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hi my name is Betsy. I live in Michigan. US.

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Posted on Mon, 4 Feb 2019
Question: hi my name is Betsy. I live in Michigan. US. I h,ave Hepatic Encephalopathy.
i was diagnoised when it was called non A non b. I have aquired a blood diseases. Is Laculose the only that they can do ?
doctor
Answered by Dr. Ramesh Kumar (25 minutes later)
Brief Answer:
No many treatment options are there.

Detailed Answer:
Hello Betsy and welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.

1)Don't panic your condition is fully treatable.
2)Rifaximin 550 mg twice daily should also be started along with lactulose 30 to 60 ml.Rifaximin is an antibiotic and would kill the bacteria's developing in gut and producing toxins.
See frankly speaking treatment depends on the symptoms intensity you are having and ranges from medical management to liver transplantation(Don't be afraid it's very successful now days and good news is that you only need 20%of your liver to be functional to live a near normal life).
So as said above choice and intensity of treatment depends on the number of symptoms you are having.If level of ammonia are non controllable and patient is prone to land up in coma then transplant is done.However if Rifaximin and lactulose are successful in symptom control then patient is managed conservatively.

Diet also plays a major factor you should take 50% complex carbohydrates around 30% protein(lean) and 10 to 15% good fat in diet.

There are 4 stages of hepatic encephalopathy.So unless you are highly symptomatic with uncontrolled levels of ammonia taking Rifaximin with lactulose and proper diet would stabilise you.

Don't panic it's fully managable these days.
Hope I was helpful,
Follow ups are welcome.
Regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar (1 hour later)
he put me xfan stuff and then took me off.
doctor
Answered by Dr. Ramesh Kumar (11 minutes later)
Brief Answer:
Kindly post details of your symptoms, so that I am better able to help

Detailed Answer:
Hello again,
How are your symptoms now?
Which stage of encephalopathy were you diagnosed?
Do you have reports with you kindly attach?
We're you feeling better on xfan?
What's your age?
Can you upload reports?
Waiting.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar (16 minutes later)
I wasn't on it long. I don't know if it had anything to with 13in of my lg intestines remove I don't know
doctor
Answered by Dr. Ramesh Kumar (6 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Hello again,
Unless these symptoms are intense for e.g Abnormal movements or shaking of hands(flapping tremors),seizures,Disorientation,Drowsiness or confusion,Slurred speech very sluggish movement you would be treated conservatively by doctors on medicines.
As told earlier the main stay of medical therapy is-
Lactulose and Rifaximin.
Now as far as removal of large intestine is concerned possible cause can be ischemia(reduced blood supply to that area) leading to necrosis(rottening ),That could be a possible scenario for that operation.
I would appreciate if you can attach some discharge sheets/Reports/Investigations or papers to provide me more information for the cause of this resection surgery(Very likely i can't figure out a scenario that it is related to encephalopathy).
Thank you.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar (2 hours later)
I had hershsprungs diease.
doctor
Answered by Dr. Ramesh Kumar (14 minutes later)
Brief Answer:
follow up.

Detailed Answer:
Clinically 97% patient of Hirschsprung's disease are diagnosed below an age of 5 years so i am sorry to hear that you are a rare case scenario.Well as resection surgery has already been done so unless there is any bowel obstruction/any symptom i don't think it has any thing to do with your encephalopathy.

Chating with you i feel that clinically you are fully stable and lactulose is helping you.
You may ask your doctor to add Rifaximin 55o mg a day and yes keep your diet in control.Get ammonia levels checked up weekly.
Do you have any query regarding prognosis?
If you have any other specific query related to either of these disease feel free to follow up,
Hope i was helpful,
Thanks!

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar (2 hours later)
I had the surgery when I 13 mos. old. Mom was a RN.
doctor
Answered by Dr. Ramesh Kumar (0 minute later)
Brief Answer:
follow up.

Detailed Answer:
Hello again and thanks for follow up Betsy,
Ok that was done when you were 13 months old ,That's fine it has nothing to do with your encephalopathy right now.
Just take lactulose 30 to 60 ml
Rifaximin 550 mg once or twice daily(as suggest by your gastro)
And proper diet.
Milk of thistle seeds, containing a mixture of flavonolignans consisting of silibinin can should be taken two times a day.Its a very potent liver rejenuvator and is very effective in maintaining liver healthy.
You can have it also.
What are the remarks of your primary gastroenterologist my dear patient on your condition?
In case i can help you further feel free to follow up,
Hope i was helpful,
Have a quick recovery.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar (12 hours later)
Thank you
doctor
Answered by Dr. Ramesh Kumar (35 minutes later)
Brief Answer:
Welcome.

Detailed Answer:
Hope i was helpful.
Get well soon,
Feel free to follow up.
Do rate the answer.
Thanks!
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2465 Questions

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hi my name is Betsy. I live in Michigan. US.

Brief Answer: No many treatment options are there. Detailed Answer: Hello Betsy and welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. 1)Don't panic your condition is fully treatable. 2)Rifaximin 550 mg twice daily should also be started along with lactulose 30 to 60 ml.Rifaximin is an antibiotic and would kill the bacteria's developing in gut and producing toxins. See frankly speaking treatment depends on the symptoms intensity you are having and ranges from medical management to liver transplantation(Don't be afraid it's very successful now days and good news is that you only need 20%of your liver to be functional to live a near normal life). So as said above choice and intensity of treatment depends on the number of symptoms you are having.If level of ammonia are non controllable and patient is prone to land up in coma then transplant is done.However if Rifaximin and lactulose are successful in symptom control then patient is managed conservatively. Diet also plays a major factor you should take 50% complex carbohydrates around 30% protein(lean) and 10 to 15% good fat in diet. There are 4 stages of hepatic encephalopathy.So unless you are highly symptomatic with uncontrolled levels of ammonia taking Rifaximin with lactulose and proper diet would stabilise you. Don't panic it's fully managable these days. Hope I was helpful, Follow ups are welcome. Regards.