HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

question-icon

Suggest Treatment For Feet Swelling Due To Protein Deficiency

default
Posted on Mon, 27 Oct 2014
Question: Thanks for enquiring about my health. I am sorry for reverting back to you.
As I told you I am suffering from auto immune hepatitis for more than a year. I enclose two repoprts one being the latest one for you to peruse and suggest me the course of treatment.
Lately, I have developed swelling on my feet and doctors say that it is due to protein deficiency. I am taking protein supplements.
The liver parameters are very high and as I am told that as billi rubin level decreases other parameters would also decrease.
I await your reply.
doctor
Answered by Dr. Rahul Tawde (1 hour later)
Brief Answer:
Albumin supplementation and immunomodulation

Detailed Answer:
Hi, thanks for posting the concern.
From your current question and question & answer history, I think you want a second opinion overall.
Now, I would agree with the overall summary and management mentioned by Dr. Sood in the previous thread.
In this thread, I would try to put some light on a bit greater details regarding the disease and its management along with management of swelling.
Now, let's have some idea about autoimmune hepatitis.
This is a long standing disease of unknown etiology and is characterised by ongoing hepatocellular inflammation and necrosis and there is increased chance of Cirrhosis of liver.
Proposed pathophysiology involves complex interaction between genetic and environmental factors.
Some viruses like rubella, EBV, Hepatitis A, B, C are thought to be producing the environmental trigger.
Some drugs may also cause the disease.
Based on the autoantibody marker reports you attached, this is most likely type I disease, althogh not manifesting the marker profile classical for type I AIH.
Now, regarding the treatment part,
Time-tested treatment of choice is steroid. Response to steroid is also better in type I disease. Steroids can be used alone or in combination with Azathioprine for the treatment of autoimmune hepatitis. The dose and schedule and tapering of the dose of steroids and use of Azathioprine, all depends upon the treating gastroenterologist's discretion.
Regarding the management of swelling, use of diuretics would help remove the extra third space fluid. But, this should be done judiciously to avoid electrolyte imbalance.
The definitive management of edema due to protein deficiency is, infusion of human albumin. These days low salt albumin infusions are also available. Alongwith that a salt restricted moderate to high protein diet may help.
Regarding the prognosis, nearly 50% patient die within 5 years if left untreated. But, the magic is, with treatment even the 10 years survival is as high as 90%. However, relapse occurs in 50% patients within 6 months of treatment withdrawal and in 80% patients within 3 yrs of treatment. Relapse for single time would require the reinstitution of original therapy and relapse for two times require indefinite treatment with steroid and/ or Azathioprine.
In completely refractory patients, liver transplantation is the definitive therapy.

If you are satisfied with my answer, please close the thread and rate my answer.
Regards.
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
Answered by
Dr.
Dr. Rahul Tawde

General & Family Physician

Practicing since :1980

Answered : 1 Question

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Suggest Treatment For Feet Swelling Due To Protein Deficiency

Brief Answer: Albumin supplementation and immunomodulation Detailed Answer: Hi, thanks for posting the concern. From your current question and question & answer history, I think you want a second opinion overall. Now, I would agree with the overall summary and management mentioned by Dr. Sood in the previous thread. In this thread, I would try to put some light on a bit greater details regarding the disease and its management along with management of swelling. Now, let's have some idea about autoimmune hepatitis. This is a long standing disease of unknown etiology and is characterised by ongoing hepatocellular inflammation and necrosis and there is increased chance of Cirrhosis of liver. Proposed pathophysiology involves complex interaction between genetic and environmental factors. Some viruses like rubella, EBV, Hepatitis A, B, C are thought to be producing the environmental trigger. Some drugs may also cause the disease. Based on the autoantibody marker reports you attached, this is most likely type I disease, althogh not manifesting the marker profile classical for type I AIH. Now, regarding the treatment part, Time-tested treatment of choice is steroid. Response to steroid is also better in type I disease. Steroids can be used alone or in combination with Azathioprine for the treatment of autoimmune hepatitis. The dose and schedule and tapering of the dose of steroids and use of Azathioprine, all depends upon the treating gastroenterologist's discretion. Regarding the management of swelling, use of diuretics would help remove the extra third space fluid. But, this should be done judiciously to avoid electrolyte imbalance. The definitive management of edema due to protein deficiency is, infusion of human albumin. These days low salt albumin infusions are also available. Alongwith that a salt restricted moderate to high protein diet may help. Regarding the prognosis, nearly 50% patient die within 5 years if left untreated. But, the magic is, with treatment even the 10 years survival is as high as 90%. However, relapse occurs in 50% patients within 6 months of treatment withdrawal and in 80% patients within 3 yrs of treatment. Relapse for single time would require the reinstitution of original therapy and relapse for two times require indefinite treatment with steroid and/ or Azathioprine. In completely refractory patients, liver transplantation is the definitive therapy. If you are satisfied with my answer, please close the thread and rate my answer. Regards.