Brief Answer:
Liver dysfunction with acute onset fluid retention, need thorough work-up..

Detailed Answer:
Hello Dear, Welcome to HCM..

I've gone through your query in details and understand your concern..

It's certainly quite bothersome to have such array of symptoms..

Now you've mentioned that the Hepatitis A came back negative, can you please tell me whether the other types were tested or not (specially Hep E and type B& C) ?..as they can present with this similar scenario too..

Good to know that there was no history of alcohol or recreational drug consumption..

Yes your doctor is right as from your history and the investigations, it's quite likely to be liver dysfunction only so it has to be examined in details..first of all you need to undergo for an Ultrasonography of the whole abdomen to look for any internal organic pathology.. simultaneously needed to rule out any infectious origin (CBC, CRP, complete hepatitis work-up as i've already mentioned before along with blood cultures if there was any history of fever,pain abdomen,loose motion,vomiting etc.)..

Due to acute onset fluid retention, you've developed those swelling of legs and feet and there is a possible Acute Renal Dysfunction(Uremia) also, so you've been put on diuretics(Lasix) and it's quite common in this case to have increased pain in your legs after diuretics therapy due to rapid metabolic changes happening in the neuro-muscular tissue(keeping your legs elevated and ice-bag compression will help)..it's a quite complex process which happens in the tissue level, don't worry as with gradual normalization of kidney function, it'll subside within a few days..


You should also note that drugs like Hydrocodone and Acetaminophen(Tylenol) are exclusively metabolized by the liver and excreted by the kidneys, so unsupervised intake of these medications are quite prone for causing this type of Hepato-Renal impairments.. I've come across many such patients in my practice due to the same reason and some were really severe even landed on emergency dialysis, however the rate of recovery is also quite fast with prompt management and since your on diuretics already, i hope you must be responding too..

In this scenario the liver and kidney are actually inter-related so it's not exclusively due to a single organ dysfunction but a combined effect which you're experiencing..

Yes, these tiredness, dizzy feeling all the time is also due to the hepato-renal dysfunction causing metabolic (electrolyte imbalance as well as acid-base disorder and possibly acute rise of of Blood urea nitrogen)..

No it's not related to blood pressure or diabetes so don't worry..

Right now you need to be under strict medical supervision of your doctor along with judicious fluid and diuretics therapy and needed to investigated thoroughly (USG whole abdomen, sr. ammonia level, PT/INR, serial Blood Gas & KFT & LFT analysis)..

In my advice it would be much better if you can discuss with your doctor regarding a short duration of hospitalization as all these monitoring and investigations as well as follow-up on your progress can get much more systematic in that way and you'll be recovering a lot faster also, please discuss this with your doctor..

I hope now I've cleared your doubts in this regards..

Please feel free to ask me if there's any further queries you have, i'll be glad to clarify..

Do keep me updated on your progress in the due course..


Take Care
Kind Regards

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Brief Answer:
follow-up consultation..

Detailed Answer:
Hello Dear, Welcome Back..

Thanks for following up with these details..

First of all, please try to collect all of your test results from your PCP as even for a second opinion, you'll be needing them so that other specialists can review them to opine further..

Secondly, please have a detailed discussion with your doctor and ask about the details of those additional tests as you have the right to know what all has been done so far and what's on the way to be done..

No, you must insist on the Renal function testing (BUN, Creatinine, urine routine and microscopy along with electrolytes sp. sodium,potassium,calcium ,magnesium and phosphorus) as it's extremely important at this phase, and i'd suggest to get it done at the earliest for further evaluation..

The probable reasons for your breathlessness are :

1. excessive abdominal distension due to fluid retention(which is also causing the weight gain and gradual increase in the waistline) as it's pushing your diaphragm(the muscular structure which separates the chest from abdomen)..

2. seepage of fluid in to your lungs from mostly abdomen and surrounding organs..

3. excessive pressure over your heart due to additional fluid retention which is making it pump faster and harder (which explains the increase in resting hear-rate also)..

At this point, I'd advice you to refrain from strenuous activities as well as avoid climbing stairs for now..

Well the Gastro-enterologis'ts appointment is still 12 days away and if fluid retention keeps on increasing then it'll further worsen the breathing difficulty in which scenario there'll be a need to undergo for a procedure called as abdominal paracentesis (where they'll put a small bore needle in to your abdominal cavity under local anaesthesia to relief the pressure symptoms and drain some of the fluid under strict monitoring and also send the fluid for further analysis)..

So like I've already mentioned, in view of this further progressive breathlessness and other symptoms, it's better to discuss with your doctor regarding hospitalization for a short time-span, get investigated and evaluated thoroughly and in that case you don't need to be worried about the Gastroenterologist's visit, as you'll be primarily managed by them only..

Let me know how it goes in the due course..

Wishing you a faster recovery..

Take Care
Kind Regards

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Brief Answer:
self education is the best education, i'm happy that now your on the right track

Detailed Answer:
Dear XXXXXXX Welcome Back,

I'm glad that finally you've taken the right step which I explained to you earlier..

You can ask me as many questions as you like, i'll be happy to answer..

Actually both Hep-B & C are chronic viral disease and mainly Hep-B is the silent type and if diagnosed on time along with proper anti-viral therapy, it remains silent throughout the person's life.while on the other hand, Hep-C is a much more aggressive type and a potential cause for Hepatocellular Carcinoma, so anti-viral therapy must be initiated as soon as possible after diagnosis..

Don't worry, as your symptoms are generalized as it's seen in both of the cases, so let the investigations come back at first then it'll be properly addressed..

Prognosis depends on several factors, most of them are decided and written down as well as calculated during your clinical examination along with some specific lab-investigations results..

I'm providing you 3 different links below , the first one's for Hep-B & the second One's for Hep-C and the third one's for their differences in a nutshell, which will help you to educate your-self regarding these(it's a very vast topic, so you need to read them thoroughly) :

http://www.hepb.org/pdf/patient_info_packet.pdf

http://www.hepatitis.va.gov/pdf/hepatitisc-booklet.pdf


http://www.immunize.org/catg.d/p4075.pdf



Go through them and let me know if there's any doubts..

Wishing you the best of health..

Kind Regards
Take Care

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