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What Causes Diarrhea While On Treatment For Alcohol Hepatitis?
Question: My 36 year old daughter is newly recovering from alcoholism. She's been sober for 5 weeks, but I fear it may be too late. Her specialist told her there is no need to run any tests because her chances are 50/50. She can die at home or at a hospital...they couldn't do anything for her at a hospital anyway. She had an ultrasound done several weeks ago ordered by her primary, prior to seeing this gastroenterologist. Since then he has changed her diet to low sodium and gives her powdered packets to mix with water for potassium. Her bilirubin is at 15. She is swollen all over, VERY confused, although he told me she seemed fine the other day. This was the same day she had a disagreement with her cat about taking a shower, called his clinic 4-5 times to ask the same question and still had no idea of the answer, and so much more. I assured him she is, but he just ignored me. He said she has alcohol hepatitis and acities. She looks 8 months pregnant, but her arms are very thin. She has lost a lot of muscle. She is very yellow...her skin and eyes. She's in a lot of pain and has trouble going to the bathroom. She said she just cries. She thinks it may be hemorrhoids so he ordered her to take a stool softener daily. She has diarrhea. He tells her it is okay for her to drive to have blood drawn once a week, but she can barely walk. It seems as if he doesn't care. He will not talk with me even though she gave permission. She will allow me in with her during appointments. If I contradict her too much she will put a stop to that too. She refuses the hospital. I will not bury my daughter. What can I do to save her? Should she be having a scan or some other tests to see how advanced this really is or can a doctor tell it's too late for tests? A fellow was in and saw her prior to this specialist on her first visit. She put her chances at 30% for survival. Thank you.
Brief Answer:
she's in a pretty severe situation
Detailed Answer:
Hello,
I've read your description carefully. Unfortunately I cannot see the reports. I don't know why. Perhaps you can send the report directly at my mailbox ( YYYY@YYYY ). Don't worry about confidentiality! Nobody is going to talk about them either to your daughter or to her doctor.
I understand that your daughter is an pretty severe situation with alcoholic cirrhosis and all the related complications like ascites (the big belly you've noticed), hemorrhoids, surely esophageal varices, etc. I suppose that her doctor has calculated her MELD score (a prognostic score for such situations) before speaking about 50-50 chances of surviving. I cannot comment on her doctor's actions because it wouldn't be right and I don't have all the data in my hands, not to mention clinical examination data.
There is a point to provide treatment to such patients when reversible complications ensue. Such complications may include a worsening of the ascites (and encephalopathy, presenting with confusion like the situation you've described but ranging to even worse situations like hepatic coma), spontaneous bacterial peritonitis (a bacterial contamination of the ascitic fluid usually presenting with fever, abdominal pain and confusion, but not always), etc. Other unrelated conditions may apply in any particular case and will have to be excluded by the doctor. For example a confused patient may have an infection, electrolyte disorder, stroke, etc.
I suppose that her doctor has done all the above and has provided appropriate treatment for her addiction (benzodiazepines mostly) and treatment for her cirrhosis. The treatment for cirrhosis may vary depending on the patient's status. Beta-blockers are given to patients with esophageal varices to reduce the risk of bleeding, diuretics (furosemide and spironolactone) are given to keep ascites at a steady state, etc. When encephalopathy ensues, the diuretics make things worse, so enemas with lactulose and decontaminants (like rifaximin or others) may reduce ammonia production and let her brain function improve.
So getting back to your question, this is the main treatment. Liver transplantation is a controversial issue. Nobody but herself can decide when it's too late. She should be provided treatment if she chooses so. If she doesn't want to be treated then this is an option too. Remember that this condition is irreversible. Only the complications may be partly reversed.
I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information. And of course you can either try to upload again the reports or send them directly to my email address. I'll be glad to comment on them.
Kind Regards!
she's in a pretty severe situation
Detailed Answer:
Hello,
I've read your description carefully. Unfortunately I cannot see the reports. I don't know why. Perhaps you can send the report directly at my mailbox ( YYYY@YYYY ). Don't worry about confidentiality! Nobody is going to talk about them either to your daughter or to her doctor.
I understand that your daughter is an pretty severe situation with alcoholic cirrhosis and all the related complications like ascites (the big belly you've noticed), hemorrhoids, surely esophageal varices, etc. I suppose that her doctor has calculated her MELD score (a prognostic score for such situations) before speaking about 50-50 chances of surviving. I cannot comment on her doctor's actions because it wouldn't be right and I don't have all the data in my hands, not to mention clinical examination data.
There is a point to provide treatment to such patients when reversible complications ensue. Such complications may include a worsening of the ascites (and encephalopathy, presenting with confusion like the situation you've described but ranging to even worse situations like hepatic coma), spontaneous bacterial peritonitis (a bacterial contamination of the ascitic fluid usually presenting with fever, abdominal pain and confusion, but not always), etc. Other unrelated conditions may apply in any particular case and will have to be excluded by the doctor. For example a confused patient may have an infection, electrolyte disorder, stroke, etc.
I suppose that her doctor has done all the above and has provided appropriate treatment for her addiction (benzodiazepines mostly) and treatment for her cirrhosis. The treatment for cirrhosis may vary depending on the patient's status. Beta-blockers are given to patients with esophageal varices to reduce the risk of bleeding, diuretics (furosemide and spironolactone) are given to keep ascites at a steady state, etc. When encephalopathy ensues, the diuretics make things worse, so enemas with lactulose and decontaminants (like rifaximin or others) may reduce ammonia production and let her brain function improve.
So getting back to your question, this is the main treatment. Liver transplantation is a controversial issue. Nobody but herself can decide when it's too late. She should be provided treatment if she chooses so. If she doesn't want to be treated then this is an option too. Remember that this condition is irreversible. Only the complications may be partly reversed.
I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information. And of course you can either try to upload again the reports or send them directly to my email address. I'll be glad to comment on them.
Kind Regards!
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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