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Hernia and Hepatitis C together
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Hernia and Hepatitis C together

A close relative is suffering from hepatitis C in and for a few months he has a problem of hernia. Hernia problem has grown bigger. His body is swollen around that area. Doctors say he can not be operated because of his condition of hepatitis C as the bleeding will not stop. Water also accumulates in his body. What treatment should he get. Thanks for you advice and help.
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446474_tn?1385271190
Do you mean a umbilical hernia of the belly button?
The problem is because he has advanced cirrhosis (scarring of the liver), caused by the hep c virus, which causes the abdomen to retain fluid and bleed without their blood clotting. This complication of cirrhosis is called ascites. It is fluid retention in the abdomen. By using diuretics the ascites can be managed. They may also have bloated ankles or feet caused by ascites also. All these symptoms appear because the liver is unable to fully function as it should. I'm sure your relative has many other complications also. This is why they MUST see a hepatologist (a doctor who specializes in liver disease) ASAP. Your relative will only get sicker over time and needs medical help to stay a live until they can get a new liver.

Your relative should go to the nearest transplant center that performs liver transplants and get listed for a new liver.
A hernia is not a major issue. It is not worth the risk of surgery to repair it. I have the same thing myself. The symptoms of liver disease are much more serious and painful then a hernia. Umbilical (around the bellybutton)  can cause abdominal discomfort. Surgical repair is generally avoided unless there is severe pain suggesting the intestines or tissue may be pinched or twisted along with a persistent bulge from the hernia.

Best of luck to you and your relative!
hectorsf
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Avatar_f_tn
Dear HectorSF, Thanks for your quick reply. I am not sure what it is called (umbilical hernia or something else) but  it started as pain near testicles region a couple of months before but worsened during last two weeks. I shall try to get more information about hernia if it is umbilical or something else. He lives in Pakistan where there is no health care insurance. Finding a donor of liver and then the cost of transplant is out of reach of a person. It could be in millions of Rupees and impossible for an ordinary family. Some people say that if hernia explodes inside the body, it will kill the person. Is there any way to contain the Hepatitis C and reduce the bulge of swollen hernia? If hepatitis is contained or bleeding could be stopped after the operation, then doctors might operate the hernia. How many bottles of blood would be required in case of operation of hernia is necessary?
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Avatar_f_tn
Dear HectorSF, Thanks for your quick reply. I am not sure what it is called (umbilical hernia or something else) but  it started as pain near testicles region a couple of months before but worsened during last two weeks. I shall try to get more information about hernia if it is umbilical or something else. He lives in Pakistan where there is no health care insurance. Finding a donor of liver and then the cost of transplant is out of reach of a person. It could be in millions of Rupees and impossible for an ordinary family. Some people say that if hernia explodes inside the body, it will kill the person. Is there any way to contain the Hepatitis C and reduce the bulge of swollen hernia? If hepatitis is contained or bleeding could be stopped after the operation, then doctors might operate the hernia. How many bottles of blood would be required in case of operation of hernia is necessary?
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446474_tn?1385271190
I am so sorry your relative is in Pakistan and can't get treatment due the the cost. Even here in the US it can cost hundreds of thousands of dollars, more then 99% of what the average American can afford.
That is a horrible situation to be in. Knowing that if your relative had been here in the US they could survive this disease.
Thank you for reminded us how good we have it here in the US despite all of the problems we have with our medical system. Most people, not all, have some form of medical coverage. More than 50 million people were uninsured last year, almost one in six U.S. residents. But most people are insured.

Maybe your friend has an inguinal (groin) hernia which can be caused by ascites. It can cause abdominal discomfort. Surgical repair is generally avoided unless there is severe pain suggesting the intestines or tissue may be pinched or twisted along with a persistent bulge from the hernia. Surgeons who have experience in treating patients with cirrhosis should perform the operation.

If the intestines get twisted in the bulge it can be very painful and dangerous.
I have a belly button hernia. My doctor told me the only way they would operate would be if my intestines got twisted in the bulge.
I believe and operation could be done but your friend would need blood transfusions to replace the blood he lost during the surgery.

Some people say that if hernia explodes inside the body, it will kill the person.
No, not true. If his intestines get twisted in the hernia that is what your relative needs to be concerned about. See information below as to what danger signs are.
Hep C is not the problem. The problem is that the hep c has damaged the liver so much it is unable to function properly. That is why they become swollen and bleed amongst other complications.

How many bottles of blood would be required in case of operation of hernia is necessary? I am not sure because I don't know how much they will bleed. Only a doctor or surgeon could tell you.

The bleeding can be stopped if the hospital gives him platelets and a transfusion I believe.

Remember I am not a doctor. I am telling you what I know from my own experience with hep C and advanced liver disease.


Here is some information on inguinal hernias from the MayoClinic. One of the leading medical centers in the US.
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Inguinal hernia
An inguinal hernia occurs when soft tissue — usually part of the intestine — protrudes through a weak point or tear in your lower abdominal wall. The resulting bulge can be painful — especially when you cough, bend over or lift a heavy object.

Not necessarily dangerous by itself, an inguinal hernia doesn't get better or go away on its own. An inguinal hernia can lead to life-threatening complications. For this reason, your doctor is likely to recommend surgical repair of an inguinal hernia that's painful or becoming larger. Inguinal hernia repair is a common surgical procedure.

Inguinal hernia signs and symptoms include:

    * A bulge in the area on either side of your pubic bone
    * A burning, gurgling or aching sensation at the bulge
    * Pain or discomfort in your groin, especially when bending over, coughing or lifting
    * A heavy or dragging sensation in your groin
    * Weakness or pressure in your groin
    * Occasionally, in men, pain and swelling in the scrotum around the testicles when the protruding intestine descends into the scrotum

You should be able to gently and easily push the hernia back into your abdomen when you're lying down. If not, applying an ice pack to the area may reduce the swelling enough so that the hernia slides in easily. Lying with your pelvis higher than your head also may help.

If you still aren't able to push the hernia in, the herniated intestine may have become trapped (incarcerated) in the abdominal wall — a serious condition that may require immediate medical attention. This condition may be accompanied by nausea, vomiting, fever, rapid heart rate, sudden pain that quickly intensifies, and a hernia bulge that turns red, purple or dark. If any of these signs or symptoms occur, call your doctor right away!!!

Complications include:
    * Pressure on surrounding tissues. Most inguinal hernias enlarge over time if they're not repaired surgically. Large hernias can put pressure on surrounding tissues — in men they may extend into the scrotum, causing pain and swelling.
    * Incarcerated hernia. This complication of an inguinal hernia occurs when a loop of intestine becomes trapped in the weak point in the abdominal wall. This may obstruct the bowel, leading to severe pain, nausea, vomiting and the inability to have a bowel movement or pass gas.
    * Strangulation. When part of the intestine is trapped in the abdominal wall (incarcerated hernia), blood flow to this portion of the intestine may be diminished. This condition is called strangulation, and it may lead to the death of the affected bowel tissues. A strangulated hernia is life-threatening and requires immediate surgery.

TREATMENT
If your hernia is small and isn't bothering you, your doctor may recommend a watch-and-wait approach. But enlarging or painful hernias usually require surgical repair to relieve discomfort and prevent serious complications. There are two general types of hernia operations:

    * Herniorrhaphy. In this procedure, also called "open" hernia repair, your surgeon makes an incision in your groin and pushes the protruding intestine back into your abdomen. Then your surgeon repairs the weakened or torn muscle by sewing it together. Often the weak area is also reinforced and supported with a synthetic mesh, a procedure called hernioplasty. After the operation, you'll be encouraged to move about as soon as possible, but it may be as long as four to six weeks before you're able to fully resume your normal activities.

Laparoscopy. In laparoscopic surgery, your surgeon uses several small incisions rather than one large one. A fiber-optic tube with a tiny camera is inserted into your abdomen through one incision, and miniature instruments are inserted through the other incisions. Your surgeon then performs the operation using the video camera as a guide. In laparoscopic surgery, synthetic mesh is always used to repair the hernia (hernioplasty).

Advantages of laparoscopic repair include less discomfort and scarring after surgery and a quicker return to normal activities — most people are back to work within a few days. The procedure is a good choice for people whose hernias recur following traditional hernia surgery because laparoscopic methods allow surgeons to work around scar tissue from earlier repair. It's also good for people who have hernias on both sides of the body (bilateral inguinal hernias).

Disadvantages of laparoscopic repair include an increased risk of complications and of recurrence following surgery. These risks are reduced if the procedure is performed by a surgeon with extensive experience in these kinds of repairs.

You may not be a candidate for laparoscopic hernia repair if you have a very large hernia, if your intestine is pushed down into the scrotum or if you've had previous pelvic surgery such as a prostatectomy.


Best of luck to you and your relative!!!
Hectorsf

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446474_tn?1385271190
Hello. I just reread your original question.
You ask what treatment should they get.
By getting some of these medicine your relative can feel much better even though their liver disease will continue to progress. I am taking all of these meds myself and have from them to make a big difference in how I feel every day.

To manage Ascites:
* For the swelling (ascites) they should reduce they salt intake. Stay away from salty food and never add salt to anything they eat.
* What they need as far as treatment is to take diuretics. Sometimes known as "water pills". The medicine is very inexpensive at least here in the US. The common meds and dosages are what is recommended.
* Spironolactone (also known as Aldactone, Novo-Spiroton, Aldactazide, Spiractin, Spirotone, Verospiron or Berlactone)

* Furosemide (Aisemide, Apo-Furosemide, Beronald, Desdemin, Discoid, Diural, Diurapid, Dryptal, Durafurid, Edemid, Errolon, Eutensin, Flusapex, Frusetic, Frusid, Fulsix, Fuluvamide, Furesis, Furix, Furo-Puren, Furosedon, Hydro-rapid, Impugan, Katlex, Lasilix, Lasix, Lodix, Lowpston, Macasirool, Mirfat, Nicorol, Odemase, Oedemex, Profemin, Rosemide, Rusyde, Salix, Trofurit, Uremide, Urex, Frudix, Fusid.frusone)

Since salt restriction is the basic concept in treatment, and aldosterone is one of the hormones that acts to increase salt retention, a medication that counteracts aldosterone should be sought. Spironolactone (or other distal-tubule diuretics such as triamterene or amiloride) is the drug of choice since they block the aldosterone receptor in the collecting tubule. Diuretics for ascites should be dosed once per day. Generally, the starting dose is oral spironolactone 100 mg/day (max 400 mg/day). 40% of patients will respond to spironolactone. For nonresponders, a loop diuretic may also be added and generally, furosemide is added at a dose of 40 mg/day (max 160 mg/day), or alternatively (bumetanide or torasemide). The ratio of 100:40 reduces risks of potassium imbalance. Serum potassium level and renal (kidney) function should be monitored closely while on these medications.
They will cause the person to urinate frequently. They take about 2 weeks to have full effect.

To manage mental confusion loss of memory and concentration, "flapping" shaking of the hands when attempting to hold the arms out in front of the body and lift the hands (Hepatic Encephalopathy).
* Lactulose (brand names CEPHULAC, CHRONULAC, CHOLAC, CONSTULOSE, ENULOSE)
Again this is an inexpensive medicine. Lactulose is also used to reduce the amount of ammonia in the blood of patients with liver disease. The ammonia goes to the brain and causes altered brain function. Lactulose comes as liquid to take by mouth. It usually is taken three or four times a day for liver disease. It should be taken so the patient has 3-4 bowel movements per day.

To manage high blood pressure Portal Hypertension
Medications such as propranolol and isosorbide may be prescribed to lower the pressure in the portal vein and reduce the risk of recurrent bleeding.
* Propranolol (Inderal, Inderal LA, Innopran XL) The recommended dose is 80-160 mg daily using long acting formulations.
* Or Nadolol (Corgard). Start propranolol (20 mg BID) increase to maximum tolerable dosage or a heart rate of 55-60 beats per minute.  It should be taken to reduce the heart rate to about 60 beats per minute. I take 20mg.

In general here are some guideline for people with cirrhosis of the liver:
Maintaining good nutritional habits and keeping a healthy lifestyle will help your liver function properly. Some of the things you can do to improve the function of your liver include the following:

    * Do not use alcohol or street drugs.
    * Do not take any over-the-counter or prescription drugs without first consulting with your physician or nurse. Some medications may make liver disease worse, and they may interfere with the positive effects of your other prescription medications. When taken at recommended doses, acetaminophen, the medicine in TYLENOL, is the preferred pain reliever for patients with chronic, stable liver disease.
    * Follow the dietary guidelines given to you by your physician or nurse. Follow a low-sodium (salt) diet. You will probably be required to consume no more than 2 grams of sodium per day. Reduced protein intake is required only if confusion is a symptom. Plant protein is recommended rather than animal protein. Red meats are especially bad as they make many complications of liver disease worse.

I hope this helps.
Hectorsf
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Avatar_m_tn
I have a groin hernia, does it cause toxins or liver problems?  I had a regular hepatitis panel negative, does that rule out hep c, autoimmune hep?
my liver levels are 80/250 and my liver is damaged after anesthesia, I was weak and bedridden for a month
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Avatar_m_tn
I've heard sometimes the hernia repair fails or causes groin pain so I'm not rushing to surgery.  that sounds pretty terrible though if it gets strangulated
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