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Hemorrhoidal Bleeding & Stage 4 Cirrohsis
My husband had a colonoscopy done this morning and we were told that he had Hemorrhoidal Bleeding caused by the pressure of the blood. He is also Hep C (found out 10/08), Stage 4 Cirrohsis (found out 2/09) He was also a non responder to treatments. Doctor told us Feb 2010 that he may live a year. But can anyone explain this bleeding. And it not just a little on the tissue paper.
Patti
Patti
The main "Complications" that threaten a cirrhosis patient are:
1. Ascites (fluid build-up in the abdomen) that can become infected. (Ascites is caused by portal hypertension and low albumin levels).
* Treatment:
Low Sodium Diet (to avoid more fluid build-up)
Diuretics (to help shed the excess fluid)
When taking Diuretics---- Have blood tests done on a regular basis to monitor Kidney Function and Electrolytes
Keep track of your weight--- Call the doctor if there's any weight gain of 5 pounds or more during a week
Go to the Emergency Room for any signs of infection (fever, or pain in the abdomen, or vomiting, or trouble breathing, etc.)
2. Varices (internal varicose veins usually in the esophagus, stomach, or intestine) that can burst and bleed. (Varices are caused by portal hypertension).
* Treatment:
Endoscopy to look for any signs of varices
If there are varices--- they can be treated during endoscopy
The doctor may also prescribe a beta-blocker (to reduce blood pressure)
Go to the Emergency Room for any signs of bleeding--- (coughing blood, or vomiting blood, or vomiting a substance that looks like coffee grounds, or passing blood, or passing black stools)
3. Encephalopathy (mental changes, coordination changes, sleeping changes) that can lead to coma
* Encephalopathy can be caused by many things: a build-up of toxins (especially ammonia), drugs, alcohol, electrolyte disturbances, infections, internal bleeding, excess protein in the diet (especially red meat), constipation, dehydration, etc.
* Treatment:
Lactulose (a prescription liquid laxative that binds with ammonia and removes it from the body)
Rifaximin, prevents the bacteria from growing inside the intestine. It has less side effects then lactulose. Is used in combination with lactulose. Expensive.
Avoid alcohol, get an approval on any drugs (even over-the-counter medications or supplements)
Have bloodtests done on a regular basis (to monitor electrolytes, CBC, etc.)
Call the doctor if you see any signs of encephalopathy worsening)
Go to the Emergency Room if it's really bad
4. Kidney Problems (difficulty urinating, or decreased urination, or painful urination, or blood in the urine, etc.)
Kidney problems can be caused by several things: Hepatorenal Syndrome (kidney failure caused by liver failure), infection, dehydration, electrolyte problems, etc.
Treatment:
Have bloodtests done on a regular basis (to monitor kidney function, electrolytes, CBC, etc.)
AVOID NSAIDs (non steroidal anti-inflammatory drugs). (Example- ibuprofen, aleve, advil, motrin, celebrex, etc...) NSAIDs can cause kidney failure in cirrhosis patients.
Go to the Emergency Room if you see any signs of kidney problems
The sooner you get help at ER the easier the problem can be controlled.
TIME COUNTS.
Thanks IM.
Hectorsf
1. Ascites (fluid build-up in the abdomen) that can become infected. (Ascites is caused by portal hypertension and low albumin levels).
* Treatment:
Low Sodium Diet (to avoid more fluid build-up)
Diuretics (to help shed the excess fluid)
When taking Diuretics---- Have blood tests done on a regular basis to monitor Kidney Function and Electrolytes
Keep track of your weight--- Call the doctor if there's any weight gain of 5 pounds or more during a week
Go to the Emergency Room for any signs of infection (fever, or pain in the abdomen, or vomiting, or trouble breathing, etc.)
2. Varices (internal varicose veins usually in the esophagus, stomach, or intestine) that can burst and bleed. (Varices are caused by portal hypertension).
* Treatment:
Endoscopy to look for any signs of varices
If there are varices--- they can be treated during endoscopy
The doctor may also prescribe a beta-blocker (to reduce blood pressure)
Go to the Emergency Room for any signs of bleeding--- (coughing blood, or vomiting blood, or vomiting a substance that looks like coffee grounds, or passing blood, or passing black stools)
3. Encephalopathy (mental changes, coordination changes, sleeping changes) that can lead to coma
* Encephalopathy can be caused by many things: a build-up of toxins (especially ammonia), drugs, alcohol, electrolyte disturbances, infections, internal bleeding, excess protein in the diet (especially red meat), constipation, dehydration, etc.
* Treatment:
Lactulose (a prescription liquid laxative that binds with ammonia and removes it from the body)
Rifaximin, prevents the bacteria from growing inside the intestine. It has less side effects then lactulose. Is used in combination with lactulose. Expensive.
Avoid alcohol, get an approval on any drugs (even over-the-counter medications or supplements)
Have bloodtests done on a regular basis (to monitor electrolytes, CBC, etc.)
Call the doctor if you see any signs of encephalopathy worsening)
Go to the Emergency Room if it's really bad
4. Kidney Problems (difficulty urinating, or decreased urination, or painful urination, or blood in the urine, etc.)
Kidney problems can be caused by several things: Hepatorenal Syndrome (kidney failure caused by liver failure), infection, dehydration, electrolyte problems, etc.
Treatment:
Have bloodtests done on a regular basis (to monitor kidney function, electrolytes, CBC, etc.)
AVOID NSAIDs (non steroidal anti-inflammatory drugs). (Example- ibuprofen, aleve, advil, motrin, celebrex, etc...) NSAIDs can cause kidney failure in cirrhosis patients.
Go to the Emergency Room if you see any signs of kidney problems
The sooner you get help at ER the easier the problem can be controlled.
TIME COUNTS.
Thanks IM.
Hectorsf
Patty -
Here is some information about cirrhosis and End Stage Liver Disease (ESLD). I also have the same condition as your husband, so this is based on my own experience and knowledge of this illness and its symptoms and complications.
Anytime someone has rectal bleeding. They should go to the ER ASAP. Internal bleeding can be fatal! Should he vomit blood he should also go to the ER ASAP.
If your husband is drinking alcohol or abusing drugs these substances will worsen his his symptoms and will further damage his liver. He needs to be free of any addictions if he wants to continue living.
He should be under the care of a local gastroenterologist or hepatologist who coordinates treatment with Mayo. He needs to be listed at a transplant center ASAP if he is as ill as you say. I am not sure how your insurance with deal with this but it has to be done somehow.
“He has been tired and no energy” Fatigue is the most common complication of cirrhosis. Unfortunately this and all of his other symptoms will continue to get progressively worse over time until he gets a liver transplant.
Varices. “Mayo said it was more like a 2-3.” He will probably need banding at some point to prevent his veins from bursting. An endoscopy is used to perform the procedure. Make sure he is taking his Propranolol. It slows his heart beat and reduces the portal hypertension that causes varices and rectal bleeding.
"Symptoms of bleeding from varices include vomiting blood (can be red blood mixed with clots or "coffee grounds" in appearance, the latter due to the effect of acid on the blood), passing stool that is black and tarry due to changes in the blood as it passes through the intestine (melena), and orthostatic dizziness or fainting (caused by a drop in blood pressure especially when standing up from a lying position)."
The AFP numbers are alright. Imaging, ultrasound and CT scan should be done every 6 months and AFP taken then to look for liver cancer (HCC) which all cirrhotics have a high risk of having as time goes on. Yes, if AFP constantly rises in the 100s or is over 500 this is a sign of liver cancer.
Edema of the feet ankles and legs is another common complication of Cirrhosis. The diuretics can help to manage this. As long as he has less than 2000 mgs of sodium per day. No processed food. Look on cans of food and buy No Salt or very low sodium items only.
Confusion - there is some, biggest thing is he will be talking and stops. He says it's like the words are in his mind but he can't get them to come out.
This is hepatic encephalopathy. A common complication of liver cirrhosis. Toxins from the food digestion process create ammonia that because the liver is not able to function well go to his brain causing memory problems, coordination problems, and disorientation problem. Driving a motor vehicle is dangerous as be could have an attack while driving. He could easily got lost and not know where his is. He should be taking Lactulose and Rifaximin which will help him manage his symptoms.
He should be getting on the Mayo clinic Liver transplant list.
What is his MELD score?
What is his prognosis?
Here is some information about cirrhosis and liver transplant.
Cirrhosis
http://www.medicinenet.com/cirrhosis/article.htm
Liver transplant
http://www.medicinenet.com/liver_transplant/article.htm
Good luck.
Hectorsf
Here is some information about cirrhosis and End Stage Liver Disease (ESLD). I also have the same condition as your husband, so this is based on my own experience and knowledge of this illness and its symptoms and complications.
Anytime someone has rectal bleeding. They should go to the ER ASAP. Internal bleeding can be fatal! Should he vomit blood he should also go to the ER ASAP.
If your husband is drinking alcohol or abusing drugs these substances will worsen his his symptoms and will further damage his liver. He needs to be free of any addictions if he wants to continue living.
He should be under the care of a local gastroenterologist or hepatologist who coordinates treatment with Mayo. He needs to be listed at a transplant center ASAP if he is as ill as you say. I am not sure how your insurance with deal with this but it has to be done somehow.
“He has been tired and no energy” Fatigue is the most common complication of cirrhosis. Unfortunately this and all of his other symptoms will continue to get progressively worse over time until he gets a liver transplant.
Varices. “Mayo said it was more like a 2-3.” He will probably need banding at some point to prevent his veins from bursting. An endoscopy is used to perform the procedure. Make sure he is taking his Propranolol. It slows his heart beat and reduces the portal hypertension that causes varices and rectal bleeding.
"Symptoms of bleeding from varices include vomiting blood (can be red blood mixed with clots or "coffee grounds" in appearance, the latter due to the effect of acid on the blood), passing stool that is black and tarry due to changes in the blood as it passes through the intestine (melena), and orthostatic dizziness or fainting (caused by a drop in blood pressure especially when standing up from a lying position)."
The AFP numbers are alright. Imaging, ultrasound and CT scan should be done every 6 months and AFP taken then to look for liver cancer (HCC) which all cirrhotics have a high risk of having as time goes on. Yes, if AFP constantly rises in the 100s or is over 500 this is a sign of liver cancer.
Edema of the feet ankles and legs is another common complication of Cirrhosis. The diuretics can help to manage this. As long as he has less than 2000 mgs of sodium per day. No processed food. Look on cans of food and buy No Salt or very low sodium items only.
Confusion - there is some, biggest thing is he will be talking and stops. He says it's like the words are in his mind but he can't get them to come out.
This is hepatic encephalopathy. A common complication of liver cirrhosis. Toxins from the food digestion process create ammonia that because the liver is not able to function well go to his brain causing memory problems, coordination problems, and disorientation problem. Driving a motor vehicle is dangerous as be could have an attack while driving. He could easily got lost and not know where his is. He should be taking Lactulose and Rifaximin which will help him manage his symptoms.
He should be getting on the Mayo clinic Liver transplant list.
What is his MELD score?
What is his prognosis?
Here is some information about cirrhosis and liver transplant.
Cirrhosis
http://www.medicinenet.com/cirrhosis/article.htm
Liver transplant
http://www.medicinenet.com/liver_transplant/article.htm
Good luck.
Hectorsf
That's the weird thing. He was being seen at the Mayo and where he was working changed insurance and the new insurance didn't cover him going to the Mayo. There was a 10 month peroid that he couldn't go until he was only on my insurance. In this time frame Mayo wanted him to go throught Drug/Alcohol treatment, fine but we couldn't get a refferal from Mayo for him to go to the treatment places they wanted him to go to. So now they won't see him anymore because he didn't have the evaluation and treatments completed!
But when they started checking his AFP it was 28 and in 3 months it was 185. All his blood work as to be done stat because the platelets start clumping almost immediately. So at the local hospital it has been 68 for about the past 8 months. Will be checked again the end of this month. Mayo doc told me to look for it to increase and least 25 each month!
He has had a hugh problem with edema. With the meds now it seems to be under control. But last summer he couldn't take the meds, he got dehaydrated 4 times.
Demeanor, he goes off about any little thing now. I asked him the other night if he was just trying to push me away.
Confusion - there is some, biggest thing is he will be talking and stops. He says it's like the words are in his mind but he can't get them to come out.
My brother was just in here with me and he says that combativeness is well advanced. Wants to argue about eveything. My brother lives with us and I think he is the only one keeping me sane.
Sorry for the length for this. And thanks for all your help.
Patti
But when they started checking his AFP it was 28 and in 3 months it was 185. All his blood work as to be done stat because the platelets start clumping almost immediately. So at the local hospital it has been 68 for about the past 8 months. Will be checked again the end of this month. Mayo doc told me to look for it to increase and least 25 each month!
He has had a hugh problem with edema. With the meds now it seems to be under control. But last summer he couldn't take the meds, he got dehaydrated 4 times.
Demeanor, he goes off about any little thing now. I asked him the other night if he was just trying to push me away.
Confusion - there is some, biggest thing is he will be talking and stops. He says it's like the words are in his mind but he can't get them to come out.
My brother was just in here with me and he says that combativeness is well advanced. Wants to argue about eveything. My brother lives with us and I think he is the only one keeping me sane.
Sorry for the length for this. And thanks for all your help.
Patti
How elevated is his AFP now? I forgot to ask previously; has he been evaluated for transplant? If so, what are his MELD score and his current transplant status? It sounds like they’re wringing lots of water out of him too; is he having difficulty with edema (swelling of the ankles)? How is his demeanor; any confusion or combativeness?
Take care-
--Bill
Take care-
--Bill
Thanks Bill
The doctor put him on Propranolo 10 mg X2 when this was discover back in Feb 10. He is also taking Lasix 20mg X1, Aldacotone 50mg X1, Ambien 5mg for sleep, Forinal for headaches, which are pretty much daily. Plus daily vitamins with an extra B complex. He has been tired and no energy for the past month and a half. Then the bleeding started. The specialist is now seeing him every 2 months. First the past 2 years it has been every 3 months. Also his afp is elevated. Doctor says few months to a year. But he said a year last February.
The doctor put him on Propranolo 10 mg X2 when this was discover back in Feb 10. He is also taking Lasix 20mg X1, Aldacotone 50mg X1, Ambien 5mg for sleep, Forinal for headaches, which are pretty much daily. Plus daily vitamins with an extra B complex. He has been tired and no energy for the past month and a half. Then the bleeding started. The specialist is now seeing him every 2 months. First the past 2 years it has been every 3 months. Also his afp is elevated. Doctor says few months to a year. But he said a year last February.
Hi again; sure, I remember you posting in here before. Sorry to hear of the problems.
I don’t believe all varices require immediate band ligation. I’ve heard of others doing the watch ‘n wait with stage 1 and 2 varices, if my memory serves me. Hopefully someone going through this right now will add their thoughts; HectorSF is really helpful with issues revolving around cirrhosis in here.
I imagine as long as the doctors are monitoring things he’ll be okay; this stuff sneaks up on folks that aren’t in the medical loop and can be problematic, for sure.
Is there an NP or PA at the clinic you might be able to discuss this with? You might also talk about the ‘TIPS’ procedure too; I’m not sure it’s indicated for your husband at this juncture, but you might want to at minimum become informed in case it comes up later. Have they prescribed a beta blocker for him yet?
--Bill
I don’t believe all varices require immediate band ligation. I’ve heard of others doing the watch ‘n wait with stage 1 and 2 varices, if my memory serves me. Hopefully someone going through this right now will add their thoughts; HectorSF is really helpful with issues revolving around cirrhosis in here.
I imagine as long as the doctors are monitoring things he’ll be okay; this stuff sneaks up on folks that aren’t in the medical loop and can be problematic, for sure.
Is there an NP or PA at the clinic you might be able to discuss this with? You might also talk about the ‘TIPS’ procedure too; I’m not sure it’s indicated for your husband at this juncture, but you might want to at minimum become informed in case it comes up later. Have they prescribed a beta blocker for him yet?
--Bill
Hi Bill,
Thanks for the quick response. You have helped me before. He does have portal hypertension, that was diagnosed in Feb 10. The doctor said that this was the cause. I asked the doctor about another endoscopy this morning, his reply was he didn't expect it to be that much different. But when he did the first one he said it was about a 1-2 varies. And a Dr he was seeing at the Mayo said it was more like a 2-3. He is nolonger able to go to the Mayo because of insurance changes. The doctor just didn't explain this very well. We see him next month, but I don't want to wait until next month to get a better explanation.
Thanks for the quick response. You have helped me before. He does have portal hypertension, that was diagnosed in Feb 10. The doctor said that this was the cause. I asked the doctor about another endoscopy this morning, his reply was he didn't expect it to be that much different. But when he did the first one he said it was about a 1-2 varies. And a Dr he was seeing at the Mayo said it was more like a 2-3. He is nolonger able to go to the Mayo because of insurance changes. The doctor just didn't explain this very well. We see him next month, but I don't want to wait until next month to get a better explanation.
and maybe its completely different in combination with portal hypertension, that is all I know about Hemorrhoids
Hemorrhoids are hemorrhoidal tissue at the anus which fills with blood to cushion the bowel movement at the anus, this tissue is fed blood much like arterial blood which does not have any valves (so that it can quickly go to the area) it takes a little bit for the blood to be reabsorbed. If there is pressure at the anus, sitting on the toilet to long, pushing, constipated, this tissue fills with blood stretches and sometimes creates blood clots. very painful.
Walking moves the blood back into the system, swimming, lots of water, Metamucil w/ lots of water,,,,, It can take a while for this to resolve itself and if you are noticing blood you should be careful of blood clots, you will know because you will have grape size sacks hanging down that really hurt and do not go away.
These are the answers that I came up with during my horrendous bout.
IF you have blood clots you will need a surgeon (not a doc) excise the tissue so that it can drain..... and they will remove some of the clots.
Sometimes these sacks can hemorrhage and you can actually bleed out.... Sometimes the hemorrhoidal tissue stretches so much w/ blood that it avulses.
Just drink lots of water, watch whats going on, be grateful it is only hemorrhoidal bleeding, but take allot of TLC
Walking moves the blood back into the system, swimming, lots of water, Metamucil w/ lots of water,,,,, It can take a while for this to resolve itself and if you are noticing blood you should be careful of blood clots, you will know because you will have grape size sacks hanging down that really hurt and do not go away.
These are the answers that I came up with during my horrendous bout.
IF you have blood clots you will need a surgeon (not a doc) excise the tissue so that it can drain..... and they will remove some of the clots.
Sometimes these sacks can hemorrhage and you can actually bleed out.... Sometimes the hemorrhoidal tissue stretches so much w/ blood that it avulses.
Just drink lots of water, watch whats going on, be grateful it is only hemorrhoidal bleeding, but take allot of TLC
Hi there,
Sorry to hear of your husband’s diagnosis and subsequent problems.
You should talk to his doctor and have him clarify whether this bleeding is the result of true hemorrhoids or if it’s due to rectal varices from portal hypertension; it sounds like maybe the later.
Wikipedia has an article on this; you can read through it here:
http://en.wikipedia.org/wiki/Portal_hypertension
As the liver becomes scarred as a result of the HCV infection, blood from the GI tract becomes obstructed and can’t travel through the portal vein efficiently. This causes portal hypertension, or elevated blood pressure in the portal tract (not to be confused with high blood pressure that you measure with a arm cuff).
This blood then seeks other paths, sometimes leading to bleeding/hemorrhaging of the esophagus, stomach or rectum. His doctor will likely prescribe meds to lower his blood pressure, and he should also have periodic endoscopies to monitor for future bleeds.
Here’s an article on esophageal varices:
http://en.wikipedia.org/wiki/Esophageal_varices
Good luck to both of you,
--Bill
Sorry to hear of your husband’s diagnosis and subsequent problems.
You should talk to his doctor and have him clarify whether this bleeding is the result of true hemorrhoids or if it’s due to rectal varices from portal hypertension; it sounds like maybe the later.
Wikipedia has an article on this; you can read through it here:
http://en.wikipedia.org/wiki/Portal_hypertension
As the liver becomes scarred as a result of the HCV infection, blood from the GI tract becomes obstructed and can’t travel through the portal vein efficiently. This causes portal hypertension, or elevated blood pressure in the portal tract (not to be confused with high blood pressure that you measure with a arm cuff).
This blood then seeks other paths, sometimes leading to bleeding/hemorrhaging of the esophagus, stomach or rectum. His doctor will likely prescribe meds to lower his blood pressure, and he should also have periodic endoscopies to monitor for future bleeds.
Here’s an article on esophageal varices:
http://en.wikipedia.org/wiki/Esophageal_varices
Good luck to both of you,
--Bill
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