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New Hospitalizaton and chirrosis

I posted a couple of weeks ago about my husband's lab getting worse and going from MELD 10 to 15 in three months.
He was hurt this weekend. Lost his balance and fell off a step ladder. Broke is ankle in two places. Orthopedic surgeon was worried about his lab. Mainly about sugar in the 200-300 and low blood oxygen. I'm assuming these are related to his chirrosis? They called in his doctor and he visited him. The doc called me and said he did not own up to any drinking, which is far from the truth. He ordered more test, My husband is still in the hospital and waiting on the next step. Please help me with an explanation on how his chirrosis has something to do with these new issues.
Thanks!
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1475202 tn?1536270977
COMMUNITY LEADER
Val I am sorry to hear you are having to deal with so much. Cirrhosis is tough enough and anything else makes things way more complicated. I hope some of this information below will help.

“sugar in the 200-300”
The liver is the primary disposal site of insulin; when the liver is damaged, less insulin is taken up and degraded, causing a condition of chronic hyperinsulinemia. This means that in people with impaired liver function, glucose is not as efficiently removed from the blood by muscle tissue, leading to a chronic elevation of blood glucose levels (high sugar). Diabetes is common in about 30% of cirrhotic individuals.

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“low blood oxygen”
Hemoglobin is the oxygen-carrying substance in red blood cells. Low hemoglobin is common is those with cirrhosis. As cirrhosis develops the contour/structure of the liver changes. Scaring prevents blood from flowing through the liver as efficiently as it once could. Portal Hypertension begins to build, as a result the spleen becomes enlarged trapping red and white blood cells and platelets. This condition is known as splenomegaly.

To learn more about “splenomegaly” please visit: http://hepatitiscnewdrugs.blogspot.com/2010/11/cirrhosis-what-happens-when-spleen-is.html

One of the most serious complications/symptoms of cirrhosis is portal hypertension:
Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. As a result, high pressure in the portal system develops. This increased pressure in the portal vein may lead to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, or umbilical area (belly button). Varices can rupture and bleed, resulting in potentially life-threatening complications.

To learn more about “portal hypertension” please visit: http://www.webmd.com/digestive-disorders/digestive-diseases-portal

Randy



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Avatar universal
Great explanation.  Thanks Randy.
Advocate1955
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Avatar universal
Thanks so much for the info. It makes sense now. Wondered if diabitis  could have been avoided if he stopped drinking 2 years ago, Now he has to take insulin everyday. It is another obstacle to overcome. Hope this is another wake up call, and it is not too late. Appreciate your help!
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1475202 tn?1536270977
COMMUNITY LEADER
Val you are very welcome and too answer your question:

Wondered if diabetes  could have been avoided if he stopped drinking 2 years ago?
It’s is very likely. See here is how cirrhosis works, the shortened version:

Everything we ingest kills liver cells but this is okay because the liver has this amazing ability to heal itself. The problem is when we abuse alcohol for several years massive amounts of liver cells are being destroyed and the liver cannot keep up so scar tissue begins to form. We call this fibrosis and in more severe cases cirrhosis. With liver disease if you remove the cause you stop the advancement as long as the disease hasn’t progressed to far. Failure to eliminate the cause will result in death. Transplant is only available to those with six months of document sobriety.
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Val we are very fortunate to have such wonderful people here that spend their time committed to helping others going through the same thing as yourself and/or your husband. You understand how critical it is for your husband to stop drinking as you mentioned in another thread you were going to show him this site. I can imagine you have hoped and prayed for this many times.
http://www.medhelp.org/posts/Cirrhosis-of-the-Liver/Progress-of-Chirrosis-Update/show/2131758#post_10155216

I wonder if you did show him and does he clearly understand that his cirrhosis Will continue to advance until he has expired? Does he just think “oh poor me” or has he realized all that you and his loved ones are going through and it is his fault? Don’t allow him to think that he is sick and that is so sad but that he is selfishly doing this to himself with little regard to what he is putting everyone else through. He continues to make this worse drink after drink.

4 years ago I too was diagnosed with alcoholic cirrhosis and it too took me some time to realize I was being selfish by continuing to drink, since that moment I stopped immediately and my adult life has never been better despite the challenges this disease brings. As an alcoholic I understand what it is like to lose yourself to the drink, after a while you don’t know who you are anymore and it is real scary to find out. I even worried if my wife would like the new me but as it turned out she liked me better and so did I.

I wish you both the very best.
Randy
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Avatar universal
Randy.      You've really summed up the devastating reality of alcoholism.   Thank you for that.     I hope and pray Val's husband finds some understanding of the progression of this disease before its to late.     ..Kim
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Avatar universal
Dear Val,
You're fortunate to be getting the benefit of Randy's experience - he is among the most knowledgeable and generous people that I've ever come across.  Many of us are learning that the (relatively) simple act of removing alcohol from our lives has led to improvements in our liver health and function.  It normally will take several months, up to a year in some instances, but in all likelihood your husband - if he will stop drinking altogether -  will improve.  And a word about diabetes:  as Randy has shared with you, diabetes and cirrhosis frequently coexist.  I personally know of several cases where the combination of (a) alcohol cessation, (b) dietary changes and (c) regular exercise has eventually resulted in the remission of diabetes.  This is often a bit lengthier process - and may take at least a year or two, however there is HOPE on that front as well.
Please continue to keep us updated, and best wishes to you and to your husband!
PD
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Avatar universal
Thanks all of you for the helpful insights. My husband decided that this is the time he needs to stop drinking if he would like to stay around much longer. Came home from the hospital and has not had a drop of alcohol since that. Even though it has only been a week or so I'm so hopeful that everything will turn around and his health will improve. Hope he did not destroy his liver so much that it can't recover enough and  he couldn't survive without a transplant. I will keep in touch if anything changes in his condition and I really appreciate all of your help, support, and understanding!
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Avatar universal
Thank you, Randy.  Continued good progress in your healing.  You are a  good news story.

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Avatar universal
Thanks for your great explanation. My husband is still on track since he is home from the hospital. Has not had a drink for a couple of weeks now. He is in a cast because of his broken leg so he is not able to get his drink, but I'm hoping his reason is that he really decided to quit for good. In the last couple of days he has been throwing up on and off and says he is dizzy all the time. Is this a symptom of his liver worsening or maybe something else is going on? He was at a point when he wanted to go to the emergency room. Wondered if you experienced any of these during your progression. Thanks for your input!
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1475202 tn?1536270977
COMMUNITY LEADER
Hi Val,
No the vomiting is not normal and what concerns me is that if he had some bleeding going on that would surely make him light headed/dizzy feeling and nauseous.  Variceal bleeding/hemorrhage could be the direct result.

Bleeding esophageal varices

Bleeding esophageal varices are enlarged veins in the walls of the lower part of the esophagus (the tube that connects your throat to your stomach) that bleed.

Causes:
Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring reduces blood flowing through the liver. As a result, more blood flows through the veins of the esophagus.
This extra blood flow causes the veins in the esophagus to balloon outward. If these veins break open, they can bleed severely.
Any type of chronic liver disease can cause esophageal varices.
Varices can also occur in the upper part of the stomach.

Symptoms:
People with chronic liver disease and esophageal varices may have no symptoms.
If there is only a small amount of bleeding, the only symptom may be dark or black streaks in the stools.

If larger amounts of bleeding occur, symptoms may include:
• Black, tarry stools
• Bloody stools
• Light-headedness
• Paleness
• Symptoms of chronic liver disease
• Vomiting
• Vomiting blood

Val this condition can be life threatening so a trip to the emergency room may be warranted since these symptoms exist. Another thing that comes to mind is has there been a change in his medications?

I am really happy to hear he has two weeks sober now, already his body is healing the best it can. Proper nutrition at this point is essential and since he is not keeping food down he should be examined either at the ER or his liver specialist (hepatologist). Persons with cirrhosis often use vitamin supplements since the livers ability is compromised.  Diet plays a very important role in the treatment of cirrhosis.

I hope the best for you and your husband Val,

Randy
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Avatar universal
His medication did change, he is still taking a beta blocker and now he has pain medication for his broken leg, I think  it is hydrocodone. He is also giving himself insulin shots for his newly diagnosed diabetes. The doctor said he could not take any pills for that because of his liver. They also took him of from  diuretics. He still has Ascites, but his legs are not  as swollen as they used to be. I will check if his condition improved today since unfortunatlly I have to work and not able to care for him. If he did not improve we will go back and try to see what is going on. Thanks again for your support and helpful advice. This disease always shows a  new challenge, but hopeful that it will improve if he behaves himself.
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1475202 tn?1536270977
COMMUNITY LEADER
Hi Val,
Sorry I’m just now getting back to you. You are right there are many challenges that come with liver disease but I promise it can get easier once you become more familiar with the do’s and don’ts. It is important you and your husband learn all you can about cirrhosis, this will help him tremendously as well as allow him to better communicate with his doctors. This is a good place to start: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/

Your husband’s liver disease should be managed by a Hepatologist at a liver transplant facility if it’s not already. This doesn’t mean he will need a transplant or that he is eligible if he does but just that he will receive the best care available. Though other doctors may have very good intentions they just are not qualified to treat cirrhosis.

Pain relievers should be avoided by persons with liver disease since most medications are processed by the liver to include Hydrocodone. Dizziness and vomiting are also side effects of Hydrocodone. You will find the side effects listed here and you should consult your doctor if they occur.

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601006.html

Often (not always)Hydrocodone will also contain acetaminophen. Drugs containing acetaminophen (including Tylenol) should not be used by cirrhotic individuals unless approved/prescribed by a Hepatologist.

By now I hope your husband is feeling much better and still maintaining his sobriety.

Take care,

Randy
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