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What Does Severe Rectal Bleeding When Diagnosed With Liver Cirrhosis Indicate?
Question: My husband is 61 yrs old, has been incarcerated since age 22. Diagnosed with Hep C, advanced liver disease and severe cirrhosis. He has had rectal bleeding for 3-4 days, sometimes accompanied by unintentional bowel release (thinks he will pass gas, but feces and dark blood run down his legs and it very foul-smelling). One night, while sleeping, blood soaked his clothes and mat sheet. An endoscopy 1-2 yrs ago, report stated that due to the high portal hypertension, it was surprising that he had not had a varices bleed. His feet and legs swell until yellow fluid leaks out. Over 5 yrs ago, he had polyps removed from colon, but has not been sent back for another colonoscopy. I can't talk to the prison doctor without a court order. The doctor is not there every week day and no weekends. He has had high ammonia levels for years, his memory is very bad, he gets paranoid, etc. Can you give me a "ball park" idea of longevity? ( Inmates in Alabama cannot get transplants, and they are not using the newest drugs on inmates.) FYI, in 1978, he was diagnosed with "non A, non B hepatitis"
Should I have chosen a hematologist rather than oncologist?
Should I have chosen a hematologist rather than oncologist?
Brief Answer:
I'm waiting for the requested data.
Detailed Answer:
Hi and thank you for asking on HCM!
I am Dr.Klerida Shehu gastroenterologist!
I read carefully all your concerns and I am sorry for the situation your husband is in.
You are reporting that he is diagnosed with liver cirrhosis due to hepatitis C and alcohol abuse.
His symptoms are completely related with end stage liver disease.
1. With regards to rectal bleeding it is related with high portal pressure. High portal pressure can cause hemorrhoids, esophageal varices and enlarger blood vessels allover his GI tract ( intestine, large bowel, stomach).The blood in his gut increase bowel peristaltic and cause diarrhea with black blood.
2. He has swelling on his legs which is due to low albumin (hypoalbuminemia) in his body. Albumin is produced by the liver and hypoalbuminemia is very common in patients with liver failure and cirrhosis. High level of ammonium cause chronic encephalopathia that is related with low memory and apathy
3. From what you are describing he has end stage liver disease. Usually in clinical practice we calculate the average 3 month mortality rate using his bilirubin, creatinine and INR level. This is why I would like to know these data in order to calculate his overall life expectancy (survival rates).
Can you upload these data for me?
However, I can say that unfortunately for him the survival rates are very low and his life expectancy is too short. Only 10-20 percent of these patients live up to 12 months.
I'm waiting for the requested data.
Meanwhile, wish you and your family all the best!
Dr. Klerida
I'm waiting for the requested data.
Detailed Answer:
Hi and thank you for asking on HCM!
I am Dr.Klerida Shehu gastroenterologist!
I read carefully all your concerns and I am sorry for the situation your husband is in.
You are reporting that he is diagnosed with liver cirrhosis due to hepatitis C and alcohol abuse.
His symptoms are completely related with end stage liver disease.
1. With regards to rectal bleeding it is related with high portal pressure. High portal pressure can cause hemorrhoids, esophageal varices and enlarger blood vessels allover his GI tract ( intestine, large bowel, stomach).The blood in his gut increase bowel peristaltic and cause diarrhea with black blood.
2. He has swelling on his legs which is due to low albumin (hypoalbuminemia) in his body. Albumin is produced by the liver and hypoalbuminemia is very common in patients with liver failure and cirrhosis. High level of ammonium cause chronic encephalopathia that is related with low memory and apathy
3. From what you are describing he has end stage liver disease. Usually in clinical practice we calculate the average 3 month mortality rate using his bilirubin, creatinine and INR level. This is why I would like to know these data in order to calculate his overall life expectancy (survival rates).
Can you upload these data for me?
However, I can say that unfortunately for him the survival rates are very low and his life expectancy is too short. Only 10-20 percent of these patients live up to 12 months.
I'm waiting for the requested data.
Meanwhile, wish you and your family all the best!
Dr. Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I very much appreciate this info. Sadly, I have no access to his medical records without getting a court order or filing suit. Years ago, My husband, Ted McGinnis, was one of the named plaintiffs in a lawsuit filed by Southern Poverty Law to force the Alabama Dept of Corrections to give treatment to the many Hep C patients. It took the lawyers over a year to obtain medical records.
My husband can ask the medical staff for those levels.....if he can remember to ask....and remember to write it down.
Will you give me the "formula" used based on these levels,so I can figure it on my own? He's supposed to see the doctor 01/05/2016, but it is not guaranteed. Maybe a nurse will give him the numbers before my 2 day are up on this site/question.
My husband can ask the medical staff for those levels.....if he can remember to ask....and remember to write it down.
Will you give me the "formula" used based on these levels,so I can figure it on my own? He's supposed to see the doctor 01/05/2016, but it is not guaranteed. Maybe a nurse will give him the numbers before my 2 day are up on this site/question.
Brief Answer:
Please follow...
Detailed Answer:
Dear XXXXXXX
The "Formula" that is used in clinical practice is called MELD score.
If he cannot remember all the exams creatinine, bilirubin and INR level, he can ask the doctor only for MELD score ( one number).
This is the formula for MELD score:
MELD Score = 10 * ((0.957 * ln(Creatinine)) + (0.378 * ln(Bilirubin)) + (1.12 * ln(INR))) + 6.43
but there is no need to calculate it by yourself. you can calculate it online at link given below:
http://reference.medscape.com/calculator/meld-score-end-stage-liver-disease
To interpret Meld score regarding 3 month mortality, please follow:
Meld score 40 or more -- 71.3% mortality
30-39 -- 52.6% mortality
20-29 -- 19.6% mortality
10-19 -- 6.0% mortality
<9 -- 1.9% mortality
Hope it was helpful !
Dr.Klerida
Please follow...
Detailed Answer:
Dear XXXXXXX
The "Formula" that is used in clinical practice is called MELD score.
If he cannot remember all the exams creatinine, bilirubin and INR level, he can ask the doctor only for MELD score ( one number).
This is the formula for MELD score:
MELD Score = 10 * ((0.957 * ln(Creatinine)) + (0.378 * ln(Bilirubin)) + (1.12 * ln(INR))) + 6.43
but there is no need to calculate it by yourself. you can calculate it online at link given below:
http://reference.medscape.com/calculator/meld-score-end-stage-liver-disease
To interpret Meld score regarding 3 month mortality, please follow:
Meld score 40 or more -- 71.3% mortality
30-39 -- 52.6% mortality
20-29 -- 19.6% mortality
10-19 -- 6.0% mortality
<9 -- 1.9% mortality
Hope it was helpful !
Dr.Klerida
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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