Tilva Neurology Clinic

Ahmedabad, Gujarat
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Tilva Neurology Clinic - Nursing Homes / Clinics / Hospitals of liver function test service, hepatitis treatment & hepatitis b in pregnancy treatment in Ahmedabad, Gujarat.

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Nursing Homes / Clinics / Hospitals

Liver Function Test Service
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Liver is an organ of your body that carries out nearly 500 functions. It is impossible for us to test for each of these functions. The freely available tests at all laboratories are usually called liver tests or liver function tests which are ideally a screening test and helps the doctor decide a direction for the direction of next investigation. Liver disease per se develops symptoms very late. When they develop symptoms, the liver damage is often quite severe. The only ways to detect abnormalities of liver before the development of symptoms are the above battery of tests.  They not only tell us the reason for liver abnormalities, they also help to decide the severity. The tests include bilirubin, ALT, AST, ALP, GGT, Proteins, Albumin and Prothrombin Time. These tests are bundled together in different combinations are known as liver function tests. It is based on these tests doctors can gauze what is wrong with your liver.

The term jaundice is derived from French “jaun” (yellow). Bilirubin is a substance responsible for jaundice. Bilirubin is measured as total, direct and indirect. They differentiate between patients with predominant type of jaundice. Indirect bilirubin or unconjugated hyperbilirubinemia could be due to Gilbert’s syndrome, hemolysis, ineffective erythropoiesis or due to resorption of large hematoma in post-operative period. A series of investigations can then help differentiate thes conditions. Direct hyperbilirubinemia is suggestive of liver disease (viral, alcohol related, drug induced, autoimmune or metabolic etiology) or obstructive jaundice (stone, tumour or stricture) or uncommonly intrahepatic cholestatic disease (primary biliary cirrhosis or primary sclerosing cholangitis).  Hereditary direct hyperbilirubinemia due to Rotor syndrome or Dubin-Johnson syndrome is rarely encountered.

The transaminase (AST, ALT) and serum ALP elevations in patients with jaundice also give clue to possible etiology. They are markers of ongoing liver cell damage. Most commonly cause of these elevations currently in city of Ahmedabad is fatty liver. However other diseases also need to be ruled out when an individual has elevated levels of these enzymes. According to current data, the normal upper limit of ALT in males is 30 while those in females is 19 IU/L. Patients who have predominant increase in AST and ALT without significant elevation of alkaline phosphatase require further investigations for hepatocellular jaundice. These include tests for viral markers, autoimmune markers and tests for metabolic disorders.The range of elevation of AST and ALT may also give clue to possible etiology. The transaminase levels of 1000 to 2000 typically occur in acute viral hepatitis. Levels of up to 2 to5 times the upper limit of normal may occur in chronic viral hepatitis, drug induced hepatitis, autoimmune hepatitis or alcoholic hepatitis. Ratio of SGOT to SGPT of more than 2:1 is typical of alcoholic hepatitis. Transaminases levels of over 3000 to 5000 are seen in toxic hepatitis and in patients with circulatory shock.

ALP is indicative of obstructive etiology and an ultrasound is the next step to exclude some pathology in the bile duct or gall bladder.

In patients with severe liver disease prothrombin time becomes abnormal and in patients with long standing liver disease albumin levels start to come down.

If you have a abnormal test on routine screening, do not ignore it and meet your liver specialist right away. As described, liver disease produces symptoms very late.

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Hepatitis Treatment
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Hepatitis Treatment

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What is hepatitis?

  • Inflammation of liver is usually referred as hepatitis.
  • Infection or non-infectious causes – Infectious is mainly by virus

What is viral hepatitis?

  • Hepatitis is caused by the hepatotrophic viruses A, B, C, D and E.
  • D is not a concern in India

How are these viruses different?

  • A and E are spread from unhygienic food practices
  • A is seen usually before 25 years of age and is most common cause of liver failure in children
  • E is mainly seen in adults. E in pregnancy is dangerous causing 20-25% mortality
  • A & E virus infections are self-limiting and immunity is life long
  • B & C are spread by unsafe practices and by contact with infected blood
  • Tattoo, razors, toothbrushes, dental extractions are also risk factors
  • They cause chronicity and can cause permanent liver damage

What are the symptoms?

  • A, E and rarely B present acutely with jaundice, fever, malaise, bodyache, anorexia, nausea
  • C and most of the time B is chronic (> 6 months) – No symptoms – diagnosed when investigated routinely

What Happens if left undiagnosed

  • Acute Liver Failue
  • Cirrhosis – Hemetemesis, Jaundice, Ascites, Oedema, Encephalopathy
  • Liver Cancer
  • Death


  • Simple blood tests can diagnose all of these infections
  • Sonography , Fibroscan and other higher blood tests are required for staging


  • Vaccination for A and B
  • Beyond 2002 it is a part of national immunization schedule


  • A and E – supportive
    B and C – Drugs are available with great efficacy to cure

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Hepatitis B In Pregnancy Treatment
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Hepatitis B is a global public health problem, with the highest number of hepatitis B virus (HBV) positive cases in China and India. Since the majority are asymptomatic, the disease burden is under appreciated. It is a unique challenge to manage HBV infection in pregnant women, as can have consequences to both mother and newborn. About 12 studies in the Indian subcontinent have looked specifically at the prevalence of hepatitis B surface antigen (HBsAg) positivity in the pregnant women. The prevalence rate of HBsAg positivity in pregnant women varies from 1-9% in different parts of the country. All pregnant women should be tested for hepatitis B surface antigen (HBsAg) early in pregnancy. Pregnancy does not have a major effect on the liver disease in mothers with chronic hepatitis B, except in the context of cirrhosis but cirrhosis is relatively uncommon in young childbearing women with HBV infection. All hepatitis B positive women should be monitored closely during pregnancy and in the postpartum period for exacerbation of disease. The risk of flares in serum aminotransferases is somewhat raised during pregnancy and postpartum but deaths, fortunately, are rare. The major concern of hepatitis B in pregnancy is when the mother is envelope antigen (HBeAg) positive which significantly increases the risk of foetal transmission (70-90%). The presence of both HBsAg and HBV-DNA in the child at birth are often transitory events and do not imply transmission of the infection.

The presence of antibodies against hepatitis B e antigen or antibodies against Hepatitis B core antigen at birth or up to 2 years of age is simply due to their crossing the placenta from the mother to the foetus, and therefore is unrelated to infection. Positivity at 12 months of life of the hepatitis B surface antigen (HBsAg) or of HBV-DNA in an infant born to an infected mother indicates a chronic infection. Infection of infants born to HBsAg-positive mothers, or of children early in life confers a high risk of chronic infection (90%), but an effective and safe vaccination prevents HBV childhood infection. The World Health Organisation recommends universal vaccination of all infants and as of 2012, 183 countries have instituted universal vaccination against hepatitis B. All infants born to HBsAg-positive mothers should receive hepatitis B vaccine and hepatitis B immunoglobulin as soon as possible after birth; preferably within 12 h. Completion of HBV vaccine is important for the newborn to gain maximal protection and consists of the birth dose followed by two subsequent doses. Mode of delivery is not associated with an increased risk of transmission. Women should have their HBV DNA level checked at the start of the third trimester as vaccine prophylaxis may fail in infants born to highly viraemic mothers (HBV DNA >107 IU/ml).

HBV transmission can be prevented in this group by concurrent nucleoside analogue therapy during the third trimester. Tenofovir and Telbivudine are both category B drugs while Lamivudine is a category C drug. In view of side effects of Tenofovir on bone mineral density of the new born few groups prefer Telbivudine therapy. Subsequent discontinuation of nucleoside analogue therapy at 1–3 months postpartum for those women who do not need continued therapy is recommended. This selective strategy requires measurement of HBsAg and HBV DNA during pregnancy. Deliverymode should be decided by obstetric indications and caesareansection is not recommended for the sole indication ofreductionof vertical HBV transmission. Breastfeeding should beencouraged provided immunoprophylaxis is given at birth.

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Liver Disease Treatment
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Liver Disease Treatment

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There is a myth that because alcohol is banned in Gujarat, there is no liver disease in Gujarat. Though, alcohol is one of the major reasons for liver failure, there are many other diseases which one needs to be aware of.

The most common cause of liver failure in India is Hepatitis B. The most common cause of liver cancer is Hepatitis B. Those who were born before 2002 need to check themselves for hepatitis B. vaccination is available and is now a part of national immunization schedule.

Hepatitis B has no symptoms and the only way to diagnose is a simple blood test. If you have received blood transfusion in past, you have the risk of being exposed to Hepatitis C.

The diet in Gujarat is full of sugars and oils. With adaption of western sedentary lifestyle, obesity and diabetes is on the rise. With that fatty liver is also on the rise. Fatty liver can cause liver damage similar to that caused by alcohol. Fatty liver is worldwide becoming the most common cause of liver transplant. A healthy diet and regular exercise can prevent it.

Alcoholic liver disease is as prevalent in Gujarat as other states. Though not freely available, people still have managed to get access to alcohol. Even those who drink also develop alcoholic liver disease.

Acceptance of a low fat diet, a regular exercise and vaccination for hepatitis A and B is advisable to protect your liver.
Stay aware, stay healthy!! Protect your LIVER

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Liver Transplant Treatment
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Liver is the largest internal organ of the body and is the largest gland of the body. It weighs 1000 to 1500 mg and is responsible for carrying out more than 500 functions. Unlike kidney, we do not have a any artificial machine to take care of all liver functions and so when an individual develops liver failure, they are left with liver transplant as their only option.

Myth 1 – Liver Transplant is only for elite class

Liver transplant is 100 times cheaper in India than any other developed country of the world. The overall cost varies from 12 -25 lakhs for the operation. But the most important fact that people do not know is that there are a lot of social organizations and NGOs that help people financially for liver transplant. What people fail to understand that you end up spending more than the cost of transplant after cirrhosis just for repeated admissions with complications. It is advisable to get transplanted rather than getting admitted multiple times in Intensive care unit. A lot of individuals who present to us have spent more than 30-35 lakhs for treatment before even thinking of liver transplant.

Myth 2 – Liver Transplant is not successful

The survival rate in India in whichever center of India you take is equal to the rest of the worlds. In fact when we compare the data from majority of our centers, as we do LDLT, the survival is superior. We expect 90% patients to walk home after a transplant and the survival rate of 5 years is 70 percent which is 5 times that of the patient who is in need for liver transplant.

Myth 3 – You have to travel out of Gujarat to get a liver

We have fully functional transplant set ups in Ahmedabad. The transplant service is offered at Civil Hospital, Sterling Hospitals, Shalby Hospitals as well as Apollo Hospitals. We, at Zydus Hospitals have a complete in house team for Liver Transplant unlike other centres with a combined experience of more than 1000 transplants. You no longer need to travel out of the state to get a liver.

The best is to protect your liver from developing cirrhosis. Even if you develop cirrhosis, it is not the death sentence nowadays and you can still expect to survive a functional life with good quality after a liver transplant.

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Fatty Liver Problem Treatment
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The answer is yes and no.

It indeed is a liver problem and it indicated that there is fat accumulated in your liver. However, it is not just a liver problem and it is one of the manifestations of a complete metabolic problem.

Liver is a store house. Whatever we eat, the excess amount is converted to fat and is stored in the liver. If on a daily basis, we have a positive balance between calories we eat and calories we burn, the difference is converted to fat and stored in the liver. Over a period of time the fat accumulated to such a great extent that it starts damaging your liver cells and they start dying. This is the time when your liver function tests start becoming abnormal. If no corrective action is taken at that moment, the liver tries healing itself with abnormal fibrosis and eventually it becomes cirrhosis. Once cirrhosis happens, it is irreversible and can then lead to all complications like blood in vomit, blood in stools, abnormal behavior, fluid accumulation in your tummy and swelling of your feet. It then remains no different from the damage caused by alcohol! So fat is as bad for your alcohol as alcohol.

All the recent studies in last decade have shown that the fatty liver problem is not just limited to liver. It is a marker of a complete abnormal profile. You can simultaneously have diabetes, hypertension, cardiac problems, thyroid problems, abnormal lipid profiles, menstrual problems, PCOS, gout, narrowing of your neck vessels, obstructive sleep apnea, kidney disease, arrhythmias, stroke, obesity and a complete metabolic syndrome. Once you are detected with fatty liver you should not ignore and rule out simultaneous all these problems.

If you have fatty liver, do not ignore – consult your liver specialist at the earliest!


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Blood In Stools Treatment
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Type Of TreatmentBlood In Stools

Blood in stools is a common symptom. Many of the individuals face it once in a while. But if it is a recurrent symptom, Ulcerative colitis is a disease that needs to be ruled out. Intestine is divided into two main parts- small and large. Large intestine is the last one metre of the intestine which helps not only in forming stools but also storing it till the time we evacuate during our routine defecation.

What is Ulcerative Colitis?
It is a type of disease where the last part of our intestine gets damaged by our own immune cells and is a type of Inflammatory Bowel Disease or in common terms, IBD. The other types of IBD are Crohn’s Disease and Microscopic Colitis. In ulcerative colitis, the lining of the large intestine gets damaged and ulcerated. Once it gets ulcerated it starts oozing blood.

Who is likely to have it?
Ulcerative colitis is common among young individuals of both the sexes, though, no age is protected from it. The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected, but now we know that these factors may aggravate but don’t cause ulcerative colitis. One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.The role of heredity is controversial.

What are the Symptoms of Ulcerative Colitis?
The symptoms of disease vary according to the severity. However, the most common symptoms are diarrhoea, increased frequency of stools, blood in stools, urgency to defecate, rectal pain, inability to defecate in spite of an urge and pain and occasional incontinence. If the disease becomes severe, it can come with weight loss, swelling of legs, fatigue, breathlessness, fever and failure to gain height in children. Blood in stools is the hallmark symptom but diarrhoea is not a must.

What are the Complications if Left Untreated?
If it is not treated the person keeps on losing blood and becomes anaemic. He may even develop severe diarrhoea and complications of diarrhoea. If the disease is not controlled, it may cause obstruction of the bowel in long term and even cancers can occur. It can cause involvement of other body organs. Person can have joint pain, liver disease, bone disease, skin disease, oral ulcers and even increased risks of clots in the body.

When to see your Doctor?
Everyone who has persistent blood loss in stools, awakening at night for passing stools, diarrhoea, abdominal cramps or fever should get themselves checked. The doctor would evaluate by few simple blood tests, stool tests, x-ray and an endoscopic examination. A small biopsy needs to be taken from the intestine via endoscopy to confirm the diagnosis.

What is the Treatment for the disease?
The treatment of this disease is usually life-long. There are drugs available to keep the disease in check. Few patients may even require steroids and injectables. As a last resort person might have to get the affected large bowel removed. There is no specific dietary guidelines but certain foods and beverages can aggravate symptoms, especially during a flare-up. During the flare up of disease they are advised to restrict dairy products, fibre rich foods and are advised to take small frequent meals with plenty of fluids.

Do not neglect your blood in stools because piles is not the only cause. The greater the delay in diagnosis and beginning of treatment, more is the chance for complications and need for surgery.

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Intrahepatic Cholestasis Of Pregnancy Treatment
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Intrahepatic cholestasis of pregnancy is a disorder characterized by itching, with onset in the third trimester of pregnancy, without any primary skin lesions with relief of signs and symptoms within two to three weeks after delivery. It affects 0.7% of pregnancies in multiethnic populations and 1.2–1.5% of women of Indians. Prevalence is influenced by genetic and environmental factors and varies among populations worldwide. In Chile, 2.4% of all pregnancies are affected, with a 5% prevalence in women of Araucanian – Indian origin. Pruritus in pregnancy is common, affecting 23% of pregnancies, of which a small proportion will have obstetric cholestasis.

A higher incidence is seen in twin pregnancies, following IVF, women of age more than 35 years, with a history of itching in previous pregnancies and in women with a history of the biliary disease. Patients with IVF may present in the second trimester with ICP. The itching/pruritus of obstetric cholestasis is typically worse at night, like most other cholestasis, is often widespread and may involve the palms of the hands and/or the soles of the feet. Jaundice typically develops 1 to 4 weeks after the onset of pruritus but occasionally can be the initial symptom. Often there may be no overt jaundice. Typically, transaminases will range from just above the upper limit of normal to several hundred. It has been associated with increased risk of pre-term delivery (up to 19 to 60%), meconium staining of amniotic fluid (up to 27% cases), fetal bradycardia (up to 14%), fetal distress (22%-41%)and fetal loss (0.4 to 4.1%), particularly when serum bile acids level goes beyond 40 μmol / L. Maternal complications include bleeding from fat-soluble vitamin deficiency and a higher incidence of gallstones. It has been seen that a higher proportion of these women (10-36%) undergo a caesarean section, the relative role of ICP is difficult to prove, though. Topical emollients like calamine lotion have been tried for pruritus, the efficacy though has not been proven by clinical trials but is still useful in some patients. Cholestyramine has not been subjected to randomised trials and antihistamines such as Chlorpheniramine may provide some welcome sedation at night but do not have a significant impact on pruritus. There is insufficient evidence to demonstrate whether S-adenosyl methionine (SAMe) is effective for either control of maternal symptoms or for improving fetal outcome.

Ursodeoxycholic acid (UDCA) improves pruritus and liver function by displacement of more hydrophobic endogenous bile salts from the bile acid pool. This may protect the hepatocyte membrane from the damaging toxicity of bile salts and enhance bile acid clearance across the placenta from the fetus. UDCA seems to be well tolerated by pregnant women and no adverse effects on mothers or newborn have been observed. Steroids should not be used. In order to reduce fetal complications, labour is induced at 37-38 weeks.

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