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Suggest Treatment For Cirrhosis Of Liver

Posted on Fri, 20 Feb 2015

Question: Dear Sir, I am a M 50 y WT. 74 Kgs K/O Cirrhosis of liver since Oct 2008(alcohol induced), PHG with 2 column of gd II Varices(Non bleeding/ no binding) on 5 gm Hepa Merz BD, Inderal 20 mg BD, Lactulose 15 ml HS, Cap Renerve BD, Cap Astymin forte OD. Hb 10.2 mg/dl, Platelet 75000 cumn, INR 1.2 USG shows enlarged Spleen,other vitals are WNL including LFT, Pure Veg, Non drinker (since may 2006) non-smoker. Presently having pain in lower abdomen with loose motion(no blood but brown tarry) sometimes with fever and severe headache earlier the Gastro Spl advised Norflox 200 mg Bd X 07 days with Rifaximin. Now the episode is frequent and the Gastro Spl attending me is not available due own health. Please advise future action and is it turning serious what shall i do ?

Answered by Dr. Prof. Kunal Saha (1 hour later)

Brief Answer:
ORS needs to be taken

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have carefully gone through the details provided by you. It seems that you are suffering from acute gastroenteritis. Your doctor has done the right thing in prescribing Norflox. Please complete the course of 7 days even if it gets corrected earlier. Also complete the course of Rifaximin. Apart from this, the mainstay of treatment would be in taking ORS (oral rehydration solution) in order to replenish the salt and water lost. ORS can be prepared by mixing a full XXXXXXX in a litre of water. Even if the frequency continues, you need not worry. Just keep taking ORS sip by sip, and consume the entire amount in less than 24 hours. If the amount of replenishment is greater than or equal to the amount lost, dehydration will not occur and you would be fine. The frequency may take some time to come down. Please be patient. If you are passing urine at long intervals or feel lethargic, it probably indicates dehyration which can be serious if left untreated. In that case, you would need to visit the emergency of a hospital without delay.

Apart from the above measures, take plenty of curd or yogurt. It will increase the number of beneficial bacteria and would provide relief.

Hope that helps.

Regards
Dr. Kunal Saha

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Prof. Kunal Saha (2 days later)

Dear Sir, Thanks for the valuable advice, my main problem is not the frequency of loose motions in a day as it seems you have interpreted.It is the recurring of loose motions say every 10 to 15 days it starts all of a sudden . May i submit if every time i take Rifaximin and Norflox my system may get immune to it and further it may not work, moreover there might be some precaution or diet control by which recurring of acute gastroenteritis may be prevented. As of now the loose motion has stopped but as usual i feel whistling noise in my ears (mostly left ear). The area around the navel and in particular just below the navel extending down further feels stretching pain superficially. Is it because of gas,which i pass very frequently, ( in my last question i forgot to mention i take Pantocid 20 mg in morning 15 min prior to breakfast) Sir, further may i request if the above can be examined by a Gastro specialist and advise accordingly. Please also advise: (i) Is USG of abdomen required ? (ii) Shall i go for Endoscopy. (iii) Visit some other Gastro specialist( as my previous Gastro Spl is unavailable) in person for further advice.
Regards, Thanks in anticipation yours truly....

Answered by Dr. Prof. Kunal Saha (5 hours later)

Brief Answer:
Gluten enteropathy needs to be excluded

Detailed Answer:
Thanks for writing back.
Sorry for not being able to write back earlier.

In case of recurrent diarrhoea, the cause needs to be evaluated. The first thing to exclude would be coeliac disease or gluten enteropathy. It occurs due to sensitivity to a substance called gluten that is present in members of wheat family. I would suggest you to eliminate all wheat based and related products for at least two weeks and see if it makes a difference. Based on your findings you may visit your gastroenterologist once he is back. I would also suggest you to take a high fibre diet and fibre supplements like isabgol regularly at dinner. They would help in regularising your bowel habits by correcting the gastrointestinal movements, difficulties in which could be the cause of your problems.

The pain around your navel could be due to stomach acids getting stagnant and causing gastritis. You may continue Pantocid but I would not suggest going for Rifaximin and Norflox since I do not think that bacterial infection is the cause of your recurrent diarrhoea. I would not suggest going in for endoscopy or colonoscopy at the moment. After the dietary modification, if your gastroenterologist feels, you can go forward with these.

I would suggest you to get a ENT specialist checkup and assess the reason for the whistling sound in your ear which could be due to sensorineural cause and needs to be diagnosed and treated.

Hope that helps.

In case you found my answers to be helpful, please close the thread with a positive review and a 5 star rating.

Regards
Dr. Kunal Saha

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Above answer was peer-reviewed by : Dr. Vaishalee Punj