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Hepatocellular cancer treatment

Comprehensive Hepatocellular Cancer Treatment in Ahmedabad by Dr. Divakar Jain

Dr. Divakar Jain – Your Trusted Destination for Advanced Hepatocellular Cancer Treatment in Ahmedabad!

At Dr. Divakar Jain, we understand the challenges and complexities that come with a diagnosis of hepatocellular cancer. Led by the esteemed Dr. Divakar Jain, our team is dedicated to providing comprehensive, personalized care to each patient, ensuring the best possible outcomes.

About Hepatocellular Cancer

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, characterized by the malignant transformation of hepatocytes, the main type of liver cell. It typically arises in the setting of chronic liver disease and cirrhosis, although it can also occur in patients without underlying liver conditions.

Advanced Treatment Approaches

Dr. Divakar Jain is a renowned expert in hepatocellular cancer treatment, offering a range of advanced therapeutic modalities tailored to each patient’s unique needs. Our comprehensive approach to care encompasses:

1. Early Detection and Diagnosis: Timely detection is crucial for effective treatment. Dr. Divakar Jain utilizes state-of-the-art imaging techniques and diagnostic tools to accurately identify and stage hepatocellular cancer.

2. Multidisciplinary Treatment Planning: Our team of specialists collaborates closely to develop personalized treatment plans that may include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.

3. Surgical Expertise: Dr. Divakar Jain is highly experienced in complex surgical procedures for hepatocellular cancer, including liver resection, liver transplantation, and minimally invasive techniques such as laparoscopic and robotic-assisted surgery.

4. Innovative Therapies: We stay at the forefront of medical advancements, offering access to cutting-edge treatments and clinical trials that may not be available elsewhere.

5. Supportive Care Services: We understand the importance of addressing the physical, emotional, and psychological aspects of cancer care. Our supportive care services include pain management, nutritional support, counseling, and palliative care to enhance quality of life.

Why Choose Dr. Divakar Jain?

1. Expertise: Dr. Divakar Jain is a leading authority in hepatocellular cancer treatment, known for his clinical excellence, research contributions, and commitment to patient care.

2. Compassionate Care: We prioritize compassionate, patient-centered care, ensuring that each individual receives the attention, respect, and support they deserve throughout their cancer journey.

3. Advanced Facilities: Our clinic is equipped with state-of-the-art infrastructure and technology to deliver the highest standard of care.

4. Holistic Approach: We believe in treating the whole person, not just the disease. Our holistic approach addresses the physical, emotional, and social aspects of cancer care to promote overall well-being.

5. Dedicated Support Team: Our team of skilled nurses, oncologists, surgeons, and support staff are committed to providing personalized care and support at every step of the treatment process.

If you or a loved one is facing hepatocellular cancer, trust Dr. Divakar Jain for expert guidance, compassionate care, and innovative treatment options. Contact us today to schedule a consultation and take the first step towards healing and hope.

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Combined Liver-Kidney Transplantation: When and How?

Combined liver-kidney transplantation (CLKT) is a procedure where both a liver and a kidney are transplanted simultaneously into a recipient who requires both organs due to end-stage organ failure. Here are some key points about when and how CLKT is performed:

When is CLKT considered?

Indications: CLKT is typically considered when a patient has concurrent liver and kidney failure. This could be due to:

Chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) alongside liver failure, often seen in conditions like cirrhosis.

Acute kidney injury (AKI) that does not recover, combined with acute liver failure.

Evaluation: Patients undergo rigorous evaluation to determine the need for CLKT. Criteria include severity of liver disease (often assessed by MELD score) and kidney disease (usually assessed by eGFR or need for dialysis).

How is CLKT Performed?

Surgical Procedure: CLKT involves transplanting both organs simultaneously in a single surgical procedure. The liver is typically transplanted first, followed by the kidney. The surgical team may consist of liver transplant surgeons and renal transplant surgeons working together.

Immunosuppression: After transplantation, patients require lifelong immunosuppressive therapy to prevent organ rejection. The immunosuppressive regimen is tailored to balance preventing rejection with minimizing side effects.

Recovery: Recovery from CLKT involves monitoring for organ function, managing immunosuppressive medications, and addressing any post-operative complications. Recovery times can vary, but patients typically stay in the hospital for several weeks post-surgery.

Considerations and Outcomes

Patient Selection: Selecting appropriate candidates for CLKT is crucial. Candidates should have a reasonable expectation of survival and improvement in quality of life compared to their pre-transplant state.

Outcomes: CLKT can offer excellent survival rates and improved quality of life for appropriately selected patients compared to sequential liver and kidney transplants or other treatments.

Challenges: CLKT is a complex procedure with inherent risks, including surgical complications, rejection of transplanted organs, and side effects from immunosuppressive medications.

In summary, CLKT is performed when a patient has concurrent liver and kidney failure and is evaluated as a suitable candidate for dual organ transplantation. The procedure involves simultaneous transplantation of both organs, followed by lifelong management with immunosuppressive therapy to maintain organ function and prevent rejection.

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Combined Liver-Kidney Transplantation: When and How?

Introduction

Organ transplantation is a complex surgery. But After years of research and technological advances, these surgeries have become safer today. Kidney transplantation alone or liver transplantation alone is a major and complex surgery. So, performing these surgeries together in one go warrants advanced infrastructure and skilled doctors and nursing staff.

Indications of CLKT – when do you need it?

CLKT – How to do it?

CLKT is done in two ways:

Deceased donor (cadaveric) transplantation

Living donor transplantation

While the cadaveric CLKT utilizes organs from brain-dead donors, the living donor CLKT utilizes organs from living donors, generally, healthy, family relatives. The recipient gets one or two kidneys and whole (adult recipient)/part of liver (paediatric recipient) in a cadaveric transplant.  On the other hand, we need two separate donors for liver and kidney in living donor transplantation. The patient receives a part of liver and one kidney in living donor transplantation. However, the outcome of CLKT with either technique is similar.

Preoperative, intraoperative, and postoperative optimization are very important for a successful CLKT.

How to do CLKT – Preoperative optimisation

Liver cirrhosis patients tend to accumulate lot of fluid in third spaces in advanced stage, which causes pedal oedema, ascites, pleural effusion, pulmonary oedema, pulmonary hypertension, and other complications. Such patients with added renal dysfunction, are on a higher risk of such complications. So, they need preoperative optimization in form of fluid restriction, salt restriction, diuretics, regular dialysis (as advised by physician), and vitamin and mineral supplements. The patients must consult their physician regularly and follow their advice. Also, they must also consult a physiotherapist for lung optimization in form of respiratory exercises and physiotherapy.

How to do CLKT – Intraoperative challenges

CLKT is a challenging surgery because of long surgical duration, fluid shifts and need for experienced and skilled OT staff. Liver is transplanted first, followed by kidney transplantation through a separate incision. The surgery lasts for approximately 12-16 hours. A lot of fluid shifts happen during surgery. The surgery may need transfusions of blood and blood components. Also, fluid balance needs to be taken care of and as and when required and the patient may need dialysis during the surgery in some cases. Transplantation is a skill-intensive surgery and requires skilled surgeons, anaesthetists, and nursing staff.

How to do CLKT – Postoperative challenges

All organ transplantation patients need immunosuppression to prevent graft rejection postoperatively. However, the immunosuppression requirement is different for different organ transplantations – kidney transplantation needing more immunosuppression than liver transplantation. However, liver when transplanted along with other organs like kidney impart an immunoprotective effect. So, immunosuppression requirement in CLKT is usually less than kidney transplantation alone.

Once transplanted kidney starts functioning and producing urine, fluid replacement is very important to prevent early complications like acute tubular necrosis (ATN). This replacement needs to be done through intravenous route.

We manage the patients with CLKT with a goal of optimized long-term immunosuppression. The patients must follow up regularly with their treating physicians and must undergo liver function tests and kidney function tests and tests to assess the blood level of immunosuppressive medication on a regular interval. Also, they must take immunosuppression life long as advised by physician.

Conclusion

CLKT is a complex and major surgery. Selective patients need it. It has good outcomes but needs experienced surgeons, physicians, and good infrastructure.

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Meet Dr. Divakar Jain: Your Trusted Liver Transplant Specialist in Ahmedabad

Are you or your loved one in need of a liver transplant? Look no further! At KD Hospital in Ahmedabad, you have access to one of the finest liver transplant specialists in the region – Dr. Divakar Jain. With a wealth of experience and a dedication to patient care, Dr. Jain stands out as a beacon of hope for those in need of liver transplant surgery.

Who is Dr. Divakar Jain? Dr. Divakar Jain is a highly esteemed liver transplant surgeon with an impressive array of qualifications and experience. He holds an M.B.B.S., M.S., F.A.C.S., and D.N.B. in Surgical Gastroenterology, showcasing his commitment to excellence in the field of surgical medicine. Additionally, Dr. Jain has completed a Fellowship in HPB Surgery and Liver Transplantation, further honing his skills in this specialized area.

With a career dedicated to hepato-pancreato-biliary (HPB) surgery and liver transplantation, Dr. Divakar Jain brings a depth of knowledge and expertise to his practice at KD Hospital in Ahmedabad. As a Senior Consultant in HPB Surgery & Liver Transplantation, he is at the forefront of medical advancements, ensuring that his patients receive the highest standard of care available.

Why Choose Dr. Divakar Jain for Your Liver Transplant Needs? 1. Expertise: Dr. Jain’s extensive training and experience in liver transplantation make him a trusted authority in the field. Patients can have confidence in his ability to perform complex surgeries with precision and skill.

2. Compassionate Care: Beyond his medical expertise, Dr. Divakar Jain is known for his compassionate approach to patient care. He understands the emotional and physical challenges that come with liver transplantation and strives to support his patients every step of the way.

3. State-of-the-Art Facility: KD Hospital is equipped with cutting-edge technology and resources necessary for successful liver transplant procedures. Patients can rest assured that they are receiving top-tier care in a modern and comfortable environment.

4. Holistic Treatment Approach: Dr. Jain believes in a holistic approach to patient care, addressing not only the physical aspects of illness but also the emotional and psychological well-being of his patients and their families.

5. Accessible Location: Located in Ahmedabad, KD Hospital offers convenient access to patients from across the region. Whether you’re local to Ahmedabad or traveling from afar, you can easily reach Dr. Divakar Jain’s practice for consultation and treatment.

Conclusion: When it comes to liver transplantation, choosing the right surgeon is crucial. With Dr. Divakar Jain at KD Hospital, you can trust that you’re in capable hands. His expertise, compassion, and dedication to patient care set him apart as a leading liver transplant specialist in Ahmedabad. Don’t hesitate to reach out and schedule a consultation to discuss your liver transplant needs with Dr. Jain today. Your journey to renewed health and vitality starts here.

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Liver donor safety – learning the facts and busting the myths

Liver has a peculiar ability to regenerate. The Greeks knew about it. According to the Greek mythology, Prometheus was punished by Zeus by being chained. Zeus’ eagle used to come and eat a part of Prometheus’ liver. The liver regenerated till being eaten again by the eagle. It is because of this regenerative ability of liver, living donor liver transplantation is possible and safe.

Fig 1. Zeus’ eagle eating Prometheus’ liver

Liver is an important organ in the body. It performs many essential functions. Unlike kidney, there is no effective dialysis system for liver. So, when liver becomes diseased, liver transplantation is the lifesaving and curative option. The liver can be donated in two ways:

1) Living donor

2) Deceased donor

The living donor is a person who voluntarily donates a part of his liver, while he/she is healthy. A deceased donor is a person who is brain dead and donates his/her whole liver, with consent of the relatives.

Unfortunately, the deceased organ donations do not happen in adequate numbers in India. So, we rely more on living donor liver transplantation so that the patients can timely get healthy liver, which can save their lives.

How much of the liver can be safely removed from the body?

The part of liver which remains with a donor is called remnant liver. Approximately, 25% of healthy liver or 35-40% of diseased liver is essential for survival. Any remnant volume less than that puts a person to risk of liver failure, which may be life-threatening.

How much liver is donated?

The volume required for donation is calculated based on graft-recipient weight ratio (GRWR).

GRWR = the weight of liver being donated (graft liver)/weight of the recipient

The weight of the graft liver and the remnant liver are calculated before the surgery using advanced software based on CT imaging. A GRWR of more than 0.8 is desirable to achieve good outcomes after liver transplant. A remnant liver of more than 25% is desirable for donor safety.

The right lobe of liver forms approximately 60-70% of the whole liver while the remaining 30-40% is contributed by the left lobe. Usually, the right lobe is taken for donation for adult recipient, while the left lobe or smaller than that (left lateral section, segment 2 or segment 3) is taken for a pediatric patient.

Fig 2. Lobar anatomy of liver

Donor liver surgery

The donor liver surgery starts with mobilisation of liver, porta dissection and proceeds with transection of liver, finishing with disconnection of blood vessels and removal of the donor liver (the graft liver). The surgery usually lasts for 5-6 hours.

Postoperatively, a liver donor is generally kept in ICU for 2-3 days. Ambulation and oral feeds are started from 1st postoperative day. The donor is generally discharged from the hospital in 6-8 days.

Complications of donor surgery

The donor surgery is relatively very safe. But, being a major surgery, it is associated with approximately 0.2-0.5% risk to life. There can be surgical complications like bleeding, infection, bile leak and development of hernias. Most of these complications are uncommon and can be managed well in a good surgical unit.

Long-term outcomes and quality of life after donor surgery

The remnant liver regenerates to normal size in 2-3 months. The donor does not have to be on any long-term medications. One can have a normal quality life after liver donation. One can pursue laborious work, participate in sports activities, go to gym, and can marry and have a normal sexual life.  Female donors can have normal pregnancy. The surgery does not affect the long-term life in any way.

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Biliary Surgeries in Ahmedabad

Dr Divakar Jain is a renowned surgeon who specializes in biliary surgeries. He has extensive experience and expertise in treating various disorders of the gallbladder, bile ducts, and liver. He performs the following types of biliary surgeries:

Gall Bladder Cancer Surgery:

This surgery involves removing the gallbladder and some surrounding tissue to treat cancer that originates in the gallbladder or spreads to it from other organs. Dr Jain uses minimally invasive techniques to reduce the risk of complications and speed up recovery.

Choledochal Cyst Surgery: 

This surgery involves removing a cyst (a fluid-filled sac) that forms in the bile duct, which can cause jaundice, pain, and infection. Dr Jain performs this surgery using laparoscopy, which involves making small incisions and inserting a camera and instruments through them.

Bile Duct Stones Surgery:

 This surgery involves removing stones that form in the bile duct, which can block the flow of bile and cause inflammation, infection, and pancreatitis. Dr Jain uses laparoscopy to perform the surgery which ensures faster recovery of the patient.

Biliary Cancer Surgery: 

This surgery involves removing cancer that affects the bile ducts, which can be either inside the liver (intrahepatic) or outside the liver perihilar or periampullary. Such patients may need preoperative or postoperative chemotherapy, which is available in the hospital.

Bile Duct Injuries Surgery:

This surgery involves repairing damage to the bile ducts that can occur due to trauma, infection, or previous surgery. Dr Jain is well experienced in operating such complex surgeries.

Dr Divakar Jain is committed to providing the best care and outcomes for his patients. He is affiliated with reputed hospital KD Hospital in Ahmedabad, Gujarat. He is also involved in research and education in the field of biliary surgery. To schedule an appointment with Dr Jain, please contact us… Click Here

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How do you evaluate the effect of fucoidan to liver fibrosis by inhibited TGF-B1?

Evaluating the effect of fucoidan on liver fibrosis by inhibiting transforming growth factor-beta 1 (TGF-β1) involves a comprehensive approach that typically includes both in vitro and in vivo experiments. Here's a general outline of steps you might consider:

Literature Review:Conduct a thorough literature review to understand the existing knowledge about fucoidan and its potential anti-fibrotic effects, especially in the context of liver fibrosis and TGF-β1 inhibition.

Cell Culture Studies (In Vitro):Select relevant liver cell lines (such as hepatic stellate cells or hepatocytes) and culture them in vitro.Induce fibrosis in the cells using TGF-β1 or another appropriate inducer.Treat cells with different concentrations of fucoidan and assess its impact on:Cell viabilityExpression of fibrotic markers (collagen, alpha-smooth muscle actin, etc.)TGF-β1 signaling pathway activityUse techniques like Western blotting, immunofluorescence, or qPCR for molecular analysis.

Animal Studies (In Vivo):Choose an appropriate animal model of liver fibrosis (e.g., induced by carbon tetrachloride or bile duct ligation).Administer fucoidan to the animals and evaluate its effects on liver fibrosis development.Assess liver function through serum markers and imaging techniques (e.g., ultrasound, MRI).Examine liver tissue histology for signs of fibrosis and inflammation.Measure expression levels of key fibrotic markers using molecular techniques.

TGF-β1 Inhibition:Verify the inhibitory effect of fucoidan on TGF-β1 signaling pathway.Assess TGF-β1 expression levels in both in vitro and in vivo models.Confirm downstream effects on TGF-β1-associated signaling molecules.

Biochemical Assays:Perform biochemical assays to measure markers of liver function, inflammation, and fibrosis in both cell culture supernatants and animal serum/plasma.

Statistical Analysis:Use appropriate statistical methods to analyze the data and determine the significance of the observed effects.

Controls:Include positive and negative controls in your experiments to validate the results.

Ethical Considerations:Ensure that all experiments adhere to ethical guidelines and regulations concerning the use of animals and human cell lines.

Data Interpretation:Interpret the results in the context of existing literature and draw conclusions regarding the potential anti-fibrotic effect of fucoidan through TGF-β1 inhibition.

Publication:Share your findings through peer-reviewed publications to contribute to the scientific understanding of fucoidan's impact on liver fibrosis.https://www.drdivakarjain.com/all-about-liver-donation/

Remember to consult with experts in the field, and consider seeking advice from researchers who specialize in liver fibrosis and related areas for a more tailored approach to your study.

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I already donate a kidney. Can I donate a liver?

Donating a kidney and donating a liver are separate procedures, and typically, individuals cannot donate both a kidney and a liver. This is because both organs are crucial for normal bodily function, and the body's ability to function with only one kidney or a partial liver is a consideration in the donation process.

When someone donates a kidney, the remaining kidney compensates for the loss, and the donor can continue to lead a healthy life with just one kidney. However, the liver has a unique ability to regenerate, and in the case of living liver donation, only a portion of the liver is removed. The remaining liver then regrows to near its original size over time.

It's important to note that living liver donation is a more complex and involved procedure compared to living kidney donation. The decision to donate a liver involves careful evaluation, including medical, psychological, and social assessments. The risks and benefits of the procedure are thoroughly discussed with potential donors.

If you have already donated a kidney, it's unlikely that you would be eligible to donate a liver as well. The decision to become a living organ donor should be made voluntarily, and individuals should undergo a comprehensive evaluation to ensure their safety and well-being.

If you are considering living liver donation or have specific questions about your eligibility based on your medical history and previous donation, it is recommended that you consult with a transplant team or healthcare professionals who specialize in organ transplantation. They can provide you with personalized information and guidance based on your circumstances.

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Acute Liver Failure and its Management

Acute liver failure, also known as fulminant hepatic failure, is a rare and life-threatening condition in which the liver rapidly loses its ability to function. This can occur over a period of days to weeks and is often associated with the sudden onset of severe liver dysfunction. There are many potential causes of acute liver failure, including viral infections (such as hepatitis), drug toxicity, autoimmune disorders, and metabolic diseases.

Symptoms of acute liver failure may include jaundice (yellowing of the skin and eyes), confusion, abdominal pain, bleeding tendencies, and changes in mental status. It is crucial to seek immediate medical attention if acute liver failure is suspected, as it can be fatal if not treated promptly.

The management of acute liver failure involves several key aspects:

Hospitalization: Patients with acute liver failure need to be admitted to the hospital, typically in an intensive care unit (ICU), to receive close monitoring and supportive care.

Identifying and treating the underlying cause: The first step is to identify and address the cause of acute liver failure. Depending on the specific cause, this may involve antiviral medications (for viral hepatitis), discontinuation of offending drugs or toxins, or treatments for autoimmune or metabolic conditions.

Supportive care: Supportive care is essential for patients with acute liver failure. This includes maintaining adequate nutrition, managing complications, and addressing the symptoms. Patients may require nutritional support via a feeding tube if they are unable to eat.

Medications: In some cases, medications such as N-acetylcysteine may be used to treat certain types of drug-induced liver injuries. Other medications may be used to manage complications and symptoms.

Monitoring and management of complications:

Coagulation and bleeding issues: Patients often have blood clotting abnormalities, which may require blood products or medications to correct.

Cerebral edema: Acute liver failure can lead to swelling in the brain, which is a life-threatening complication. Intracranial pressure is monitored, and therapies such as mannitol or hypertonic saline may be used to reduce brain swelling.

Infections: Patients with acute liver failure are at an increased risk of infections, so vigilance for and prompt treatment of infections is crucial.

Liver transplant evaluation: In cases of severe acute liver failure, a liver transplant may be the only life-saving option. A patient's eligibility for a transplant is determined based on various factors, including the severity of liver damage, overall health, and availability of suitable donor organs.

Dialysis: If kidney function is also affected, hemodialysis or continuous renal replacement therapy (CRRT) may be necessary to support kidney function.

The prognosis for acute liver failure can vary depending on the cause, the patient's overall health, and the speed at which treatment is initiated. Timely diagnosis and appropriate management are critical for improving the chances of survival. It's essential for patients and their healthcare providers to work closely together to determine the best course of action based on the individual circumstances.

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Non-surgical management of liver cirrhosis

Non-surgical management of liver cirrhosis primarily focuses on slowing down disease progression, managing complications, and improving overall liver health. It’s important to note that liver cirrhosis is a serious condition that should be managed under the guidance of a healthcare professional. Here are some key components of non-surgical management:

Lifestyle Modifications:

Alcohol Abstinence: If the cirrhosis is related to alcohol consumption, complete abstinence from alcohol is crucial to prevent further liver damage.

Healthy Diet: A well-balanced diet with limited sodium intake can help manage complications like ascites and fluid retention. This may include avoiding processed foods, reducing salt intake, and maintaining a healthy weight.

Medications:

Viral Hepatitis Treatment: If cirrhosis is caused by chronic viral hepatitis (e.g., hepatitis B or C), antiviral medications may be prescribed to suppress the virus and slow disease progression.

Symptom Management: Medications can help manage symptoms and complications. For example, diuretics may be prescribed for fluid retention (ascites) or beta-blockers for portal hypertension.

Vitamin and Mineral Supplements: Cirrhosis can lead to nutrient deficiencies. Supplements, such as vitamin D or iron, may be recommended if deficiencies are identified.

Regular Medical Follow-up:

Patients with cirrhosis should have regular check-ups with their healthcare provider to monitor liver function, screen for complications, and adjust medications as needed.

Monitoring for liver cancer (hepatocellular carcinoma) is also essential, as cirrhosis increases the risk of developing this cancer.

Management of Complications:

Ascites: This fluid buildup in the abdomen can be managed with diuretics (water pills) and dietary sodium restriction. In severe cases, therapeutic paracentesis (fluid removal) or a shunt procedure may be required.

Variceal Bleeding: Medications (such as beta-blockers) and endoscopic procedures (like band ligation) can help prevent or treat bleeding from esophageal varices.

Hepatic Encephalopathy: Medications like lactulose or rifaximin can help manage cognitive and neurological symptoms associated with liver dysfunction.

Coagulopathy: In cirrhosis, the liver’s ability to produce clotting factors is compromised. Vitamin K and clotting factor replacements may be used to manage bleeding tendencies.

Lifestyle Factors:

Exercise: Regular physical activity can improve overall health and reduce the risk of complications.

Weight Management: Maintaining a healthy weight can help reduce the risk of non-alcoholic fatty liver disease (NAFLD), a common cause of cirrhosis.

Supportive Care:

Emotional and psychological support can be crucial, as living with cirrhosis can be challenging. Support groups and counseling may be beneficial.

Vaccinations:

Patients with cirrhosis should receive vaccinations for hepatitis A and B to prevent further liver damage.

It’s important for individuals with liver cirrhosis to work closely with their healthcare team to create a personalized treatment plan. In some cases, liver transplantation may be considered if the cirrhosis is severe and not responsive to medical management. However, transplantation is a surgical intervention and would be the last resort in non-surgical management.

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Pancreatic Surgeries Overview

Pancreatic surgery refers to surgical procedures performed on the pancreas, a gland located behind the stomach that plays a crucial role in digestion and the regulation of blood sugar levels. Pancreatic surgeries are typically carried out to treat various medical conditions, including pancreatic cancer, pancreatitis (inflammation of the pancreas), pancreatic cysts, and other abnormalities.

Some common types of pancreatic surgeries include:

Whipple Procedure (Pancreaticoduodenectomy): This is a complex surgical procedure that involves removing the head of the pancreas, the duodenum (first part of the small intestine), a portion of the bile duct, and the gallbladder. It is often used to treat pancreatic cancer, tumors of the ampulla of Vater, and other conditions involving the head of the pancreas.

Distal Pancreatectomy: This surgery involves removing the tail and sometimes a portion of the body of the pancreas. It may be performed to treat tumors located in the body or tail of the pancreas or for cases of chronic pancreatitis.

Total Pancreatectomy: In this procedure, the entire pancreas is removed. It may be necessary in cases of widespread pancreatic cancer or severe chronic pancreatitis.

Enucleation: Enucleation involves removing only the tumor or cyst within the pancreas while preserving the surrounding healthy tissue. It is often used for benign or low-risk tumors.

Laparoscopic Pancreatic Surgery: Some pancreatic surgeries can be performed using minimally invasive techniques, such as laparoscopy. This approach involves making small incisions and using a camera and specialized instruments to perform the surgery.

Palliative Surgery: In cases where pancreatic cancer is advanced and curative treatment is not possible, palliative surgeries may be performed to relieve symptoms, improve quality of life, and manage complications.

It's important to note that pancreatic surgeries are complex procedures that require a highly skilled surgical team and specialized facilities. Recovery from pancreatic surgery can be challenging, and patients often require close post-operative care.

If you or someone you know is facing the possibility of pancreatic surgery, it's important to have thorough discussions with healthcare professionals to understand the risks, benefits, and potential outcomes of the procedure. Each case is unique, and the appropriate surgical approach will depend on the individual's medical condition and overall health.

For More Info click now: https://www.drdivakarjain.com/service/pancreatic-surgeries/

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Fatty liver treatment in Ahmedabad

More and more patients are getting diagnosed with fatty liver and fatty liver, if not treated in time, can lead to serious complications. Fatty liver treatment in Ahmedabad is possible at most hospitals which have physicians, medical gastroenterologists and liver specialists.

What is fatty liver?

Fatty liver is a condition where excess fat builds up in the liver and it is also known as hepatic steatosis. We define fatty liver by excess fat deposition in liver which is not secondary to alcohol, certain medicines and certain hereditary disorders. It is commonly associated with diabetes mellitus, obesity and dyslipidemias like hypercholesterolemia and hypertriglyceridemia.

Non-Alcoholic Fatty Liver Disease (NAFLD) is a broad term, encompassing a spectrum of fatty liver disease from fatty liver to steatohepatitis to liver cirrhosis. It is categorized in NAFL (Non-Alcoholic Fatty Liver) and NASH (Non-Alcoholic Steatohepatitis). NAFL is a condition where there is 5% or more fat deposition in liver without liver cell injury. NASH is a condition, characterized by 5% or more fat deposition in liver with inflammation and liver cell injury with or without fibrosis.

Magnitude of the problem

The incidence of fatty liver disease is rising in the general population worldwide and it is now one of the commonest causes of liver cirrhosis. NAFLD affects approx. 20-30% of general population worldwide and NASH affects approx. 1.5-6%. Sedentary lifestyle, increasing prevalence of diabetes mellitus and unhealthy food habits have contributed to increasing incidence of fatty liver disease. In fact, NAFLD and NASH more often affects high-risk groups like people with obesity, diabetes mellitus and dyslipidemias!

What are the complications of fatty liver?

Fatty liver disease is a progressive disease. With continuing injury to the liver, the NAFL stage progresses to NASH. With time, progressive fibrosis sets in, and NASH progresses to cirrhosis of liver. A cirrhotic liver is a fertile ground for developing liver cancers (hepatocellular carcinoma). A peculiar thing about NAFLD is that liver cancers can develop even in absence of cirrhosis in NAFLD.

How to diagnose fatty liver?

Blood investigations like liver function tests and imaging studies like abdominal ultrasound, fibroscan, MR Elastography (MRE) and CT scan for liver attenuation help in diagnosing fatty liver. Most of these patients may not have any symptoms in the initial stage of the disease. An abdominal ultrasound, done as a part of routine health check-up or for other indications and sometimes mild derangement of liver function tests may diagnose fatty liver in most instances. Fibroscan and MRE are very accurate to confirm the diagnosis of fatty liver.

How to prevent fatty liver?

Fatty liver is a lifestyle disease and lifestyle modifications can prevent fatty liver and keep liver healthy. Keeping the weight controlled by active lifestyle and avoiding unhealthy and junk foods goes a long way in keeping the liver healthy. Adding regular physical exercise in daily routine also helps in a big way to avoid fat deposition in liver.

How to treat fatty liver?

Fatty liver treatment is possible in most hospitals in Ahmedabad. The treatment requires guidance from liver specialists, diabetologist, dietician and physiotherapist. The treatment of fatty liver pivots on 3 things

Weight loss by diet control and physical exercise

Strict diabetes control in diabetic patients

Treatment of dyslipidemias like hypercholesterolemia and hypertriglyceridemia

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Weight control is the key to treatment of fatty liver. Studies have found that higher the degree of weight loss, the better is the improvement in fatty liver. Even, 5-7% weight loss in a person causes marked improvement in fatty liver. Diet control (restricting the calorie intake) and physical exercise in any form help in reducing weight.

Strict diabetes control is very important in diabetic patients with NAFLD to prevent progression of the disease. Also, medical treatment of dyslipidemias is also imperative for control and reversal of NAFLD.

Once cirrhosis sets in, in NAFLD, the treatment is very much like other patients of liver cirrhosis and most of these patients will ultimately require a liver transplantation.

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How to keep liver healthy?

Introduction of liver

Liver is the largest gland in the body. A healthy adult liver weighs 1300-1500 grams approximately. It is in the right upper quadrant of the abdominal cavity just below the diaphragm. It is in close relation with the diaphragm on the top, abdominal wall on right side and in the front, spleen on the left side, abdominal wall, inferior vena cava, and stomach behind, and gall bladder, transverse colon of large intestine and duodenum below. 

A healthy liver is soft in consistency and reddish brown in color. It is composed of three lobes – right, left, and caudate. The main blood supply of liver comes from portal vein and hepatic artery and blood drains out through hepatic veins.

Liver functions

Liver is an essential organ in the body for survival. It performs over 500 vital functions. These functions are mainly categorized into synthetic functions, metabolic functions, excretory functions, and immune functions. Important ones are mentioned below:

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More information: https://www.drdivakarjain.com/how-to-keep-liver-healthy/

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Liver Transplant Cost in Ahmedabad

Liver Transplant – the only cure!!

Liver cirrhosis is an irreversible structural transformation of a healthy liver to a scarred liver. Liver cirrhosis patients with decompensation, complications, and selected cases of liver cancers need liver transplantation. It is the only curative option in such cases.

However, transplant surgery comes at a cost.

Cost of liver transplant in Ahmedabad and India

The transplant surgery used to cost a fortune in its initial days. With major advances in technology and medicines and more centers coming up with transplant programs, the cost has come down significantly in last few years. Presently, the surgery costs anywhere between 15 lacs and 30 lacs in our country. There are few government hospitals, who have started liver transplant surgeries. The surgical cost is quite lower in such hospitals.

Why is transplant surgery costly?

Liver transplant is a team effort. The donor surgery and recipient surgery are done simultaneously. This surgery needs a team of at least 2-3 trained surgeons and 2-3 trained anesthetists and trained OT staff. The duration of the surgery is quite long, and the recipient surgery usually takes 7-12 hours to complete. The equipment and instruments, required

More information: https://www.drdivakarjain.com/liver-transplant-cost-in-ahmedabad/

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Alarm Bells in Liver Cirrhosis! When to contact the doctor urgently?

Liver cirrhosis causes nodular transformation of liver parenchyma with progressive deterioration of liver function. Liver Transplantation is a sustainable curative option for liver cirrhosis.

The patients of liver cirrhosis may live for a long time without needing liver transplantation, if they stay away from chemicals harming liver like alcohol, certain drugs and include a balanced, protein rich diet and regular exercise in their lifestyle. They must be in regular follow up with their physician with regular blood reports and imaging reports, as advised by the doctor.

There are certain alarming symptoms and signs in liver cirrhosis, which must prompt the patient to reach the doctor or the hospital immediately.

1) Blood in vomitus or stool or coffee colored vomitus or black colored stool

Blood in vomiting or vomiting of ground coffee color is suggestive of bleeding from dilated veins (varices) in food pipe (esophagus) or stomach. Black colored stool with tar-like appearance is also suggestive of bleeding in gastrointestinal tract. These bleeding episodes may often turn to be life-threatening. One must immediately reach the hospital in event of any such episode. One may require upper GI endoscopy or colonoscopy to find the source of bleeding and control it.

2) Increasing abdominal girth

Increasing abdominal girth may be suggestive of fluid accumulation in abdomen, also known as ascites in medical term. Ascites formation is indication of deteriorating liver function. One must consult the doctor as control of ascites may require some diet modification and/or addition of some medicines, known as diuretics. Ascites, which is not controlled by diuretics (refractory ascites), or intolerance to diuretics (diuretic-intolerant ascites) may warrant an early liver transplantation.

3) Altered sensorium, altered sleep cycle or loss of consciousness

Ammonia is detoxified by liver. Once liver function deteriorates, ammonia is not excreted out and starts building up in blood. High ammonia circulating in blood, may cause altered sensorium, altered sleep cycle or loss of consciousness, also known as hepatic coma. The conglomeration of these features is also known as hepatic encephalopathy, which may turn out to be a life-threatening condition. Onset of any of these symptoms warrants urgent hospitalization. Control of blood ammonia levels may require certain measures like lactulose enema and lactulose syrup.

4) Jaundice – yellowish discoloration of eyes, skin and urine

New onset of jaundice may be related to a binge of alcohol drinking or may be indicative of worsening function of liver. One must visit the doctor in such situation to get evaluated.

5)  Reduced urine output

Decreasing urine output in liver cirrhosis may be due to multiple causes like infection, hepatorenal syndrome (kidney dysfunction due to liver disease) or may indicate worsening of liver function. It may warrant hospitalization in some situations especially if it is associated with deranged kidney function tests or infection.

6) Acute pain in abdomen

Acute pain in abdomen in liver cirrhosis may be because of infection in fluid in abdomen (spontaneous bacterial peritonitis). It is a serious complication of liver cirrhosis and warrants hospitalization and intravenous antibiotics with tapping of fluid (ascites).

7) Fever

Liver cirrhosis compromises the immune system of a patient. Such patients are at risk of recurrent infections which may affect any part of the body, commonly – lungs, urinary system, and biliary system. It will require antibiotics and often hospitalization if infection is serious.

8) Difficulty in breathing

Patients with liver cirrhosis, may often develop fluid accumulation in abdomen or chest. Excessive fluid collection in abdomen can cause difficulty in breathing and/or difficulty in eating. Excessive fluid collection in chest can cause difficulty in breathing. One should immediately reach the hospital in any such situation. One may need removal of fluid and modification in medicines to relieve the symptoms and prevent further complications.

9) Significant weight loss

Sudden and significant weight loss (involuntary weight loss – more than 10% of weight in last 6 months or more than 5% of weight in last one month) may be indicative of worsening of liver function or onset of a new complication like liver cancer. In event of significant weight loss, one must immediately contact the doctor and get evaluated.

10) An abnormal mass or lesion on routine ultrasound or CT scan

Liver cirrhosis is a pre-malignant (cancer predisposing) condition. This is the reason, why, regular scans in form of ultrasound are advised for the patient. If during such scan, any mass or lesion in liver is detected, it warrants further evaluation in form of blood tests and CT scan or MRI. Such patients may require liver transplant, surgical resection of tumor containing part, ablation, TACE or chemotherapy, depending on the stage of the tumor, functional status of the liver, and general health status of the patient.

Conclusion

The patients with liver cirrhosis must stay in regular follow up with their physicians. Onset of any of the above symptoms must prompt them to reach the hospital and get evaluated by their physician.

The above is the management in brief about liver cirrhosis. If you have any patient suffering from liver problems, do consult your Liver specialist. To know more, feel free to call +91 6359 602647

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Dr. Divakar Jain - Liver Transplant Specialist | HPB Surgeon

ABOUT

Dr. Divakar Jain

M.B.B.S., M.S., F.A.C.S., D.N.B. (Surgical Gastroenterology) Fellowship in HPB Surgery & Liver Transplantation Senior Consultant HPB Surgery & Liver Transplantation KD Hospital, Ahmedabad

The treatment of liver, pancreatic, and biliary diseases need expertise and experience. Liver transplantation is one of the most complex surgeries in medical science. These surgeries need an experienced surgeon, best OT complex, excellent infrastructure, and support from other medical specialties.

Dr. Divakar Jain is an excellent surgeon of cancerous and non-cancerous diseases of liver, biliary system and pancreas, and liver transplantation. He has an experience of 20 years in surgical field. He is trained in best surgical centers and has worked in top notch hospitals in world. He has a cumulative experience of more than 800 liver transplants, which includes living donor and deceased donor liver transplants, pediatric liver transplants, and ABO incompatible liver transplants. He also has an extensive experience in complex hepato-pancreatic-biliary surgeries.

The surgeries are done in one of the best hospitals in the country. The hospital has excellent OT complex, finest infrastructure, experienced doctors, and always helpful nursing staff. We have a full-time available team to take care of the patients. We have a state of art liver transplant ICU, spacious and large patient rooms and one-on-one nursing care. As a result, we have one of the best results in our surgeries. [Read More]