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Diabetic. Have hepatic encephalopathy. Treated with lactulose. Should I go for transplantation?

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General & Family Physician
Practicing since : 2005
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Who do I call, or where do I go for info on liver transplant. I have hepatic encaphalopathy, or at least I'm being treated with Lactulose. i AM A DIABETIC. i BELIEVE IT IS CONTROLED, THOUGH i AM IRRITATED THAT THE PAPERS i BRING HOME FROM THE DR.'S LIST IT AS UnCONTROLLED, UNSPECIFIED. Sorry about the caps. I see a neurologist on Thursday to do a test to find out the extent of my autoimmune neuropathy. The constipation can sometimes be more than I can take. Am I at end of life? My family dr. says I'm not sick enough for a transplant. I've already lost over 100lbs., but I still weigh 340. My numbers mostly look good, but my RBC is within range, but low, my IgM is 290-that's 15 over the limit at this lab. Can you help?
Posted Mon, 15 Apr 2013 in Liver and Gall Bladder
Answered by Dr. Prasad 4 hours later

Thanks for this query.

I went through the details submitted with diligence. However there are few details which are unclear to me. Before I proceed to clarify those, let me answer your primary question about liver transplants.

Liver transplant is a procedure performed in patients with extensive liver failure (end stage). As the numbers of liver donors are few, the procedure is performed only in patients whose liver has extensively failed to perform minimal functions that can make a person survive. I think University of Maryland Medical Centre is the closest to you from where you can get enough information about Liver transplant.

That being said let me clarify few of my doubts:
1. Are you diagnosed with liver failure? - Hepatic encephalopathy is a stage of liver disease which falls before liver failure. A person experiences mental confusion and disorientation along with largely distended abdomen, blood stained vomiting and other symptoms.
The details provided by you are not sufficient to suspect hepatic encephalopathy because
a) You don't seem to be suffering from disorientation and mental confusion
b) Lactulose has other uses apart from hepatic encephalopathy. It can be used routinely to treat constipation
c) Use of furosemide (diurectic) is contraindicated in the presence of hepatic encephalopathy.
Therefore discuss with your treating doctor to learn about your current liver state before you contact Maryland Medical University.

2. You can easily know whether or not diabetes is controlled through a simple test known as glycosylated hemoglobin (Hba1c). You could ask your treating doctor to order this test during the next visit and learn about diabetes status. Ideally you should be repeating this test every 3 months while on diabetes treatment.

3. Autoimmune neuropathy is a very broad term. I hope this neuropathy is managed adequately and you do not face any more troubles.

4. Hypothyroidism is associated with obesity. Your current weight loss may be due to levothyroxine (thyroid supplement) if no other definitive cause has been found to explain the weight loss. Many people lose weight while on treatment with thyroid supplements.

5. The exact indication for furosemide is not clear. It is used routinely in the treatment of hypertension, congestive heart disease, ascitis and other fluid accumulation. Potassium loss (hypokalemia) is a common side effect of this drug. This may be the reason why you are on klor-con.
Please discuss with your treating doctor about the indication of furosemide. If there is no real benefit, perhaps it can be stopped.

6. Do you mean the spinal surgery was performed for spondylisthesis. S1 and S2 are sacral vertebrae which are fused anatomically after 20 years of age; therefore I guess the fusion surgery was targeted at L1-L2 vertebra.

To summarize, I feel you need to have a bit more clarity about your current medical condition. You can learn by good one on one discussion with your current treating doctor and repeating blood tests. You can proceed to contact Maryland Medical University after all your health concerns are sorted.

I am sorry for this lengthy reply; but I though you need to know. Let me know if you need clarifications.

Good Luck!!
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