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Cirrhosis of the Liver Community
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Sudden death from Cirrhosis of the liver? No autopsy performed

I am really hoping to find some answers or at least guidance on this issue, for the past 3 months I've been doing nothing but researching and I cannot for the life of me figure out why this happened.

I'll give you some background story, my father has drank pretty heavily his whole life but other than that was in relatively good health. Well  mid September 2017 I received a phone call that my father had a heart attack and they were giving him a 50/50 shot at surviving, my father being 53 years old. Frantic I drove as fast as I could over to the hospital living in adl different city was an hour away. When I got to the ER he was awake, alert, but looked terrible. The first thing he said to me after smiling that I was there was "those paramedics had some smelly feet" haha. Usual dad. But Apparently he had not been feeling well for several months and never went to the doctors. Unbeknownst to me, the day before his heart attack, he had another episode where he passed out and was not breathing but refused medical care once he regained consciousness and the paramedics said they would most likely be back tonight. Well it ended up being the following night.

When the doctors came back with results I had been there less than 10 minutes, the doctor looks at him and says you are very sick. Apparently his hemoglobin was at a 4 I believe, and the doctor said they do Transfusion at 7 or 8. My father had massive internal bleeding and had lost about 70% of his blood. He never told anyone their has been blood in his stool for months, I'm not sure if he was throwing up blood or anything but I'm sure he was. But he was PETRIFIED of doctors so he tried to hide everything.

They diagnosed him with cirrhosis of the liver but said treatment will help but if he continued drinking he'd be dead in a year, and the next day took him in for an endoscopy to see what was going on. Long story short they wake him up and advise him there is a clot that could kill him very soon if they don't act right then, surprisingly he gave the go ahead "do what you need to, to fix me." When the procedure was done the doctor admitted he'd only performed 12 of the type of surgery that was performed my father being the 13th. Unlucky I guess. Well the next few days were filled with tests on his heart, liver, blood transfusions, etc. I went home, I figured he was under good care.

So he has now been in the hospital a total of 4 days. On the 4th night they transfer him to a regular room! I was furious... But these are the professionals after all, but we were just grasping how sick he actually was and the doctors being the ones telling us! So the fact they threw him in a regular room was very surprising in a bad way for me. Apparently they were pumping him full of antibiotics and fluid, about 5x more than they were in the ICU. He said it was ridiculous how much larger the bags were and how much more frequent they were than in ICU. And he did not like any of the nurses. My dad began to bloat, a lot way more than I have ever seen but other than that was in good spirits and his usual self. As a matter of fact he never once was not his usual self throughout the entire process always laughing and joking. The doctors advised him that they recommend putting stints in his heart and that they would schedule that for later in the week (scheduled for Thursday the next week, this was Saturday that they told him) and would go in to look at his liver, etc again to make sure no bleeding reoccurring, and that he is at very high risk for developing more internal bleeding again.

Now the real shocker, on the morning of his 6th day (second day out of ICU) THEY RELEASE HIM! I am absolutely livid but I drive down to stay with him and his wife to keep him company, he's very happy, but he's even more bloated to the point he can't even walk, doctors said it was normal and that he'd be back normal in a couple days. So we watch football that Sunday, and Monday night I leave and plan to be back over the following Saturday. He seemed in good spirits other than the strict diet he was on but it was an amazing visit and we really bonded and spent the whole weekend laughing and joking. I was going to surprise him with a new TV that weekend because we were joking how small his TV was and he would be bed ridden for atleast a couple or more weeks.

Tuesday morning (2 days before scheduled surgery) I get the call I never wanted to hear, it's his wife "your father had passed out again the paramedics are on their way" my heart sank... Something felt different this time, I was at work and by the time I talked to my boss to the time I got in my truck to head over again I called to let them know I was coming probably 5 minutes past since the initial phone call, "your father's gone, honey." It was the neighbor on the phone. Apparently she was sent to check on him because he convinced his wife he was okay to stay home by himself. This was at 8:17am that I got the call, she left at 7:15am. But she was concerned when he didn't answer the phone when she arrived at 7:50am to work.

This is where it's confusing. (Discretion advised as it might be disturbing)

I arrived to police out front and all the neighbors approaching to comfort me, but I immediately went upstairs to examine what had happened after they took my dad out and I saw him once last time. I noticed dried blood in his nose, eyes dark like mice. Very cold. He'd been gone atleast 3 hours since I got there (@10:30am). My father was found in between the toilet of his bathroom, tissues still in his hand with blood coming out of his mouth, and a little bit out of his nose. It was the hardest thing I ever saw, but upon turning around I noticed blood droplets on the bathroom mirror which nobody had noticed prior, it seems as though he was coughing up blood maybe moments before his death and went to get tissues. The medical examiner did not perform an autopsy because he was "under medical care" and the doctors IMMEDIATELY signed off on it, I thought that was strange.

The cause of death was listed under 3 things: 1) Coronary Artery Disease, 2) Chorssis of the liver, and 3) Anemia.

But that does not explain him coughing up blood and sudden death, I can't figure out why this would happen. Based on my research the cause of death, heart attack would not make a person cough up that amount of blood or at all, and Chrossis doesn't cause sudden death (that I know of). I am so very sad that I can't find out even a glimpse of information to put the pieces together of his final moments and maybe a cause of death which is making it tremendously hard to find closure.

Does someone have ANY idea or Theory behind what could cause that kind of death? I do not agree with how this whole thing was handled, why release him knowing he's that sick? Why schedule a surgery so far out, NO medications? Not even an aspirin.. Nothing! It infuriates me. Please someone give insight!


Thank you!  
4 Responses
683231 tn?1467326617
So sorry for your loss of your father.

I am sure they were listing all the serious life threatening illnesses that complicated his situation.

Yes sadly very advanced liver cirrhosis can result in sudden death. A major variceal bleed is one of the several causes of sudden death in cirrhosis. Liver cirrhosis can cause reduced platelet counts making is more difficult for blood to clot then add to that enlarged blood vessels in the esophagus which can rupture. From the sound of things he was likely very ill for a very long time.

Unfortunately, the only thing that can be done to save someone with end stage liver disease is a liver transplant. But to be eligible the patient must have abstained from alcohol for at least 6 months to even be considered for transplant. Then there is an involved process to evaluate the patient for example their basic health, would they be expected to survive the procedure along with social situation. Do they have someone to care for them during the recovery from the transplant and is the patient likely to be compliant in taking their anti-rejection drugs for the rest of their life.

It does take many years of continuous injury to the liver to arrive at advanced liver disease but yes death can come suddenly from internal bleeding, hepatic encephalopathy which can cause coma, or ascities which is retaining lots in fluid in the abdomen to where the patient looks pregnant and the fluid can develop serious infection.

Again my sincere condolences to you and your family may you father Rest In Peace.
3 Comments
Thank you so much, I was was just trying to maybe get some guidance on the thing that actually "did him in" thank you so much for your reply.

So you are saying that a major esophageal variace could have killed him in that short of time? He died in the bathroom which is about 5 feet from his bed, and before coughing up blood, after he was dead blood continued from his mouth. So is that mostly common when you die of one and that suddenly? Within minutes. Another possible thing I was thinking was the blood loss caused him to lose consciousness which is why he fell, similar to the first instance when paramedics were called, however since nobody was there to help he literally bled to death possible in under 10 minutes. He was cold and blue when we found him approx. 1 hour-1 1/2 hours after his wife left for work.
Oh my, I think you may have solved it! This is a medical study I read "In the present study, bloodstains at the death scene and unusual body positions of the deceased that aroused suspicion of a violent death were leading reasons for conducting a medicolegal autopsy. Apart from aspects of forensic pathology, the demographics of our study population are also noteworthy from the viewpoint of social medicine. The data we present stress the importance of fatal esophageal variceal hemorrhage as a relevant cause of sudden death occurring outside the hospital in socially isolated, alcohol-addicted individuals"

This sounds exactly what my dad expirenced
Yes unfortunately a bleed from esophageal varicies is one of several causes of sudden death from cirrhosis. It does take a long time for someone with cirrhosis to get to that point but once there having very advanced cirrhosis a bleeding episode can be sadly quite often fatal.

I myself have had cirrhosis for 10 years caused by being infected with hep c for likely 30 years when I was diagnosed.

I have been seeing my doctors regularly and am followed by a hepatologist at a liver transplant center. I am currently in reasonably good shape especially because of new medicines my hep c was cured 3 years ago.

Five years ago I was diagnosed with serious grade 3 esophageal varicies and underwent several banding procedures to get rid of them. I am checked every year to make sure they don’t return.

I hope you can find peace with the passing of your father now that you know more about how seriously ill he was and more about the horrible illness liver cirrhosis.
683231 tn?1467326617
I found this on livestrong

Esophageal Hemorrhage & Alcoholism Symptoms
By Leah DiPlacido, Ph.D.

Esophageal hemorrhage occurs when varices (enlarged veins) in the esophagus bleed extensively, according to the online medical library Merck Manuals. Merck Manuals reports that the primary cause of varices is cirrhosis of the liver, which is where tissue in the liver is replaced by non-functioning scar tissue. The American Liver Foundation reports that the most common cause of cause of liver cirrhosis in the United States is alcoholism, and is responsible for approximately 40 percent off deaths due to liver cirrhosis.

BLEEDING

The principle symptom of esophageal hemorrhage is sudden bleeding in the upper gastrointestinal tract, according to Merck Manuals. Merck Manuals reports that the bleeding is often from the distal esopohagus, meaning the part of the esophagus closest to the stomach. According to the Mayo Clinic, blood that normally flows to the liver becomes blocked due to liver cirrhosis. The blood then backs up into the smaller and more fragile blood vessels in the esophagus. When the pressure in the vessels of the esophagus becomes too high, blood may leak from the vessels into the esophagus. If the pressure is excessively high, the varices may burst, resulting in a massive influx of blood into the gastrointestinal tract. The Mayo Clinic reports that about 1/3 of people with enlarged blood vessels in the esophagus will experience bleeding. Other symptoms of esophageal hemorrhage linked to bleeding are vomiting blood and the presence of blood in the stool. Bleeding in the esophagus is very serious: Merck Manuals reports that death from esophageal hemorrhage may be greater than 50 percent of cases.
Avatar universal
Evening

Firstly I will tell you about my friend Rick. He was 48 and was an alcoholic. Drinking 2 x 2 litres of Frosty Jack Cider a night.  One night he was eating a sweet and sour chinese take away drunk.  He suddenly felt very sick in the stomach and had pain in his throat.  He starting throwing up Pints of black foul sticky liquid.  All up the walls, he headed to sink throwing up more and collapsed.  

A friend who was with him called an ambulance and they carted him off to ICU.  He just about made it through, but was given blood etc. He was diagnosed with Alcoholic Cirrhosis , after many test and Liver Doctor appointments he was given about 5 years to live provided he stopped drinking and they could control bleeding.  He was also diagnosed with COPD.  He still with us at 51 now, but very frail.

Cirrhosis has a nick name of "Silent Killer". The Liver feels no pain, you cant tell you are damaging it. When these type of bleeds show up the Liver is badly damaged and no way back. Its pure luck of the draw when a person may bleed out.  

Its not just the bleed outs, the Liver needs to clear toxins, when its damaged it cant do that properly and infections can occur aswel with Toxins getting into the brain.  Muscle wasting, Ascites etc.

I know it wont be much comfort, but you father could have died much worse, it can be a long and very very ugly disease to die from.  It sounds like he coughed and passed out and faded away.
Avatar universal
Hello....I am sorry to hear about your father and I know this was from a couple of months ago, but I went through a similar experience with my mom and she passed away in August. It is hard to find stories of others who has gone through a similar experience. I am 34 and my mom was a alcoholic my entire life. The last 10 years she had gone through some medical problems associated with her drinking such as pancreatitis. Cirrhosis was never mentioned by any doctors, but doctors did know she drank and told her if she continued she would die. I was not on speaking terms with my mom for a couple of months because of her drinking and then one day in August my sister text me because she was worried about my mom because she couldn’t get a hold of her. After a day of calling with  no response and also going to her house and to find she had the inside lock lock d. My sister got bolt cutters from work and we went inside together. We went to my moms room and she was laying in her bed, I automatically went to shake her and her body was cold and hard. There was dried blood under her nose and on her legs. This was the worst day of my life. There was a garbage next to her bed full of towels with blood all over them. Her room, the hallway and the bathroom looked like a murder scene. I have had those same questions go through my head. My mom also did not have autopsy and her doctor listed, cardiac arrest, pancreatitis and cirrhosis due to alcoholism. I think everyday did she suffer? Why didn’t she call someone or 911? How long was she bleeding? My mom was 59 years old.
1 Comments
Hi Heathjm

So sorry to hear about what happened with your mom. It sounds like she had esophageal varicies that began bleeding. This is sadly one of the ways cirrhosis leads to end of life for many people with end stage liver disease.

People with cirrhosis already have a disrupted clotting process and then because of portal hypertension due to cirrhosis enlarged blood vessels form in the esophagus. When these blood vessels burst significant bleeding occurs and death can come very quickly due to blood loss.

I am sorry for your loss cirrhosis is a horrible disease.
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