How can my uncle manage hepatitis C-related cirrhosis at 70?

Question

Hello doctor,

My uncle, 70, has hepatitis C–related cirrhosis and suddenly became very drowsy and confused this morning. He answered simple questions incorrectly and, for a few minutes, did not recognize his own son.

He is only on lactulose and takes it irregularly because of diarrhea. We have not started Rifaximin yet. He recently had a urinary infection and completed antibiotics.

Can infections precipitate overt hepatic encephalopathy this quickly? His abdomen looks more swollen with ascites, and he seems physically weaker.

I am not sure if this counts as grade 2 or grade 3 overt hepatic encephalopathy, but his behavior is clearly different from baseline. Should Rifaximin be started urgently, or does he need hospital admission first?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query.

Your uncle’s symptoms strongly suggest an acute worsening of hepatic encephalopathy in the setting of liver cirrhosis caused by hepatitis C.

The symptoms he is having such as being confused all of a sudden, not knowing the answers to questions, not recognizing family members for a little while, and being very sleepy, show that he has a bad case of hepatic encephalopathy.

This is likely very serious, and he needs to see a doctor right away.

Infections often trigger hepatic encephalopathy. Can cause symptoms quickly. Even if his urinary infection was treated with antibiotics, it could come back. He could get a new infection.

Doctors must check for infection in the fluid in his belly. This infection can cause confusion and weakness.

Other things that can trigger liver brain disease are constipation, not drinking enough, electrolyte problems, bleeding in the gut, kidney problems, or not taking lactulose correctly.

If lactulose is not taken as directed, toxins can build up in the blood. Make confusion and drowsiness worse. The goal of lactulose is to have two to three bowel movements a day.

Since he is confused and very drowsy, he should not be cared for at home. He needs to go to the hospital as soon as possible. Doctors will do blood tests, check his electrolytes and kidneys, look for infection, and maybe check his belly fluid.

His lactulose dose may be changed. He may be given Rifaximin to help reduce bacteria in his gut and improve symptoms.

I hope this helps you.

Thank you.