Browsing by Author "Pathak, Rahul"
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Publication Clinical Spectrum and Demographic Profile of Alcoholic Liver Disease Among Females Attending Tertiary Care Center in Nepal(Institute of Medicine, 2021) Koirala, Dinesh; Anees, Shahbaaz; Pathak, Rahul; Bhandari, Brindeswari Kafle; Jha, Anurag; Hamal, Rabin; Gnawali, Arun; Bhusal, MohanABSTRACT Introduction: Alcohol is the most common abused substance in Nepal. Women tend to present with more severe liver disease with a shorter period of excessive drinking and at a lower daily alcohol intake compared to men. Methods: Adult female patients aged 16 years and above, with a diagnosis of ALD were included for a period of 1 year. Liver disease secondary to other causes were excluded. Demographic profiles, clinical features, laboratory, endoscopic findings, Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD) of the patients were recorded. Results: A total of 144 female patients with ALD were included in the study. The mean age of the patients was 48.6 years (SD=12.7). Majority of the patients were from Hilly region (n=66, 45.8%), married (n=135, 93.8%), housewife (n=83; 57.6%), Hindu by religion (n=93; 64.6%), and Tamang (n =39; 27.1%) by caste. Most common clinical features of the patients were abdominal distension (n=117; 81.2%), bilateral lower limb swelling (n=89; 61.8%), jaundice (n=54; 37.5 %) and anorexia (n=53; 36.8%). The main reason for alcohol consumption was found to be family custom in 42.3%. Esophageal varix was present in 119 (82.6%) patients. Out of 124 patients with cirrhosis, 63 (50.8%) patients were in CTP stage C and 103 (83.1%) patients had MELD score ≥ 16. Conclusion: ALD was predominantly seen among the younger female patients. The most common clinical presentations were abdominal distension, bilateral lower limb swelling, jaundice and anorexia. Among the cirrhotic patients, most of patients were in CTP class C and had MELD score ≥ 16. Keywords: Alcoholic liver disease, clinical profile, demographic profile, femalePublication Clinical Profile and Endoscopic Management in Patients with Choledocholithiasis(Nepal Health Research Council, 2024) Lamsal, Manoj; Jha, Anurag; Kafle, Brindeswari; Hamal, Rabin; Sherpa, Tshering Wangdi; Kafle, Pradip Kumar; Bhattarai, Tulsi Ram; Bhusal, Mohan; Koirala, Dinesh; Pathak, RahulBackground: Common bile duct stones is a common medical problem that are usually seen in association with gallstone disease. Endoscopic management of Common bile duct stones involves doing Endoscopic retrograde cholangiography for bile duct clearance which is the primary therapeutic modality of choice. This prospective study was done to identify the clinical characteristics and outcome of patients presenting with Common bile duct stones undergoing Endoscopic retrograde cholangiography. Methods: A prospective observational study was conducted on all patients undergoing Endoscopic retrograde cholangiography in department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of diagnosed or suspected choledocholithiasis from April 2023 to March 2024. Patient demographics, clinical characteristics, Endoscopic retrograde cholangiography findings and post procedure outcome data were collected and analysed. Results: A total of 110 patients (61.8% male and 38.2% female) were included in the final analysis. Successful clearance of Common bile duct was obtained in 76.4% patients with overall adverse events of 18% related to the procedure. Among patients undergoing the procedure, 16.4% couldn’t be managed with Endoscopic retrograde cholangiography and were referred for surgical management. Conclusions: Endoscopic management in form of Endoscopic retrograde cholangiography is a safe and effective method to manage patients with Common bile duct stones. Keywords: Common bile duct calculi; endoscopic sphincterotomy; ERCP.Publication Comparison of Acute Physiology and Chronic Health Evaluation II, Bedside Index for Severity in Acute Pancreatitis and Modified Computed Tomography Severity Index Scores in Predicting the Outcome in Acute Pancreatitis in a Tertiary Care Centre in Nepal(Nepal Health Research Council, 2023) Pandey, Rajesh; Pathak, Rahul; Jha, Anurag; Gnawali, Arun; Koirala, DineshAbstract Background: It is important to identify the severity of acute pancreatitis in the early course of the disease. Methods: This prospective observational study included 83 patients with acute pancreatitis. The Acute Physiology and Chronic Health Evaluation II and the Bedside Index for Severity in Acute Pancreatitis scores were assessed within 24?hours of admission, and the modified computed tomography severity index score was calculated in those patients who underwent contrast enhanced computed tomography. The sensitivity, specificity, positive predictive value, and negative predictive value of scoring systems were calculated. The area under the curve was calculated for assessing the prognostic value of scoring systems. Results: The modified computed tomography severity index was the most accurate score in predicting severity and local complications with an area under the curve of 0.92 and 0.91, respectively. The Bedside Index for Severity in Acute Pancreatitis score was the most accurate in predicting organ failure and the need for intensive care unit admission with an area under the curve of 0.70 and 0.78 respectively. Conclusions: The results of this study demonstrate that modified computed tomography severity index and Bedside Index for Severity in Acute Pancreatitis scores had overall better predictive value than the Acute Physiology and Chronic Health Evaluation II score in predicting severity, organ failure, local complication, and need for intensive care unit admission. Keywords: Acute pancreatitis; APACHE II; BISAP; modified CTSIPublication Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient(Institute of Medicine, 2019) Parajuli, Pawan; Bhandari, Ramesh S; Pathak, Rahul; Sharma, Shashi; Khadga, Prem K; Jha, Anurag; Hamal, Rabin; Kafle, BrindeswariABSTRACT Introduction Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology. Methods Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis. Results Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy. Conclusion Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology. Keywords: Ascites, peritoneal carcinomatosis, peritoneoscopyPublication Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient(Institute of Medicine, 2019) Parajuli, Pawan; Bhandari, Ramesh S; Pathak, Rahul; Sharma, Shashi; Khadga, Prem K; Jha, Anurag; Hamal, Rabin; Kafle, BrindeswariABSTRACT Introduction Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology. Methods Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis. Results Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy. Conclusion Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology. Keywords: Ascites, peritoneal carcinomatosis, peritoneoscopyPublication Diagnostic and Therapeutic Value of ERCP : Experience from a Tertiary Care Center(Institute of Medicine, Tribhuvan University, 2024) Pathak, Rahul; Lamsal, Manoj; Jha, Anurag; Kafle, Brindeswari; Hamal, RabinAbstract: Introduction The role of ERCP to diagnose and manage biliopancreatic diseases is increasing since its inception with refinement of operator skill, technical advancement and better patient selection. The aim of the study was to explore common clinical and endoscopic characteristics, outcome, adverse events and safety profile of patients. Methods An observational study was conducted on patients undergoing ERCP in Department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of biliopancreatic diseases from April 2023 to March 2024 after taking approval from IRC-IOM. Patient demographics, clinical characteristics, ERCP findings and post procedure outcome data were collected and analyzed using SPSS version 26. Results A total of 200 patients were included with mean age 52.36±17.04 years and female:male ratio of ~3:2. Elective procedures were done in 182 (91%) patients and in 18 (9%) as urgent procedure (within 48 hours). The most common indications were choledocholithiasis (157, 78.5%) followed by benign biliary stricture (12, 6%). The most frequent papilla was type 1 papilla (normal variant) in 48% followed by type 3 papilla (protruding) in 30%. Difficult cannulation was encountered in 130 (51.5%) cases. Post ERCP pancreatitis (8, 4%) and hypoxia (9, 4.5%) were the most common procedure and anesthesia related adverse events respectively. Common therapeutic interventions included sphincterotomy (176, 88%), CBD stenting (154, 78.5%) and precut sphincterotomy (45, 22.5%). Conclusion ERCP was mostly done for benign diseases like CBD stone and benign biliary strictures. Common therapeutic procedures were sphincterotomy and CBD stenting. Complications related to procedure and anesthesia though occured, their rate was low.Publication Efficacy of Lactulose and Polyethylene Glycol in the Treatment of Hepatic Encephalopathy(Nepal Health Research Council, 2025) Pathak, Rahul; Lamsal, Manoj; Bhusal, MohanBackground: Hepatic encephalopathy presents a significant clinical challenge in individuals with advanced liver dysfunction, manifesting as confusion, altered consciousness, and personality changes. This study aimed to compare the efficacy of lactulose and polyethylene glycol in managing Hepatic encephalopathy. Methods: The study is conducted at Tribhuvan University Teaching Hospital in Nepal; the study enrolled 45 cirrhotic patients with altered mental status in each study group. Ethical approval and informed consent were obtained. The basic demographic and clinical data were collected, including laboratory investigation and precipitating factors for Hepatic encephalopathy. The severity of Hepatic encephalopathy was assessed using the West Haven Criteria. Results: In this study there was significant difference between two groups in terms of mean time taken for complete resolution of hepatic encephalopathy, with mean of 2.98 ± 2.129 days in Polyethylene Glycol group compared to mean of 4.67 ± 3.076 days in Lactulose group, with a significant p-value of 0.004. There was also significant difference in length of hospital stay between two groups, with a mean hospital stay of 6.36 ± 3.654 days in Polyethylene Glycol group compared to 9.70 ±5.388 days in Lactulose group, with a significant p-value of 0.001. Conclusions: In conclusion, polyethylene glycol showed promising results in the treatment of Hepatic encephalopathy compared to lactulose polyethylene glycol. demonstrated an improvement and quicker resolution of Hepatic encephalopathy symptoms, highlighting its potential as a cost effective and safe alternative for managing Hepatic encephalopathy in cirrhotic patients. Keywoards: Hepatic encephalopathy; lactulose; polyethylene glycol.Publication Epidemiological Characteristics of Hepatitis C Patients Attending a Tertiary Care Hospital(Nepal Health Research Council, 2024) Kattel, Hari Prasad; Sharma, Sangita; Alfsnes, Kristian; Pathak, Rahul; Rijal, Komal Raj; Ghimire, Prakash; Andreassen, Ashild K; Banjara, Megha RajBackground: Hepatitis C infection is a major public health concern in Nepal. Epidemiological information on hepatitis C virus along with the status of co-infection with hepatitis B virus and human immunodeficiency virus is essential to controlling the hepatitis C burden. The objective of this study was to determine the sero-prevalence of hepatitis C virus infections, proportions of co-infections with human immunodeficiency virus and hepatitis B virus, and identify the demographic characters, and routes of transmission. Methods: A cross-sectional study was conducted from December 2019 to February 2024 at Tribhuvan University Teaching Hospital. The serological tests were performed by enzyme-linked immunosorbent assays from 25133 patients’ serum in four years. Results: The sero-prevalence of hepatitis C virus -infected patients was 0.8% (211/25133). Among them, 6.6% (14/211) were co-infected with human immunodeficiency virus and 1.4% (3/211) with hepatitis B virus. Among 211 hepatitis C virus patients, 174 (82.5%) were male, 156 (73.9%) were young aged 15–47 years with various professions, 167 (79.1%) were literate, and almost one-third of the patients (33.2%, 70/211) were regular alcoholics. Needle sharing among intravenous drug users (45.5%, 96/211) and sexual intercourse (28%, 59/211) were the most common modes of transmission. Conclusions: Although the prevalence of hepatitis C infections is less than 1%, it is more common among young male intravenous drug users. Awareness of the spread of hepatitis C infections among this population needs to be emphasized to control hepatitis C in Nepal. Keywords: characters; co-infection; hepatitis C, sero-prevalence.Publication Epidemiology and Demographic Profile of Inflammatory Bowel Disease in Nepal(Institute of Medicine, 2023) Ranjan, Mukesh K; Pathak, RahulABSTRACT Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract. Once thought to be a disease of the developed nations, the burden of IBD has been rising in Asian countries. Inflammatory bowel disease leads to severe impairment in the quality of life of the patients. There have been numerous studies across the globe which have provided new insight into different aspects of this disease. Not only IBD is being diagnosed more but patients are also becoming more aware of this debilitating condition. It is encouraging to see a few studies from Nepal in the recent past. However, the epidemiological and demographic features of IBD remain largely unknown. Through this review, we aim to gain insight into the epidemiology and demographic features of patients with IBD in Nepal. Keywords: Crohn’s disease; epidemiology; inflammatory bowel disease; ulcerative colitisPublication Hepatocellular Carcinoma among Patients with Chronic Liver Disease in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Gnawali, Arun; Pathak, Rahul; Koirala, Dinesh; Pandey, Rajesh; Hamal, Rabin; Jha, Anurag; Bhandari, Brindeswari Kafle; Gyawali, SiddinathAbstract Introduction: Hepatocellular carcinoma is the most common primary liver cancer. Viral hepatitis, alcohol abuse, and autoimmune hepatitis are the common causes of hepatocellular carcinoma. Usually patients present at advanced stages where curative treatment is no longer possible. This study aimed to find the prevalence of hepatocellular carcinoma among patients with chronic liver disease in a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted in a single tertiary care centre from March 2020 to August 2022. The study was done among inpatients of the Department of Gastroenterology after ethical approval from the Institutional Review Committee. A total population sampling method was used and data were collected using predetermined proformas. Point estimate at 95% Confidence Interval was calculated. Results: Among 1440 patients, hepatocellular carcinoma was seen in 54 (3.75%) (2.77-4.73, 95% Confidence Interval). At the time of diagnosis, 48 (88.89%) were symptomatic. The presenting symptoms were weight loss seen in 35 (64.81%) being the most common. Out of them, 37 (68.52%) consumed alcohol and 40 (74.07%) smoked cigarettes. Conclusions: Hepatocellular carcinoma is a notable concern. Alcohol-related liver cirrhosis is the most frequent condition encountered in patients with hepatocellular carcinoma in our setting.Publication Liver and Spleen Stiffness as Predictors of Esophageal Varices in Patients with Liver Cirrhosis(Institute of Medicine, 2023) Jaishi, Shila; Pathak, Rahul; Bhandari, Brindeswari Kafle; Jha, Anurag; Hamal, Rabin; Koirala, Dinesh; Gyawali, SusmitaABSTRACT Introduction: The risk for the occurrence of esophageal varices in a cirrhotic patient is assessed by two gold standard invasive tests: hepatic venous pressure gradient measurement and esophagogastroduodenoscopy. We aim to find the association between spleen and liver stiffness with the occurrence of esophageal varices in our settings. Methods:This was a prospective cross-sectional study. In the study duration of one year, 94 cirrhotic patients who met the inclusion and exclusion criteria were included. All patients were subjected to transient elastography for measuring liver and spleen stiffness and endoscopy. Results: Of 94 patients, only 77 (81.9%) had esophageal varices. The mean liver stiffness in patients with and without varices was 19.46±4.9SD kPa and 12.92±1.52 SD kPa respectively. The difference was statistically significant, p<0.001. The mean spleen stiffness in patients with and without varices was 22.26±4.6 SD kPa and 14.08±1.20 SD kPa respectively. The difference was statistically significant, p<0.001. The optimal cut-off value of liver and spleen to detect patients with any grade of esophageal varices was 14 and 16.15 kPa respectively. Conclusion: The stiffness of liver and spleen using transient elastography can be considered an equivalent method for screening cirrhotic patients for esophageal varices in clinical settings. Keywords: Cirrhosis; esophageal varices; liver stiffness; spleen stiffnessPublication Liver Cirrhosis among Young Adults Admitted to the Department of Gastroenterology in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Bhusal, Mohan; Pathak, Rahul; Bhandari, Brindeswari Kafle; Jha, Anurag; Hamal, Rabin; Koirala, Dinesh; Lamsal, Manoj; Kafle, Pradip KumarAbstract Introduction: Cirrhosis in young adults is an important health problem worldwide and is a common disease. Patients usually present late in a decompensated state with varied complications. However, national data on the exact burden of the disease is lacking. The aim of this study was to find out the prevalence of liver cirrhosis among young adults admitted to the Department of Gastroenterology in a tertiary care centre. Methods: A descriptive cross-sectional study was done among patients admitted to the Department of Gastroenterology in a tertiary care centre between 25 November 2021 to 30 November 2022 after receiving ethical approval from the Institutional Review Committee [Reference number: 227(6-11)E2-078/079]. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 989 patients, liver cirrhosis in young adults was seen in 200 (20.22%) (18.12-22.32, 95% Confidence Interval). Chronic alcohol use was the primary cause of cirrhosis seen in 164 (82%) cases. The most typical presenting symptom was abdominal distension seen in 187 (93.50%) patients. The most frequent complication was ascites seen in 184 (92%) patients. The most frequent endoscopic finding was gastro-oesophagal varices seen in 180 (90%) patients. There were 145 (72.50%) men and 55 (27.50%) women. Conclusions: The prevalence of liver cirrhosis in young adults was found to be lower than the other studies done in similar settings.Publication Nutritional Assessment of Patients with Liver Cirrhosis by Nutrition Screening Tool and Anthropometry at a Tertiary Care Center(Institute of Medicine, 2019) Sherpa, Tshering W; Pathak, Rahul; Khadga, Prem K; Sharma, Sashi; Hamal, Rabin; Jha, AnuragABSTRACT Introduction Malnutrition is one of the most common complications of liver cirrhosis. Yet, little attention is paid in evaluating nutrition in this group of patients. This study aims to assess malnutrition among cirrhotic patients using a nutrition screening tool and anthropometry. Methods This was a prospective, observational study of admitted patients with liver cirrhosis. In the study duration of 3 months, 50 patients met the inclusion criteria and were included. Nutritional assessment was performed using the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), BMI and standard anthropometry including TSF, MUAC and MAMC. Results The mean age was 51.56 ± 11.50 with a Male to Female ratio of 3:2. Chronic alcohol consumption (72%) was the most common etiology while management of tense ascites (40%) was the most common reason for hospital admission. 58% had Child Pugh Class C cirrhosis while the remaining 42% were Class B. The average MELD Na score was 19.64 ± 6. Significant differences in anthropometric measurements including BMI, MUAC, TSF and MAMC were found between Child B and C cirrhosis. Similarly, those patients who had low, moderate and high risk of malnutrition by the RFH-NPT had significant differences in anthropometric measurements between them. Conclusion A significant number of patients had moderate to severe risk of malnutrition that correlated well with anthropometric measurements. The degree of malnutrition is parallel with the severity of liver disease among these patients. Both the RFH-NPT and anthropometry are relatively easy to perform and effective. Hence, they can be used as a practical means for identifying malnutrition among cirrhotic patients in routine clinical practice. Keywords: Anthropometry, liver cirrhosis, malnutritionPublication Symptomatic Hyponatremia following Bowel Preparation for Colonoscopy: A Case Report(Nepal Medical Association, 2020) Shrestha, Pramesh Sunder; Acharya, Utsav; Karki, Bipin; Pathak, Rahul; Acharya, Subhash PrasadAbstract: Colonoscopy is considered a gold standard tool for the diagnostic evaluation of colorectal diseases. Bowel preparation, a pre-requisite for colonoscopy, usually involves ingestion of purgatives for the cleansing of the bowel so that visualization is not obscured during the procedure. Commonly used preparations are sodium phosphate-based solutions, sodium picosulphate and polyethylene glycol. The use of such preparations is associated with electrolyte disturbances, commonly hyponatremia. Hyponatremia is usually seen with sodium phosphate based solutions and is rare with polyethylene glycol. Symptomatic hyponatremia, however, is rare following bowel preparation and is attributable to other factors as well, such as the age of patient, non-osmotic release of antidiuretic hormone and the procedure itself. In this report, we discuss a case of severe symptomatic hyponatremia observed in a 71-year-old gentleman who underwent polyethylene glycol based bowel preparation for colonoscopy.