver disease
Alcoholic liver disease

20. Alcoholic liver disease
• Significant alcohol consumption
• 60-80 g of alcohol per day
• Obesity

21. What next ?
• Viral markers
• INR
• RFT

22. Severity Scores
• MELD ?
• DF score ?

23. Treatment
• Nutrition
• Vit E
• UDCA
• Silymarin
• Metadoxine
• Pentoxyphylline
• Steroids
G-CSF

24. Anything else ?
• Fibroscan !!
• If Platelet > 150 K + LSM < 20 can rule out
significant varices
• In presence of jaundice and high OT/PT good
negative predictive value to rule out cirrhosis

25. Case 3
• 35 year female presenting with nausea and
vomitting
• 2 year back :Routine testing OT/PT 150/50
• USG Fatty liver

26. • Alcohol 30-60regular basis x 7 years

28. • Recent pregnancy..delivery 1 month ago
• Resumed alcohol intake
• Nausea and vomitting

29. Case
• Bil 2
• OT/PT 300/200
• SALP 3fold elevated
• USG showing edematous GB walls

30. Non Alcoholic liver disease
Alcoholic liver disease

31. • Bil 7
• OT/PT beyond detectable range/10k
• SALP 400
• INR 2

32. • Viral studies negative
• Autoimmune studies negative

33. • ECHO EF of 25 %
• Peripartum cardiomyopathy
• Ischemic hepatitis

34. • Managed on lines of heart failure + IV NAC
• Significant improvement in 48 hours
• Discharged with advice to avoid subsequent
pregnancy
• No alcohol
• Follow up echo after one year improvement in
EF

35. Case 4
• 60 year male
• Diabetic for 10 years with poor control on
OHA
• Alcohol consumer : quarter a day for > 10
years

36. • Abdominal pain
• Jaundice
• Bil 3 ; OT/PT 200/50; GGTP elevated
• USG : Hepatomegaly with no f/s/o PHTN

37. Non Alcoholic liver disease
Alcoholic liver disease

38. Alcoholic liver disease
Non Alcoholic liver disease
CO-EXIST

39. • Abstain alcohol
• Insulin for diabetic control

40. • Pain abdomen persisted
• Sitophobia
• LFT showed persistent OT/PT elevation
• CBC showing persistently falling Hb
• Weight loss of 20 kg over 3 months

41. • CECT chest + Abdomen : NAD
• PET CT : NAD

42. 1 month 3 month
Bilirubin 3 (D = 0.5 ; ID 2.5) 5 (D = 1.5 ; ID 3.5)
SGOT/SGPT 200/50 350/250
SALP/GGTP 200/100 200/100

43. • Hb 11 🡪 6
• PBF : Basophilic stipplings

44. CAM use ??

46. Highlights
• Always see Total Bilirubin /D/ID fraction
• Always see OT/PT ratio

47. Think out of the Box !!!

50. Post- webinar !!
Hope That’s not U