Cirrhosis of the liver

[FILHELP]

My father in law has late stages of cirrhosis of the liver. He is back to drinking and will not take any meds. How long before the ammonia enters the brain and causes a coma?

[Dee1956]

I'm sorry for what you are going through Lynn and FOH have given you good information.  It is heartbreaking when someone you love is committing suicide in front of you.
I am experiencing something similar with an old friend.  He won't take the lactulose that could help him think.  He is not following any of the hospital's recommendations.  His family is barely speaking to him at this point.  It is awful
I had thought he would have lapsed in to a coma in the past month but somehow he is still chugging along.  He sleeps more and more all the time but still manages to get up when he needs to.  I am sorry
I hope you all can get him to listen.

[fanofhawks]

If your dad is in the late stages of cirrhosis, he may make sense one minute, and sound like nonsense the next.  My sister is in the late stages of cirrhosis too, and I can tell you she comes out with some bizarre stories sometimes and then sounds perfectly normal in the next sentence.  One day she told our mother that she ran half a marathon and then said she has a busy work day and has to go back to work.  There is NO way she ran a marathon!  She could hardly walk due to edema.  Another time she said she cooked a roast for ALL her neighbors with all the trimmings.  There is no way she did this, as she physically can't stand for any length of time to even cook for herself.  She sounds very convincing and we often scratch our heads after we hear these stories.  I give you these examples because HE doesn't necessarily mean that you have bizarre behavior or act out.  It could be subtle like with my sister's stories.  She also forgets she tells us one thing one day, and then the next day tells us something completely different.  I suppose the worse the HE, the more bizarre the behavior, but there are probably different severities of it.  

flyinlynn explained what his doctor may prescribe if he shows signs of HE.  I hope you go with him to the doctor appts.  My sister won't allow that, so we don't have a solid idea of her medications.  I would love to be her advocate now, but she won't let me help her.  Some isolate themselves and refuse help, and others are more accepting.  I hope your dad lets you help him.  Do your research so you know the questions to ask at his appointments and you will be able to help him as best you can.  The best to you and your dad.

[flyinlynn]

I am so sorry to hear about you and your fathers situation.

There is no way to predict how long he can carry on with late stage liver disease and cirrhosis.

There are many consequences of having cirrhosis and continuing to drink other than hepatic encephalopathy (HE). Often patients develop ascities or fluid retention in the abdomen which can develop to the point  the look pregnant and will need this fluid drained. They can develop enlarged blood vessels in the swolllowing tube (esophagus) called esophageal varicies which can cause internal bleeding where they can have black tarry bowel movement indicating they have blood in their stool or vomiting of blood those are a medical emergency which will require a blood transfusion to survive and repair of the bleeding vessels.

Has he seen a specialist at all? Can you speak with his doctor to have a better understanding of the potential progression of his liver disease so you will know what signs and symptoms to be watchful for?

You mentioned ammonia does he currently have HE and is the medicine he does not want to take a sweet tasting liquid called Lactulose that causes him to have a lot of bowel movements? Many patients dont like to take this medicine due to the taste and the frequent need to use the restroom. It is important to take Lactulose in such a way so that he has 2 to 3 soft bowel movements a day to remove the ammonia from his blood. Too much and he will have diarrhea which can lead to dehydration and could cause an episode of HE from being dehydrated not enough and you won't be removing the ammonia. Some have said you can mix the Lactulose with water or juice to help with the taste.

Again so sorry to hear about your father I hope you are able to speak with his doctors to learn more about his individual situation or at least they can help you to learn more about the effects of ESLD (end stage liver disease)

Best to you both