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Q. I have hepatosplenomegaly with free fluid in the abdomen. Do I need a liver transplant?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 13, 2020

Hi doctor,

I received a diagnosis from a hospital as mild hepatosplenomegaly with the liver parenchymal disease. There is moderate free fluid in the abdomen, and also, the surgeon advised for a liver transplant.

#

Hello,

Welcome to icliniq.com.

Well, I write down the problem list for you and my understanding.

-You have got a chronic liver disease, the cause of which is still not established.

-And you have got water in the tummy, which is a sign of liver failure.

-Esophageal varices, which are low risk, you have been given Cardivas (Carvedilol) 3.125 mg once daily to prevent the variceal bleeding.

-We classify the chronic liver disease into three stages of the Child-Pugh score: A, B, and C, given in your blood reports (attachment removed to protect patient identity). It seems C, a score of 12/15, that is the severe stage of the liver disease.

-Another risk scoring system is called the Model for end-stage liver disease (MELD). In your case, the score is 16. Any score of more than 15 should be referred to the transplant team for consideration of liver transplantation.

So here is my recommendation for you.

It seems obesity (overweight) has caused you to develop liver disease.

Since it is an advanced stage, you should discuss with the liver transplant team to expedite you for liver transplantation. I think the liver transplant specialist is the best person to tell you about the advantages and disadvantages. Given your weight, it can guide you better about weight reduction before and after liver transplantation because overweight individuals are always a challenge for the transplant surgeon. However, I must emphasize that it is possible.

Thirdly I suggest you stop Cardivas since it can give you more harm than benefit. This drug tends to cause deranged renal functions and can cause low blood pressure, which is not suitable for you at the moment.

I suggest to check your weight every day and make sure it decreases by 0.5 kg per day. If not, then need to consider increasing the dose of Dytor (Torsemide) plus tablets.

You should avoid taking extra salt. Only five pinches of salt are allowed to you in 24 hours, which means you are supposed to avoid anything that contains salt like pickles, pepper, chips, soda drinks, and soft drinks. You are allowed to take the salt, which is mixed in flour or gravy, made at home for all.

You are not supposed to limit your water intake. You can take water as much as can.

Continue with the rest of your medications like Rifagut (Rifaximin), Lactulose, vitamin supplements.

Take egg white like at least four to six in a day if vegetarians take Beneprotein powder (instant protein powder) available commercially. Similarly, to ensure powder available over stores.

I want to know, do you have a history of taking alcohol? Or smoking? Any family history of chronic liver disease? And how your functional status at the moment? I mean, are you able to walk around, can you do your works like toileting?


The Probable causes:

Decompensated chronic liver disease.

Investigations to be done:

ANA (Antinuclear antibody test), and
Anti-LKM-1 antibody (Liver kidney microsome type 1).

Regarding follow up:

Follow-up with the above information. And keep me posted about your weight as I can adjust your medicines. If you want to have a video consultation, I am happy to do that.


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