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Repeated Jaundice. Hep B Test, Ultrasound, CBC Blood Test. Difficulty Breathing, Normal BP

Posted on Fri, 5 Oct 2012

Question: I have jadaice three months back , the Bilirubin level was 3.8 and SGOT AND SGPT Was 500 and 450 repsectively that time , the blirumbin level and sgot and sgpt came to normal after 1 month , but soon i again had jadice with 2.8 bilirum and sgpt and sgot of 349 and 234 , which also lasted for fifteen days .. Again today i have jaducie with bilirium normal and sgpt 255 and sgot 192 ,, what is the reason for this repeated jaudice? What should i do , i have done hep b test its negaive , ultrasound showns inflammed liver somewhat , kft is normal , cbc bllod test is normal > i have some itching ,, and find somewhat diffiuclt in breathing also from last two days . I have normal bp and no blood pressure

Answered by Dr. Sapan J. Pandya (26 minutes later)

Hi XXXXXXX

Thanks for the query.

Jaundice is a sign of an underlying Liver pathology. It is could be due to poor liver function or infection harbored in the biliary system. Recurrent episodes of jaundice would damage your liver. A thorough examination with a specialist Hepatologist / Gastroenterologist is needed.

The most common possibilities are:
1) Hepatitis C - This is the most common cause of recurrent hepatitis. Please get evaluated for Antigen and Antibodies for Hepatitis C.
2) Hepatitis B - You have been tested negative ( Hope that is HBsAg test. If yes, then please get Anti HBc test done).
HBsAg test can be negative in the window period, so it would be better to get Anti HBc which would confirm to be infected with Hepatitis B or not.
3) Other viral hepatits causes like Hep A, Hep E and Hep D
4) Autoimmune Hepatitis

The other investigations would be required are as follows:
1) Liver biopsy
2) CT scan of abdomen
3) ERCP or MRCP
3) Serum XXXXXXX ASMA, Anti-LKM, and quantitative immunoglobulins- these are the tests for autoimmune hepatitis.

Please discuss about these possibilities and investigations with your treating Gastroenterologist.

As viral hepatitis is the most common cause, the main aim would be to protect the liver from excessive damage. These following measures would be helpful in this regarding:
1) Avoid oily and spicy food.
2) Avoid fatty foods like eggs, meat
3) Avoid smoking and alcohol
5) Low salt diet
6) Medications for better liver function which would be prescribed by your treating Gastroenterologist.
7) Maintain hygiene.

Hope this answers your query, In case of any doubts I am available for the follow ups.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (2 hours later)

thanks for fruitful reply , i have never till now had jaundice or any liver problem ,, and take proper care of my diet and water . WE take only hot water and higenic food . Has the above jaudice which is recurring in nature caused by antibitics and pain killer which i have been taking for two months post operation of my piles and fistula. What i mean to say is , is this drug induced jaudice

Answered by Dr. Sapan J. Pandya (1 hour later)

Hi! XXXXXXX

No the chances of Drug Induced Hepatitis are very low.
Normally Pain-killers cause injury to stomach and kidneys.
Antibiotics may uase injury to stomach.
Still if you can give me the names of antibiotics and pain-killers taken, I can advise you better.

Shall wait for your reply.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (1 hour later)

1)Augumentin duo 1000mg taken for 45 days ( Twice daily)
2) Tab Zeradol & Obactin for next 30 days ( one per day)
3) Enzoheal tablet ( pain killer ) for 45 days ( four times in a day )
4) Cap Mulmin plus ( Pain Killer) for next 30 days ( four times in a day)

Also i want to ask one more thing to you ,, i have head ache now , can i take nice tablet or crosine , becasue i have liver problem , that is why i am asking

Answered by Dr. Sapan J. Pandya (40 minutes later)

Hi! XXXXXXX

The above mentioned drugs do not have much effect on the liver. So i would consider it better for you to get the tests i mentioned above.

MULMIN PLUS is a BCOMPLEX pill.
Avoid NISE / NIMESULIDE. It has very bad effect on liver. You may take Paracetamol (Crocin)

Wish you good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (19 hours later)

i have one more question as regard to repetative nature of jaudice which i have
I was prescribed 1 month medicine for jaundice when i had jaudice for the second time . But I took only for 2 days , and i thought of controlling jaudice by diet . After 15 days my jaudice was normal . However after 3-4 days from the date on whihch it became normal , again i had jaudice for the third time. My question is whether jaudice has come back becasue non taking of medicines prescribed by the physician ; For your information i was prescribed 1-1 Tudiliv 300 and 1-1 Lornit .
by the genral physican, Which i took for only 2 days instead of 1 month prescription period.

Answered by Dr. Sapan J. Pandya (13 hours later)

Hi XXXXXXX

Yes, not taking medications could be the cause for the third time jaundice you had.

Tudiliv and Lornit are Hepatoprotectives ( liver protectives) bring remarkable change and betterment in the liver functioning and repairing the damage.Prevent recurrence when taken for a month or two based on the severity.

Hope I cleared your doubt,

Wishing you good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (8 hours later)

thanks for your reply , Do you suggest i take these medicines menioned above for one month before doing the test precribed by you . There is one more reason for this is that the liver specilist docters in Nagpur are not there ,,, they are coming on may 21 . Meanwhile Should i continue the above drugs .

Answered by Dr. Sapan J. Pandya (2 hours later)

Yes kindly continue the medicines for a month. Then you may get the tests done. If you are able to get an appointment of the Liver Specialist, you may take his / her opinion too.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (1 hour later)

ok,, Suppose i take these medicins for 1 month and in between sgpt bilrubin, sgot and alk phoshphe comes to normal ,, then even then i have to go in for those test which you have told me , like hep b test , hep c , hep a , ct scan etc etc . ?

Can i also work , under this situations or require complete bed rest . My work is just sitting in office ... auditing ?

Answered by Dr. Sapan J. Pandya (1 hour later)

You may wait for a month. If the reports come normal you may avoid the tests. But if the reports are stagnant or recurrence is there you have to undergo tests.
As for rest, the same thing. If the reports are showing a decreasing trend you may start light work. Otherwise rest till reports start decreasing.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (2 hours later)

based on your advice i have started taking medcines Tudiliv 300 mg and Lornit . Shall i take this three times in a day or two times in a day? And shall it be taken post meal or premail. ? I am also taking Nexdom for headache ,, is this good for liver or shall i stick to crocine

Answered by Dr. Sapan J. Pandya (2 hours later)

Both Tab. Tudiliv 300 and Tab. Lornit have to be taken twice a day. Both medicines can be taken with or before meals. Stick to Crocin instead of Naxdom (Naproxyn and Domperidone).

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (13 hours later)

Regarding diet , should i avoid oil and ghee completely or some degree of oil or ghee is accetable . Whether i can take food with less oil , like dal roti , vegetable curry in less oil or they should be completely avoided . If the answer to my question is no , please let me know for how many days such hard restrictions shoulod be followeed

Answered by Dr. Sapan J. Pandya (42 minutes later)

All forms of Fats like Oil, Ghee, paneer are hard to digest with compromised liver. So avoid them for a period till your reports become normal.

You could take dal roti and curry but with less oil once you recover.No need to completely restrict them

Carbohydrates and Clear liquids are best diet.

Wish you good health

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (3 days later)

Based on your advice i have been taking Tudiliv and Lornit from last three days. As a result of this my LFT results have improved.
Results Before 7 days : T B = 1.57 Direct-0.57 Indirect-1.00 SGPT 232 SGOT 192
Results today : T.B 1.43 Direct-0.45 Indirect-0.89 SGPT 89 SGOT 43

Alkaine phosphate is in normal range 99 same

Do you think , things will become normal in next fifteen days. Should i still continue to have dietary restrictions especillly on fats consumption

Answered by Dr. Sapan J. Pandya (4 minutes later)

Hi XXXXXXX

Yes, I believe that you might become normal in next 15 to 30 days.

And Please follow these measures too:
1.Take Rest.
2.Avoid fats in all forms.
3.Take plenty of clear liquids.
4.kindly continue with the same regimen of medicines.

Hope this answers your query.

Wish you speedy recovery.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (2 days later)

Can u please elaborate on in which indian foods we have fats , and please let me know whether i can take tea half cup 3-4 times in a day beacuase i am quite habitual to it

Answered by Dr. Sapan J. Pandya (9 minutes later)

Hi! XXXXXXX

You may have tea made with double-toned milk with cream removed.Limit it to three times a day.

Ghee, Oil, Paneer, butter,Cream,cheese, Fried Food, Non-Veg Foods like meat are XXXXXXX sources of fats, which need to be avoided.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (18 days later)

hello docter , my lft reports were ok on 27 may with sgpt 32 and sgot 22 and birium 1.25 . However thinking that reports are normal i started going to office and started taking normal food . I had a chek yesterday sgot sgpt now are 75 65 rspectively and total bilirubin level 2.3. has the jaudice again increased becasue me not taking rest and eating normal food. Shall i continue udilip and lronit three times in a day to bring the levels of sgpt and sgot down. Is taking udilip and lornit for long time harmful for liver. For how many days after the the results are normal ,, i have to strictly follow the diet as given by you in order to ensure that jaudice is not repeated again and same is the case of rest

Answered by Dr. Sapan J. Pandya (48 minutes later)

Hi XXXXXXX

Yes, REST and DIET form the best medicine in Hepatitis. You may have started going to office, that is OK, but take a diet meant for jaundice, I had advised earlier.
Yes, you may continue the medicines.
No, taking these medicines do not damage the liver.
For at least one month, you should continue with the Jaundice diet..
I would also advise you to go for the Liver function Tests I had advised earlier.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (1 hour later)

thanks , will it be ok , if i go for all test after jaudice come back despite the diet being followed for one month as adivised by you . Howiever yesterday again the nearby pathology tested my blood for hepaptis B , its was negative . I am thinking i follow strict diet for one month with above mediciens three times in a day . and then if normallacy is not fully restored after one months ,, go for test as adivised by you .. However i would like to have your opnion on this

Answered by Dr. Sapan J. Pandya (11 hours later)

Hi XXXXXXX

Good to hear from you again.

Yes, you are perfectly right. Follow the prescribed diet properly and check out your liver function after 1 month.

Hope this answers your query.

Wish you a good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (12 hours later)

thanks , So now onward i take lormit and Udiliv (300mg) three times in a day for one month from 2/6/2011 to 1/7/2011 and follow strict diet as precribed by you ealier. Or should i reduce taking medicines three times a day to two times a day after 15 days .. once i notice reduction in sgpt and sgot level after 15 days . Please advise . Also will taking of the above medicines three times have any negative effect onliver and what about going to office should i stop that also

Answered by Dr. Sapan J. Pandya (14 hours later)

Continue taking the medicines as advised earlier.
No, the above medicines have no harm on the liver. They are meant to help the liver.
You may go to work, but avoid strenuous activity.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (63 days later)

hello docter

i have a history of repeaded jadudice
I had repeated high reading of balrubin levels , sgpt , sgot
from feb 21 2011 . These reading were around 2.3 to 3.5 bilirubin to , sgpt sgot hovering around 256-400

I have taken medicines lornit , and udilip .

However after consulting your doc ,who told me to maintain strict diet with low oil and and low fat diet . My sgpt and sgot level are normal below 40 from last 45 days .

Does it mean jaudice has gone .

I am still mainting on strict diet . For how long i have to take precaution for the diet . Is it necessary to take all test now like hepaptis a, b, c etc

Answered by Dr. Sapan J. Pandya (5 hours later)

Hi XXXXXXX
Thanks for the query.

It is a very good sign that your jaundice is under control with strict diet and you may continue the same for 45 days more, that is 3 months of normal period. If it recurs again you may go for following tests for recurrent jaundice.

1) Antigen and Antibodies for Hepatitis C.
2) HBsAg test, if negative then please get Anti HBc test done.
HBsAg test can be negative in the window period, so it would be better to get Anti HBc which would confirm to be infected with Hepatitis B or not.
3) Other Hepatitis markers ike Hep A, Hep E and Hep D
4) Serum XXXXXXX ASMA, Anti-LKM, and quantitative immunoglobulins-Autoimmune Hepatitis
5) Liver biopsy
6) CT scan of abdomen
7) ERCP or MRCP

Hope i have answered your query.

Wishing you good health.

Above answer was peer-reviewed by : Dr. Radhika

Follow up: Dr. Sapan J. Pandya (17 days later)

as i have wirtten eearlier ,, the jaudice was stable from last 55 days , However today i have cheked up LFT , the following are the results : Alkaline Phosphate 72.1, Bilirubin total 1.83, Bilrubin direct -0.46, Bilrubin-1.37, GGT -13.3,sgot-41.3 sgpt-61, Protien -7.64, albumin 3.95, Serum albumin/Globulin raio 1.07

What does it indicate, Has my jaducie relapsed after being silent for 55 days?

Answered by Dr. Sapan J. Pandya (21 hours later)

Dear XXXXXXX

Most of the values are borderline. It may suggest residual effect of the previous liver disease.

I had advised you to carry out comprehensive liver tests in my first answer (08-May-11) and again in my last answer (08-Aug-11). So kindly get those tests done, which would benefit you in terms of perfect diagnosis.

I would not call this a relapse as the values are minimally high.

Hope this helps.

Regards,

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Sapan J. Pandya (1 hour later)

ok , but fifteen days back my bilirubin was 1.20 (normal) sgot 17 sgpt 20. Does the reading i have given in my ealier email reprsent relapse. Is this variation normal ,
hello docter ,,as advised by before and now i had done the following test Heptatis a, b (antingen) c and e ,,,, I have heptatis c with the values of 4.9 . What shall i do .. Has this infection come from operations which i had in XXXXXXX . I had two operations of piles and fistula . Subsequently i had 3-4 dental procedurs for root cana. What shall i do now . Is 4.9 range excessive .. Is hep c curable .

Answered by Dr. Sapan J. Pandya (23 hours later)

Dear XXXXXXX

Good to hear from you again.

I believe that you have undergone Enzyme Immunoassay to detect hepatitis C antibody. If the value is 4.9 (anything more than 1, but depending on individual kits), then you have Hepatitis C infection.

The infection could have occurred after any of the procedures you have mentioned. It could have been either Piles or Dental. But if you have undergone Piles surgery at ayurvedic centre, the chances are very high that you got infected from there.

Next you have to undergo Hepatitis C RNA assays to measure virus levels (viral load). After that you have to check for Hepatitis C genotype. Six genotypes exist. The treatment is based on the genotype.

The treatment of Hepatitis C is of Pegylated Interferon Alfa and Ribavarin. Treatment is given for nearly one year. It is very expensive treatment and the results after spending a lot of money are variable. Kindly consult a gastroenterologist and start treatment as we are already three months late.

Hope this answers your query.

Wish you a good health.

Regards.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Sapan J. Pandya (49 minutes later)

nice to hear from you . How much this treatment cost appoximately for one year .
Even after spending so much money , its not cured. Do you mean I should try aurvedic or hamoepathic treatment . If hepatatis c is not cured by the above alophatic treatment , then what is the other options .

Answered by Dr. Sapan J. Pandya (5 hours later)

Dear XXXXXXX
Around 2.5 lakhs. Varies according to institutes. The treatment of Hepatitis C is not with guaranteed results even after spending so much money.
I am an allopathic doctor, who has never studied Ayurveda or Homeopathy. I do not recommend non-scientific options.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Sapan J. Pandya (7 hours later)

ok , i agree with you . But if i take alopathic treatment and if the treatment does not respond . This would mean leaving with heaptatis c . What are the compliations , and how long a person can surivive with this . Can a person leave with hepatitis c throughout life?

Answered by Dr. Sapan J. Pandya (14 hours later)

Dear XXXXXXX

The life expectancy and results of treatment to Hepatitis C vary from person to person. There are many factors involved - known and unknown. Viral Load, Genotrype of virus, etc.
Again I advise you to XXXXXXX a Gastroenterologist urgently.
Also you may need to get the two tests done. I had mentioned them in previous message.

Wish you good health.

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Above answer was peer-reviewed by : Dr. Raju A.T