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Wife's Acute Hospitalization resulting in Dead Colon

Wife's Acute Hospitalization resulting in Dead Colon

My wife, a 63y/o white lady with a 18 year history of Parkinson's Disease, was taken to hospital approx 4 wks ago after an acute onset of vomiting and low abdominal pain.  After a tenuous ER visit controlling falling blood pressure, escalating pain, a CT scan of abdomen showed dead bowel.  This resulted in a Compartment Syndrome, shutting down the kidneys and also resulting in a secondary pancreatitis.  The next AM a surgical procedure found the entire large intestine necrotic and the majority of the small intestine in the same condition.  All but 110cm of the small intestine were resected, as well as the entire colon.  The abdomen was kept open under a sterile window.  An ultrasound showed the mesenteric artery & vein with minimal flow and the portal system patent.  The remaining intestine was found to be viable and an ostomy completed 2 days later.  

Almost 4 weeks later, it seems the lungs, heart and brain are in good shape.  The small intestine has been absorbing some nutrition this week, however, we have some liver issues in the fourth week.  The bile ducts are open by ultrasound and although the liver labs are now trending in the better direction, they remain very high.  Yesterday a nuclear medicine exam confirmed decreased function, but I need to get more input from the doctors this weekend.  

I know we've just witnessed some major miracles in recent weeks of bringing the organs back on line.  She has been on a ventilator the first week, then converted to a tracheostomy.  Currently, they are test driving the lungs with CPAP and she has done well in recent days.  She has remained on full-time kidney dialysis but they are lokking to change to hemo-dialysis in the next week.  Her heart rate and blood pressure has been good recently, however she did have some low pressures over the last few weeks. The liver seems to be in the slow lane at this time and I'm uncertain of the prognosis and questions that I should be asking at this time.  I have been in the healthcare industry for over 30 years, so I understand many of the processes and terminology.

I know the liver can be resilient, but how guarded are we at this junction?  As she is weaned off TPN and gets more small intestine nutrition, could that make a positive liver adjustment.  My wife was more jaundiced a few days ago and that has visually improved.  She is more alert in the last few days with eyes wide open and all neuro signs looking intact.  Could it simply be that the the liver is in shock and will need some time?

Other thoughts at this time?
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