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Suggest Treatment For End Stage Liver Disease

Posted on Sat, 28 Feb 2015

Question: Hi, My father is suffering from final stage liver disease. We are visiting hospital on a regular basis for check ups and fluid removal from his stomach. It has reached a stage that with in one week fluids are accumulating and he is feeling very uneasy. Just checking if there is any other way to remove the fluids other than removing it manually? Secondly his whole body is itching severely. Is there any medicine that he can take which will help him this?

Thanks,
XXXX

Answered by Dr. Suresh Heijebu (2 hours later)

Brief Answer:
Indwelling Peritoneal Catheter will help.

Detailed Answer:
Hi Sir.

I understand your query and concern.

Final stage liver disease is usually associated with refractory or resistant fluid accumulation in the abdomen-Refractory ascites.

The basic and safe recommended procedure is manual removal of fluid as high as 20 L in a day.

But in case if there is difficulty with manual removal of fluid on daily basis,I recommend you the following alternatives to serial paracenteses.

1.Automated Pump Systems .

2.Placement of indwelling peritoneal catheter-the fluid can be removed either by continuous drainage or intermittent drainage with a proprietary system using vacuum bottles,which can even be performed at patient's home.

The itching in your father's case is due to deposition of Conjugated bilirubin in the skin and blood due to deranged liver metabolism-Cholestatic Pruritis.

Drugs like Cholestyramine and UrsodeoxyCholic acid will help to relieve itching effectively.

Thank you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Suresh Heijebu (27 minutes later)

Thank you doctor. Can I get a little more details on the automated pump systems which can be performed at home? Who can I consult with to help me with the process? we are usually going to the hospital every 10-12 days to remove fluid and XXXXXXX we have removed so far is 8-9 ltrs per visit. My father is Hepatitis positive B and C, thought I should inform you.

Answered by Dr. Suresh Heijebu (6 hours later)

Brief Answer:
Not advisable for home based services due to high risk of cross infection

Detailed Answer:
Hi Sir.

I understand your concern.

In case if your father is positive for Hep B and C,its highly contraindicated to have home based therapies, pumps or catheters whatsoever.

Such therapies carry the risk of infecting household inhabitants.

Hence I strongly advise you against these policies.

Thank you.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar