Services to offer: 

Liver Clinic:

1. Specialized clinic to specifically cater to the needs of patients with liver and bilio-pancreatic diseases.
2. Virtual clinics (Tele-conferencing)
3. Specialty clinics
   Jaundice clinic – Monday
   Fatty Liver clinic – Tuesday
   Viral hepatitis clinic – Wednesday
   Alcohol liver clinic – Thursday
   Liver Tumors clinic – Friday
   Liver Transplant clinic – Saturday
4. Fibroscan/ARFI

Intensive care Liver unit:

1. The multi-disciplinary approach to intensive care in liver disease is different from other diseases and it is a rapidly growing field with new opportunities.
2. New treatment algorithms can be developed for treatment of patients with acute liver failure, acute-on-chronic liver failure, hepatic encephalopathy and GI bleed.

Hepatic Hemodynamic Laboratory:

1. Trans jugular liver biopsy: Needed in patients with diagnostic dilemma but cannot undergo percutaneous liver biopsy due to ascites or coagulopathy or need simultaneous HVPG measurement
2. Hepatic venous pressure gradient:
   To risk stratify patients with liver cirrhosis
   To measure hemodynamic response to beta-blockers
   Part of pre-op evaluation of patients with cirrhosis going for surgery.
   Part of pre-op evaluation of patients going for liver transplantation
   Best surrogate marker of clinical events in hepatology
   Gold standard for measurement of portal hypertension.

Interventional Radiology (under fluoroscopy and USG):

1. Percutaneous liver biopsy
2. Percutaneous trans-hepatic biliary drainage (PTBD)
3. Percutaneous cystic drainage (PCD)
4. Radio-frequency ablation (RFA)
5. Trans-arterial chemo-embolization (TACE)
6. Trans jugular intrahepatic Porto-systemic shunt (TIPS)

Endoscopy services:

1. Advanced diagnostic upper GI endoscopy, colonoscopy, enteroscopy.
2. Therapeutic endoscopy (EST, EVL, APC, Heater probe, glue injection, dilatation)
3. Emergency GI Bleed services (round the clock strictly maintaining door to needle time < 10 mins and door to scope time < 6 hours)
4. Endoscopic retrograde pancreato-cholangiography (Diagnostic and therapeutic)
5. Endoscopic ultrasound (Diagnostic)
6. Cholangioscopy (Diagnostic and therapeutic)

Day Care:

1. Post-intervention monitoring of patients as per protocol
2. Large volume paracentesis
3. Periodic albumin infusions

Liver nutrition services:

1. Body composition analysis
2. Protein content and salt content
3. Lifestyle modifications

Psycho-social services:

1. Alcohol de-addiction clinics
2. Manage families of liver transplant patients on psycho-social issues to maintain compliance to drugs and follow up post-surgery

 Advanced liver support systems:

1. Therapeutic plasmapheresis

New research in Liver regeneration:

1. Recruitment of hepatic progenitor cells and bone marrow stem cells
2. Stem cell transplantation in liver diseases

Mobile Liver clinics as part of rural outreach programs (To start):

1. OPD
2. Viral hepatitis screening, USG abdomen
3. Mobile endoscopy

Liver transplantation:

1. The transplant team comprising of
   Transplant surgeons
   Hepatologists (Adult and Pediatric)
   Intensivists
   Nutritionist
   Transplant coordinators
2. Supportive services
   General Medicine
   GI Surgery
   Infectious Diseases (Transplant service)
   Pulmonology
   Cardiology
   Psychiatry
   Nephrology
   Neurology
   Radiology (Diagnostic and interventional)
   
   "Every hour counts in the successful management of these complex and critically ill patients.  Continuous monitoring and aggressive completion of necessary tests is essential to get these challenging patients to transplantation"

Liver Helpline:
24 - hour telephone services to cater to needs of patients with liver disease in emergency