CIRROHSIS HEPATIC ENCEPHALOPATHY NO IMPROVEMENT

[arh6]

We are post op (cancer mass removal) and surgeon noted fibrosis of the liver consistent with cirrhosis (stage 4 of 4) we are week 7 and have 2 decent days where she is awake a bit more talks somewhat and then its back down hill for a week and then again may have a couple of decent days.  Is this something that will get better or are we fighting a losing battle.  They are using every available med to treat but I am not seeing any steady improvement or prolonged improvement.  

[Thomas D Schiano, MD]

her age is definitely not a preclusion to liver transplantation, but the tumor is.  if there is any tumor outside of tthe liver, a transplant is contraindicated unfortunately.

[arh6]

If you do not mind me asking one more thing.  Why would she not be a candidate for liver transplant.  I asked 4 wks ago the nurse said oh she wouldn't qualify she's too old.......she is 64.  Would it be because of the type cancer she had removed, we understand it has a high recurrence peritoneal liposarcoma?  Seems like all the issues she is having could be forgone just from a transplant.  Thank you we are not battling severe ascites and fluid in lungs again.........they were going to pull fluid off but something occurred and doctor said it has past the window to safely remove???  Another thing we are unsure what is going on.

[Thomas D Schiano, MD]

i am sorry about this chain of events.  I presume that there is no hidden infection somewhere contributing to things.  When patients decompensate after a resection it can in fact take several weeks for recovery.  If all the vessles are intact and there is no portal vein thrombosis, it hopefully will just be some more time and she will need to be maintained through this period of time.  I wish you guys the best.

[arh6]

They did do a biopsy during surgery but other than that I am not aware of anything else directly towards the liver.  She had 1500cc of blood loss.  They are giving her xifaxan and neomycin along with 3-4 heavy doses of lactulose and an enema daily, lasik and another diuretic along with many other meds to which I wonder if she should even be taking.  If her liver function tests are semi ok but she keeps on with ascites HE and having many problems breathing and being coherent she is rarely awake.  Is this something that will correct itself over time or is she going to be in this state until her times comes.  Would the statement on the pathology report be correct in stating the staging...........we were told stage 2 to begin with but the chart shows otherwise.  She is swollen so bad right now she hurts and it has been this way for a few days.  We told the nurses the other day and have directed my sister in law to direct again that the fluid build up is enormous and please do something to relieve it.  It is problem upon problem upon problem.  For some reason we seem to see things as they begin but we have hard time getting some to be proactive.  They will wait until things get out of hand almost react then see levels good for one day and think she's cured.  Its so frustrating as caregivers to see her in this state as before the surgery she was living a pretty normal life.   Thank you very much -

[Thomas D Schiano, MD]

sometimes there can be loss of liver function when a cirrhotic liver is resected.  this would also manifest with abnormalities in the liver function tests.  if the liver tests are ok, I am hopeful that things will slowly get better still