This document discusses the diagnostic approach for overlap syndrome of the liver, which presents with both hepatitis and cholestatic symptoms and progresses to cirrhosis and liver failure. It defines overlap syndrome and describes the main immune disorders of the liver - autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis. Diagnostic criteria for each disorder are provided. Ayurvedic views of the condition, differential diagnosis of various types of jaundice conditions, and treatment approaches for halimak are also summarized.

1. PRESENTED BY
Dr. POOJA
MD Scholar
DEPARTMENT OF KAYACHIKITSA
AIIA, New Delhi
GUIDED BY
DR. DIVYA KAJARIA
ASSISTANT PROFESSOR
ENUMERATING DIAGNOSTIC APPROACH FOR OVERLAP
SYNDROME OF LIVER W.S.R TO HALIMAK

2. OVERLAP
SYNDROME OF
LIVER
(HALIMAK)

3. DEFINATION
The three major main
immune disorders of
liver are
Autoimmune hepatitis(AIH),
Primary biliary cirrhosis(PBC) and
primary sclerosing cholangitis (PSC)
OVERLAP SYNDROME OF
LIVER

4. PARTS OF LIVER

6. INTRODUCTION
overlap syndrome present
with both hepatitis and
cholestatic symptoms
Syndromes shows a
progressive course
towards liver cirrhosis
and liver failure

7. AIH
PSC
PBC

8. CAUSES

9. PATHOPHYSILOGY

10. FEATURES OF AIH, PBS & PSC
VARIABLE AIH PBC PSC
AGE ALL AGES 30-65 30-50
SEX Predominately
females
Predominately
females
Predominately
males
AST & ALT Marked elevation Normal or
marked elevation
Normal or mild
elevation
BILIRUBIN Normal or
elevated
Normal or
elevated
Normal or
elevated
ALP Normal or mild
elevated
Moderated to
marked elevation
Moderated to
marked elevation

11. DIAGNOSTIC CRITERIA
AIH
(Autoimmune
hepatitis)
1. Alanine aminotransferase (ALT)
Levels>5× ULN
2. Serum immunoglobulin G (IgG)
Levels >2 × ULN or Positive test
for smooth muscle antibodies
(ASMA)
3. Liver biopsy showing moderate
or several necrosis
(2 out of 3 criteria)

12. PBS
(Primary
biliary
cirrhosis)
1. Alkaline phosphate (AP)
Levels>2× ULN
2. Positive test for anti
mitochondrial antibodies (AMA)
3. Liver biopsy showing florid bile
duct lesion
(2 out of 3 criteria)

13. AYURVEDIC VIEW

14. Nidana of KAMLA
• Ksharamal lavan ati ushd ahara
• Ati Madhya pana
• Divasvapna,Vyayama,methuna
vegvidharad
• Kam, chinta, bhya, kortha
(ch.chi.15/7)

15. पाण्डुरोगी तु योऽत्यर्थं पपत्तलानि निषेवते|
तस्य पपत्तमसृगमाांसां दग्वा रोगाय कल्पते||३४||
Samprapati of Kamla

16. PANDU
ROGI
PITTA
VARDHAK
PATHARTH
CONT….

17. PITTA
VRIDDHI
RAKTA OR
MANSA
DUSTI
CONT….

18. CONT….
KAMLA

19. DIFFERENTIAL DIAGNOSIS
KAMLA
KUMBHKAMLA
HALIMAK

20. KOSTH SHAKHA AAKSHIT
(HAEMOLYTIC)
SHAKHA AAKSHIT
(HAEPATIC)
KOSTH AAKSHIT
(OBSTRUCTIVE)
KAMLA

21. KAMLA
(JAUNDICE)

22. SHAKHA AAKSHIT KAMLA
हारिद्रनेत्रमूत्रत्वक् श्वेतवर्ाास्तदा निः||१
२६||
भवेत् साटोपववष्टम्भो गुरुणा हृदयेन र्|
दौर्ाल्याल्पाग्ननपाश्वाार्ताहिकहकाकाश्वासारुचर्
ज्विः||१२७||
Clay colour
stool

23. KOSTHA AAKSHIT KAMLA
हारिद्रनेत्रः स भृशं हारिद्रत्वङ्ननााननः|
िकातपीतशकृ न्मूत्रो भेकवणो हतेग्न्द्रयः||३५|
|
दाहाववपाकदौर्ाल्यसदनारुचर्कवषातः|
skin colour
like frog

24. KOSTHA SHAKHA AAKSHIT
KAMLA

25. KUMBH KAMLA
कालान्तिात् ािीभूता कृ च्छ्रा
स्यात् क
ु म्भकामला|
कृ ष्णपीतशकृ न्मूत्रो

26. HALIMAK
यदा तु पाण्डोवाणाः स्याद्धरितश्यावपीतकः||१
३२||
र्लोत्साहक्षयस्तन्द्रा मन्द्राग्ननत्वं मृदुज्विः|
स्त्रीष्वहषोऽङ्नगमदाश्र् श्वासस्तृष्णाऽरुचर्र्भ्ामः||
१३३||
हलीमक
ं तदा तस्य ववद्यादर्नलवपत्ततः|१३४|

27. CHIKITSA SITHANTH
तत्र पाण््वामयी ग्स्ननधस्तीक्ष्णरूर्ध्ववाानुलोकमकः|
संशोध्वयो मृदुकभग्स्तकातः कामली तु वविेर्नः||४०
||

28. CHIKITSA OF
HALIMAK
गुडूर्ीस्विसक्षीिसाचधतं माहिकहषं घृतम ्||१३४||
स वपर्ेग्त्त्रवृतां ग्स्ननधो िसेनामलकस्य तु|
ववरिकातो मधुिप्रायं भजेत् वपत्तार्नलापहम ्||१३५||
द्राक्षालेहं र् पूवोकातं सपींवष मधुिाणण र्|
यापनान् क्षीिर्स्तींश्र् शीलयेत्सानुवासनान्||१३६||