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Suffering from cirrhosis. Have high bilirubin count. What should be done?

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My dad has advanced cirrohsis and his bilirubin count is 8.8 now. Has it now reached alarming levels. His Na is 126 and doctors are saying we need to raise that first and then look at bilirubin count
Posted Sun, 5 May 2013 in Liver and Gall Bladder
Answered by Dr. Charles S Narasi 1 hour later

Thank you for contacting XXXXXXX

Your dad has been diagnosed with cirrhosis. There a number of causes for advanced liver disease. Here in western culture, alcohol is the number one culprit. Rest includes Autoimmune disorders, metabolic disorders and drugs contribute to many cases of cirrhosis. The reason I mention these is because treatment outcomes are determined by these factors.

You just did mention Bilirubin level of 8.8 mg/dl. I would not that level alarming. If it reaches double digits and keeps climbing, that is of very much concern.

Sodium of 126 meq. is on the low side. Again if your father has a lot of fluid buildup in the belly and also has swollen legs, then he might have been put on diuretics or water pills which can make him lose both sodium and potassium from the body.

In cirrhosis, low sodium levels may indicate excess fluid and part of the treatment is fluid restriction. I would be very much interested in all other liver tests including enzymes, alkaline phosphatase, total protein, albumin and globulin levels and also kidney tests like blood urea nitrogen, serum creatinine etc. The other test that is very important is coagulation factors like bleeding time, clotting time and prothrombin, platelet count etc.

If these are very abnormal, that would indicate more serious liver damage.

Also blood ammonia levels are important, if this is high that might indicate he may have encephalopathy and may go into liver coma. At this stage he needs to be hospitalized and treated very aggressively.

There are certain surgical procedures that can be done like shunt procedures to re-circulate the fluid and also there are drugs that control elevated pressure in the veins that are associated with the liver, a condition called "Portal Hypertension". This could lead to massive bleeding from the esophagus due to ruptured enlarged veins called varices.

These are all very advanced complications that may require surgery or even liver transplantation.
Hope, I have been able to explain to you what might happen.

Your dad's bilirubin level does not indicate that yet unless other blood tests that I mention above are very abnormal.

I wish him the very best.
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