ASCITES/CIROSSIS OF THE LIVER/TREATMENT

[janise]

HELLO,

MY CASE IS AS FOLLOWS.

CIRROSIS OF THE LIVER.
DUE TO ALCHOLE CONSUMPTION AND LARGE AMOUNTS OF PAIN KILLERS FOR A FRACTURED BACK.

I HAVE HAD 3 ASCITES NOW OVER A PERIOD OF 6 MONTHS DIERETICS HAVE NOT REDUCED THE FLUID ENOUGH AND THEY HAVE HAD TO INSERT A NEEDLE INTO THIS AREA FOR DRAINAGE THEY HAVE ONLY MANAGED TO DRAIN 4 LITERS EACH TIME I AM ON 2 DIERTICS NOW BUT THE FLUID IS STILL BUILDING UP.

I AM 52 I HAVE SUSTAINED FROM ALCHOLE FOR 5 MONTHS AND WILL NOT DRINK AGAIN AND I AM CLOSELY MONITERING MY SALT INTAKE. I AM VERY TIRED ALL THE TIME AND VAGUE.

I HAVE HAD MY VARICES IN THE OSEOPHAGUS BANDED 8 TIMES DUE TO EXCESSIVE BLEEDING. THE BLEEDING HAS NOW STOPPED (OVER THE LAST MONTH).

I DO SUFFER FROM ASHMA IF THIS MAY BE RELEVENT.
I HAVE A READING OF 250 FOR MY JAUNDICE APPERANCE.

MY LIVER COUNT IS GETTING WORSE.

I WANT TO LIVE WHAT ARE MY OPTIONS FROM HERE (TRANSPLANT/SHUNT)AND HOW SUCSESSFUL ARE THE OPTIONS?. PLEASE HELP ME.


THANK YOU

JANISE NORRIS (AUSTRALIA)

[Kevin Pho, MD]

Liver transplantation is the definitive treatment for patients with decompensated cirrhosis. It is important to determine whether patients may be eligible for transplantation and to refer them to a transplant center for evaluation.  As patient selection, technique, and postoperative care have improved, one-and three-year survivals have increased to more than 85 and 70 percent, respectively.

TIPS has primarily been used to treat the major consequences of portal hypertension (ie, variceal hemorrhage and ascites).  A randomized controlled trial compared TIPS with large volume paracentesis in patients with refractory ascites. Despite clearance of ascites after TIPS two-year survival was significantly lower in this group (29 versus 56 percent). Other studies have also demonstrated no survival benefits of TIPS.

This is no well-defined criteria to recommend TIPS.  Although it is effective in clearing ascites, this should be weighed against the possible decrease in survival.  

These options should definitely be discussed with your personal physician and hepatologist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Sanyal et al.  Indications and contraindications to the use of transjugular intrahepatic portosystemic shunts.  UptoDate, 2003.

[imkindly]

Hi Janise
I'm sure the doctor here will get to your question soon.
In the meanwhile, I wanted to post some advice to you. (I am not a doctor)

We have a Cirrhosis Support Group online at:

http://www.expage.com/cirrhosis

You're welcome to visit there. (You can meet others there that are dealing with the same situation)

As far as what you're dealing with right at the moment---

* A low sodium diet is VERY important to help control ascites. Read all food and drink labels for their sodium content.
Ask your doctor how many mg. of sodium per day that you are allowed to have. (Most ascites patients have to stay under 2000 mg. sodium per day. Ask your doctor how many you can have.)

* You should weigh yourself everyday. Any weight gain of 5 pounds or more PER WEEK, needs to be reported to your doctor.
(Because your doctor may want to adjust your dosage of diuretics)

* Diuretics can be hard on the kidneys.....so your doctor should be doing bloodtests on a regular basis, especially for kidney function.
The bloodtests for Kidney function are "BUN" (blood urea nitrogen) and "Creatinine".
Request a copy of all your bloodtest results, each time you have bloodwork done.

* Keep track of all of your bloodtest results.
You especially want to monitor:
   liver function:  albumin, bilirubin, PT or INR, platelet count
   kidney function:  BUN and Creatinine
   electrolytes:  potassium, calcium, magnesium, sodium, etc.

* IF (IF) your doctor does recommend a shunt (example "TIPS")---
make sure that it is done by a doctor who is well-practiced at it.
(Ask how many procedures the doctor has done.)

* Most transplant centers demand at least 6 months documented sobriety, before allowing you on the liver transplant waiting list.
If you are interested in a transplant....ask your doctor for a Referral to a transplant center (for an "evaluation" to be done.)

* If you find yourself having any signs of encephalopathy (example: you mentioned feeling "vague", and tired all the time)----your doctor should prescribe LACTULOSE for you.
ASK YOUR DOCTOR about Lactulose.
(Lactulose is a prescription liquid laxative that removes ammonia from the body of cirrhosis patients.)

* Prescription Beta-blockers can reduce the chance of varices bleeding.
If you are not already taking a beta-blocker----ASK YOUR DOCTOR if a beta-blocker would help you.

One more thing---

Cirrhosis patients must be very careful to avoid infections.
ANY SIGN of infection (example: fever, or abdominal pain, or nausea, or vomiting) needs IMMEDIATE attention.

Hope this helps.

Again, your welcome to visit our group at http://www.expage.com/cirrhosis

[porkupine]

HI MY NAME IS ADAM,
I HAVE BEEN SUFFERING FROM CIRRHOSIS FOR THE PAST 3 YEARS,BUT THIS YEAR WAS REALLY BAD FOR ME. I ALMOST PAST AWAY IN JANUARY,I LOST ALOT OF BLOOD,AND WAS BLEEDING IN FRONT OF MY CHILDREN AND I KNOW I REALLY SCARED THEM. I HAVE STOPPED DRINKING NOW FOR 11 MONTHS NOW,BUT I HAVE HAD 2 BANDINGS IN MY ASOPHAGUS. AND I AM GOING TO HAVE A BIOPSY DONE SOON.IF THERE IS ANY ADVICE FOR ME PLEASE E-MAIL ME BACK...THANK YOU..

[imkindly]

Hi Porkupine
You didn't put your email address, so I thought I'd write you back here.
We have a Cirrhosis Support Group at:
http://www.expage.com/cirrhosis

You're welcome to visit there if you want.
There's information along with a Messageboard.
(We also do Live Chats on Wednesday evenings.)