End-stage liver failure. Nausea, lack of appetite, wasting. Precautions?
Patient: My 55 yo son has end-stage liver failure . He recently completed the medication regimen to eradicate his Hep-C, and last couple of lab results show no discernible trace of Hep C . He has an appointment at UAB on Tuesday for his three-day workup prior to being placed on the liver transplant list. He has continued to decline, suffers almost daily with nausea , lack of appetite , wasting. Today his thigh-high edematous legs began to weep. I have cleaned them well and wrapped them with absorbant gauze , and elevated them above the level of his heart. I will try in the morning to put on compression stockings after - hopefully - some of the swelling decreases. If I am unable to do so, should I wrap them with ACE bandages, and if so, what pattern, fig 8 or circle up? The trip to UAB is about 4 hrs. What precautions should I take when driving him there? Thanks so much - this is the hardest thing I ve had to do in my 76 years! Doctor: If compression bandage is not possiable then you may use ACE bandage by lightely wrapping it to cover maximum area in circle. while travelling antiemitic may be given in advance.  Liver transplant waiting some times very long and patients some times cannot wait so long. Mesenchymal Stem cell therapy may be used as a tool to pass time till liver transplant as this delays the progression of complete liver faliure and improves quality of life.