Dr Raese Khan Gastroenterologist and Hepatologist.

06/01/2026

IRON DEFICIENCY ANEMIA ! in Male.

25 year old male with no overt GI bleeding.

Patient has been prescribed Antacid medcine for acid symptoms

and IV iron on multiple times for low hemoglobin and MCV.

All male patients and post menopausal women with Iron deficiency anemia

need to have gut screening in the form of ENDOSCOPY / COLONOSCOPY and Small intestine screening.

This Patient came to my OPD and on the very first visit was advised gut screening.

Endoscopy done shows DUODENAL ULCER

03/01/2026

Hepatitis C —— Liver cirrhosis and Cancer.

This virus silently gets into our body and stays in our liver for decades without any symptoms.

The patient ultimately comes to notice the symptoms of liver cirrhosis in the form of

Drop in blood cells( hemoglobin/Wbc / platelets)
Fluid in abdomen ( ascitis) , yellow eyes,

vomiting of blood and frequent drowsiness and loss of consciousness.
Liver cancer.

At this stage there is no treatment to reverse the liver damage and the only solution is
the LIVER - Transplant.

Since there are no symptoms of hepatitis C infection and the outcome of this infection is end stage liver disease,

We need to diagnose it on priority.
WHO recommends to test every one , however there are certain groups where we need to test more frequently.

1. Diabetic patients.

2. History of dental extraction or dental procedure.

3 IV drug abuse.

4. Surgery or blood transfusion.

5. Tattoo on body.

6. Nose or ear piercings.

7 Family history of hepatitis C.

8. Those with Rheumatoid Arthritis and other connective tissue diseases.

Ensure safe syringe use, dental procedures to be done at a place where proper sterilisation is performed.

Hygienic practice of instrument sterilisation at barbershops.

Repeating hepatitis B and C testing 3 to 4 months after any invasive procedure including dental procedures.
A simple card test for hepatitis B and C costs somewhat between 100 to 300 rupees.

👇👇👇This patient had only one symptom and that was Pruritis ( itching ).

And there was a history of dental extraction.

Since one of the rare symptoms of hepatitis C which is otherwise asymptomatic is itching and body aches.

I advised hepatitis C test and it came positive.

01/01/2026

HEPATITIS E —— PREGNANCY

Hepatitis E predominantly spreads through contaminated food and water.

There has to be extreme caution in last three
months of pregnancy.

One should avoid consuming street foods , or salad, better is to strictly consume home cooked-food in last three months of pregnancy.

During outbreaks, fulminant hepatitis E disproportionately affects pregnant women, with the most severe cases occurring in the third trimester.

While the mortality rate from hepatitis E in the general population ranges from 0.1% to 4%,

this rate increases dramatically among women in the third trimester, reaching between 10% and 50%.

The precise reasons for this heightened mortality in pregnancy remain unclear.

Fatal outcomes are mainly due to fulminant liver failure and pregnancy related complications such as severe bleeding.

Additionally, infection with HEV genotype 1 during pregnancy is linked to adverse fetal outcomes including miscarriage, premature birth, and stillbirth.

In regions where genotype 1 predominates, pregnant women,

especially those in their second or third trimester,

face a significantly higher risk of symptomatic and severe disease compared to nonpregnant women and men during outbreaks.

Effects on mother!

• Increased susceptibility to illness during hepatitis E Outbreaks.

• Greater likelihood of developing symptoms upon HEV infection

› Elevated risk of severe disease progression and acute liver failure.

› These risks are predominantly linked to HEV genotype 1 rather than genotypes 3 or 4.

› HEV genotype 1 exhibits more efficient replication within maternal-fetal interface tissues compared to genotype.

Effects on fetus!

• Increased risk of complications during pregnancy
• Miscarriage
• Intrauterine death
• Premature delivery
› Increased risk of neonatal complications
• Neonatal hepatitis
• Acute liver failure
• Neonatal death
• Low birth weight
• Small for gestational age
• Still birthe

25/12/2025

GERD ———

Lifestyle Measures for Patients with Gastroesophageal Reflux Disease (GERD).

Avoid eating within 3 hr before bedtime;

sleep on the right side (use special positional pillows) and observe good sleep hygiene.

Avoid alcohol, caffeine, carbonated beverages, and smoking.

Lose weight (any amount).

Elevate the head of the bed 15to20cm or use a bed wedge and incline mattress.

Keep meal sizes small.

Consider four or five small meals instead of three large meals during the day.

Avoid spicy foods and high ­fat meals.

Avoid lying down or napping immediately after a meal.

Identify dietary triggers and minimize common precipitants (e.g., peppermint, onion, fresh citrus juices, tomato paste, and chocolate).

Avoid tight­fitting garments.

Avoid bending over.

Chew gum to promote salivation, which neutralizes acid reflux.

Avoid medications that relax the lower esophageal sphincter

(e.g., benzodiaz­epines, theophylline, calcium­channel blockers, tricyclic antidepressants, anticholinergics, progesterone, and sildenafil).

Engage in stress ­reduction techniques.

24/12/2025

STRESS and CHILDREN!

Few days ago 8 year old girl came to my Opd .

Her father complained that she has pain abdomen and occasional vomiting.

This kid was seen by many paediatricians but there was not much relief in her symptoms.

After going through the investigations I too found nothing unusual.

After prescribing some basic medicines I advised them to report back after two weeks.

On their follow up the attendant said that there was not much improvement in her symptoms.

This was the time to check her detailed daily schedule.

To my surprise - her father said that she takes little breakfast and goes for the tuition , skipping lunch and comes back at 3 PM.

Then she takes her meals and it is almost binge eating with rapid filling of stomach causing Gas - distension- reflux and pain abdomen

plus skipping meals contributes to gastric irritation.

Are we so desperate that we can’t let these tender kids to live a normal life.

I offered them counselling that their child needs to sleep and eat at proper hours - enjoy her routine day - have adequate play time.

Dear doctors most of the times the cause is not organic we need to go beyond the routine practice of prescribing medication and instead focusing on social and psychological cause.

The first priority in life is to GO- SLOW.

20/12/2025

FATTY LIVER !

when you see a fatty liver on USG report , your radiologist compares the brightness /echogenicity of your liver

with respect to your spleen , kidney , diaphragm and then reports it as grade 1- 2 or 3 Fatty liver.

This grading is not specific and we need to know the exact grade of fatty liver by Fibroscan.

The common misconception is that fatty liver means our liver gets covered with fat.

There are Liver cells called hepatocytes and when more than five percent liver cells have fat in them -

it qualifies for the definition of fatty liver.

Suppose there are 100 liver cells , if more than 5 cells get filled with fat globule/ droplet it defines fatty liver.

Grade 1 - means 5 to 30 liver cells having fat droplet in them.

Grade 11– means 30 to 60 liver cells having fat droplet in them.

Grade 111— means more than 60 liver cells having fat droplet in them.

The question remains why should we worry about this fat droplet in our liver cells ?

The liver cell one presumes is like a small pea !

When it is filled with fat droplet this pea size it may remain like this or the

liver cell swells up and becomes like a grape!
🍇 ( this stage is called steatohepatitis ).

When this swelling persists long enough, this grape like swollen liver cell starts shrinking
and becomes like a green raisin ( kismish)

- the one with some moisture in it !

( this stage can be compared to early fibrosis F1-F2 stage) .

When the cell remains like this without any intervention in the form of life style modification and medication-

This green raisin like cell further progresses to the stage where it gets further shrunken and become like a dead / dry( raisin )

A stage compared to F3-F4 fibrosis!

At this stage we say that cirrhosis liver has developed and here it is irreversible!

Once cirrhosis liver sets in - it may remain compensated for years and finally decompensation starts-

Decompensation features are :

1. Fluid in abdomen ( ascitis).

2. Vomiting of blood or blood in stool( red or tar coal like ).

3. Yellowish eyes ( jaundice).

4. Recurrent drop in consciousness ( encephalopathy)

5. Drop in hemoglobin/ WBC and Platlets ( pancytopenia)

Therefore the goal is not to start treatment on ultrasound findings of Fatty liver.

But to check if it is simple fatty liver ( pea type liver cell with fat droplet) or

The liver cell with fat droplet has swollen like a grape 🍇

Where swelling can be reversed by lifestyle changes and medcine.
Or

It has progressed to the stage where this grape like swollen cell has shrunken to green moist raisin.

Or

This green moist raisin has further progressed to the stage of dry dead raisin ( F3- F4)

19/12/2025

GOAT or SHEEP MEAT !

Is it the time to shift from the Sheep to Goat meat. ?

GOAT MEAT :

Fat Content: Leaner, typically 3-7g per 100g.

Calories: Lower, around 110-130 kcal per 100g.

Good For: Weight loss, leaner protein intake.

Sheep Meat :

Fat Content: Richer, often 9-18g or more per 100g.

Calories: Higher, around 200-240 kcal per 100g.

Good For: Weight gain, rich flavor, heartier meals.

18/12/2025

STOMACH ULCER!

Unlike Duodenal ulcer- stomach ulcer once diagnosed needs to be

checked again after 8 to 12 weeks with repeat endoscopy.

There are some percent of stomach ulcers that turn into cancers later on.

We have to follow patients very closely after diagnosis stomach ulcer.

This patient is as diagnosed with stomach ulcer in 2022 and was given H Pylori treatment.

He was advised to repeat endoscopy after 8 to 12 weeks.
Since he improved he stopped following the doctor.

Now this month he is diagnosed with stomach cancer at the same site where these ulcers were seen in 2022.

16/12/2025

PUMPKIN 🎃!

Boiled pumpkin and garlic strained for few hours !

Mixed with curd , honey , almonds , cumin , raisins.

Excellent for GUT health !

15/12/2025

15/12/2025

FATTY LIVER and LFT

Upto two-thirds of patients with fatty liver , including those with advanced fibrosis

or cirrhosis, have normal serum aminotransferase levels.

Serum ALT levels do not correlate well with the histological severity of fatty liver.

There is a poor correlation between LFT and severity of Fatty liver disease.

Therefore If you have a fatty liver on ultrasound or you are a diabetic don’t be happy that your LFT is normal.

Check whether your liver is having simply fat in the cells or there is stiffness ( swelling) or fibrosis.

There are many clinical parameters to check this
Like APRI - AST /ALT ration and many othe parameters.

You just need a Google calculator to check your liver health 👇👇👇

14/12/2025

COST - EFFECTIVE investigation !

Always make a clinic assessment of positive predictive value of the investigation you advise!

Be specific and relevant!

Always convey what you want to know by ordering the investigation!

Clinical judgement saves money , time and efforts of your patient!