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End stage liver disease, cirrhosis. Constant abdominal pain, immobile, leg cramps. Lumpy calf. What is going on?

Hello my sister has advanced End Stage Liver Disease , cirrhosis , and is in severe abdominal pain constantly. As a result she has been mostly immobile for the several weeks now and spends the majority of her time, day and night, sleeping or laying down in her bed. She has recently complained of cramps in her legs and that her hands are tightening into a position as if she is holding a tennis ball. She does have acute ascites which may be causing or contributing to edema in her right leg. I sometimes massage her legs to help relieve some of the cramping however recently her right calf (with pronounced edema) felt very lumpy and mushy such that I could press on a part and an indentation would stay, her calf felt like a bag of mashed potatoes. What is going on here? Thank You.
Asked On : Tue, 13 Nov 2012
Answers:  2 Views:  459
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Pathologist and Microbiologist 's  Response
Hello and welcome to HCM



Usually end stage liver disease is not associated with pain.

But if there is associated pain there may be involvement of nerves / nerve plexus in the vicinity of the liver secondary to disease process.

The ascitis and the edema in the lower limb is due to the end stage liver disease.



Now there are two options. Firstly a liver transplant, which is available in many countries (I don't know whether it is available in your country).

However, your treating doctor will be able to tell whether it can be done in your case at this stage.

Secondly, it is imporatant to relieve the pain and the disabling edema to improve the quality of life.



Therapeutic drainage of ascitic fluid can be done. This implies that fluid is removed from the abdominal cavity as soon as it is filled.

Pain can be relieved by drugs or by palliative surgery. In this surgery the nerves causing pain are divided or the the organ causing the pain is partially removed.



The curative option is liver transplant.

Other options will relieve the discomfort and pain only but will not cure the disease.



Thanks and take care

Dr Shailja P Wahal
Answered: Wed, 14 Nov 2012
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Internal Medicine Specialist Dr. Enrique Molina's  Response
Hello, she needs to be evaluated by a liver specialist. She will probably need a liver transplant to get rid of all the symptoms, depending on the severity of her cirrhosis (which is objectively evaluated through liver blood tests and imaging studies, and quality of life). If her disease is not so advanced, but the ascites and edema cannot be controlled with medications, she may qualify for a "shunt" procedure called "TIPS" which can help significantly (and is a minimally invasive procedure)
With the amount of edema and ascites that you describe, I suppose she was prescribed diuretics - usually furosemide and spirinolactone (pills to force urination of excess water), and if this is the case, patients can develop "electrolyte" disbalances from these medications. She needs to have those electrolytes checked, in particular the potassium, sodium, magnesium.
Hope that helped.
Answered: Fri, 16 Nov 2012
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