Question: 66yoF with advanced cirrhosis. Had esophageal bleed in 12/10 with no further bleeding. Latest EGD done in July showed no varices. Pt. in bed most of the time--does get up to do laundry or cook a little, goes to store occasionally but is in bed most of the time. Pt. has portal HTN on Propranolol, has lower extremity edema on Lasix and Aldactone. Also has little "poochy" stomach beginning. Pt. has pleural effusion. On Coumadin for SMV thromobosis which has recanalized. Pt. on Xifaxan daily for HE and has been on this for at least 8 months. Pt. takes Lexapro for depression and Prilosec 40mg, BID. Latest blood work: Plt--39,000; Bili--3.2; Alb--3.1; Hgb--10.2. U/S done in XXXXXXX shows spleen enlargement and pancreas atrophy. Gallbladder was removed 2 yrs. ago and pt. almost bled out on the operating table. Surgeon at that time told the husband the cirrhosis was "really bad." I saw this patient last week and her movements are very slow and deliberate. What is the prognosis and life expectancy for this patient? I'm sure I'm leaving out pertinent info but hopefully you can get a picture of this patient's disease process.

I knew I would leave out possible pertinent information so here is further information. The patient's lower extremity swelling is pitting edema with right leg worse than left. This pt. went without her Xifaxan for 3 days a couple of months ago and had significant issues--shaking hands and definitely needing the meds again. She has been on Levaquin 3 times since the first of the year for UTI's, the last one being 4 weeks ago when she also developed an URI--several days later she was treated for the flu with Tamiflu. Pt. also takes Ultram, Q6H, PRN pain and several weeks ago told her husband she was taking too many of them. Don't have any idea how many she was taking. She has been jaundiced in the past but has now gone to the ashen-gray coloring.
During February and March of this year she had significant difficulties with her finances and her husband had to pay some of her expenses. Last month, she was having trouble managing them again.
Pts. last MELD score in XXXXXXX was 16 and with type O blood, she is unlikely to receive a liver for transplant.
This pt. is an RN so she dispenses her meds as she sees fit. Not sure she takes any of them as prescribed. Also latest K+ level is 2.8 and she has been told to take K-Chlor. Does this added info sway your decision on her life expectancy? Thank you in advance for any information you can give. The husband is left "out of the loop" when it comes to her medical condition and I haven't figured out why--unless she is just in complete denial on her true medical condition.2 days ago told husband she woke in the middle of the night with blood in urine that scared her. She almost woke him to take her to the ER. When she got up later had slight nose bleed. She assumed it was the Coumadin so she stopped it for a couple of days. Did not get out of bed the whole day except to go to bathroom. Yesterday she went grocery shopping and came in very tired. Still in bed this AM.