Hi, How are you? My name is Dr Suresh Raghavaiah. I am a
liver transplant surgeon and I hope to help you out today.
I am sorry to hear about all the issues your patient is having and Let me congratulate you on your interest in helping her.
One piece of information you left out is the patients BMI. Going by the clues, your patient seems to be suffering from
Fatty liver disease and its complications (I say this because of the DM, which a common complication of obesity , which in turn also causes NASH). NASH is one of the leading causes of non-infectious
liver failure in the current age. The sudden "decompensation" is obviously due to the SBP. And the dialysis could be due to hepato-renal syndrome. If you haven't already done so, Please do get a "fibroscan" of the liver to rule out
cirrhosis, and an
endoscopy to r/o varices. Your patient might also need be worked up for a transplant if his condition does not improve.
Hope this helps and hope your patient gets to feel better.
Have a great day and please do not hesitate to write back for further clarifications.
Dr Suresh Raghavaiah