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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17851
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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It is regarding liver cirrhosis/ liver failure The source

Customer Question

It is regarding liver cirrhosis/ liver failure
The source is unknown (she is not alchoholic - no hepatitus - she has fatty liver - not autoimmune hepatitus) i guess the cirrhosis was due to NASH (from malnutrition & medicines)..
She removed her gallbender
She used to be diabetic
She had liver tumor and cured with RFA 6 months ago
3 weeks ago she had Hepatic enphalopathy (stage 4 - coma) intensive care reversed back to normal then 1 week ago she had it back but stage 1 and now reversed to normal
When she had her stage 4 liver coma, Bilirubin level was 10 then lowered to 3 before she leaves the hospital.. then she stayed 6 days at home getting better.. then a sudden drop happened (heavy head, unbalance, jaundice, hand jerking) then we moved her back to the hospital intensive care stage 1 liver coma and bilirubin jumped back to 8
Now bilirubin is lowering again (6).. i don't know why as long as she is in the hospital bilirubin is going down and once she leaves it is up again
She also take plasma due to her high INR
Normal blood pressure
Sugar level around 180
Here is the list of medicines that she takes at home
- liver gol
- liver albumin
- folic acid
- lasix
- zimacal
- cona adion
- depout b12
- inderal
- insulin since sugar levels sometimes gets high
above them at the hospital she takes (plasma + albumin infusion + medicines to reverse the liver come and reduce ammonia)
Here are my questions:
1) Why does the bilirubin levels reduce as long as she is in the hospital? whereas once she went home within 6 days things got worse? Is it related to the plasma that she takes?
2) Is there any possibility for the liver to cure itself at this stage with proper medicines and diet? (I read about some cases who had cirrhosis stage 3-4 from alcoholic and it reversed back to stage 2)
3) Can the liver get worse even with medicines and proper diet?
4) How can someone with fatty liver turn to reach this point (liver failure)?
5) How can you tell if someone is fit for a liver transplant surgery?
If you want attachments for her reports kindly let me know and send ur email
Submitted: 10 months ago.
Category: Medical
Customer: replied 10 months ago.
I just added some reports
Expert:  Dr. D. Love replied 10 months ago.
Hello from JustAnswer.Do you have any lab reports that show alkaline phosphatase or antimitochondrial antibodies?What was the previous focal lesion that was ablated?Neither the ultrasound or the CT scan mention fatty infiltration of the liver. Was this diagnosis made on a previous evaluation?
Customer: replied 10 months ago.
I don't have more reports but will ask for them, (why do we need the one you mentioned?)
focal lesion was cancer cells developed due to cirrhosis,
fatty infiltration was previous old evaluation yes,
Expert:  Dr. D. Love replied 10 months ago.
These tests look for a specific type of cirrhosis called primary biliary cirrhosis. We actually see more cases of cirrhosis related to fatty infiltration of the liver, but with no fatty infiltration noted on the current imaging studies, I was considering other possible causes. I also ask because the alkaline phosphatase is usually checked with other liver tests, so I was a little surprised that it was not included in the profile that included the bilirubin, ALT and AST. Knowing the underlying cause is helpful in answering questions related to long-term outcomes, such as you are asking, but if you are certain that the previous evaluation showed fatty infiltration of the liver, the I will answer based on that underlying cause. Let me type answers to each question and will post again shortly.
Expert:  Dr. D. Love replied 10 months ago.
To address each of your questions - 1) Why does the bilirubin levels reduce as long as she is in the hospital? whereas once she went home within 6 days things got worse? Is it related to the plasma that she takes? The bilirubin is likely getting better in the hospital because intensive treatment in the hospital is more effective. The plasma, itself, is probably only a single component of that care, and while it is important to prevent bleeding complications, it usually would not significantly affect the function of the liver in metabolizing bilirubin. Other aspects of care, such as albumin infusions, diuretics to control ascites, etc., would have a greater effect on liver functioning.2) Is there any possibility for the liver to cure itself at this stage with proper medicines and diet? (I read about some cases who had cirrhosis stage 3-4 from alcoholic and it reversed back to stage 2) There are some cases of cirrhosis that will improve significantly when the underlying cause is eliminated or corrected, such as the example that you note. In her case, if the underlying cause was the fatty infiltration of the liver and she has no further evidence of fatty infiltration, then her underlying cause has improved, but she has not had similar improvement in liver function, so it would be unlikely that she will cure itself or significantly improve. Adjustment of her medicine regimen may get better control of symptoms, but the cirrhosis, itself, will not likely improve. 3) Can the liver get worse even with medicines and proper diet? The liver can get worse, even with optimal medical care and lifestyle management. Although there are some cases of cirrhosis that improve with elimination or correction of the underlying cause, as discussed above, most cases of cirrhosis that have progressed to this severity are progressive.4) How can someone with fatty liver turn to reach this point (liver failure)? Someone with fatty infiltration of the liver can develop chronic inflammation of the liver. Any cause of chronic inflammation of the liver can develop scarring, which is the hallmark of cirrhosis. As the scarring gets worse, the normal architecture of the liver is lost, so that the blood does not percolate through the liver normally, so that impurities that would normally be removed from the blood, such as bilirubin and ammonia, will instead become elevated.5) How can you tell if someone is fit for a liver transplant surgery? The primary determinant of whether someone is fit for a liver transplant is their overall health. A liver transplant is a very major surgery. Obviously, anyone being considered for a liver transplant is unhealthy from the perspective of their liver, but there also needs to be consideration of the health of other organs, particularly their heart, lungs, and kidneys, to judge whether they are a candidate for transplant. If I can provide any further information, please let me know.
Customer: replied 10 months ago.
Will try to gather more information and get back to you.. thanks a lot
Expert:  Dr. D. Love replied 10 months ago.
You are most welcome.