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Can liver dysfunctioning be cured after a quad bypass surgery?

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General & Family Physician
Practicing since : 2011
Answered : 243 Questions
My Brother age 55 underwent a quad bypass 10 days ago. He is still not awake. Dr said surgery went well, but he had been diagnosed with cirrohsis while being prepared for surgery. Immediately after surgery he developed a fever, he had a kidney infection before surgery. He had been on pain and sedative meds for 4 days, each time becoming very physically agitated if they tried to wean him off. Finally they did wean him totally off and since he has shown no response to pain and only a couple of responses to commands. They determined his ammonia levels were elevated so they gave him meds to drop that from over 200 to 119--only response was tried to open his eyes and squeeze hand on command. 2 days after that his breathing became labored on vent so they had to sedate him again. Now he is totally unresponsive. He had 2 EEG's and a CT scan which came out normal. He had an MRI tonight, results unknown. Respiratory Dr says he "does not see him making it out of the hospital.." I ask lots of questions, but keep hearing that its a long process, he is probably in alcohol withdrawal, liver is slow to remove toxins etc. Finally requested an update from an MD and got the above comment.

Any help would be greatly appreciated.
Sun, 15 Apr 2012 in Liver and Gall Bladder
Answered by Dr. Sapan J. Pandya 1 hour later
Hi JaDeene,

Thanks for the query.

Liver has multifactorial roles to play in human body. It has so many functions in the body that all its actions are yet to be understood by modern science. Liver failure leads to a very fast deterioration in functioning of other body organs, known as multi-organ failure.

In your brother’s case, it seems that his liver is not functioning completely because of cirrhosis.
Because of improper functioning of liver, he is in metabolic coma. High level of Ammonia can be one of the reasons of metabolic coma.

Ideally, for such a major surgery like bypass, all the tests are done including Liver Function Tests and Abdominal Ultrasonography. So if he had liver impairment, ideally such operations should be postponed.

Also as you described, he had kidney infection before the surgery. That was one more reason to delay the surgery. Ideally such a major surgery can be done only after all infections are treated well.
The best doctors to take care of him are Hepatologist / Gastroenterologist for liver and a Neurophysician for his coma.

Hope this answers your query. In case of any doubts I am available for follow ups.

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