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Has End Stage Liver Disease With Cirrhosis Caused By Hep C. What Treatment Should Be Done?

Posted on Thu, 16 Aug 2012

Question: I have a friend who has end stage liver disease with cirrhosis caused by Hep c. Anemia He has almost monthly paracentesis some taking off 8 liters of fluid off his belly. He is from Mexico City and needs to go home to be with his family. He has another paracentesis schuduled this week and wants to fly home the following day after recovery which is probably a 5 hour flight. The only other option is driving 25 hours into Mexico. he has been advised not to fly due to the effect of altitude and cabin pressures of the plane on his ascites. He gets different opionions from different doctors. We want to try and get him home as quickly and safely as possible to be with his family.
He has also been denied a liver transplent due to CAD.

Answered by Dr. Dr. Prasad J (3 hours later)

Hi,

Thanks for posting your query.

I understand your friend’s problems and I see that your concern is whether or not he can travel by air.

In this regards I have discussed with couple of experienced gastroenterologist and hepatologist and they are of the opinion that they haven't advised any of their patients with chronic liver disease and ascitis to fly immediately post paracentesis.

I am unable to explain the reasons here as it's very complex and difficult to put across in simple words. However if you wish to know about it, I shall explain to you during the follow up.

Hope this information suffices. Let me know if you have any other enquiries.

With Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Prasad J (18 hours later)

Please explain this in followup. I have been told this situation is likened to being XXXXXXX between a rock and hard place XXXXXXX I am confused rather you think that we should wait several days after the procedure or dont go at all? Please clairfy.

Answered by Dr. Dr. Prasad J (4 hours later)

Hi,

I shall try and put across this is in simple words to you.

Liver functions as a factory of metabolism where useful products are simplified for body functions and undesired products are removed (detoxified). Optimum functions of liver is necessary both to maintain body function and detoxification.
The severity and prognosis of diseased liver such as cirrhosis / liver disease is measures by serum bilirubin levels, International Normalized Ratio (INR) and renal function tests. A model/score has been formulated taking these bodily functions into consideration. Higher score increases morbidity and mortality rates.

Flight travel at high altitude one is exposed to low oxygen levels (hypoxia) which results in oxygenation-reduction stress and production of undesired element. A person with end stage liver disease may not be able to this insult and could worsen the score and thus the morbidity and mortality rates.

I am not sure what it means being "between a rock and hard place XXXXXXX But this is the reason why I do not want your friend to travel by air; road travel is acceptable.

However if flight travel is really necessary, you could discuss with his treating doctor after the procedure about his liver status then and whether or not he would be able to withstand the flight travel. He may be permitted to travel if his liver is still capable of withstanding the insult of hypoxia.

I hope it is clear now. Let me know if you have any further enquiries.
If all your queries are answered, please close this discussion.

Best Regards
Dr. Prasad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Prasad J (36 minutes later)

Thanks

Answered by Dr. Dr. Prasad J (7 minutes later)

You are welcome.

If you have no more queries, please close this discussion.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar