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Dr. Andrew Rynne

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Diagnosed with cirrhosis. Have stone in kidney and bladder. How risky is liver transplant?

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Dr. Ketan Vagholkar

Gastroenterologist, Surgical

Practicing since :1989

Answered : 883 Questions

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Posted on Wed, 2 Jan 2013 in Liver and Gall Bladder
Question: hello Doctor
My father in law has a ascites problem and doctors have identified cirrhosis as the problem. Right now, only water is being taken out of stomach every 4 to 5 days and it is about 2 to 3 litre.
Would like to know the possible solutions and is liver transplant a risky proposition. As he has a stone in kidney and bladder as well and he is of 70 years age.
Please advise
Thank you,
XXXXXXX
doctor
Answered by Dr. Ketan Vagholkar 47 minutes later
Hi,
Thanks for writing in XXXXXXX Studying the reports reveals 4 issues.
1. Cirrhosis of liver with portal hypertension. The liver is severely compromised as aresult of which ascitis has assumed serious proportion requiring repeated tappings. The endoscopy also reveals extensive disease. It suggests that the liver is heading towards a failure.
2. Gall stones is an additional pathology. But the co morbid conditions precludes any surgical treatment for gall stone disease.
3. Regarding the kidney stone , as there is backpressure on the affected kidney it is necessary to remove the stone to prevent further damage to the affected kidney. In liver disorders the kidney is significantly affected. A stone disease superimposed on it will hasten the renal failure or rather predispose to renal failure.
With the current status I would suggest
1. Endoscopic treatment for ureteric stones to relieve back pressure changes.
2. Supportive care for the deriorating liver function.(preferably precoma treatment)
3. TIPS if possible.(this will just prevent GI bleeding if it is present. It will not improve liver function in any way)
The patients general condition may not permit a liver transplant. The chances of failure would be very high.
I hope this answers your querry.
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ketan Vagholkar 8 minutes later
Hello Doctor,

Thank you for answering my query.

I have few questions based on your suggestions as below,

- As per my understanding, you are suggesting to go for stone treatment. is it possible to do it without any further problem? as the doctors here suggested that they cant do it due to liver problem

- Can you please provide more information on precoma treatment and TIPS?

- Also, lastly, as per you liver transplant might not be possible right? is there any other way to improve the health? will precoma help in it? what if there is a liver failure and looking at current scenario, according to you how long till liver failure?

I am sorry for asking too many questions but I hope you can understand our situation.

Thank you,

XXXXXXX
doctor
Answered by Dr. Ketan Vagholkar 30 minutes later
hi,
Thanks for the feedback.
The right ureteric sone is causing obstruction to the outflow of urine from the right kidney. There is high possibility that with time that kidney may be affected significantly in function. Liver disease as it is makes a patient prone to renal failure by what is called hepatorenal syndrome. therefor I would suggest utmost care be exercised to maintain the anatomical and functional integrity of the kidneys. After a episode of tapping if the general condition is permissible to the anaesthetist then this can be done endoscopically.
Pre coma treatment comprises of a combination of medications which keeps the bowel clear of toxins. This includes oral lactulose, oral neomycin, vitamin K supplements, enemas or high bowel washes at times, liver tonics and dextrose infusions. If the patient shows altered coagulation profiles then even fresh frozen plasma infusions.
TIPS is basically done by radiologists. It is an palliative alternative to prevent the rebleeding from varices which is aletahl complication of cirrhosis with portal hypertension. It is done to bypass the cirrhotic vascular channels in the liver by stenting them.This reduces the pressure thereby reducing the chances of rebleeding. However this is indicated only if the patient bleeds through the varices.
Everything depends upon the liver reserves left. This can be determined by serial estimation of liver function tests and coagualtion profile (PT/INR). A dwindling report of these is asign of impending liver failure.
At this moment of time I would suggest good and aggressive pre coma treatment with control od ascites by tapping as well as by medications. Observe the response to treatment and the decide.
I hope this answers your doubt.
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ketan Vagholkar 1 hour later
Hello Doctor,

Thank you so much for explaining the whole thing. Appreciate the same.

So, just a last thing and to conclude our discussion,

- First thing to be done is to treat kidney stone and as I understand it can be done independently of liver related medication

- Secondly, Liver transplant doesnt seem to be a possibility and precoma medication seems to be the best option for improving the liver function.

Just to ask you the last thing, what are the chances of this liver problem being treated or improve via pre coma medication and if it is not possible to treat this, how long does he have before it becomes serious and un-treatable? this because, right now he doesnt have bleeding problem, only ascities and he is thinking of trying some herbs related medication as well.

Thank you,

XXXXXXX
doctor
Answered by Dr. Ketan Vagholkar 2 hours later
Hi,
If all his viral markers, liver function tests and coagulation profile are within the normal range then the pre coma treatment will work well. even his response to medications for ascitis will also be encouraging.
Alteration in coagulation profile namely PT/INR heralds the onset of lethal complications. Till then he has a good chance of survival.
Regarding herbs , I would suggest not to go in for it at any cost. Whatever good has been achieved by medications may all go waste. THe effects of herbal medications has not been scientifically proved. It is all hearsay evidence which is unacceptable by any cost.Strictly adhere to allopathic medications as advised by your physician.
I hope this answers your querry.
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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