Suffering from liver cirrhosis. Reached Grade3. Taking laxative. No motions, no control over bladder. Hospitalize?
Patient: my father in law has liver cirrhosis . he is currently based in patna, bihar. his condition is gradually deteriorating with the doctors saying that he has reached grade 3. wbc count is 3500; haemoglobin- 6.9;plateletes- 1.2 lacs; urea-normal;sodium-134;potassium-3.8;chloride-normal;bilirubin-2.8;calcium-0.7. he is taking hepamerz capsules with lactyhep as the laxative. though has not had any motions since 2-3 days with no control over his bladder . what do we do now? do we need to bring him to delhi or can his treatment be done in patna? do we need to get him hospitalized? Doctor: Hello, paramita.chatterjee, Sorry to hear about your father-in-law's diagnosis. I am not sure what the underlying cause of his cirrhosis was. Here in Western world, mostly alcohol is responsible for majority of cases. Other are caused by Hepatitis Type-B or Type-C . We are seeing a lot more Hep_C here and fortunately there is a lot of advance regarding early diagnosis and treatment and even cure for this. Your father-in-law's blood work actually does not look very serious. With a Bilirubin level 2.8 mg/dl it is mildly elevated. His Hb, level, white cell count are low but his platelet count is still good. If he does not have a very distended abdomen or markedly swollen legs, then he probably does not have severe "Portal Hypertension" which could cause enlarged veins in the esophagus and stomach and lead to  massive bleeding and liver coma. From the blood picture it does not appear to be that case. He still may be having slow blood loss if he has esophgeal varices (Enlarged veins) from irritation. He needs to have his stool checked for hidden blood and if he has black stools, he needs endoscopy to look inside the esophagus and stomach. If he has any signs of active bleeding, he needs to be hospitalized and may require blood transfusion and treatment for those veins. This is done by specialists. If your town does not have experts then New Delhi a university hospital may be a good choice. Hepamerz is L-Ornithine-1-Aspartate helpful to heal the liver. I am not sure if Lactyhep syrup has lactulose which is a laxative and helps to get rid of ammonia build up in the blood that leads to liver coma. If you father-in-law has any signs of altered mental status like feeling sleepy after eating high protein foods, that may be an indication for "Hepatic Encephalopathy" in different stages. Neomycin and Lactulose and more recently Rifaximin are helpful in treatment. You can discuss all of these with his doctor. I wish him well.