The elderly patient was unable to eat due to a melon-sized tumour in her liver

Navi Mumbai, 6 October 2022: Sonabai Sawant 87-year-old woman from Karjat travelled to Apollo Hospitals, Navi Mumbai with an MRI report of her liver. She was diagnosed with a tumour of melon size in the left lobe of her liver. A timely hepatectomy by a multidisciplinary team of doctors at Apollo Hospitals, Navi Mumbai gave her a new lease of life. The massive tumour in her liver was compressing her stomach making her unable to eat. She was also thin and frail with a single kidney and hypertension making her health conditions critical and a high risk for surgery.

Dr Shailesh Sable, Lead Transplant Surgeon, Apollo Hospitals, Navi Mumbai, said, “Her family was keen on improving her health condition and did not think of her age and co-morbidities as a limitation. She was at a high risk of morbidity and mortality. Nevertheless, her family wanted to get rid of the tumour as it was affecting her lifestyle significantly. With a lot of reluctance, I agreed to let her undergo the process of tumour evaluation and fitness tests which she passed effortlessly.”

After several iterations with a multidisciplinary team, she underwent a smooth surgery with no challenges during the surgery. The clinical team comprised Dr Shailesh Sable, Consultant, HPB & Liver Transplant Surgery, Dr Ketul Shah, Consultant, HPB & Liver Transplant Surgery, Dr Makrand Karpe, Clinical Associate, Surgical Oncology, Dr Deep Mashru, Clinical Associate, Surgical Oncology, Dr Ambreen Sawant, Anaesthetist, Dr Pinky, Anaesthetist, Dr Gunadhar Padhi, Consultant, Critical Care Specialist, Dr Suvadeep Sen, Consultant, Critical Care Specialist and the nursing and physiotherapy staff. She was put off intensive care and was on her foot on day two of post-surgery. A week later on her follow-up visit to the doctor, she brought indigenous sweets made by her.

Mr. Santosh Marathe, Regional CEO, said, “A lot can be learned from the elderly lady. She proves that age is just a number and that a positive attitude and active lifestyle along with an excellent clinical team can return one’s independence even at later stages in life. We are the first hospital in Western India to perform such a major Liver resection for liver cancer in an Sonabai Sawant 87 years patient. This is because Apollo Hospitals, Navi Mumbai is equipped with the latest state-of-the-art technology and clinical talent to undertake difficult surgeries and produce excellent outcomes.”

Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent liver disease that affects 34 per cent of children with obesity, according to a study published on pubmed.gov. Medical News Today stated that NAFLD is the most common liver disease among children in the United States, and the number seems to be rising worldwide. Besides liver-related morbidity, NAFLD also increases the risk of cardiometabolic diseases in adulthood.

NAFLD is a silent disease, which means it is generally a symptomless condition. But, Dr Sable shared that as the disease progresses to fibrosis and/or cirrhosis stage it can interfere with critical functions of the liver. In the early stage, symptoms could be easy fatigue or feeling of tiredness, or subtle discomfort in the right upper abdomen. Stage of cirrhosis may present with jaundice, fluid in the tummy or swelling over the legs, disorientation or excessive daytime sleepiness, etc.

Are diet and exercise the sole solutions?

Dr Sable said that even though eating a balanced diet, limiting sugars and salt, consuming lots of green leafy vegetables and fresh fruits along with regular exercise does reduce weight, thereby reducing fatty liver, not all fatty livers are associated with obesity alone; lowering cholesterol with the help of medications are sometimes indicated under specialist medical supervision. “There is no medication approved for fatty liver disease, some studies indicate the role of vitamin E and anti-diabetic drugs but remain experimental. Till then balanced diet and regular exercise remain the gold standard therapy,” he said.

What can parents do?

Screening for fatty liver is a controversial topic at this moment, partly because there’s no treatment other than weight loss and non-availability of perfect screening tool. Dr Sable said that “ultrasonography (USG) of liver (prone to inter-observer variation) and liver function test (AST/ALT) to check inflammation in liver are the commonly used modalities by most clinicians.” Rarely, MRI of the liver can be used to grade the fat in the liver. However, the requirement of sedation in smaller kids, high cost and claustrophobia limits its utility, he added.

What can be the complications if the disease progresses unchecked?

Fatty liver disease is a spectrum of disease ranging from mild fat accumulation in liver (fatty liver) to NASH or non-alcoholic steatohepatitis (inflammation in fatty liver) to cirrhosis (end stage liver disease). And even though cirrhosis due to inflammation is rare in children, it’s a concerning long term complication that leads to end stage liver disease, said Dr Sable. “Cirrhosis presents itself with jaundice, Ascites (fluid in tummy), encephalopathy (disorientation/ coma), and dysfunction of other organs like kidneys, heart and lungs.”

Liver maintains body’s metabolism, helps clearing toxins and waste products, provides immunity (filtering bacteria from blood), manufactures proteins and cholesterol and helps blood clotting etc. “If it stops working due to cirrhosis (end stage liver disease), then liver transplantation is the only life-saving treatment option available.”

Read More : All you need to know about fatty liver disease in children