Cirrhosis of the Liver Community
Reaching out for help
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Cirrhosis is the end result of chronic liver damage caused by chronic liver diseases. The purpose of the community is to share support and information with Cirrhosis of the Liver patients and their loved ones. Topics in the community include: causes, clinical trials, complications, family issues, living with Cirrhosis of the Liver, prognosis, research, surgery, treatments

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Reaching out for help

Hi everyone! My mom was just diagnosed with cirrhosis of the liver this past Thursday she also has Hep C! While in the ER they have her 4 doses of morphine. As of today she does nothing but sleep and can't seem to stay awake. I asked her if she had eatin anything today and she said she didn't know. She is just really out of it and acting weird. Just wondering if she could still be having side effects from the morphine. I'm just scared and worried! Not sure what stage she is because they didnt say! Her abdomen is swollen and she is retaining fluid they said if it didnt go down they would have to drain it off! Been to ER twice and they just send her home with pain medicine and pills to help with the side effects that come with detoxin! She has a doctor appointment tomorrow I'm hoping we get answers! Please if anyone can help with my concerns it would be greatly appeciated!
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Your mom has cirrhosis, severe scarring of the liver. The fluid on her abdomen is called ascites, and it makes your mom feel uncomfortable or in pain. Hopefully they gave her a diuretic and told her to reduce sodium to help with the fluid retention. Her mental confusion may be due to the morphine, but it may also be due to Hepatic Encephalopathy, which is a build up of ammonia due to the liver not functioning properly. Did the ER do any testing to check her ammonia levels? If her ammonia levels are high, hopefully the ER prescribed a medication such as lactulose to help her have more frequent bowel movements. Basically she should have several bowel movements each day, have a high protein diet, have no red meat, take no iron supplements, and take no medications w/o knowledge of a good hepatologist. Has your mom had any bleeding internally or in the esophagus? She needs to be under the care of a hepatologist at a liver transplant center, usually found near in a university based medical center. It sounds lime she has decompensated cirrhosis, which means that her liver is no longer functioning well. This causes ascites, hepatic encephalopathy, fatigue, weakness, and other sometimes life threatening symptoms. Try to get her to drink water, and drink ensure foe protein. Remove sodium, iron, and red meat from her diet. Get her an appt with a hepatologist in a liver transplant center ASAP. I am guessing that she is too ill to treat her Hep C, as the meds will be too hard on her liver. But a hepatologist can help her manage her serious symptoms and assess her for the possibility of a liver transplant. Your mom will need a lot of support right now, as she is probably too weak and confused to make sure that she eats properly, has enough bowel movements, and takes her meds.
Keep us posted on how your mom is doing.
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And of course, no alcohol with cirrhosis, ever.
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1475202_tn?1388955435
Hello Mertz and welcome to MedHelp.

I am very sorry to hear about your mom. I am glad you found us here and we will do our best to help you with any questions you have along the way. You mentioned “detoxing” in your post so I wonder what is she detoxing from? The Morphine is sure to accelerate her cirrhotic condition. Also what prompted the trip to the ER? What type of doctor is she seeing?

Depending on how advanced her cirrhosis is will determine her treatment options for cirrhosis and Hep C. It is very important she starts seeing a Hepatologist (liver Specialist). She will receive the best treatment possible if you can register her with a transplant center. Hep C  will also cause her cirrhosis to advance if left untreated or if treatment is not possible. The only option at this point would be transplant.

I can tell you her condition is advanced cirrhosis since she is showing symptoms of decompensation. The fluid accumulating in her abdomen is what we call ascites.

Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity). A person with ascites usually has severe liver disease. Ascites due to liver disease is caused by high pressure in the blood vessels of the liver (portal hypertension) and low albumin levels.
Cirrhosis and any illness that leads to it is a common cause of ascites. Long-term infections with hepatitis C or B and long-term alcohol abuse are two of the most common causes of cirrhosis.
When just a small amount of fluid has collected in the belly, there may be no symptoms. Symptoms often develop slowly or suddenly, but a rapid buildup of fluid and symptoms may occur with some causes of ascites.
As more fluid collects, abdominal pain and bloating may occur. When a large amount of ascites is present shortness of breath may develop also.
Treatment
The condition that causes ascites will be treated, if possible.
Treatment may include:
• Diuretics, or "water pills," to help remove the fluid; usually, spironolactone (Aldactone) is used first, and then furosemide (Lasix) will be added
• Antibiotics, if an infection develops
• Limiting salt in the diet (no more than 1,500 mg/day of sodium)
• Avoiding drinking alcohol
Procedures used for ascites that do not respond to medical treatment include:
• Placing a tube into the area to remove large volumes of fluid (called a large volume paracentesis)
• Transjugular intrahepatic portosystemic shunt (TIPS), which helps reroute blood around the liver
Patients who develop end-stage liver disease, and whose ascites no longer respond to treatment will need a liver transplant.
Possible Complications
• Spontaneous bacterial peritonitis (a life-threatening infection of the ascites fluid)
• Hepatorenal syndrome (kidney failure)
• Weight loss and protein malnutrition
• Mental confusion, change in the level of alertness, or coma (hepatic encephalopathy)
• Other complications of liver cirrhosis
Pay particular attention to the portion regarding Spontaneous bacterial peritonitis. You can read more information at: http://www.nlm.nih.gov/medlineplus/ency/article/000286.htm

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Hepatic encephalopathy is also another symptom of liver decompensation. This would explain the sleeping, memory and “acting weird”. It could also be a side effect of the morphine as I am not sure how long ago she has had it.
Hepatic encephalopathy (HE) is caused by disorders that affect the liver. These include disorders that reduce liver function (such as cirrhosis or hepatitis) and conditions in which blood circulation does not enter the liver. The exact cause of hepatic encephalopathy is unknown.
An important job of the liver is to change toxic substances that are either made by the body or taken into the body (such as medicines) and make them harmless. However, when the liver is damaged, these "poisons" may build up in the bloodstream.
Ammonia, which is produced by the body when proteins are digested, is one of the harmful substances that is normally made harmless by the liver. Many other substances may also build up in the body if the liver is not working well. They can cause damage to the nervous system.
Symptoms many begin slowly and gradually worsen, or they may begin suddenly and be severe from the start.
Symptoms may be mild at first. Family members or caregivers may notice that the patient has:
• Breath with a musty or sweet odor
• Change in sleep patterns
• Changes in thinking
• Confusion that is mild
• Forgetfulness
• Mental fogginess
• Personality or mood changes
• Poor concentration
• Poor judgment
• Worsening of handwriting or loss of other small hand movements
More severe symptoms may include:
• Abnormal movements or shaking of hands or arms
• Agitation, excitement, or seizures (occur rarely)
• Disorientation
• Drowsiness or confusion
• Inappropriate behavior or severe personality changes
• Slurred speech
• Slowed or sluggish movement
Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma.
Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms.
Learn more about HE at http://www.nlm.nih.gov/medlineplus/ency/article/000302.htm
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A liver biopsy will likely be performed to stage her cirrhosis since she has Hep C. Her diet will be important so be sure to talk to her doctor about that. You may also want to ask what her MELD score is and that will give you a more general idea of her condition. The idea with cirrhosis is to stop the progression of the disease. This can be done by removing the cause such as hepatitis, drugs and alcohol. There are many more but these are the leading causes. The hardest thing to learn is when the disease has advanced too far and the cause can’t be removed or the liver is unable to recover. I hope this is not your mom’s circumstance.
Please let me know if can help with anything else, take care.
Randy

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1475202_tn?1388955435
Advocate your advice was perfect, sorry I didn't refresh my screen to see you had responded.

Randy

You are a terrific contributor to our community, thanks for all that you do!
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No problem Randy.  I was using my cell phone, so I was a bit slow in finishing my post, but you gave excellent detail.  Thanks for the kind words.
Mertz77, please let us know how your mom is after she sees the doctor tomorrow.
Advocate1955
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Thanks for all the information I'm receiving from all of you. To answer some of Randy's questions, my mom quit drinking 3 weeks ago when her right side starting hurting. She tried to wait until she could see her regular doctor but after 2 weeks the pain was too much for her to handle and my mom has really high tolerance to pain. All I know of the testing they have done is CT scan came back showing she has the cirrhosis of the liver and after looking over her paperwork it shoes enlarged heart not really sure of why! The only medication they sent her home with was Librium and Ultram for pain. The Librium is supposed to help with tremors and other side effects that come with quitting alcohol. I just hope today we can get some help. She has no insurance so I'm thinking this is not guna be easy
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Thanks for the additional information Mertz77.  Let us know how your mom's appt went today.
Best wishes,
Advocate1955
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1475202_tn?1388955435
Hello Mertz,

I hope todays appointment went okay. I tried looking up some ideas to help your mom get treatment without insurance and I came across this link: http://www.ehow.com/how_7735373_medical-care-insurance.html
I imagine it’s stuff you already know but maybe it can help.

I also looked up the medications that were prescribed and I understand the Librium is a very important part of her detox since withdrawal can become life threatening in some cases. The Ultram/Tramadol is a very addictive drug so persons with addictive personalities should use caution.

In patients with hepatic dysfunction, such as advanced cirrhosis of the liver, the metabolism of Ultram is reduced. In patients with cirrhosis of the liver, the recommended dose is 50 mg administered as needed for pain every 12 hours.
Seizures have occurred in some people taking Ultram. Talk with your doctor about your seizure risk, which may be higher if you have:
• a history of drug or alcohol addiction;
• a history of epilepsy or other seizure disorder;
• a history of head injury;
• a metabolic disorder; or
• if you are also taking an antidepressant, muscle relaxer, narcotic, antipsychotic, or medicine for nausea and vomiting.
To make sure you can safely take Ultram, tell your doctor if you have any of these other conditions:
• kidney disease (or if you are on dialysis);
• cirrhosis or other liver disease;
• a stomach disorder; or
• a history of depression, mental illness, or thoughts of suicide.
Ultram may be habit forming and should be used only by the person it was prescribed for. Never share Ultram with another person, especially someone with a history of drug abuse or addiction.

http://www.drugs.com/ultram.html

Muscle pain is very common, toxins build up in the muscle causing them to ache. This is because of poor liver function. Stretching the muscle or light cardiovascular exercise will increase blood flow to the muscle forcing out the toxins. She should consult her doctor before beginning and form of exercise.
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Enlarged heart
Drinking alcohol in large quantities has a toxic effect on the heart. Alcoholic cardiomyopathy is a form of a condition in which the heart becomes enlarged and the heart muscle thins (dilated cardiomyopathy) due to alcohol abuse.
Alcoholic cardiomyopathy causes the weakened heart muscle to pump inefficiently, leading to heart failure. In severe cases, the lack of blood flow affects all parts of the body, damaging many tissues and organs.
Treatment for alcoholic cardiomyopathy involves lifestyle changes, including complete abstinence from alcohol use, a low sodium diet, and fluid restriction, as well as medications. Medications may include ACE inhibitors, beta blockers, and diuretics which are commonly used with other forms of cardiomyopathy to reduce the strain on the heart.
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Randy
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Thanks to all of you with all the advice. My mom is still tired all the time. She doesn't do much because she just feels weak and tired. We are still waiting for the referral to see a specialist. Until then she just continues to take the water pill, Ultram when needed and her Librium. I keep hoping she will start to feel better.
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