Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
142 Doctors are Online

Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure?

User rating for this question
Very Good
Answered by

General & Family Physician
Practicing since : 1978
Answered : 6675 Questions
Question
My husband is jaundice and anemic, he is very tired, exhausted. He has had an abdominal ultrasound. Results are enlarged liver 19.5 cm and enlarges spleen 16 cm. Is he in liver failure?
"The findings are probably on the basis of fatty infiltration of the liver with focal fatty sparing."
Posted Thu, 26 Sep 2013 in Liver and Gall Bladder
 
 
Answered by Dr. Pavan Kumar Gupta 53 minutes later
Hello,
Thanks for the query.
Brief answer....there are various other signs of liver failure besides jaundice.
Detailed answer..
Liver failure is supposed to occur when large parts of liver are damaged and beyond repair and the functioning of liver stops.
There are various causes for liver failure like hepatitis B and C,excessive alcohol consumption,cirrhosis,use of drugs like pain killers or herbal supplements,poisioning etc
Although nausea,vomiting,diarrhoea,fatigue,tiredness and jaundice can be found common in liver failure and other non serious hepatitis cases,but in liver failure there are specific symptoms like bleeding easily,swollen abdomen because of ASCITIS,sleepiness,mental confusion,drowsiness,coma etc.
Just having jaundice and liver and spleen enlargement doesn't mean liver failure.
I hope it helps however you may revert to me for any further query.
Please let me know if you have any specific question.
Best of luck
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 25 minutes later
Thank you so much for your response, I am relieved. We have an appt tomorrow with a doctor of XXXXXXX medicine. My husband takes 6 different perscribed meds for high bp, cholestoral, a water pill, I am not sure what else, he takes tylenol and advill every day and he is a beer drinker @ 4 - 6 beers 3 or 4 times per week for many many years. I think it is save to assume he has liver damage. What should we ask the doctor? Will they offer treatment? When do they consider a transplant?
 
 
Answered by Dr. Pavan Kumar Gupta 2 hours later
Hello,
First of all he has to stop consuming alcohol and ibuprofen.
Tylenol may be taken but only when necessary.
Liver transplant is considered only if their is considerable liver damage which is beyond repair and is in failure.
Your doctor has to assess the condition of your husband's liver by doing various blood tests like liver function tests,tests for bleeding and clotting disorders,CT or MRI of liver for deep assessment and a possible biopsy of liver.
Once the assessment is done,then future guidelines of treatment are set.
In any case,he has to completely go off from alcohol,and to be true,not even a single drop of it.
Please let me know,if there is something else to ask.
Best of luck to you and your husband.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 4 hours later
Thank you again. He has stopped drinking, because he feels so sick. He is very scared, as am I. Will he remain feeling sick all and so exhausted? What if he is perscribed more medication? Will they take him off the current meds? He is an accountant and we have our own business, will he be able to work again soon? He is so tired and can not think clearly and very yellow. He seems to be getting worse and I understand the liver can regenerate but how can we tell if it has gone too far? Is that what a biopsy shows?

Thank you. This came on so suddenly, we are in shock. When I start to remember I realize he started showing signs of tired and weak and irritable during tax season, so April. The dark urine and started @ 2 weeks ago and the jaundice happeden on Monday Aug 26. Since it probably started several months ago does that indicate it could be too far along?

 
 
Answered by Dr. Pavan Kumar Gupta 50 minutes later
Hello,
I can understand the stress and anxiety being faced by you.
The fact is that nothing can be said till your husband gets investigated completely.
Lover biopsy is very important and shall tell about the extent of damage.
It could simply be just alcoholic hepatitis where abstinence of alcohol with plenty of water and fruit juices and proper nutrition and medications shall be able to regenerate the liver completely.
Just remain calm and be hopeful.Everything shall be all right.
Best of luck
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 6 hours later
We have been to the XXXXXXX medicine specialist and he has requested more blood work. They seem to be concerned about the red blood cells. They didn't ask about the alcohol or over the counter meds. I volunteered that information to them. Why is the red blood cell count such an issue and not the liver? They said they check 4 liver enzimes and they are fine. Does this mean cancer?

Thanks again.
 
 
Answered by Dr. Pavan Kumar Gupta 55 minutes later
Hello,
This doesn't mean any cancer.Since your husband is anaemic,it requires investigations to see whether anaemia is iron deficiency or FOLIC acid or VIT B12 deficiency.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 1 hour later
we have the blood work results back that were done Tues Aug 27th. Wouldn't it show if there was a deficiency? Wouldn't the specialist have been able to identify that immediately?
 
 
Answered by Dr. Pavan Kumar Gupta 6 hours later
Hello,
It is not necessary that all the tests are done on first day.Many a times,follow up tests are required after getting the initial tests done.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 16 hours later
It is confirmed my husband's body in not producing red blood cells, we do not know why yet. He has been perscribed 50 mg prednisone to take daily until our next dr visit on Friday Sep 7.

Why does your body stop producing red blood cells?

Thank you.
 
 
Answered by Dr. Pavan Kumar Gupta 6 hours later
Hello,
Now the picture is getting clearer.
Your husband seems to be suffering from hemolytic anemia where there is abnormal destruction of red blood cells ( rbc's ).
This destruction of red cell has numerous causes.
There is increased destruction of Rbc resulting in anemia increased production of bilirubin which leads to jaundice.
The causes of destruction could be due to some defect in RBc itself like thalassemia  and some other inherited conditions or some extrinsic factors like auto immune conditions.
Your doctor is suspecting a auto immune pathology to be responsible for the hemolytic anemia and that's why steroids like PREDNISOLONE has been prescribed.
It would be a matter of investigation that which auto immune disease is responsible for the problem.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 12 hours later
Thank you for your answer, oddly enough, last night I read alot about anemia and I came up with auto immune as well. It seems like a broad term to me.

I have lost a sister (aged 47) to liver cancer and one my dear friends died at 40 with cirrhosis, their life styles we very different from my husband's mind you, but as soon as he went jaundice I was reminded of the past. I was with them both until they passed, not a pleasant experience. Panic set in when my husband colour changed. That is just a little of my background so you don't think I am a crazy person.

This is a long weekend here so very few of his test results have been received and the doctors are not in to communicate their finding, we are on hold until Tues.

My question to you today is - Can the cause of the auto immune disease be pinpointed and is it likely involving the liver?

Thank you for you help, I really appreciate it.

 
 
Answered by Dr. Pavan Kumar Gupta 25 minutes later
Hello,
First of all I must say that I liked your inquisitiveness and never took you as a crazy person.I feel very impressed by the fact that you are so concerned for your husband.
Considering the background,it is perfectly logical and understandable for you to be stressed about.
As far as causes of hemolytic anemia are concerned,you would find that in 50% of cases,the cause is not found and is called as idiopathic hemolytic anemia.
In rest of cases, causes like lymphoprolierative disorders like lymphoma and other immune disorders like SLE,rheumatoid arthritis,Ulcerative colitis etc are found.
The treatment would depend upon finding the cause and giving steroids and immunosuppressant drugs.
Best of luck.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 22 hours later
Good morning, thank you again for all your help.

My husband has been taking the prednisone and he feels better. He is still pale, he doesn't seen to appear so jaundice. Is prednisone a cure? Will he remain on it indefinitely?

Thanks again.
 
 
Answered by Dr. Pavan Kumar Gupta 3 hours later
Hello,
First of all the cause has to be found and the ultimate treatment would depend upon that.
Even if the cause is idiopathic,steroids are not given for some time and other options like immunosuppressants are tried.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 10 hours later
Hello again, tomorrow we go to see the gp. Will he have any answers and what questions should we ask?
 
 
Answered by Dr. Pavan Kumar Gupta 41 minutes later
Hello,
You should ask about the cause for hemolytic anaemia in your husband and what further tests he is planning to carry out and whether there is any need to take consultation from a haematologist.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 21 hours later
Hello. I have a few more questions. This is what is written on the blood test result from Fri Aug 30

Polychromasia

Normocytic anemia, marked reticulocytosis, absent spherocytosis or schistocytosis. Picture (A) suggests acute blood loss for a cause other than immune or microangiopathic hemolysis.

HB is 68 RBC is 2.11 PB is 112/54

Does this mean his body is not producing RBC or it is destroying its own RBC?

What will they test for now? Will they be able to find the problem or will he be in the 50%, If it is idiopathic, will he get back to normal? Do they treat it?

Thanks again.

 
 
Answered by Dr. Pavan Kumar Gupta 7 hours later
Hello,
This blood loss is due to destruction of blood cells and not because of production problems.
That's why the disease is called as hemolytic anemia.Hemolysis means destruction.
Your reports point towards the possibility of cause as idiopathic only.
As far as other investigations are concerned,your haematologist would be in a better position to tell about it.
Generally the condition in adults can run a chronic course and can flare or reverse itself without any explanation.Most of the people suffering from this condition generally make full recovery.
First line treatment is always steroids.
Sometimes removal of spleen is also done which can reverse the destruction of red blood cells.The third option of treatment is use of immunosuppressant drugs.
in all likelyhood,your husband shoud do well.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 39 hours later
Hello again Dr XXXXXXX it has been a quiet week. The prednisone seems to be helping. XXXXXXX is having trouble sleeping now, I assumDe it is a side effect of the drug. He continues to tire very easily and he is still pale but not as jaundice. He has been eating alot, the prednisone has increased his appetite, but he looks thinner and feels weak.

I forgot to mention that the "direct coombs test" was negative. I know a positive coombs indications the hemolytic anemia. Does the negative result mean it is not hemolytic anemia. Will they be looking for something else now.

We are seeing the doctor at the Urgent Medicine Clinic tomorrow, should we ask for to see a blood specialtist or perhaps a liver specialist?

Thank you, again
 
 
Answered by Dr. Pavan Kumar Gupta 56 minutes later
Hello,
Tiredness and fatigue is due to the anaemia.
Eating well is due to the effect of steroids.
Negative direct coomb's test means that auto immune process is not the cause,which means that it is not autoimmune hemolytic anaemia.
Now other causes for hemolytic anemia have to be found out.
The best would be to consult a Hematologist.
Thanks
Above answer was peer-reviewed by
 
Follow-up: Have jaundice and anemic. Feel tired and exhausted. Abdominal ultrasound showed enlarged liver and spleen. Liver failure? 20 hours later
Hello Dr XXXXXXX we have the results from the follow up blood tests.

My husbands HB has gone up from 68 to 87

The biliruban is down from 45 to 24

his BP was 100/68

They have reduced the prednisone by 10 mg/week and want to see him when he is taking 20 mg so in 3 weeks

Do you think it would be benificial to go to a hematologist or should we wait the three weeks and have his blood tests redone then?

Thank you for your help.
 
 
Answered by Dr. Pavan Kumar Gupta 2 hours later
Hello,
It is a very good news that your husband is improving clinically as well as internally.
Although one may think of waiting for another 3 weeks but if I were you,I would have gone and consulted a Hematologist because the issue of cause is still unresolved.
Finding an exact cause is very important,as it shall prepare us for future.
Thanks
Above answer was peer-reviewed by
 
Share on Facebook
Share on Twitter
Share on Google+

The user accepted the expert's answer

Ask a Gastroenterologist

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor