<b>Gastrointestinal and hepatobiliary manifestations of COVID-19 infection: A single center study from Pakistan</b>

BACKGROUND: Coronavirus disease was a global challenge affecting around 229 countries with over 700 million confirmed cases with significant morbidity and mortality. OBJECTIVE: To determine the frequency of hepatobiliary manifestations in patients of COVID-19. METHODOLOGY: This was a cross-sectional study conducted at North Medical Ward, Mayo Hospital, Lahore for three months. After ethical approval of the study, 200 COVID-19 RT-PCR positive cases of ages 15 to 80 years were included in the study. Complete history & examination regarding hepatobiliary symptoms were noted. Liver function tests & prothrombin time were sent to pathology laboratory & results were noted. Data was analyzed using SPSS-26. Quantitative variables like age, bilirubin, Aminotransferases & Prothrombin time were taken as mean ± standard deviation. Qualitative variables like gender, hepatobiliary symptoms were taken as frequency and percentages. RESULTS: The most common symptom at presentation was diarrhea 30 (15.0%) followed by fatigue, pruritic and anorexia 17 (8.5%), nausea, vomiting and abdominal pain 15 (7.5%), body petechiae & purpura in 13(6.5%), Right hypochondrial pain 11(5.5%) & Hiccup and dark color urine 1(0.5%). On laboratory findings,17(8.5%) patients had elevated bilirubin levels while AST was raised in 79(39.5%) of cases, ALT in 23(11.5%), Alkaline phosphatase in 6(3.0%), GGT in 95(47.5%) of cases. 8 (4.0%) cases showed decrease albumin level and 12(6.0%) cases had prolonged PT levels. CONCLUSION: Hepatobiliary symptoms and laboratory derangements are not uncommon in patients with COVID-19. So, attention should be given to these extra-pulmonary symptoms to avoid any delay in treatment & disease progression and complications.