My father has recently (two months ago) gone through hemiarthroplasty surgery, as he fell down due to electrolyte imbalance specifically hyponatremia. He also had blood transfusion during surgery. He is 73 and diabetic patient (normally under controlled). He was cured from the surgery, and was able to walk with walker with in a month. Suddenly his health started deteriorating. He lost his appetite and cough started with sputum. He started losing his weight. We observed that his eyes are yellow with dark yellow urine. Some of his lab results are as follows:
Serum ALT raised from 20 to 137 U/L (before and after blood transfusion)
Serum Total Bilirubin raised from 7 to 170 umol/L (before and after blood transfusion)
Serum Alkaline Phosphatase raised from 92 to 529 U/L (before and after blood transfusion)
Also his Gamma GT is now 960 U/L (normal 12-64)
AST is 187 U/L (normal 0-38)
Ultrasound Abdomen indicates:
Liver enlarged measuring 18 cm in mid clavicular line, showing parenchymal echotexture. No cholestasis seen.
Porta Hepatis normal, Pancreas, Spleen, Kidneys are normal.
Gall Bladder Distended with edematous thick wall measuring 12 mm.
Urinary bladder in minimally distended.
Minimal bilateral pleural effusion seen.
Mild to moderate amount of free fluid seen in peritoneal cavity.
Predominant hypoechoic cresent shaped area seen superior to spleen in subphrenic location. Diffuse internal echoes measures 7.2X5.5 cm.
Ultrasound concluded ith Hepatic parenchymal disease.
There are also some problem in lungs (He has been a chain smoker). He has breathing issue these days.
Gastric varices, Grade I, also found through endoscopy.
His Hep A, B, C profiles all are negative using ELISA based techniques.
Platelets went down to 34000 from over 200000 in just a month. Three days ago he also had platelets infusion. Now its again 44000.
He is non-alcoholic. Doctors are confused as some time they say it is hemochromatosis, sometimes they say its a kind of cirrhosis etc
He is now in ICU with Hepamerz, nebulizer and esomeprazole, aminoleban and Rocephin treatment.
He is now moderate edema in hand and feet as well.
But his condition is not getting better.
What exactly is the diagnosis for him??? Is it liver cirrhosis? What is the treatment?? Are we on the right path??
What is the hope for him?
Please do reply.
Thanks.
This can be a trying time for a family. Sit down in a quiet place and write out your questions. Find out from the head of the unit that your patient is on how to best get in touch with the hospitalist. If the doc says anything you don't understand, ask for it to be explained. Ask for the benefits and downsides to any treatments suggested.
The suggestions given by Babalou, in her posting above, are good... follow what she suggested. Hopefully you will get some answers.