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Liver Disorders/Chronic Diarrhea
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Liver Disorders/Chronic Diarrhea


  Hello,
  My father has been very ill over the course of three months and with two hospitalizations, working with an internalist and a gastrointestalist, there has been no relief.
  Let me begin with a history.  
  February 1998, my father went to his internalist for his annual checkup.  At that time, his adult onset diabetes was found that it needed to be medicated.  They prescribed him Glucotrol which he had taken up until this last week.
  A couple of days after his appointment, they docotors office called and told him they found blood in his stool sample, and that they needed another.  He supplied them with that, and they still found blood.  They scheduled for him to have a colonoscopy they end of March.  His stool at that time was normal.  
  March he had his colonoscopy, and they found he had some ulcers in his colon and prescribed a medicine for that.  Soon after the colonoscopy, he began to have diarrhea, which he assumed was a temporary thing, and that it would soon go away.  
  The beginning of April he went to the docotr compaining about his diarhea (diarrhea).  The doctor prescribed him an anitbiotic, saying that it was a stomach infection.  He took the 10 days of meds, and the diarrhea did not clear up.  
  Several days after that, he went back to the doctor and once again complained of the diarrhea.  The doctor then prescribed him another antibiotic and said it was a intestinal infection, that they probably missed the infection in his stomach and it has passed through, and the other antibiotic didn't work.
  He took his prescribed dosage for that, and he still had diarrhea.  Meanwhile, he's getting very very weak, and easily fatigued, and my mother is getting concerned about him being dehydrated, so she starts to have him drink Gatorade.
  He went back to the doctor, who *thought* he would get better, who then prescribed him an anti-infective.  It was a seven day treatment of metrodonizale (sp?).  He's looking terrible at six days into the treatment, and my mom wants to bring him in to the docotr again, and by this time my dad is getting really fed up, however, he is weaker, and weaker and showing definite signs of dehydration.
  She brings him into the doctor, who admits him to the hospital and puts him on IV's and runs several test including a CAT scan.  They find nothing that they can detect problematic in the CAT,however I found out this week that there was some fluid build up around his stomach/liver area that they saw in the CAT be decided it was not a big problem, but they determine that he is no longer diabetic from blood testing, and that he doesn't need to take the Glucotrol.  They also determine that his Pancreas is not working properly, so they prescribe Creon.
  They released him after only two days, even though he looked *terrible*, and still had severe diarrhea.  
  Six days after this my mother decided once again to bring him to the hospital.  He's even weaker, eyes sunken, and his stomach is HUGELY bloated.  She brings him to the Emergency room and the first question the doctor asks is, "When was your husband diagnosed with Cirrhosis?  
  He has never been diagnosed with any liver disorder, in fact, every year in his annual testing, his liver enzymes come back normal, although he was diagnosed in 1972 with Hepatitis B.  In fact they last time he went in for his annual, they said they couldn't find any trace of Hepatitis in his liver.
  They gave him a "tap" today and removed 3 liters of water, and at some point over the last coupld of days, they discussed a shunt.  They have not run any biopsy on his liver, or a MRI.
  They took him off his IV today, because they were going to do the "tap", but I presume they will put him on it again, (he still has the IV rig in his hand, plus he still has diarrhea, and they are giving him some sort of medicine to help him urinate.  
  He's miserable, and fed up.  We all are.  We feel like no one knows what is going on.
  Any insights would be appreciated.  I hope I covered it all.  Sorry for the long post.
  Best Regards,
  Dawn Marie
______________
Dear dawn Marie,
irrhosis is a pathologic diagnosis meaning that you need to have findings of scarring when you do a liver biopsy.  One of the manifestations of cirrhosis can be fluid accumulation in the abdomen, but other diseases can also cause the fluid accumulation.  In your father's history there are also the loose ends of the colon ulcers and diarrhea.  It is possible that your father has chronic intestinal infections, but I would suggest that he may have inflammatory bowel disease.  The pancreas issue is also unexplained.
If possible your father should have a liver biopsy.  The abdominal fluid needs to be carefully analyzed including a cytologic examination looking for cancer.  The bowel problem needs to be better defined and treated.
This information is presented for educational purposes only.  always consult your personal physician for specific medical questions.
If you want, we would be happy to see your father in the Division of Gastroenterology at Henry Ford Hospital and perform the appropriate investigations after we have had the chance to meet him and to review the history in greater detail. You can arrange an appointment with Dr. Batra, one of our experts in the diagnosis and treatment of liver disease by calling the Henry Ford Physician Referral Line at (800)653-6568.
HFHSM,D,-rf
*keywords; cirrhosis, diarrhea, inflamamtory bowel disease
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