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When should you contact hepatologist Dr Kinisha Patel

Paediatric hepatologist is a super specialist doctor who diagnose and treat liver and biliary diseases
in children.
Liver diseases in children are different than adults as they have varied presentation, as most of them
are progressive from birth or from early infancy.


  • Jaundice – yellow eyes, skin
  • Dark color urine
  • Change in stool color (Pale yellow or clay or white)
  • Abdominal distension (Fluid in abdomen –ascites)
  • Loss of appetite
  • Itching
  • Pain abdomen (right upper quadrant)
  • Vomiting
  • Blood in vomiting
  • Tarry black color stool


  • Jaundice
  • Liver &/or spleen enlargement
  • Abnormal behavior
  • Neurological disorientation or other abnormalities with jaundice
  • Nails clubbing
  • Abdominal distention (Ascites)
  • Swelling of limbs
  • Other organ involvement (kidney, lungs)

Role of liver transplant Physician:

  • An expert with experience to manage all children from birth to 18 years of age, who needs liver transplantation along pre & post transplant surgery care (Medical management).
  • To decide when child needs transplant-specific indication other than liver failure How much time we have till liver transplant procedure- to take a decision from advancement of liver disease –whether can be treated medically for longer duration/other option till transplant – supportive management.
  • When transplant is planned – certain contraindication for management like blood transfusion, certain medication use Pre transplant preparations- counselling, documentations, donor & recipient investigations, continuous supportive treatment. To send to correct centre for transplant based on finance, age, weight, emergency, Finance.
  • Post transplant – PICU Care, medical management, immunosuppressant decision, Complication identification & management.
  • Long term follow up care- Regular medications, doses changes, investigations to choose, any complication like rejection, PTLD, Infection, GVHD, surgical complication, drug related complication – to identify correctly & to manage – to contact transplant surgeon (As who has done the surgery must be in loop to know anatomical changes while surgery is been done)

Important Liver Disease

  • Biliary atresia
  • Choledochal cyst
  • Hemochromatosis
  • Viral infection causing liver failure
  • Budd chiari syndrome
  • Metabolic liver disease/In born error of metabolism
  • Neonatal hepatitis
  • PFIC
  • Alagille syndrome

In older children:

  • Autoimmune hepatitis
  • Sclerosing cholangitis
  • Wilson disease
  • Metabolic liver disease
  • Acute liver failure
  • PFIC
  • Viral Hepatitis (A to E)
  • Portal Hypertension

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