A 45-year-old gentleman presented to us with a 1-week history of passing black colour stools. He is a diabetic and hypertensive since 15 years, and never had any complaints in the past. His lab investigations showed low haemoglobin (6.3gm), low platelets (70000) with normal total leukocyte count. LFTS showed Total bilirubin=1.6; ALT (SGPT) =30; SGOT (AST) =60; ALBUMIN=2.8. 2 units packed red blood cells were transfused and to evaluate GI bleed, he was taken up for upper GI endoscopy which showed large oesophageal varices with signs of recent bleed. Hence endoscopic variceal ligation (EVL) was done.
To evaluate the cause for oesophageal varices, ultrasound abdomen was done which showed coarse liver with dilated portal vein and splenomegaly with no ascites. Triple phase CT scan was done to rule out the presence of any lesions in the liver and CT scan confirmed the features of chronic liver disease with no lesions in the liver. Blood workup for the cause of liver disease including ANA, AMA, ASMA,
FERRITIN, CERULOPLASMIN, HBsAg and HCV was negative.
He was managed with IV terlipressin, IV fluids and IV albumin. He recovered very well with the above treatment and was discharged home with non-selective beta-blockers (carvedilol) to reduce his portal hypertension. He is stable at subsequent follow-up and was counselled regarding the need for regular follow-up and that he would need liver transplantation eventually.
LIVER IS A SILENT KILLER. The symptoms of chronic liver disease appear only when the liver has gone into permanent irreversible damage (cirrhosis) and the presentation is often with any one of the decompensations like GI BLEED / HEPATIC ENCEPHALOPATHY/ ASCITES. At the stage of cirrhosis, the only definitive solution would be liver transplantation. Hence regular monitoring of liver function tests will not only help in early diagnosis but also will aid in arresting further progression to CIRHHOSIS OR HCC (HEPATOCELLULAR CARCINOMA).
Dr. Naveen Polavarapu, MRCP (UK), FRCP (GASTRO), UK CCT (Consultant Transplant Hepatologist)
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