Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Question Title: Cirrohsis, gallstones and abdominal pain

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Cirrhosis


My husband i2 46 years old. He was diagnosed with Hepatitis B in 1986, not sure how contracted, but believe from transfusion (1972)or from injections when in military (Marines 1970; Army 1980). He has been a heavy beer drinker
ever since I first met him in 1990. Never knew him to be sick (a slight cold once in a great while). Had elevated liver enzymes, and extremely low platelet count with no clumping factors noted in 1992; diagnosed with fatty liver at that time. Continued to drink beer.
To make a long story short began drinking really heavily in April, and in May got to point where he was drinking around the clock, could barely walk, literally falling down drunk. I started noting personality changes, confusion.
On May 19 he fell and cut his finger. It wouldn't stop bleeding, but he refused treatment. Later that night, he fell off the toilet and (I believe) hit his left eye on the corner of the countertop. That night the entire left side of his
face was purple, and I got two of his friends to carry him to the E.R. He was admitted, his platelet count was 19 (I presume thousand, but all I was told was 19). He was kept in the hospital until Memorial Day, then released. The following Friday he was admitted
again, and his internist told him he would die if he didn't get a transfusion and other help. While he was in the hospital they had done a CT scan and ultrasound, but no biopsy, I presume because of the risk of a bleed. I asked the doctor if he had cirrohsis and
he said it's certainly beginning to look that way. The doctor told him IF he quit drinking he might still have a few good years left, if not months at most, and that he wasn't out of the woods yet. He was given a transfusion, 3 shots of Vitamin K and sent home on
Sunday. He was terribly confused, very jaundiced, and developed edema in his feet and pruritus. His doctor gave him Aldactone and put him on a moderate low sodium diet (2,000 mg.) That didn't bring the swelling down, so he gave him a stronger diuretic for 4 days in
addition to the Aldactone, and that did the trick. His platelet count had doubled by June 9. When he saw the doctor on Jun 30, he was told that he was still jaundiced, but not as badly, and that he still had a touch of edema. He has not had any alcohol, has kept to
the low sodium, low carbohydrate diet, but has had diarrhea for over a week now, had nausea, threw up twice and severe stomach pain last Wednesday, which was relieved by Mylanta and Pepcid, but still has abdominal discomfort and his stomach is very bloated, and now his
ankles and feet are starting to swell again. He says he feels like he is filled with gas; his abdomen is hard, does not have any sloshing sounds, and does not have a wave effect when gently pushed. Due to personal problems (I had started to divorce him over the drinking
and personality changes) he is currently without any medical insurance and hesitates to go to the doctor. We ended up having to get divorced and remarried so I could put him back on my insurance (Blue Choice HMO) but he will not be covered again until Aug. 1. Any
suggestions in the meantime??? He called his doctor today but the doctor was not available. Will be talking to him tomorrow. I have told him to go in if doctor tells him to, we will manage to pay for doctor appointment somehow, but we will be in bad shape if he has
to be hospitalized between now and Aug 1. as I am ourand have been our sole suport for over a year. Thanks for any advice.

_

Dear Cecelia,
The liver plays an essentail role in maintaining the body in a stable condition by its activities to synthesize proteins (for example clotting factors) and removing waste. Severe liver damage from any cause will impair the liver's ability to perform. The alcohol and the hepatitis have destroyed liver cells and caused scarring (cirrhosis). Cirrhosis alters the circuits by which blood from the intestines and spleen returns to the heart. As a result of the changes blood may accumulate in the spleen, leading to low platelet counts. Ascites (fluid in the abdomen) and swelling of the ankles are also consequences of cirrhosis.

The confusion that you desribe may be hepatic encephalopathy. The liver removes a number of waste products and failure to perform this function can impair nerve function, causing confusion. This confusion can get worse if your husband develops electrolyte abnormalities as can happen with vomiting, diarrhea or taking water pills.

I appreciate the difficult choices that you must make. Your husband requires close monitoring of his medical condition and electrolytes. If he is fortunate and does not have any unexpected complications and the doctor is judicious in his use of medications, it is possible for your husband to be successfully managed in an ambulatory environment. Your physician, however, must watch your husband closely because he can get very sick in a short time.

This information is presented for educational purposes only. Always ask your personal physician questions regarding specific medical issues.

HFHSM.D.-rf
*keywords: cirrhosis, ascites
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