No proper diagnosis,  dementia, fatty liver, ammonia levels and bilirubin high. Other possibilities ?
Patient: MY HUSBAND HAS FATTY LIVER DISEASE AND GETS CONFUSED AFTER EATING. WE WERE TOLD THEY THINK HE HAS HEPATIC ENCEPHALOPAGTHY. HE IS A NON DRINKER. WAS ORIGINALLY DIAGNOSED WITH DEMENTIA , NOW THAT THE AMMONIA LEVELS ARE HIGH AND BILLERUBIN UP, THEY SAY ITS MOST LIKELY THE LIVER. EVEN WITH LACTOULOUSE AND RIXFAXIMIN HE IS GETTING WORSE WITH CONFUSION. WHAT OTHER POSSIBILITIES COULD BE GOING ON. Doctor: Hello and welcome to HCM  all the findings in your husbands case- increase in levels of ammonia, high bilirubin, dementia, confusion after having food point towards the diagnosis of Hepatic Encephalopathy. This diagnosis is already made. However, now there is no response to lactulose. It is due to the progression of the disease process going on in the liver. Now, the condition has progressed from simple fatty liver to more serious state. You need to get a liver biopsy to know the exact picture. In case of end stage liver disease or liver failure, liver transpant is the next step in management.  Thanks and take care  Dr Shailja P Wahal