• Based on the complaints, your mother is suffering from a disease associated with the liver function.

• Any disruption in liver function that produces ailment which is referred to as liver disease. The liver is in charge of several vital activities in the body, and if it becomes ill or damaged, the loss of such functions can cause serious harm to the body. Hepatic disease is another name for liver disease.

• Along with fever, vomiting, loss of appetite and extreme fatigue, stomach tightness bloating, abdominal pain can also be seen in individuals with liver diseases.

• Further investigations and procedures will provide you with a clarity.

• Laboratory investigations include AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase) Total Albumin, Lactic Dehydrogenase, Alpha protein, 5’nucleotide, mitochondrial antibody and PTT levels and procedures such as CT scan, MRI (for liver tissue damage) and biopsy (in case of chance of any cancerous growth).

• Infection, autoimmune liver illnesses such as cholangitis, Wilson's disease, cancer, alcoholic liver (due to alcohol overuse), non-alcoholic liver (due to excessive fat consumption), and drug-induced liver dysfunction are all possible causes of liver dysfunction.

• Lifestyle and diet changes can help in to reduce the further damage of liver.

• Hepatitis B carriers are persons who carry the hepatitis B virus in their blood but do not experience symptoms. Between 6% and 10% of persons infected with the virus will become carriers and will be able to infect others without knowing it.

• A considerable proportion of chronic hepatitis B (HBV) patients are in the inactive carrier state, which is characterised by normal transaminase levels, limited viral replication, and little liver necroinflammatory activity. After at least one year of frequent monitoring, a diagnosis is made, and lifelong follow-up is required to ensure that this status is maintained.

• In case there is no improvement in HBVDNA levels, consult your expert but do not stop the medication on your own.

• Drugs prescribed such as Tafero (tenofovir) acts by ceasing the production of new viruses, blocks or slows viral proliferation in human cells, and eliminates the infection and also boost the level of CD4 cells (white blood cells that fight infection) in your blood. Entaliv (entecavir) acts by inhibiting the viral replications processes like reverse transcription, DNA replication and transcription.

• Fatty liver disease is a condition caused by fat buildup in the liver (i.e., when fat percentage exceeds 5 - 10% of your liver's weight), which can be caused by alcohol intake and/or a high fat diet. Individuals who are obese/overweight, have poor glycemic control/insulin resistance, have metabolic syndrome, and are taking specific drugs such as amiodarone, diltiazem, tamoxifen, or steroids are at risk of developing fatty liver.

• In some situations, it is thought to be symptomless, but in others, it can cause substantial liver damage. The good news is that it is frequently avoidable or reversible with lifestyle modifications.

• It progresses through 3 stages which include Steatohepatitis (swelling and damage of liver tissue), Fibrosis (scar tissue formation where your liver is damaged) and Cirrhosis (extensive scar tissue replacement with healthy tissue). Cirrhosis can lead to liver failure or cancer.

• Laboratory investigations consists of Liver functions tests such as AST, ALT, ALP and GGT; Total Albumin and Bilirubin, CBC, Test for viral infection, Fasting Blood Glucose, HbA1c and Lipid profile.

• Imaging procedures such as Ultrasound, CT /MRI, Elastography (for measuring stiffness of liver) and Magnetic resonance elastography and Biopsy (for ruling out any cancerous growth and for signs or any inflammation and scarring).

• If a patient has a fatty liver, he or she should be checked for the entire metabolic syndrome, which includes diabetes, hypertension, cholesterol, and thyroid issues.

• The best way to treat fatty liver is with making some lifestyle changes which can significantly improve your health which includes – Avoiding alcohol and High fat diet, Losing weight, taking medications for controlling glucose and fat(Triglyceride and Cholesterol) levels and Vitamin E with Thiazolidinediones in specific instances.

• Currently, no drug treatment is approved for management of fatty liver disease.

In order to prevent further progression of disease one can:

 Maintain a healthy weight by consuming food less/minimal in in its fat percentage.

 Follow a Mediterranean diet which is high in vegetables, fruits and good fats.

 Exercise regularly for 45 minutes where in you can include combination of cycling with walking, cardio, CrossFit and yoga with meditation.

 Restrict alcohol consumption

Based on the complaints and elevated bilirubin levels you seem to be suffering from a type of liver disorder, a condition wherein excess accumulation of bilirubin (a brown yellow coloured compound formed in breaking down of red blood cells) occurs. With loss of appetite, vomiting, stomach tightness and bloating; fever, extreme fatigue and abdominal pain can also be seen in liver diseases.

• There are multiple causes for development of liver dysfunction such as infection, autoimmune liver diseases like cholangitis, Wilson’s disease, cancer, alcoholic liver (due to alcohol abuse) and non-alcoholic (due to excessive consumption of fats) and drug induced.

• When using a medicine that is known to have the potential to cause liver damage, your doctor may recommend you to have blood tests done on a routine basis after starting the medication so that any signs of liver damage may be recognised before symptoms develop.

• Common medications that can cause damage to the liver include Paracetamol, Statins – drugs for lowering cholesterol levels and certain herbs.

• Other liver function parameters such as AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase) bilirubin are required to be evaluated and additional to this for determining the exact cause of dysfunction especially to confirm presence of jaundice; urinalysis, CT (for distinguishing between biliary obstruction and liver disease including cancer) and liver biopsy (for ruling out concern about possible liver cancer) needs to performed.

• The treatment is based on the underlying cause and damage levels and can range from dietary changes, medications such as antibiotics, sedatives, etc to liver transplants.