The scan for my maid's husband shows early liver cirrhosis. We need a consultation on the scan. He has stomach pain with water-filled abdomen. Is surgery necessary?
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I have reviewed your given details. (attachment removed to protect patient identity).
I agree with you that he is suffering from end stage liver disease and ultrasound is showing fatty liver. We need to look at the cause of this fatty liver, which could be due to excessive alcohol intake or obesity related or it could be because of certain drugs.
For treatment of water filled abdomen, I need further information to decide whether it can be treated with drugs or he will require paracentesis. Paracentesis is a procedure in which needle is inserted into the abdominal cavity and inside accumulated fluid is taken out.
I need to know about how much discomfort he feels because of this water-filled abdomen? Is there difficulty in breathing? And will need the following test.
1. CBC (complete blood count)
2. BUN (blood urea nitrogen)
3. Creatinine, serum electrolytes
4. LFT (liver function test).
5. Serum albumin
6. Urine analysis.
Perfect cure for end stage liver disease is liver transplantation which is a long procedure. Before deciding whether he needs it now. We need above workup so we can calculate scores how early, he will need it.
Viral hepatitis, Alcohol, Nash, metabolic cause.Investigations to be done:
CBC, BUN, Creatinine, serum electrolytes, LFTs, serum albumin, Urine DR, PT-INR, AFP, HBsAg, Anti HCV antibodies.Differential diagnosis:
Liver cirrhosis.Probable diagnosis:
Liver cirrhosis decompensated with ascites.Treatment plan:
Will decide after investigations.Preventive measures:
Take low salt diet. Avoid constipation by taking syrup. Lactulose 30 ml at bed time (should pass two to three stools per day), if target does not achieved then take 30 ml twice a day.Regarding follow up:
Follow after reports as soon as possible. Please answer the asked questions. History of alcohol intake? Weight and height of the patient? History of viral hepatitis? History of iv drug abuse? Family history of liver disease or cancer?
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