Patients who have history of alcoholism, hepatitis B or hepatitis C infection, obesity or diabetes have a high chance of having liver disease and should consult a liver specialist to evaluate if their liver has any damage or if there is liver disease. The stage of the liver disease will be examined and the need for precautions and further treatment will be suggested. Patients with early liver disease (fatty liver) may have no symptoms but they should have a regular follow-up with their liver specialist at least every few months.
Patients who have recently developed jaundice, excessive sleepiness, irrelevant talk, excessive weakness, itching or other similar symptoms should also consult a liver specialist, as they could have developed an acute form of liver disease sometimes called as hepatitis. Such diseases always need urgent attention of a liver specialist, although most often these are not serious. These liver diseases may be more common after having contaminated food or in a person who is habituated for binge drinking (large amount of alcohol consumed in a short time) or after taking some medicines (especially anti-TB and ayurvedic medicines containing heavy metals).
Patients with advanced liver disease such as liver cirrhosis may have symptoms such as jaundice (yellow eyes or urine), blood vomiting, swelling in the feet or abdomen (belly), excessive sleepiness, irrelevant talk, excessive weakness, itching or others. Patients who may have developed such symptoms recently should consult a liver specialist as soon as possible as these symptoms could indicate a serious underlying problem. Depending on their symptoms, their liver specialist may advise them to restrict their liquid and salt intake, take a high protein diet and medicines to keep their bowel movements regular, keep their swelling and other symptoms under control and treat their liver disease. These medicines should be available for about 1 month as their availability may be an issue due to the lockdown.
Patients with very advanced liver disease who need a liver transplant are often under care of a liver specialist and may be waiting for a liver transplant. Regular testing should not be omitted, if required use home collection of blood samples offered by many labs. Most doctors also offer tele-consultation which could be utilized to review your progress with them. If the patient is stable, the transplant should be planned only after the lockdown period. However, in case of an emergency, if the patient’s condition is worsening or if a cadaveric liver is offered to the patient, they should be able to go ahead with the transplant if the donor and the patient are both negative for the COVID infection.
During the COVID-19 pandemic, they should limit their movement in the community and exposure to other sick patients as patients with advanced liver disease may have a weak immune system. As there is currently no proven vaccine to prevent or antiviral medicine to treat this infection, it may be best to avoid it as it may be more difficult for patients with advanced liver disease to fight this infection. Patients may have a lot of free time during the lockdown and should identify productive activities to keep themselves occupied indoors such as pursuing their hobby (painting, reading, etc.). Try to continue indoor exercises such as walking or jogging (in a small area) or using stationary exercise cycle as tolerated by you. Patients and their family members should strictly avoid smoking as it can be dangerous in case of COVID-19 infection. There should be no alcohol intake as it can suddenly worsen a stable liver disease. In case of high-grade fever, dry cough or sputum production, they should be seen immediately and tested for suspected infection by a pulmonologist (lungs specialist) and an infection disease (ID) specialist keeping the liver specialist informed of all progress.
While being treated for the infection, the condition of their liver disease should be closely monitored by a liver specialist.
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