chronic active hepatitis v/s cirrhosis

Sir/Madam,
My father 60 year old non hypertensive non diabetic
has complaints of  :
pedal edema since a year
was investigated - found to have ascites + abnormal liver function tests in June 2002.
He has a history of Hepatitis B infection in 1986 but was seronegative after that and had was asymptomatic till April 2002 when he had a sudden dislike for coffee.

Has been under treatment with rest + diuretics + protein restriction due to early hepatic encephalopathy stage 1.

On further investigations repeated every 15 days now has raised prothrombin timeINR 3 and decreased Albumin 2.1.
Also recent tests showed antiphospholipid antibody both against cardiolipin and lupus anticoagul;ant to be positive.

Liver biopsy avoided till now because of raised prothrombin time. Anti microsomal AB negative

There is a dilemma of -
whether it would be safe to proceed with liver biopsy may be after administering fresh frozen plasma
Can medications be tried without biopsy
What would be further management in such a case especially how to rule out autoimmune hepatitis considering anti phospholipid antibody and role for steroids & immunosuppressives in such a case.
Please do reply

Dhabuli.

[georgie439]

I'am sorry I cannot help you, although I do have a question for you, Is having a dislike for coffe a symptom of hepatitis or liver disease??

[dhabuli]

coffee i read is to be avoided in liver disease. i do not know if such a symptom is a natural warning by our body

[imkindly]

Dhabuli,
Here are some things that you may already know:

Cirrhosis (scar tissue in the liver) usually causes Portal Hypertension.
Portal Hypertension can cause an enlarged spleen, which makes the Platelet Count drop....and the Prothrombin Time and INR rise.
Portal Hypertension also contributes to Ascites.

Cirrhosis (scar tissue in the liver) can also cause Albumin production to fall.
Low Albumin levels cause Ascites.

Cirrhosis can also cause a build up of waste products in the bloodstream (such as ammonia), which causes encephalopathy.

An Ultrasound (Sonogram) test can show the size of your father's liver, spleen, etc.
A CT Scan (or an MRI) will show a very detailed picture of his liver, spleen, etc.
(These tests are non-invasive, and can be used to diagnose liver problems......if his doctor says that a biopsy wouldn't be safe for him.)

The first line of treatment for Ascites should be diuretics and a LOW SODIUM DIET.
(Salt, sodium, makes Ascites much worse.)

Encephalopathy can be kept under control with LACTULOSE.
Lactulose is a prescription laxative that binds with ammonia and removes it from the body.

If your father does have cirrhosis, and if a CT Scan (or MRI) shows that his spleen is enlarged........he should have an endoscopy done to check for VARICES.
(Varices are enlarged blood vessels (common in cirrhosis) that need to be found before they burst.)

Hope this helps.